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THE NEW LIBRARY OF MEDICINE 
 
 EDITED BY C. W, SALEEBY, M.D., F.R.S.E. 
 
 » 
 
 DISEASES OF OCCUPATION 
 
DISEASES 
 OF OCCUPATION 
 
 FROM THE LEGISLATIVE, SOCIAL, AND 
 MEDICAL POINTS OF VIEW 
 
 BY 
 
 THOMAS OLIVER, M.D., F.R.C.P. 
 
 1 1 
 PHYSICIAN, ROYAL VICTORIA INFIRMARY, NEWCASTLE-UPON-TYNE ; 
 PROFESSOR OF PHYSIOLOGY, DURHAM UNIVERSITY 
 
 METHUEN & CO. 
 
 36 ESSEX STREET W.C, 
 
 LONDON 
 
* .6'' 
 
 First Published in igo8 
 
CONTENTS 
 
 CHAPTER PAGE 
 
 Introductory . . . . . ix 
 
 I. Factors Contributing to Industrial Diseases 
 
 AND Accidents ..... i 
 
 II. Diseases Due to Gases, Vapours, High Tem- 
 peratures, ETC. . . . '54 
 
 III. Diseases Due to Working in Caissons and 
 
 Compressed Air . , . .88 
 
 IV. Diseases Due to Diminished Atmospheric Pres- 
 
 sure . . . . . • "5 
 
 V. Chemical Trades . . . . 120 
 
 VI. Explosives and the Effects upon Health by 
 
 THE Gases Evolved . . . .130 
 
 VI 1. Diseases Due to Metallic Poisons, Dust, 
 Fumes, etc. .... 
 
 VIII. Diseases Due to Metallic Poisons, Dust 
 
 I Fumes, etc. {Continued) 
 
 IX. Diseases Due to Organic and Inorganic Dust 
 Heated Atmosphere, etc. 
 X. Mining ..... 
 
 XL Diseases Due to Parasites and Micro-organ 
 isms ..... 
 
 137 
 
 216 
 
 242 
 267 
 
 312 
 
 320302 
 
vi DISEASES OF OCCUPATION 
 
 CHAPTER PAGE 
 
 XII. Dangers Attendant upon the Generation and 
 
 Uses of Electricity and Electric Welding 347 
 
 XIII. Diseases the Consequence of Fatigue; Occu- 
 
 pation Neuroses . . . '358 
 
 XIV. Diseases in Miscellaneous Trades and Occu- 
 
 pations ...... 366 
 
 XV. Soldiers, Sailors, and Fishermen . . 393 
 
 XVI. Rescue Work in Mines .... 400 
 
 Index. ...... 413 
 
 ILLUSTRATIONS 
 
 FIG. PAGE 
 
 1. Ankylostoma Duodenale (Human, Natural Size) 322 
 
 2. „ „ (Human, x 12 Diams.) . 322 
 
 3. „ „ (Human, Conjugation, 
 
 X 7 Diams.) . 322 
 
 4. Ankylostoma Caninum (Ova of, x 200 Diameters) 322 
 5- M „ (Larva of, x 300 Diams.) . 322 
 
 {Proc. Royal Society^ Edin.^ Vol. xxv., Pt. ix. T. Oliver.) 
 
PREFACE 
 
 IN " Diseases of Occupation " I have endeavoured to place 
 before the general and professional reader important 
 facts dealing with the effects of industries upon health. The 
 subject is one which within the last few years has attracted, 
 and in the future is still likely to attract, considerable 
 attention. The health of the nation must be viewed from 
 all standpoints, and as the working-classes form the largest 
 proportion of the population the conditions under which they 
 labour call for thoughtful study. I am hopeful that this 
 book will prove useful to Members of Parliament, to all 
 persons interested in schemes for social betterment, to 
 medical officers of health, and to members of the medical 
 profession generally. 
 
 To the authorities at the Home Office and especially to 
 Dr. Whitelegge and Dr. T. M. Legge I take this opportunity 
 of acknowledging the great assistance I have received from 
 the Annual Reports of the Chief Inspector of Factories. My 
 thanks are due to M. Le Clerc de Pulligny, of the Minist^re 
 du Travail, Paris, for his unvarying kindness and his genial 
 companionship in my visits to French factories ; also to Mr. 
 I. H. L. Van Deinse, of the Netherlands Factory Department, 
 and to Dr. G. Waller, of Amsterdam. To Professor Bedson 
 and Mr. Belger, of the Armstrong College, Newcastle-upon- 
 Tyne, and to Drs. R. A. Bolam and Alfred Parkin I am 
 indebted for help always cordially given. 
 
 Thomas Oliver 
 Ellison Place 
 
 Newcastle-upon-Tyne 
 November 20, 1907 
 
f 
 
 INTRODUCTORY 
 
 THE subject of Diseases of Occupation is so intimately 
 associated with the operation of the factory laws, that 
 in order to study the one we must know something of the 
 other. Factory legislation has been in the main devised to 
 protect the health of the workpeople and to safeguard their 
 interests. 
 
 It is a far cry from 1802, the date of the rise of factory 
 legislation in this country, to the passing of the Workmen's 
 Compensation Act in 1906. Within these years are included 
 all that is known of factory legislation and what it has accom- 
 plished. Before the dawn of the eighteenth century the 
 Industrial Revolution had already altered the conditions of 
 life and labour in Great Britain. The substitution of steam 
 for water power further changed those conditions, so that the 
 health of the workpeople necessarily became a matter of 
 State concern and State control. Labour flocked to where 
 machinery was most active. Since then may be dated the 
 rise of modern towns and the depletion of rural areas. It 
 was soon found that machinery could be worked by young 
 and, comparatively speaking, unskilled hands, hence came 
 the demand for women's and children's labour. Factory legis- 
 lation at its inception was in the main concerned with those 
 who could not take care of themselves. The exploitation of 
 child labour is a harrowing story, and one of the dark spots 
 on the page of the industrial history of our country. It is to 
 the credit of Great Britain that she was the first to move in 
 
X DISEASES OF OCCUPATION 
 
 the matter, and thus became the pioneer of industrial legisla- 
 tion. Since then decade after decade has witnessed a succes- 
 sion of Factory Acts and Labour Laws based upon experience 
 and necessity. It might have been expected that at the end 
 of a century of experience and progress industrial evolution 
 would have reached such a degree of excellence and attained 
 to such a standard of hygienic perfection that little more 
 would require to be done. Not so, however, for the subject 
 is endless. Each succeeding decade brings its own problems 
 for solution, and each new invention imposes its own special 
 trials upon producers. Child labour was fostered by parental 
 greed and poverty, and was encouraged by employers. 
 Although Great Britain has, practically speaking, abolished 
 the iniquity, child labour still lingers in several of our home 
 industries, and is not unknown in other countries. It is only 
 within the last quarter of a century (1886), for example, that 
 the first Factory Act was passed in the State of New York. 
 There, as here, factory legislation began with child labour 
 and female labour questions, and the compelling agents were 
 the working men's trades unions and philanthropic societies. 
 The reproach is sometimes levelled at trades unions that 
 their interference with children's and women's labour has not 
 been altogether disinterested, since by raising the age for 
 commencing work they have diminished the numbers of 
 children employed, and by checking female labour they have 
 kept up the standard of wages and given more work to men. 
 In the United States there is a greater tendency to bring 
 labour questions within the range of politics than in Great 
 Britain. Organised labour and capital have more power 
 there than here. By the Factory Act of 1 886 no child was 
 allowed to work in New York State under thirteen years of 
 age; since then the minimum age has been raised to four- 
 teen. The drawbacks to child labour are that children are 
 deprived of leisure and freedom in the open air, and are sub- 
 jected to a monotonous life when they ought to have variety. 
 The physical effects are those of degeneracy, as seen in 
 stunted growth and impaired nutrition, while of the moral 
 effects illiteracy and its consequences are the more imme- 
 diately apparent. 
 
INTRODUCTORY xi 
 
 Factory legislation has been a gradual restriction of the 
 freedom of the individual and of his subjection to State 
 control. The events which stand out prominently in the 
 industrial legislation of last century are, in addition to the 
 curtailment of children's and women's labour, shortening of 
 the hours, improvement of the conditions under which labour 
 generally is carried on, hygiene of dangerous trades, restric- 
 tion of the power of employers, and the transference of this 
 power to organised labour. In factory work individualism is 
 subordinated to general requirements. Theoretically there 
 is nothing to prevent a man in his individual capacity work- 
 ing as long as he chooses, but there is no place for such 
 personal action in the corporate life of a factory. The con- 
 ditions do not admit of this. It is not maintained, for 
 example, that by working longer than eight hours a day a 
 man's health is injured, for experience proves the contrary, 
 but it is held that no employer has the right to utilise the 
 whole of the working part of a man's day, and thus deprive 
 him of the leisure to which he as a human being is entitled. 
 Since his whole nature has to be developed, it is claimed that 
 the intellectual, moral, and physical powers of man cannot be 
 developed if the hours of employment are too long, the work 
 too hard and of a grinding nature. Nor must the hours of 
 labour be the same for all trades. There are some, such as 
 the textile industries, work in shipbuilding yards and iron 
 works, coal mining, and several artisan trades, in regard to 
 which a common basis of agreement can be arrived at as to 
 whether the number of hours of work should be eight or nine. 
 In trades that are dangerous to health the hours should not 
 be long ; and in the textile industries as the speed of 
 machinery is quickened and the nervous tension upon the 
 worker becomes greater the hours of labour should be 
 proportionally reduced. 
 
 Shortening of the hours of work per day and the Saturday 
 afternoon holiday have given the working classes more 
 leisure, while improved conditions of labour in factories, 
 fencing of machinery and hoists, abolition of night work for 
 women and children, better provision of sanitary conveniences 
 for the workers, and better education generally have done 
 
xii DISEASES OF OCCUPATION 
 
 much to raise the working classes to a higher platform of 
 comfort as well as to one of discontent. It was apparent 
 that the conditions of labour that prevailed before the 
 passing of the first Factory Act could not be allowed to 
 continue. There was a waste of human life which had to be 
 checked and a physical degeneracy and ignorance which had 
 to be stopped. No tongue can tell the saving of human life 
 that has been effected by the Factory Acts. At present each 
 fatal accident is carefully investigated, and the circumstances 
 attendant upon each death in a trade believed to be dangerous 
 to health are carefully sifted so that further fatalities may 
 be averted. These precautionary methods have only been 
 arrived at as a result of the death of many poor and 
 unknown men and women whose lives were sacrificed that 
 the life of others might be saved. 
 
 Industrial problems in their medical aspect not only con- 
 cern society, in many instances they control the future of 
 the race, as witness the employment of women during preg- 
 nancy and after confinement, also the baneful effects of lead 
 upon motherhood. All work should ennoble, and yet there 
 are certain trades that tend more to degrade man than raise 
 him, as witness the work of the iron puddler. The cheerless 
 days, too, spent in a textile factory amid the din of 
 machinery, and the monotonous character of the work, are 
 not such as of themselves to quicken the intellect and pro- 
 mote the higher interests of life. Is it not rather that they 
 tend, through the strain they cause, to encourage a craving 
 for that form of recreation which seeks an outlet in excite- 
 ment and pleasure, and, on the other hand, to dishearten 
 men and women who, as factory operatives, feel that they 
 cannot rise to a higher occupation than that of minding 
 machinery? The despotism of some branches of modem 
 labour is overpowering. Factory legislation has done some-' 
 thing to minimise this. The present age is marked by social, 
 benevolent, and parliamentary schemes which are meant to 
 dispense industrial justice and to provide greater personal 
 opportunities. To be of helpful service factory legislation 
 must be progressive and keep pace with the industrial 
 problems special to each succeeding age. 
 
INTRODUCTORY xiii 
 
 The Rise and Progress of the Factory System 
 
 The Peel Act of 1802 was passed to preserve the health 
 and morals of apprentices and others employed in " cotton 
 and other mills and factories " ; the rooms of the factories 
 were to be washed with quicklime and water twice a year, 
 night work was prohibited, the hours of work were to be 
 twelve per day, the apprentices were to be instructed in 
 reading, writing, and arithmetic every working day for the 
 first four years, and in the principles of the Christian religion 
 on Sunday. The factories and mills were to be visited by a 
 justice of the peace and by a clergyman. Although not a 
 Factory Act in the usual acceptation of the term, but simply 
 an extension of the Elizabethan Poor Law relating to parish 
 apprentices, and therefore likely to fall short of the actual 
 requirements of the time, it was something to have succeeded 
 in getting a few of the principles of factory legislation recog- 
 nised, such as the limitation of the hours of work. The Bill 
 passed without serious opposition from the manufacturers. 
 It was otherwise when, later on, fresh factory legislation was 
 attempted. In 18 16, on Sir Robert Peel's proposition. Par- 
 liament caused an inquiry to be made into the condition of 
 the factory population, and three years afterwards powers 
 were conceded to the Government to limit the age at which 
 children should be admitted into factories. When in 1833 
 Lord Ashley inaugurated the industrial and social reforms 
 with which his name is associated, and by which it was 
 sought to limit the working hours of children under thirteen 
 to eight hours a day, and girls under eighteen to twelve 
 hours a day, employers and several members of the House of 
 Commons urged that Parliament was exceeding its duty in 
 attempting to restrict the hours of labour. At this period 
 the infant death-rate was high. One half of the children 
 born in Manchester died under three years of age, and in 
 factory towns the youthful population was physically worn 
 out before manhood. Four inspectors had been appointed to 
 see that the factory laws were obeyed throughout the country. 
 Power was given to these Government officials to enter fac- 
 tories at any hour and to examine the workers. The employ- 
 
xiv DISEASES OF OCCUPATION 
 
 ment of children under eight years of age was prohibited, and 
 women's labour restricted by the 1844 Act. The following 
 year witnessed the passing of Lord Ashley's Print Works Act. 
 A demand for shorter hours of labour was also raised. In 
 1847 the Ten Hours' Bill was passed, and by it the working 
 time for women and children was restricted to ten hours a 
 day ; it was also arranged that the working day was to be 
 the period between 5.30 a.m. and 8 p.m. In 1854 the fencing 
 of all shafts was made a requirement, but not without con- 
 siderable opposition from a section of employers. The Act 
 of 1853 limited the working time for children to the period 
 between 6 a.m. and 6 p.m. In 1864 certain trades were 
 scheduled as unhealthy, and regulations were issued bearing 
 upon ventilation. Under the 1864 Act were included 
 earthenware and other manufactures. Removal of dust by 
 fans was required by the Act of 1867 both in factories and 
 workshops. Three years later bleaching and dye works were 
 brought within factory law. The Act of 1878 forbade chil- 
 dren to work in certain processes of white lead manufacture. 
 This was the first Consolidating Act. It was passed after an 
 exhaustive inquiry by a Royal Commission, and was followed 
 by a series of Amending Acts : that of 1883, in which were 
 embodied Special Rules for white lead factories and bake- 
 houses ; of 1 891, in which were included Special Rules for 
 dangerous trades, notification of accidents, and the abolition 
 of the employment of children under eleven years of age ; of 
 1895, whereby laundries were brought within the sphere of 
 factory inspection, and rules were made applicable to docks ; 
 while the Act of 1897 dealt mainly with cotton, cloth, and 
 other factories. 
 
 Until 1 89 1 workshops had not been included under all 
 the provisions of the Factory Acts ; the difference between 
 the two places lay in the use of motive power in factories. 
 The Factory Act of 1891 repealed the special exemption 
 enjoyed by women's workshops and extended sanitary 
 regulations to workshops in which only adult men are 
 employed. The main "design and object" of this Bill 
 "was to bring all workshops and factories up to the same 
 sanitary level." To local sanitary authorities was entrusted 
 
INTRODUCTORY xv 
 
 the supervision of the sanitary condition of the workshops, 
 and although to give this effect special inspectors of work- 
 shops for certain large towns were appointed it cannot be 
 said that the dual control was an unqualified success, owing 
 to the fact that local authorities too frequently shirked 
 their responsibilities. By the Act of 1901 increased powers 
 were given to local authorities, and medical officers of health 
 were called upon to keep registers of the workshops in their 
 districts and to report upon them annually. 
 
 It is required by the factory laws that all dangerous 
 njiachinery shall be fenced, safety valves and steam gauges 
 be provided on steam boilers, that boilers be examined by 
 an expert and reported upon once in every fourteen months, 
 and that no machinery in a factory shall be cleaned by a 
 child when the machinery is in motion, nor shall a young 
 person clean any dangerous part of mill gearing. Women 
 are also forbidden to clean mill gearing while the machinery 
 is in motion. Fire escapes must be provided. At present 
 no child under twelve can be employed in a factory or 
 workshop. The Act of 1878 allowed children to be employed 
 at the age of ten ; the Act of 1891 raised the age to eleven; 
 and now no child can be employed under twelve. To the 
 Home Secretary has been given greater power for the 
 regulation of dangerous trades. In Great Britain Sunday 
 employment is forbidden. 
 
 The last decade of the nineteenth century and the com- 
 mencement of the present have been marked by the appoint- 
 ment of several Departmental Committees of the Home 
 Office. As I had the honour and the privilege of sitting as 
 a member on a few of the Committees appointed to inquire 
 into the effect of certain industries upon the health of the 
 workpeople, to that circumstance and to the experience 
 gained as a hospital physician must be attributed the raison 
 ditre of this contribution to the subject of factory legisla- 
 tion and occupation diseases. 
 
 The work of the Factory Department of the Home Office 
 has enormously increased within the last few years, and 
 recent legislation tends still further to increase it. Beginning 
 with four factory inspectors in 1833 there are now upwards 
 
xvi DISEASES OF OCCUPATION 
 
 of 170 all told in the department. The appointment of 
 special inspectors has been most useful. It is only within 
 recent years that female inspectors have been employed, but 
 the excellent work done by the Principal Lady Inspector of 
 Factories and her staff of ladies has more than justified the 
 creation of this particular section of the department. 
 
 Into the details of the Workmen's Compensation Act of 
 1906, which is an extension of the Act of 1897, I do not 
 propose to enter. In this country industrial legislation is 
 based upon experience and expediency, so that no sooner is an 
 Act in operation than its weak points become apparent and 
 a fresh Act is required to remedy defects and remove flaws, 
 but it too generally ends in introducing controversial matter 
 and in providing employment to lawyers and doctors. The 
 Workmen's Compensation Act of 1906 repeals the Acts of 
 1897 and 1900, and it extends the principle of compensation 
 to all classes of persons engaged under contracts of service, 
 including domestic servants and sailors. In addition, by 
 including certain defined trades, it makes employers liable to 
 pay compensation for diseases arising out of and in the 
 course of employment. By a "workman" is meant "any 
 person who has entered into a works under a contract of 
 service or apprenticeship with an employer, whether by way 
 of manual labour, clerical work, or otherwise, and whether 
 the contract is expressed or implied, is oral or in writing." 
 Certain persons are outside the Act, e.g., policemen, persons 
 in the naval and military services, profit-sharing fishermen, 
 non-manual workers whose remuneration exceeds ;^250 a 
 year, and others. The Act is comprehensive and includes 
 most trades and lowly-paid members of professions, among 
 which are mentioned house-surgeons and hospital nurses. 
 It also includes certain industrial diseases, the consequences 
 of which may be immediate or remote and which are often 
 more severe than accidents. A workman is entitled to com- 
 pensation if he is incapacitated by a disease contracted in his 
 trade and due to his employment exactly in the same way as 
 if he had been thrown hors de combat by an accident. The 
 following have been scheduled : Poisoning by nitro- and 
 amido-derivatives of benzene or its sequelae, carbon bisulphide 
 
INTRODUCTORY xvii 
 
 or its sequelae, nitrous fumes or sequelae, nickel carbonyl 
 or sequelae, arsenic poisoning or sequelae, lead poisoning, 
 African boxwood or sequelae, chrome ulceration or sequelae, 
 ulcerations produced by dust or caustic or corrosive liquids, 
 cancer or ulceration of skin or of corneal surface of eye due 
 to pitch, tar, or tarry compounds, chimney sweeps' cancer, 
 nystagmus, glanders, compressed-air illness or its sequelae, 
 beat hand (subcutaneous cellulitis) of coalminers, miners' 
 beat knee and beat elbow, and inflammation of the synovial 
 lining of the wrist-joint and tendon-sheaths of miners. In 
 order to claim compensation a workman must produce (i) a 
 certificate from the local certifying factory surgeon, (2) or 
 prove that he had been suspended from his usual employ- 
 ment on account of having contracted one of the diseases 
 scheduled, and (3) in the event of death proof will have to 
 be given by friends or dependants that death was due to one 
 of the diseases mentioned above. 
 
 It is generally conceded that the effect of the factory laws 
 has been to improve the condition of labour in factories, to 
 promote the health of operatives, to reduce the hours of 
 labour, and to give the workpeople often healthier and more 
 sanitary surroundings than they have at home. Much yet 
 requires to be done, for factory life is not always so satisfactory 
 as at first sight it appears. It is said that factories existed 
 in Greece, Rome, and in the older civilisations, but these 
 establishments were not factories in the sense we know them. 
 The men, women, and children who worked therein were 
 slaves, and their work was carried on under the eye of task- 
 masters. The factory system of Great Britain was the 
 necessary consequence of the introduction of machinery and 
 the massing together of large numbers of workpeople in mills 
 and factories. The first factory of modern type was built by 
 Sir Thomas Lombe, in 17 19, in Derbyshire, for the manufac- 
 ture of silk. Other establishments soon followed, but many 
 of them were of rude description, and in these the employes 
 worked long hours, little regard being paid by the masters 
 to the health of the workpeople. It was the age of laissez 
 faire. There was no limitation as to hours of labour, the age 
 of workers was not defined, there was little consideration 
 
 A* 
 
xviii DISEASES OF OCCUPATION 
 
 shown to female workers, and no regard for health generally. 
 Factory legislation has altered all these, and while the trend 
 of industrial methods is in the direction of increasing the 
 speed of machinery, and therefore of taxing still further the 
 nervous energy of the workpeople, there is greater respect 
 for the health of the workers and for their comfort than fifty 
 years ago. The factory system has its defects. It is urged 
 against modern industrial methods that they allow female 
 labour and that as consequences of the increasing employment 
 of women there are ensuing a weakening of home interests 
 and a neglect of home duties. Where both parents work in 
 factories, as in the cotton mills in Lancashire, there is little 
 home life. The young children are taken from their warm 
 bed in the early morning and carried by the mothers to a 
 caretaker, usually an elderly female, with whom several 
 children are left for the day. At the end of the day's work 
 the mother calls on her way from the factory for her infant 
 and proceeds to her home, all dark, cold, and cheerless, for 
 the shutters have not been opened, the fire has not been lit, 
 and no evening meal awaits them. Of home life for textile 
 workers where both parents go to the factory there is almost 
 none. All is made subservient to the requirements of the 
 factory, whose incessant demands sap all that is best of 
 family life and maternal instinct. 
 
 While there is doubtless much to condemn in the factory 
 system there is also something to be said in its favour. 
 Under the heading " Factory " in the American supplement 
 of the " Encyclopaedia Britannica," Mr. Carroll D. Wright, 
 formerly Chief of the Bureau of Labour Statistics in 
 Massachusetts, says that while by no means perfect, the 
 factory system is in advance of previous methods of produc- 
 tion. " The evils which were apparent during the early days 
 of the factory system were simply the result of bringing 
 together the labour which had become pauperised under the 
 domestic system and in agricultural districts. . . . The factory 
 has not so much destroyed the home as it has enabled 
 members of broken families to earn a livelihood. If it has 
 at times taken the mother from the care of her young 
 children — the worst feature of the employment of married 
 
INTRODUCTORY xix 
 
 women — it has enabled more who had no home to be 
 self-supporting." It is claimed for the factory system that 
 rather than tending to degrade, mentally or physically, 
 those brought under its influence, it has raised the lower 
 classes and improved their scale of living. Because better 
 machinery has enabled less educated persons to engage in 
 and accomplish what formerly required skilled labour, this 
 fact does not necessarily imply that the work has degraded 
 skilled labour, for it may have lifted the unskilled. Things 
 were undoubtedly bad when the factory system was insti- 
 tuted. While it displaced many evils, several have been 
 retained, some of which are only gradually being eliminated. 
 Many of the present defects in our factory life and methods 
 are therefore to be considered as less the result of the system 
 than the outcome of want of knowledge on the part of the 
 workpeople, and of an unwillingness on the part of employers 
 to recognise the fact that capital has duties as well as rights. 
 
DISEASES OF OCCUPATION 
 
 CHAPTER I 
 
 FACTORS CONTRIBUTING TO INDUSTRIAL DISEASES AND 
 
 ACCIDENTS 
 
 NO matter what parliamentary legislation may enact, 
 industrial hygiene will never be secured until the 
 workers themselves are educated in regard to the dangers 
 incidental to particular trades and are willing to co-operate 
 in making Home Office regulations effective. There must be 
 a greater amount of mutual trust and a heartier co-operation 
 of employers and employed. Only thus is it possible to 
 remove the stigma that attaches to many occupations and 
 the cause of their unhealthiness. No person should be 
 employed in a dangerous trade until the risks have been 
 explained to him by the employers and the means indicated 
 whereby danger to health may be averted. Of the conditions 
 met with in factories that contribute to industrial diseases 
 mention may be made of imperfect ventilation, absence of 
 means for the withdrawal of dust, imperfect supervision of 
 the workers, and inadequacy of washing appliances. Want 
 of cleanliness has long been recognised as an important 
 contributing factor, especially when combined with poverty, 
 deficient food and clothing, and improper housing. Sex 
 is in some instances a predisposing circumstance, as, for 
 example, in the greater liability of women to plumbism and 
 to the rarer types of the malady than men. Age, too, is not 
 without its influence, for experience has shown that young 
 adults of both sexes are more predisposed to lead poisoning 
 
2 DISEASES OF OCCUPATION 
 
 than persons of maturer years. The bad effects of over- 
 crowding and of sleeping in ill-ventilated rooms are seen in 
 the readiness with which fatigue is induced and in the 
 inability of workers thus imperfectly housed to keep pace with 
 their healthier comrades and the increased speed at which 
 machinery is run. It is largely owing to the influence of 
 fatigue that, as the day proceeds, the workers, becoming tired 
 in mind and body, become careless, and as a consequence the 
 number of accidents increases with the hours of toil. As a 
 result of general fatigue the exhausted and overheated work- 
 man on leaving the factory is less resistant to the weather, 
 and readily catches cold. In a similar manner groups of 
 over-worked muscles readily become paralysed, compared with 
 other muscles that are not so constantly in action. Knowing 
 this fact, house-painters, by educating themselves to use both 
 hands, become less liable to " wrist drop." There are certain 
 people, the victims of an inherited weakness of the nervous 
 system, the subjects of neurasthenia, others again the subjects 
 of anaemia or bloodlessness, who through sheer physical 
 inability are unable to do an ordinary amount of work and 
 who are more quickly laid aside by industrial disease than 
 others. Where the work is hard, and heavy weights have to 
 be lifted or carried, the effect of such strain may show itself 
 in rupture of a blood-vessel, the formation of an aneurism, 
 dilatation of the heart, rupture of muscle, strained tendon, 
 or hernia. The habits of the workpeople, too, are not with- 
 out an important bearing upon their freedom from or their 
 liability to industrial diseases. There is nothing that induces 
 to certain forms of industrial poisoning or is more likely to 
 become a cause of accident to a workman than indulgence 
 in alcohol. An intemperate man is only courting disaster 
 when he continues to work, for example, in a white lead 
 factory. Apart from the imperfect character of the workman- 
 ship, the excessive use of alcohol makes a man careless 
 and heedless of danger; he runs risks he otherwise would 
 not incur, and to this circumstance may be traced many of 
 the accidents that happen in docks and wharves, and to it, 
 also, probably some of the shipwrecks that have taken place 
 shortly after vessels have put to sea. The excessive use 
 
INDUSTRIAL DISEASES AND ACCIDENTS 3 
 
 of alcohol is a cause of epileptic attacks in men previously 
 free from fits, and as epilepsy assumes many forms — for 
 example, often only a sense of giddiness or faintness — it is 
 not improbable that some of the unexplained falls of men 
 which result in serious injury to life and limb, may be the 
 result of ill-nourished, poisoned conditions of the nervous 
 system, not the outcome of an immediate debauch but of 
 long-continued indulgence in alcohol. If we add to alcohol 
 the infection of syphilis we have in these a combination of 
 circumstances the influence of which, from a medico-legal 
 point of view, is far reaching so far as workmen's compensa- 
 tion is concerned. 
 
 It is an interesting problem to consider the probable effects 
 upon the health of the workpeople in the future of the in- 
 creased speed at which machinery is being run in the factories 
 and the speeding-up of the work in shipyards. That there 
 is greater strain upon the nervous system, more exhaustion 
 and consequently need for greater leisure, few will deny, and 
 that in many instances tho*- hard work induces premature old 
 age goes without saying. Will this speeding-up tend to 
 make female mill-workers better mothers and help them to 
 give birth to healthy and robust children, or to infants who 
 are puny, ill-nourished and of a highly strung nervous system ? 
 In some American factories in which stitched muslin under- 
 wear is made, so great has been the improvement in the 
 machinery of late that the sewing machines are carrying two 
 to ten needles instead of one as formerly, and as a con- 
 sequence many of the girls are no longer capable of the 
 sustained effort necessary to follow the improved speed, and 
 have been obliged to relinquish their occupation. The strain 
 of the eyes in watching for broken threads, in order to stop 
 the machinery, is almost intolerable ; it requires an amount 
 of nervous energy and a constancy of attention which the 
 operators cannot supply. There is a limit beyond which the 
 speeding of machinery cannot be run without detriment to 
 the health of the operators unless their hours of work are 
 materially shortened. 
 
 Clearly, therefore, there are occupations, especially the 
 textile trades, that tend through sheer strain to wear out 
 
4 DISEASES OF OCCUPATION 
 
 the body of the worker and induce premature old age. 
 These industries may be said to show their baneful effects 
 upon the nervous system. In some of the so-called 
 dangerous trades there is observed a vulnerability of 
 certain organs of the body. Industrial poisoning, e.g.^ plumb- 
 ism, is prevented or retarded by the functional activity of 
 such of the eliminating organs as the liver, intestines, and 
 kidneys. Lead is thrown out of the system by the intestinal 
 canal and kidneys. The predilection of lead for the liver 
 is largely due to the fact that most of the lead which enters 
 the body does so by the alimentary canal, whence it is 
 absorbed and carried by the blood to the liver. It is 
 abstracted from the blood by this organ and either thrown 
 out in the bile or retained in the hepatic cells. Although 
 lead has a strong affinity for nervous tissue and induces 
 paralysis of the hands, arsenic rapidly causes an acute and 
 painful neuritis which, like that due to alcohol, is principally 
 met with in the legs and feet. It is the same with many 
 micro-organisms. In the human body each poison has its 
 special site of selection and its channel of elimination. 
 It may be said of the tubercle bacillus, taking this micro- 
 organism to illustrate my point, that notwithstanding the 
 channel by which it has gained an entrance into the body, 
 through the air we breathe, the food or drink we take, 
 the tubercle bacillus ultimately finds its way to the lungs. 
 There is a selection for certain organs or tissues of the 
 body by poisons and micro-organisms that we cannot 
 always explain. 
 
 Fatigue. General Aspects of the Question 
 
 Hurry and absence of repose are characteristic of our 
 age. Life as a consequence is fuller. We put more into it 
 than did our forefathers, but it remains to be seen whether 
 in thus spending more we are getting a corresponding 
 return. Among all classes there is both a demand and a 
 need for a larger number of holidays than formerly. The 
 pace at which we live, and the rate at which the industrial 
 machine is run, create a wear and tear far in excess of 
 
INDUSTRIAL DISEASES AND ACCIDENTS 5 
 
 anything hitherto known. The pressure pervades all forms 
 of human activity. Its effects are seen in the infant whose 
 mother has no time to nurse her child, since she must be 
 in the factory ; it is felt by the pupil at school, the appren- 
 tice, and by the adult well-nigh on till the working day of 
 life is done. In many occupations men are old at 55, and 
 the years of declining life, which ought to be marked by 
 quietude and repose, are frequently shortened, since relatives 
 have no time to give the personal attention to the old that 
 is necessary. Although the introduction of machinery has 
 cheapened products and placed more of them within the 
 reach of the poorer working classes, it has not always 
 lightened labour. The rate at which machinery is run 
 demands greater attention from the workpeople and im- 
 poses upon them a severe strain. To the artisan classes 
 the Saturday half-holiday and the shortened working day 
 have proved a boon from a purely physical point of view. 
 Great as the rush and pressure are in this country, they 
 are even greater in America. An attempt is being made 
 to Americanise some of our industries. In the shipbuilding 
 yards on the Tyne and elsewhere, so hard do the men in 
 some departments work that it is impossible for the appren- 
 tices to keep pace with them. Not only is this "rushing" 
 a cause of serious accidents, as a consequence of the hard 
 nature of the work and the vigour with which it is sus- 
 tained, but the men themselves are frequently so tired that 
 many of them spend part of the Saturday afternoon in bed. 
 When to fatigue is added severe strain the effects may be 
 lamentable, as, for example, in the use of mechanical drills 
 for ship-plates. The implement is very heavy, and has 
 frequently to be held by a workman standing in an awkward 
 position. I have been consulted by young workmen suffering 
 from cardiac distress, owing to acute dilatation of the heart, 
 consequent upon the use of mechanical drills. In the textile 
 trades the speeding-up of machinery is responsible to a large 
 extent for the tiredness and poor physique of the female 
 workers. Where husband and wife both work in the factory 
 the house is closed during factory hours and the children 
 are confided to the care of a neighbour for a few pence per 
 
6 DISEASES OF OCCUPATION 
 
 day. Tired after the day's work, and the home unattractive, 
 recreation is too frequently, but not always wisely, sought in 
 music-halls and cheap theatres where, in a vitiated and over- 
 heated atmosphere, the opportunity is not given for the 
 elimination from the body of the fatigue products formed 
 during the day. 
 
 I have spoken of fatigue products, but what is fatigue ? 
 Fatigue or tiredness is a sensation, the outcome of a par- 
 ticular state of the nervous system, the result of work carried 
 beyond the capabilities of the organism. In ordinary 
 physiological activity exhaustion is never attained, for fatigue 
 is the warning signal. In each of us there is a certain 
 amount of reserve force which allows our muscles and nerves 
 to be overtaxed at times without injurious consequences. The 
 increased functional activity is met by a corresponding im- 
 proved nutrition, whereby recovery is secured. Life involves 
 change of structure. The waste products added to the 
 blood act upon the nerve endings in muscle and upon the 
 grey matter of the brain, and create a sense of fatigue. 
 Although the sensation of tiredness is referred by us to the 
 overworked muscles, the location of the cause is less in the 
 peripheral than in the central nervous system. On the one 
 hand waste products act upon the muscles, diminish their 
 contractility and render them less responsive to nerve stimuli ; 
 and on the other hand they poison the large nerve cells in the 
 grey matter of the brain, render them less receptive of sensory 
 stimuli, and in this way reduce their power of emitting 
 volitional impulses. There is, therefore, in fatigue an 
 element that is mental as well as physical. After rest and 
 sleep the sensation of fatigue wears off, we rise invigorated 
 and strengthened for work. During repose structure is 
 being rebuilt and waste products are eliminated. The proof 
 that the circulation of waste products in the blood is a 
 cause of fatigue is demonstrated by taking some of the blood 
 of a fatigued animal and injecting it into a healthy one, 
 when in the latter the physical signs of fatigue gradually 
 appear. Weichart, in 1904, advanced the theory that the 
 cause of fatigue is a toxin generated in the overtaxed 
 organism, and that the ravages of the toxin, like the poison of 
 
INDUSTRIAL DISEASES AND ACCIDENTS 7 
 
 diphtheria, can be met by the introduction of an antitoxin 
 into the body. Wolf-Eissner {Centralb. f, Bakteriol. bd. xL, 
 1906, p. 634) is of the opinion that, during athletic training 
 there is produced an immunity to the toxin of fatigue, where- 
 by the trained athlete becomes capable of accomplishing 
 more than the untrained man, and without experiencing the 
 sensation of fatigue. It is common knowledge that men 
 who are doing hard, physical toil regularly have not the 
 sense of tiredness felt by men who are new to the work, and 
 we explain this by saying that the latter are not trained. 
 Wolf-Eissner throws new light upon the subject. Having 
 obtained a fatigue toxin from overworked animals, he 
 injected small doses of the poison into other animals and pro- 
 duced in them symptoms of fatigue, drowsiness, and a lessen- 
 ing of activity. Large doses caused death, but if very minute 
 doses were injected for a lengthened period there was 
 established in the animals a genuine immunity to fatigue. 
 The toxin is not found in the blood but in the muscles, 
 whereas the antitoxin is only present in the blood. There 
 are certain people whom I have already alluded to as neuras- 
 thenic who are languid physically and mentally, and who 
 are so readily tired that they are unable to take up the 
 ordinary duties of life. We speak of them as being deficient 
 in nerve force, but may the explanation not be that their 
 condition is one of toxaemia and that they are unable to 
 produce the antitoxin of fatigue? 
 
 Men and women who have worked hard and been exposed 
 to the weather often look older than they are, and they give 
 evidence of arterio-sclerosis or structural changes in their 
 blood-vessels. A man's age is largely that of his heart and 
 arteries. In men who have wrought hard the circulation of 
 waste products in the blood comes in time to tell upon the 
 kidneys, heart, and blood-vessels. The human body, as 
 already indicated, is not without its defences against fatigue, 
 and the evil effects upon the heart and kidneys consequent 
 upon the long-continued retention of waste products in the 
 blood. A. Mossaglia [Gazett. deg. Ospedale e Delle Cliniche^ 
 an xxvii., 1906, 2 Sept., No. 105, p. 1103) has shown that in 
 dogs from whom portions of the parathyroid glands have 
 
8 DISEASES OF OCCUPATION 
 
 been removed, the production of fatigue is always followed 
 by tetanic convulsions and the presence of large quantities of 
 albumen in the urine, a circumstance which points to the 
 secretion of the parathyroid glands possessing a specific body 
 which neutralises the toxins formed during muscular work. 
 In the case of several young soldiers after a march out. 
 Sir Thomas Grainger Stewart found a trace of albumen in 
 the urine, but in healthy subjects muscular exercise is not 
 followed by the presence of albumen in the urine, or if so, 
 never to any extent. The presence of albuminuria after 
 physical exercise in dogs whose parathyroids have been 
 partially removed indicates that there is a functional relation 
 between these glands and the kidneys. The toxins of fatigue 
 are capable in course of time of contributing to kidney 
 diseases, and in man the thyroid gland when healthy obviates 
 this to some extent through the internal secretion which it 
 forms. 
 
 As the result of overwork Hodge, an American physi- 
 ologist, found structural changes in the nerve cells which 
 rest removed. F. H. Scott {Journ. Physiology^ vol. xxxiv. 
 Nos. I and 2, p. 145) states that in nerve cells there is formed 
 from the nucleus and Nissl bodies of the cell a substance 
 which passes into the nerve fibres. These fibres are capable 
 of carrying impulses without becoming fatigued, but they 
 cannot maintain the end-organs of the nerve in a condition 
 of activity beyond a limited period. It would appear, there- 
 fore, as if some substance were given out from the nerve cells, 
 hence as a consequence the readier fatigue of the central 
 nervous system compared with the peripheral. Scott tried 
 to locate the seat of fatigue. Muscle fibre may become 
 fatigued, also the nerve cells in the spinal cord, owing to 
 the hypothetical substance already alluded to being used 
 up and time not given for fresh secretion to have been 
 formed. 
 
 The effects of fatigue, mental and physical, are shown on 
 various organs and functions. Intense intellectual effort 
 maintained even for a short period increases the beat of the 
 heart by 5 to 20 in the minute with a fall to the normal, or 
 even below it, on cessation of work, Mental work, when not 
 
INDUSTRIAL DISEASES AND ACCIDENTS 9 
 
 too prolonged, gently raises the arterial pressure and the 
 temperature, the muscles of the eyeballs become relaxed and 
 the pupils dilated and the crystalline lens flattened — pheno- 
 mena exactly the inverse of those observed during accommo- 
 dation. When the duration of physical work is short the 
 muscular force of the hand, as measured by the dynamo- 
 meter, is increased, but if prolonged the work done by the 
 muscle decreases. The amount of urine increases and there 
 is a slight excess of phosphates. The changes brought 
 about by muscular work were found by Byesson to be the 
 opposite of those caused by intellectual work. G. Binet 
 showed that in scholastic institutions the amount of bread 
 consumed fell with the increased amount of mental work of 
 the scholars, and that the body lost weight. One of the im- 
 portant features of overwork calling for notice is the manner 
 in which fatigue is repaired. It is a question of length of 
 time ; some persons require a longer time than others to re- 
 cuperate. It is easier to study muscular fatigue than mental. 
 During inactivity living muscle is absorbing oxygen from 
 the blood and is throwing off small quantities of carbonic 
 acid — it is storing up glycogen and fat ; but during activity 
 the nutrition of the muscle is quite altered. A larger 
 quantity of oxygen is absorbed, the carbonic acid evolved is 
 considerable, glycogen disappears, for it is used up, and the 
 temperature rises. The contractile substance of the muscular 
 fibre becomes acid in reaction, owing to the presence 
 of lactic acid and other derivatives. Whenever muscular 
 activity is carried to the point of exhaustion, glycogen, 
 which is the source of the muscular energy, disappears. It 
 is used up, being transformed into carbon dioxide and water 
 with lactic acid. Although deprived of glycogen, muscle can 
 still contract owing to the nitrogenous substances it contains. 
 Muscular activity requires nervous activity as well. Nerve 
 cells as producers of force, nerve fibres as carriers, and 
 muscles as the agents of contraction are all involved in 
 manual labour. Each of these plays its own part in fatigue. 
 The waste materials formed not only induce a sense of fatigue, 
 they exercise a paralysing influence upon the nerve endings 
 in muscle. In animals that died from fatigue H. M. Bernard 
 
10 DISEASES OF OCCUPATION 
 
 found a mottled condition of the muscles, alteration of the 
 nuclei, and under the sarcolemma fine droplets, which were 
 apparently dissolution products of myosine. Similarly 
 structural changes are met with in the nerve cells in 
 the grey matter of the motor areas of the brain. These 
 changes include chromatolysis, irregularity of the outline 
 of the nuclei of the cells, and a displacement of the 
 nuclei. It would seem that in fatigue there are three factors 
 in operation, (i) Accumulation of waste products ; (2) using 
 up of the energising substance, muscular and nervous ; and 
 (3) structural changes in muscle fibre and nerve cell. The 
 using up of the energising substance, even to the point of 
 exhaustion, is a normal or physiological process, but the 
 poisoning by disassimilation products is more or less patho- 
 logical, since it may be followed by definite alterations of 
 cell structure. Physiological fatigue is gradually recovered 
 from by rest. 
 
 When the muscular work is hard and there is considerable 
 strain as well, there is a rise of blood pressure which is not 
 without some influence upon the heart. The heart in its 
 beat has to overcome resistance ; if it cannot do this readily 
 the organ dilates. Acute dilatation of the heart is one 
 of the early physical signs of fatigue, and yet it can be 
 prevented to some extent by gradual training. In a map 
 who, by degrees, is trained to hard muscular work, the heart, 
 instead of dilating, hypertrophies ; it becomes larger and 
 stronger and therefore more fit for the requirements of the 
 circulation. Hence the heaving cardiac impulse of the 
 labourer's heart and the accentuated second sound heard 
 over the aortic area. So long as these men are doing hard 
 work we cannot regard the condition of their heart as patho- 
 logical. What sends the labourer wrong is not so much 
 the fact of his having a hypertrophied heart or of his doing 
 hard work, as alcoholic indulgence and irregular habits 
 superadded to muscular strain. In a large percentage of 
 the working men who come under my care in the Royal 
 Victoria Infirmary, Newcastle, suffering from heart disease, 
 who are broken down in health, the history is generally 
 one of exposure to weather, muscular strain, alcohol and 
 
INDUSTRIAL DISEASES AND ACCIDENTS ii 
 
 syphilis. In forgemen who are wielding a heavy hammer it is 
 easy to understand that with respiration suspended and the 
 chest kept fixed as in expiration, the thoracic and abdominal 
 aorta is compressed and the right heart and venous system 
 distended with blood. 
 
 Physical effort and the lifting and carrying of heavy 
 weights not only impress themselves upon the muscles and 
 nervous system, but upon all parts of the body, particularly 
 the bones in early adolescence and the period of growth. 
 Hence the stunted growth of the clay-carrying children 
 engaged in brickfields, and the deformities of the body and 
 spinal curvature met with in persons as the result of standing 
 the greater part of the day in a strained position when at 
 work. If standing all day when at work in an over-heated 
 factory causes tiredness of the muscles and also varicose veins, 
 prolonged sitting may be just as harmful, for the lumbar 
 region of the spinal column becomes bent, the movements 
 of the abdominal viscera are interfered with, the lower ribs 
 are compressed, and since deep inspiration is hardly possible 
 the lungs are badly ventilated and the aeration of the blood 
 is imperfect. 
 
 To protect against excessive fatigue we should encourage 
 regular and temperate habits on the part of the workpeople, 
 personal cleanliness, the use of good food, sleeping in well- 
 ventilated rooms, and the avoidance of over-crowding as far as 
 possible. It is difficult, if not impossible, for the poorer work- 
 ing classes, living as they often do in the slums ot large towns, 
 to observe and obtain these. If we cannot control the hygienic 
 conditions of the homes of the working classes, we can at any 
 rate insist that in the factory and workshop the conditions 
 under which work is carried on shall be as healthy as possible, 
 that means shall be in use to carry away dust, that the tempera- 
 ture and humidity shall not be too high, and that the air shall 
 contain even less carbon dioxide than is allowed by law. If 
 employers wish to have tidy and clean workmen they must 
 keep their factory clean. Change of clothing after work- 
 ing has a refreshing effect upon most people, and workmen 
 who have washed in the factory and changed their clothing 
 will probably make a better meal on reaching home than the 
 
12 DISEASES OF OCCUPATION 
 
 unwashed workman. The hours of toil should be propor- 
 tional to the nature of the work and its fatiguing character. 
 Upon young persons the burden of work should be lightly 
 imposed, and the individual gradually trained to it. Fatigue 
 in the case of pregnant women should be avoided by not 
 allowing them to undertake work of an arduous nature, 
 and by forbidding them going on with their work until 
 the end of term.^ 
 
 Traumatism^ Tuberculosis^ and Cancer. Medical 
 Aspects of the Question 
 
 Since in the wake of an injury there frequently follows local 
 or general disease, the question necessarily arises whether 
 these stand related to each other as cause and effect. A short 
 while ago there came under my care a young woman who, 
 when crossing one of the streets in Newcastle, was knocked 
 down by a passing vehicle. Until the day of the accident 
 she was a healthy woman and was not known to have been 
 ill. Her chest was bruised but no ribs were broken. Shortly 
 after the accident she began to spit blood. From time to 
 time she had recurrent haemoptysis. Physical signs of 
 pulmonary consumption rapidly developed, and within a year 
 the patient died with all the symptoms of tuberculosis of 
 the lungs. The diagnosis was confirmed by post mortem 
 examination of the body. I was much impressed by the cir- 
 cumstances of the case, and could not altogether eliminate 
 from my mind the post hoc propter hoc theory that the lung 
 disease was the result of the accident. Since then I have 
 seen other cases of injury to the chest wall followed for years 
 afterwards by recurrent hccmoptysis : thus the question of the 
 
 * After a discussion on fatigue at the International Congress of 
 Hygiene at Berlin, September, 1907, the following resolution was 
 passed : Since the capability for work varies not only individually 
 according to the constitution, age, sex, and mode of life, but also in the 
 same individual at different periods of life, a permanent skilled control 
 must be kept in all manual or intellectual industries, including business 
 occupations, and also occupations in which workmen are exposed to 
 special dangers ; this should be carried out in such a way that a proper 
 allowance would be made for the individual capability for work. 
 
INDUSTRIAL DISEASES AND ACCIDENTS 13 
 
 possibility of a causal connection between injury and tuber- 
 culous lung disease is one to which an answer must be 
 returned, and especially so in view of the Workmen's 
 Compensation Act. 
 
 The sequence of trauma and tuberculosis has hitherto not 
 attracted much attention in this country, either because of 
 the infrequency of the occurrence, or because medical men 
 with their knowledge of the bacillary cause of tubercle have 
 not thought it necessary to inquire into the possibility of 
 such a relationship. On the Continent, where compensation 
 for injuries received at work has been carried further in some 
 respects than in Britain, the subject has been frequently 
 forced upon medical men for their opinion, and what has 
 occurred in European countries will shortly take place in our 
 own. Medical men will be obliged to have an answer ready 
 to the question. Can an injury be the determining cause of 
 tuberculosis, or is it that injury simply lights up a tuberculous 
 lesion until then latent and possibly on its way to spon- 
 taneous cure ? If an accident received at work is the cause of 
 tuberculous disease of a subjacent organ, which disease but 
 for the accident would not have arisen, the claims for com- 
 pensation advanced by the injured person, or his relatives, are 
 not without a reasonable foundation. The difficulty will always 
 be that in most of the cases there is no proof of the healthy 
 condition of the body previous to the accident, a difficulty not 
 lessened but rather increased by the fact that in about 70 
 per cent, of the bodies of persons dying from all causes there 
 are evidences of healed localised tuberculosis of the lungs. 
 At the Morgue in Paris Professor Brouardel found old tuber- 
 culous lesions in one half of the bodies of persons above 
 30 years of age ; and Letulle, at the Hopital St. Antoine, 
 Paris, in 131 autopsies in cases of violent death, found 
 evidence of pulmonary phthisis in 25. We all know how 
 tuberculous gland disease can exist for years without 
 giving rise to symptoms. The disease remains latent until, 
 perchance, the glands become inflamed or they soften and 
 rupture and allow the imprisoned tubercle bacilli to escape. 
 A man or woman receives a blow on the chest, has a haem- 
 orrhage or not, as the case may be, and he dies months 
 
14 DISEASES OF OCCUPATION 
 
 afterwards from pulmonary phthisis ; or he meets with an 
 accident when at work, the injury is regarded and treated 
 as a sprain, but it is followed by a " white swelling " of the 
 joint, which is tuberculous. What is the association? 
 Medical opinion is divided. There are many surgeons who 
 believe that tuberculous disease of the joints and bones may 
 be the consequence of an injury, but when we consider how 
 many shocks and blows persons, young and old, are receiving 
 and how infrequently in comparison " white swelling " of the 
 joints appears afterwards, the association of trauma and 
 tuberculosis cannot be so very close and frequent, otherwise 
 we would have seen and heard more of it than we have. It 
 is an interesting fact that in these cases where patients have 
 given a history of injury there has been in nearly every 
 instance no fracture of the subjacent bone and no tearing, but 
 only bruising, of the skin, yet of 1 59 individuals who received 
 < penetrating wounds of the chest-wall Demme found that 
 j 17 died some time afterwards from pulmonary phthisis. 
 One of the first to draw the attention of the profession to this 
 subject was Professor Teissier, of Lyons {Lyons Medicale, 1873, 
 p. 10). A male patient, a baker, aged 30, who had never had 
 an illness, and who was in perfect health at the time, received 
 a blow on his right chest and shoulder by a falling beam. 
 So violent was the blow that the patient was rendered 
 unconscious. None of the ribs were broken nor was the 
 shoulder-joint dislocated, but there was swelling with redness 
 of the right shoulder-joint. Immediately after the accident 
 the man brought up a large quantity of blood by the mouth, 
 and for eighteen months afterwards haemoptysis was frequent. 
 Three years after the accident Professor Teissier, finding the 
 man in advanced phthisis, concluded that the pulmonary 
 consumption was the result of the accident and haemorrhage. 
 About the same date a shoemaker, believed to be in perfect 
 health, was struck in the chest by the pole of a carriage. 
 This man had immediately afterwards a severe haemoptysis, 
 which continued off and on for several days and then 
 remitted, but the patient succumbed later on to phthisis. 
 Teissier published his cases before the discovery of the 
 tubercle bacillus by Koch. He was of the opinion that an 
 
INDUSTRIAL DISEASES AND ACCIDENTS 15 
 
 injury was capable of causing, through the blood that 
 escapes, a bronchial irritation which ultimately leads to 
 pulmonary phthisis in persons predisposed to the malady. 
 It was therefore a phthisis ab hcemoptoe. In 1875 Perroud 
 drew attention to the frequency of phthisis among the sailors 
 on the Rhone. These men are of good physique and they 
 follow a healthy occupation in the open air. The disease was 
 attributed to the men leaning with their chest wall upon the 
 pole of the rudder in steering their ships. It was thought 
 that the repeated pressure favoured the development of 
 pulmonary lesions, the interesting point being that the 
 maximum focus of the disease as revealed by auscultation 
 always appeared to be located at the level of the point of 
 pressure by the pole, viz., under the right clavicle. The sailors 
 themselves were of the opinion that their illness was the 
 result of leaning on the pole. 
 
 In 1884 Germany decided to compensate workmen for 
 accidents received at work. At first it was principally " white 
 joints " coming on after injury that furnished the objects for 
 consideration. Honsell {Beatr, Klin. Chir.^ 1900, tome xxviii. 
 p. 659) investigated 1,729 cases of so-called articular rheuma- 
 tism. He found in 242, or 14 per cent, a traumatic origin. 
 In 577 cases of tuberculous disease of bones and joints under 
 the care of Rostock between 1890- 1902 Voss obtained a 
 history of traumatism in 125 : 88 per cent, of the patients 
 were between 30 and 40 years of age, and 4 per cent, between 
 50 and 60. In nearly every instance the accident was a 
 luxation or contusion, in only one instance was there a 
 fracture. Voss concluded that in one-third of the cases the 
 lesion was not of traumatic origin, in one-third the influence 
 of traumatism was doubtful, while in one-third injury had 
 played a part. When a white swelling of a joint has developed 
 a patient naturally tries to account for it, and he is tempted 
 to recall to memory some injury, severe or slight, to explain 
 the occurrence of his malady. 
 
 There have been, comparatively speaking, few literary con- 
 tributions to the subject of traumatism and tuberculosis in 
 British medical periodicals. One of the most interesting is 
 from the pen of Dr. James Weir, of Glasgow (Brit. Med, 
 
16 DISEASES OF OCCUPATION 
 
 Journal, May 23, 1903, p. 1196). He reports the case of a 
 man not altogether free from a tuberculous family history 
 who had had pneumonia in the left lung more than twenty 
 years previously, and who received a severe blow over the 
 lower part of the right chest and mid-axiliary region when 
 at work. He was treated at the time for a bruised side. 
 Two weeks afterwards he was found to be suffering from 
 what appeared to be pleurisy. Two months later there 
 were cough with expectoration, haemoptysis, signs of con- 
 solidation at the right apex, and considerable emaciation. 
 The sputum on being examined was found to contain tubercle 
 bacilli. Under treatment by creasote, cod-liver oil, &c., 
 patient improved considerably in strength and weight, he 
 lost his cough, tubercle bacilli disappeared from the expec- 
 toration, and the right apex became clear and free from 
 rales. In Dr. Weir's patient the part of the lung that 
 became affected corresponded with the injury to the chest 
 wall, and as the man had been apparently quite well at the 
 time of the injury, an opinion was expressed in favour of 
 some connection between the two events. The effects of the 
 bruising had penetrated the wall of the chest, had reached 
 the pleura, and after affecting it had either set up pathological 
 changes in the substance of the lung itself or weakened it 
 functionally. A focus of tubercle in the lung substance just 
 underneath the pleura is apt to set up a limited patch of dry 
 pleurisy ; but may not pleurisy as a primary lesion, such as 
 that caused by an injury, so impair the function of the under- 
 lying lung as to render it a suitable nidus for the develop- 
 ment of tubercle bacilli? Experience shows that it is in 
 those portions of the lungs that move least in respiration and 
 are therefore the least well ventilated, viz., the apices, that 
 tubercle bacilli are most prone to develop. The effect of 
 pleurisy upon subjacent lung is to impair its movements ; the 
 lung neither expands nor contracts so well, morbid secretions 
 are retained in the small bronchi, stagnation occurs, and the 
 vitality of the lung tissue is reduced. These are clinical facts, 
 but an appeal may be made to experiment. Von Krause, in 
 1890, inoculated guinea-pigs under the skin, and rabbits in 
 the pleura and peritoneum, with pure cultures of Koch's 
 
INDUSTRIAL DISEASES AND ACCIDENTS 17 
 
 bacillus. He subsequently caused contusion and sprains of 
 their joints, and in a few instances fracture of the bones and 
 dislocation of the joints. Three to seven weeks after the 
 injuries several of the animals died from miliary tuberculosis. 
 Some of the animals that had received bruises presented the 
 lesions of joint tuberculosis, viz., 34 per cent, of the guinea-pigs 
 and 50 per cent, of the rabbits. There were also evidences 
 of tuberculous disease of the lungs. In other experiments, 
 carried out by Lannelongue and Achard although the 
 animals died from tuberculosis, there were no tuberculous 
 lesions in the lungs, but in their experiments the injuries 
 were not inflicted until nineteen to twenty-one days after the 
 inoculation, too late to determine the relation of tubercle and 
 injury. Petrow {Central. Bl.f. Chir., November 26, 1904) in- 
 jected tubercle bacilli into the peritoneal cavity of twenty-six 
 guinea-pigs. All of them died of tuberculosis. In fourteen of 
 them there were, on histological examination of the epiphyses 
 of the joints, evidences of tubercle, and yet during life there 
 had been no signs present to betray its existence. In other 
 words, a latent tuberculous arthritis had been established. 
 In another set of experiments Petrow injected tubercle bacilli 
 into healthy joints, and also into other joints previously 
 subjected to traumatism. On a subsequent examination of 
 the joints of animals that had not been previously injured, 
 the tuberculous lesions remained limited to the ligaments 
 and the capsules round the joints, but in the traumatic joints 
 the lesion invaded the cartilages and the bones. These 
 experiments show how aggravated become the symptoms 
 and how extensive the tuberculous lesions when the joint 
 has been injured as well. Whatever our views individually 
 may be upon this subject, we cannot but admit that injuries 
 play an important part in lighting up pre-existing microbic 
 affections. Tuberculous lesions of lungs and joints may be 
 latent and for a time unattended by symptoms until an injury, 
 perhaps, is received, when a tuberculous lesion that was 
 dormant becomes active. 
 
 It is a question whether the subject under discussion can be 
 settled by experiment alone, since in animals tubercle bacilli 
 are usually injected in larger quantity than occurs in man. 
 
i8 DISEASES OF OCCUPATION 
 
 In them the blood is flooded with the micro-organism, but 
 in man the invasion is slow, and the injuries are not always 
 comparable with those experimentally produced in animals. 
 In the development of tuberculosis after an injury there are 
 two points to be borne in mind: (i) at the time of the 
 accident Koch's bacillus may have been already present in 
 the body of the injured person, either in the part struck 
 or at some distance from it ; and (2) the injury received 
 increases in some way or other the virulence of the bacilli. 
 The role played by injury may be simply that of an 
 accessory. Had the accident not occurred at the particular 
 time, tuberculosis might probably have developed all the 
 same, but from the Workmen's Compensation point of view, 
 since the injury roused into activity what ultimately became 
 a fatal disease, a claim for partial compensation under these 
 circumstances is not altogether unreasonable. 
 
 Dr. Mosny, of L'Hopital St. Antoine, Paris, is of the 
 opinion that an accident determines in a general way the 
 development of a localised tuberculosis at the point struck, 
 only when the malady already existed there in a latent 
 form. It requires, according to him, a local congestion of 
 the blood vessels to light up the malady, hence an injury, by 
 creating an inflammatory condition, is thus able to light up 
 disease till then latent. A contusion acts in a similar 
 manner. It is not necessary to have the skin broken in order 
 that deeper seated tuberculosis shall thereafter develop. An 
 injury may unmask a latent tuberculosis, or it may aggravate 
 an existing tuberculosis in a patient who is already phthisical 
 and hurry on the disease to a fatal termination. Taking 
 this view of the matter the injury would only reveal a morbid 
 state which was there before, but was not causing symptoms, 
 so that when a person receives an injury to his chest and 
 shortly afterwards has a spitting of blood, the haemoptysis 
 would be simply a sign of tuberculous lesion of the lung 
 already in existence, the vascular equilibrium of which had 
 become broken by the injury. But there are several cases 
 of recurrent haemoptysis after injury that have come under 
 my own observation, where I am convinced the lungs were 
 healthy before the accident, for since the injury, beyond a 
 
INDUSTRIAL DISEASES AND ACCIDENTS 19 
 
 recurrent haemoptysis once a year or once in two years, the 
 most careful examination of the lungs has failed to reveal 
 the existence of tuberculous disease of the lungs. But this 
 is in people whose family history and whose previous health 
 were good. What might have happened in persons pre- 
 disposed to phthisis it is impossible to say. In all probability 
 tuberculosis would have supervened. An injury to the chest 
 wall is sometimes followed by a limited inflammation of the 
 lung of an indefinite type, which is slow to disappear. A 
 lesion thus created becomes a fit soil for the reception and 
 multiplication of micro-organisms of various kinds, including 
 the tubercle bacillus. It is convenient in these cases to fall 
 back upon a pre-existing localised tuberculosis, but this is 
 only assumed, for there is no proof of such before the injury. 
 Sudden and profuse haemoptysis coming on shortly after an 
 accident cannot in every instance be due to an already-exist- 
 ing tuberculosis of the lungs. The vascular conditions upon 
 which the bleeding depends may be, therefore, a direct con- 
 sequence of the injury through the intermediation of the 
 nervous system, so that if the tubercle bacillus which lives, as 
 some pathologists maintain, as a saprophyte in the upper 
 respiratory passages is not kept in check by the phagocytes 
 of the lungs and bronchial mucous membrane, the tubercle 
 bacillus might become grafted on to the pulmonary lesion, 
 a circumstance likely to occur if the patient at the time is 
 run down in health and is living under unhealthy or depres- 
 sing conditions. The injury would prepare the way for 
 infection by tubercle. Dr. Marix, of the Prussian army, 
 gives the statistics of 79 cases of soldiers injured in the chest. 
 In 21 of them there subsequently developed tuberculosis. 
 The micro-organism was found in the expectoration of 7 of 
 the patients 3 months after the accident, in 8 of the soldiers 
 from 3 to 1 1 months after, in 5 after 1 2 months, and in i 
 after 7 months. In 2 of these 21 soldiers there was a family 
 history of phthisis. Seven of the soldiers were received into 
 the hospital immediately after the injury. There is no 
 definite date at which tuberculosis develops after an accident 
 to the chest wall. Tubercle bacilli have been found in the 
 sputum as early as one month after an injury. 
 
20 DISEASES OF OCCUPATION 
 
 A subject such as we have been discussing would be in- 
 complete did we not take into consideration the relationship of 
 profuse " blood spitting " after severe muscular strain, without 
 external injury and pulmonary phthisis. One illustration of 
 several will suffice. I have recently seen, in consultation with 
 Dr. Dinsmore, of Backworth, a colliery engine winder, aged 
 forty-seven, suffering from recurrent bleedings from the lungs, 
 attended by the physical signs of consumption. Twelve 
 years ago, when a typically healthy man and free from any 
 family tendency to tuberculosis, he lifted a heavy iron man- 
 hole door. He was conscious that he had overstrained himself, 
 but he paid little attention to the feeling of faintness and sick- 
 ness at the time. On the following forenoon when at work 
 he was suddenly seized with profuse bleeding from the lung. 
 He went home, stayed in bed, and in a week or ten days was 
 well again. For five years he kept, on the whole, well, when 
 he had another spitting of blood. Since then he has had 
 recurrent bleedings every few months or weeks, which have so 
 enfeebled him that he can no longer follow his employment. 
 In the chest there are the physical signs of phthisis. The 
 phthisis in this patient is as much the consequence of the 
 traumatic haemoptysis as if, instead of coming on years after 
 the accident or strain, it had developed immediately after- 
 wards. The fact that the blood spitting did not show itself 
 until the day after the strain does not militate against the 
 relationship between the two. My experience of this in other 
 patients is that the haemorrhage usually occurs on the 
 second day after the strain and not immediately after it. 
 
 It is the circumstance of the small number of cases of 
 tuberculosis following accidents, not more than 5 per 1,000, 
 that diminishes the value of the relationship. A closer 
 intimacy, on the whole, exists between injury and tubercu- 
 lous disease of the joints and bones, than between injury 
 and disease of the lungs. While some surgeons give the 
 percentages as varying from 8 to 40, the average is 12 
 to 14. This is higher than our experience in Newcastle. 
 The medico-legal aspect of this question cannot be ignored. 
 Some of my readers will be called upon to express an 
 opinion when a claim has been raised as to whether (i) the 
 
INDUSTRIAL DISEASES AND ACCIDENTS 21 
 
 accident lit up a tuberculosis that was latent or was possibly 
 on the road to cure ; (2) accelerated a tuberculosis that 
 was in process of evolution ; or (3) prepared the tissues for 
 the reception of the tubercle bacillus. If it can be shown 
 that but for the accident a man would have remained in 
 good health and been able to follow his employment the 
 claim for compensation will have to be carefully considered. 
 This will necessitate an inquiry into the personal and family 
 history of the injured workman and medical affirmation as to 
 the absence of previous pulmonary disease. It is extremely 
 desirable, too, that a stethoscopic examination of the patient's 
 chest should be made soon after the accident, and such con- 
 ditions noted, for example, as the location of physical signs 
 in the lung compared with the site of injury to the chest wall, 
 not that the disease invariably develops at the same spot. In 
 Germany the question of compensation does not arise in this 
 manner, for sick workmen are paid out of sick, accident, 
 or old age funds that are managed by the State. In Great 
 Britain the trend of legislation is in the German direction. 
 
 As after an injury to the chest wall pneumonia has occa- 
 sionally supervened, the question is sure to be raised as to 
 whether there is any causal connection between the two. 
 Pneumonia is as much a microbic disease as is tuberculosis, 
 but it is more definite both as regards its invasion and period 
 of incubation. In several instances, varying from four hours to 
 four days, pneumonia has developed after a contusion of the 
 chest wall. In some patients the disease has not developed 
 until the sixth day after the accident, and in one case not 
 till the fifteenth, but even in these patients there were 
 previously cough, sanguinolent sputa, and pains in the 
 chest on deep inspiration, all suggesting that the disease 
 had existed for several days before the patient had been 
 seen by the doctor. Part of the pain complained of is 
 probably the result of the injury to the side and not of 
 the concurrent pleurisy as in ordinary cases. In deal- 
 ing with this subject of the relation of traumatism to 
 pneumonia, it must be borne in mind that a patient might 
 go on working for a few hours after or just at the 
 time a pneumonia was developing, or had only begun to 
 
22 DISEASES OF OCCUPATION 
 
 manifest itself, so that an injury received then could not be 
 the cause of a malady that was clearly antecedent to or con- 
 current with a supposed injury. A patient may go about 
 with an " ambulatory " pneumonia for a few days and die 
 rather suddenly from it, when a lobe of the lung is found to 
 be in a stage of red hepatization. All these facts have to 
 be borne in mind when the subject of contusion pneumonia 
 is under consideration. One prominent symptom is that in 
 traumatic pneumonia there is generally a history of haemop- 
 tysis shortly after the accident. The micro-organism of 
 pneumonia is normally present in the mouth and buccal 
 secretions of healthy persons. When, therefore, a man has 
 met with an accident to his chest wall and haemoptysis has 
 occurred, the diplococcus which until then had been leading 
 a saprophytic existence in the mouth probably finds in the 
 sanguinolent expectoration and in the lung tissue altered by 
 the haemorrhage a medium favourable to its development. 
 Probably my estimate is above the mark when I say that in 
 not I per cent, of the cases of pneumonia is there a history 
 of an accident, and yet I have known of cases where the one 
 has followed the other. As far back as 1896 Professor J acoud 
 reported to the Academy of Medicine, Paris, the case of 
 a man who had received a blow on the chest which was 
 followed by haemoptysis. A few days afterwards there super- 
 vened pneumonia, which was at the time regarded as the result 
 of the injury. Five months afterwards tubercle bacilli were 
 found in the sputum and a cavity was detected at the site of 
 the previous pneumonia. As tubercle bacilli were absent 
 during the pneumonia Jacoud was of the opinion that the 
 localised pulmonary inflammation had, by reducing the 
 vitality of the lung, paved the way for the entrance of 
 the tubercle bacillus. 
 
 Contusion or traumatic pneumonia in no way differs, either 
 as regards its clinical features or bacteriology, from ordinary 
 croupous pneumonia, except that the expectoration contains 
 more blood and there is a history of haemoptysis. Although 
 the physical signs of the pulmonary disease, e.g., dulness on 
 percussion, crepitant and other rales, usually appear at the 
 site of the injury, this is not necessarily the case. Frequently 
 
INDUSTRIAL DISEASES AND ACCIDENTS 23 
 
 there is nothing to be detected externally on the side that 
 was said to have been injured. 
 
 In cases where pneumonia and tuberculous diseases have 
 appeared after accidents and the malady has led to a fatal 
 termination, no opinion as to the relation of the accident and 
 the disease should be expressed in a court of law without a 
 post-mortem examination having been made. Acute pleurisy 
 with effusion, for example, may develop any time from two to 
 six weeks after an injury to the chest wall, and while in the 
 fluid removed by aspiration from the chest for diagnostic 
 purposes no micro-organisms may be found, yet on injecting 
 some of the fluid into guinea-pigs tuberculosis may develop, 
 and at the autopsy of the injured workman evidence may 
 be found of old tuberculous disease in the apices of the 
 lungs. The pleurisy in such a case would be tuberculous 
 and due to pre-existing pulmonary disease. In a similar 
 manner tuberculous meningitis in children and also in adults 
 occasionally develops after an injury to the head, yet in 
 nearly all the fatal cases there have been found at the 
 autopsy either caseous glands or recent or old tuberculous 
 lesions in the lungs. 
 
 Blows upon the abdomen and strains and injuries to the 
 back seem, according to Rolleston (" AUbutt's System of 
 Medicine," vol. iv. p. S42), to have been the cause of 
 Addison's disease, either by the injury impairing the vital 
 resistance of the suprarenal glands as to render them more 
 vulnerable to the tubercle bacillus, or by giving rise to 
 haemorrhages in them. Since traumatism can cause inflam- 
 mation of serous and synovial membranes such as those of 
 the pleura and joints, there is no reason why it may not also 
 cause peritonitis. Injury does not appear to be often, if at all, 
 directly productive of appendicitis in previously healthy 
 persons. The cause of appendicitis is more probably ab intra^ 
 but injury of the abdomen might readily reveal a latent 
 appendicitis or give rise to a haemorrhage into the appendix. 
 Traumatism, shock, and exaggerated muscular effort are more 
 likely to re-light an appendicitis that had died down and had 
 become cured without operation. Where this occurs and an 
 operation has to be performed, is the injury to be regarded as 
 
24 DISEASES OF OCCUPATION 
 
 the cause of the malady, and is the individual therefore to be 
 compensated ? There is little doubt that the extension of the 
 Workmen's Compensation Act will tend to bring within the 
 category of injury many illnesses that have hitherto been 
 considered in no way directly associated with traumatism. 
 The importance of this remark is at once apparent in such a 
 case as the following. A man who is known to indulge too 
 freely in alcohol receives an injury. The injury of itself is so 
 slight that under ordinary healthy circumstances recovery 
 would be rapid and complete, but owing to the man's habits 
 delirium tremens develops, and in the course of this the 
 patient dies. But for the accident there would have been no 
 delirium tremens ; to that extent, therefore, the injury has 
 determined the malady, but had there been no excessive 
 indulgence in alcohol there would have been no delirium 
 tremens. What view will British lawyers take of such an 
 association of circumstances ? The French Act of 1898, 
 recognising that traumatism had played even a small part in 
 the development of symptoms, would indemnify the relatives. 
 The relation of malignant disease and injury is frequently 
 raised in medico-legal inquiries. That cancerous and sarco- 
 matous tumours develop after an accident, close to the 
 site of the injury, and that the one is the direct sequence of 
 the other, there is not the least doubt. How the tumour 
 comes we do not always know. A man receives an injury to 
 the right side of his chest and dies ten months afterwards 
 from malignant disease of the liver ; another man falls on his 
 head in a shipyard, and a year or two afterwards dies from a 
 sarcomatous growth in the brain. In some cases the connec- 
 tion is clear enough and the claim for compensation can be 
 honestly maintained, but it is absolutely necessary, in all 
 such cases leading to a fatal termination, that a post-mortem 
 examination should be made in order to ascertain whether 
 what is apparent on the surface of the body is the primary or 
 secondary growth. Only recently my opinion was asked in 
 the case of a man with a malignant growth in the glands of 
 the right side of the neck, who stated that when carrying a 
 plank two months previously he had slipped and had thus 
 injured his neck. A medical man who saw him two or three 
 
INDUSTRIAL DISEASES AND ACCIDENTS 25 
 
 days after the accident certified that the patient had ruptured 
 some of the muscular fibres above the clavicle, and, as a 
 consequence, the employers paid him his wages. When I 
 saw the patient, in addition to the large mass of glands in 
 the neck, there was loud, stridulous breathing, which the 
 glands in the neck, from their situation, could not explain, 
 and on careful conversation with the wife of the injured 
 man I learned that on the evening of the accident she had 
 detected a nodular swelling in the neck. At the autopsy, 
 two other medical men and myself found, as was expected, 
 that the glandular mass above the clavicle was but an 
 extension upwards of a much larger growth inside 
 the chest which had encircled the trachea and was the 
 primary seat of the disease. The necessity of a post-mortem 
 examination in all cases where malignant disease is said to 
 have followed an injury must be insisted upon. It is 
 impossible to discuss at length all the diseases, especially 
 those of the nervous system, that may develop after injuries. 
 Diabetes insipidus may be a direct consequence of a fall upon 
 the back of the head ; there are numerous forms of traumatic 
 neuritis and a host of neuroses, all of which must be dealt 
 with on their own merits. Nor can the subject of hernia and 
 its relation to strain and injury be dealt with here. Common- 
 sense and experience must guide a medical man in coming 
 to an opinion upon these points. Rupture of the diaphragm 
 followed by hernia of the stomach into the left pleural cavity 
 is a serious condition occasionally met with in railway servants 
 who have been crushed between the buffers of wagons, and 
 in whom the diagnosis would be made by the displacement 
 of the heart to the right, the presence of tympanitic resonance 
 in the left chest, haemoptysis and physical signs of haemo- 
 pneumothorax if the lung has been torn, coffee-ground 
 vomiting and a diminution in the circumference of the 
 abdomen. Pain is complained of over the precordium and 
 in the dorso-lumbar region of the spine. Severe as the 
 accident is, many of the injured apparently suffer very little 
 at first, but serious symptoms soon show themselves. In an 
 accident such as this, if the patient's condition permitted of 
 it an X-ray photograph would be of considerable assistance 
 
26 DISEASES OF OCCUPATION 
 
 in making a diagnosis. It must always be borne in mind 
 that a severe injury to the chest or abdomen may cause 
 rupture not only of healthy organs, e.g., spleen or kidney, 
 but may induce rupture of a latent thoracic aneurism or a 
 hydronephrosis, and thus lead to death. A fatal termination 
 under these circumstances would be none the less the result 
 of accident, notwithstanding the previous existence of serious 
 disease. 
 
 There are certain trades in which cancer occurs with 
 greater frequency than others. As the subject is dealt with 
 in other parts of this book, allusion need only be made here 
 to chimney-sweeps' cancer and the occurrence of malignant 
 warts on the forearms of coal, grease, and paraffin workers. 
 Dr. John Clay has recently drawn my attention to the 
 presence of a malignant wart on the back of the hand of a 
 bacon-curer. This is an unusual situation for a malignant 
 wart. It is therefore probably more than a coincidence. 
 
 Simulation of Disease in view of Compensation 
 
 In countries wherein conscription imposes upon the able- 
 bodied male population the burden of carrying arms, it is 
 easy to understand that all kinds of deception will be tried 
 in order to evade this national obligation, and in countries 
 in which workmen receive compensation for injuries and 
 diseases of occupation there is frequent resort to fraudulent 
 methods to obtain nioney. In Germany and Switzerland, 
 where compensation has been extended to workmen for 
 several years, it is known that the workmen have taken full 
 advantage of the Act, and that in many instances they are 
 accused of having made convalescence as protracted as 
 possible. It is only recently in France that the benefits 
 have been extended to the working classes, but already in 
 France there has grown up a special literature dealing with 
 malingering. 
 
 Many of the monographs written upon the subject expose 
 a state of things that does not bid for amity between 
 employer and employed. There is, perhaps, too great a 
 tendency on the part of the public to make a comparison 
 
INDUSTRIAL DISEASES AND ACCIDENTS 27 
 
 between an injured workman who is generally poor and an 
 employer who is believed to be wealthy, and as a consequence 
 the sympathy of the working classes and of a large section 
 of the public goes with the injured workman. By this 
 expression of sympathy and wide support the simulation of 
 disease is rather fostered than otherwise. The problem of 
 simulation has a double aspect. It is not only a question 
 of a workman who has been injured pretending to be the 
 subject of a disease from which he is quite free, it is also 
 one of a workman, for example a lead worker, continuing 
 to follow his employment and concealing his symptoms so 
 as to earn his living ; or, in view of the extension of the 
 Workmen's Compensation Act, a sailor known to be the 
 subject of heart disease or aneurism trying to pass himself 
 off as a healthy man and fit for work. How often too do men 
 and women of the middle class, also those of good society, 
 pretend to be the victims of serious injuries after even 
 mild railway accidents ! There is a nervous condition left 
 after the shock which partly explains this. Self-inflicted 
 wounds, too, and mutilations are not unknown in the arena 
 of forensic medicine. In Britain there is not, so far as I 
 know, any law which inflicts punishment upon men and 
 women for simulating disease for fraudulent purposes, but 
 in France, Prussia, and Austria the law can deal with such. 
 Both mental and physical ailments can be simulated. 
 Epilepsy, true or false, and attributed to industrial con- 
 ditions, is not always easy of differentiation. There is no 
 ONE symptom by which mock or simulated epilepsy can be 
 recognised. The tout ensemble must be considered. It is 
 always difficult to appraise at their proper value symptoms 
 that are purely subjective. Headache is just such a symp- 
 tom. A man who has received an injury to his head may for 
 months afterwards complain of headache which unfits him 
 for work. There are frequently no physical signs by means 
 of which the statement can be corroborated or disproved, for 
 it is purely a sensation on the part of the patient. It is 
 never wise to totally disregard the complaint of a patient, 
 for after severe injury to the head there may develop a 
 limited meningitis or possibly a tumour, either of which 
 
28 DISEASES OF OCCUPATION 
 
 may be causally related to the injury. On ophthalmoscopic 
 examination the detection of neuro-retinitis would be of 
 considerable assistance in guiding the medical examiner to an 
 affirmative opinion in regard to an organic cause for the head- 
 ache, but the absence of retinal changes would not necessarily 
 point to the headache as having no existence except in the 
 imagination of the patient. The urine in such cases ought 
 to be examined for albumen, and the possibility of uraemia 
 excluded. In the consideration of a paralysis complained of 
 by persons who have received injuries, the co-existence of 
 extensive anaesthesia along with the loss of muscular power 
 would suggest a hysterical or inhibitory cause, and not an 
 organic lesion, provided, of course, that such an accident had 
 not happened as the division of a nerve. None the less, too, 
 the hysterical condition observed in a patient might be just 
 as much the result of an accident and nervous shock as a 
 cerebral lesion itself, and a similar remark applies to the 
 complaint of loss of sight in one-half of the eye and to loss of 
 speech. To be the consequence of a structural lesion there 
 would have to be additional signs, and these are absent in 
 hysteria and neurosis. 
 
 It is more difficult to set a proper value upon paresis^ or 
 incomplete loss of muscular power, owing to its subjective 
 character, than upon paralysis. Simulated paralysis like 
 that due to hysteria frequently disappears and reappears — it 
 comes and goes. It is characteristic of the hysterical para- 
 lysis that comes on after an injury that the symptoms do not 
 correspond with anatomical and physiological facts. During 
 the stage of excitement that occurs when an anaesthetic is 
 being administered to any one who is the subject of trau- 
 matic hysteria the paralysed limb is often lifted and moved 
 quite well by the patient. 
 
 Spasm and contraction of limbs frequently occur after 
 fractures as the result of the broken bones having been too 
 long in splints. The joints feel as if fixed and tightened. 
 Under an anaesthetic the contracture, if it is organic, remains. 
 In hysterical spasm of the hand, for example, where the 
 fingers are drawn forcibly towards the palm, these can be 
 lifted up by the medical examiner, who will feel the small 
 
INDUSTRIAL DISEASES AND ACCIDENTS 29 
 
 tremors of the muscles gradually give way ; but if the spasm 
 is simulated, i.e., is voluntary, and is kept up by will, the 
 individual cannot help making muscular contractions, and 
 these are irregular and are felt. 
 
 Occasionally symptoms of a severe and lasting character 
 develop after an injury. A man or woman after an accident 
 becomes, for example, paralysed in the left arm and leg, also 
 in the left side of the face, although in the circumstances of 
 which I speak the face is usually unaffected. It is extremely 
 difficult at first to say whether the loss of power on the one 
 side of the body is functional or the result of an organic 
 cause. The absence of heart and kidney disease and of a 
 history of syphilis, also the normal appearance of the optic 
 disc and retina in a person who has received an injury, and 
 in whom the symptoms came on a few days after the accident, 
 suggest a functional origin for the disease, a diagnosis which 
 is strengthened should the loss of power be more pronounced 
 in the leg than in the arm and be accompanied by loss of 
 sensation, i.e., anaesthesia and analgesia in the affected limbs. 
 In hemiplegia, consequent upon a block or rupture of a cerebral 
 blood-vessel, hemianaesthesia seldom accompanies hemiplegia. 
 When, therefore, in addition to hemiplegia there is anaesthesia, 
 which involves the left half of the tongue and buccal mucous 
 membrane as well as the limbs, and is attended by defective 
 sight and hearing or by continuation of the loss of sensation, 
 while the motor power of the limbs is improving, the func- 
 tional nature of the illness is almost assured, even if there is 
 distinct evidence of a certain amount of facial paralysis 
 present at the same time. A haemorrhage into the posterior 
 part of the internal capsule might involve both motor and 
 sensory fibres, so that hemianaesthesia could quite well 
 accompany hemiplegia. It would be necessary, therefore, 
 to make a careful study of the field of vision, since in func- 
 tional cases incomplete loss of sight is often complained of 
 A lesion of the right internal capsule which interferes with 
 sight produces a left homonymous hemianopsia. The visual 
 defect would involve half the field, or be hemiopic and not 
 concentric. C. O. Hawthorne ("Functional Hemiplegia," 
 Clinical Journal, Dec. 12, 1906) maintains that "defective 
 
30 DISEASES OF OCCUPATION 
 
 acuity (amblyopia) and a contracted field when associated 
 with and on the same side as a hemiplegia (and there- 
 fore 'opposite' or 'crossed' in reference to the site of the 
 presumed cerebral disturbance) are in the highest degree 
 suggestive of a functional explanation of the paralysis." To 
 the above add dislocation of the natural order of the colour 
 fields, the circles of which are nominally from without inwards 
 blue, red, and green, and the functional nature of the malady 
 is confirmed. 
 
 Pain in the back and spinal tenderness elicited on pres- 
 sure, are often hysterical ; so, too, may be a lateral deviation 
 of the spinal column, which examination under an anaesthetic 
 clears up. On the other hand, pain in the lumbar region of 
 the spinal column may undoubtedly be the result of severe 
 strain caused by lifting a heavy weight, and be due to rupture 
 of muscular fibres or stretching of spinal ligaments followed 
 by effusion around nerve fibres. Spinal caries may even be 
 the result of such a strain, and of this in its earliest stages 
 pain may be the only symptom. As regards Pott's disease, 
 injury may be directly or indirectly a cause. 
 
 Diabetes insipidus not infrequently follows injury to the 
 back of the head. I have known it occur in men who, when 
 at work, had fallen, and in their descent had knocked the 
 head against a beam of wood or piece of iron. A few 
 days afterwards, when consciousness had been regained, some 
 of the men asked for water to drink, and exhibited a 
 thirst difHcult to satisfy. The polydypsia has invariably 
 been followed by polyuria, which persists, and diabetes 
 insipidus is the consequence. This illness, of which the 
 outward sign is the elimination of several pints — lo to 20 
 — of pale urine in the twenty-four hours, might well be 
 simulated by men drinking large quantities of water. 
 Under such circumstances the patient would have to be 
 kept under observation for a time and carefully watched. 
 One sign in particular would help to a diagnosis of 
 traumatic diabetes insipidus, and that is the presence of 
 structural changes in the optic disc in the direction 
 of atrophy, not necessarily accompanied by marked loss of 
 vision. The need of keeping also under strict observation 
 
INDUSTRIAL DISEASES AND ACCIDENTS 31 
 
 a patient who is said to be suffering from diabetes mellitus, 
 the supposed result of an accident, is apparent, since people 
 have been known to add sugar to their urine so as to simulate 
 diabetes. 
 
 Haemoptysis, or blood-spitting, is frequently simulated. 
 All manner of deception is practised to gain a particular 
 end. The chewing of raw liver is not unknown, or the 
 mixing of blood with expectoration. I have found the roof 
 of the mouth and soft palate of patients the seat of numerous 
 bleeding points caused by the puncture of needles self- 
 inflicted. Careful examination of the throat and nose in 
 suspicious cases should be made to eliminate these as the 
 sources of blood spitting. Auscultation of the lungs is 
 always necessary, the possibility of pre-menstrual pulmonary 
 haemorrhage in females, however, being borne in mind. Every 
 haemoptysis is not a sign of tubercular disease of the lungs. 
 There is a stage in pulmonary phthisis in which haemoptysis 
 can occur without any sign of tuberculous disease in the 
 lung. It is more than probable that a limited patch of 
 tubercle is present in the lung in many of these cases, but 
 it is quite consistent with good health. Chavigny^ says that 
 there exists an affection which simulates in such a manner 
 the haemoptysis of the pretubercular period that a medical 
 man runs the risk of confounding the one with the other, 
 or he is led to make a diagnosis of simulated haemoptysis 
 when, notwithstanding numerous and periodical expectora- 
 tions of blood, the health remains good and the lung free. 
 To this condition Josserand 2 in 1893 gave the name of 
 hcBmosialemesis — a condition of an undoubtedly hysterical 
 nature, yet supervening after an injury. The expectoration 
 has special characters by which it can be recognised. The 
 liquid contents of the spitoon should be emptied into a 
 conical glass and allowed to stand for twenty-four hours, 
 when it will be found to be divided into three layers. 
 The uppermost layer, wWch is the most important, is very 
 red ; it is rich in haemoglobin but poor in red blood 
 corpuscles. The middle layer is not so highly coloured : 
 
 ' " Diagnostic des Maladies Simulees," P. Chavigny, 1906, p. 407. 
 ' Lyon Midical, 1893, p. 219. 
 
32 DISEASES OF OCCUPATION 
 
 it appears as a thin, pale, rose-red disc ; while the lowest 
 layer has a greyish red appearance, and is made up mostly 
 of epithelial cells and decolourized red corpuscles. Nicolai 
 applies the term "pulmonary hysteria" to those cases in which, 
 owing to haemoptysis of the type just mentioned, the diag- 
 nosis of tuberculous disease has been made by even good 
 physicians. In any case in which the particular features of 
 haemosialemesis are present the examination should be 
 directed to ascertaining whether other hysterical stigmata 
 exist. A bacteriological examination of the sputum ought 
 also to be made, care having been taken — especially in a 
 hospital — to prevent the patient mixing his sanguinolent 
 expectoration with the sputum from a tuberculous subject. 
 This examination is only of value when positive results 
 have been obtained. We are scarcely warranted in apply- 
 ing the tuberculine test in these cases. While pulmonary 
 phthisis is simulated, it is more frequently dissimulated or 
 concealed. Men hide the fact as far as they possibly can 
 in order to be allowed to follow their occupation. 
 
 Heart disease and injury form an interesting subject from 
 the Workmen's Compensation point of view. I do not refer 
 to complaints of palpitation of the heart and of a sense of 
 cardiac distress by men who seek to palm off their complaint 
 as the result of an accident when, in all probability, it is the 
 consequence of sexual excess and over-indulgence in the use 
 of alcohol and tobacco ; nor do I allude to valvular lesions 
 of the heart other than those connected with the aortic orifice, 
 and disease of the aorta itself Sudden strain and. injury are 
 capable of causing cardio-vascular lesions which may perma- 
 nently disqualify the individual for work. It is a debateable 
 point as to whether physical strain is capable of causing an 
 aortic lesion in the absence of pre-existing disease of the valves 
 or of the wall of the aorta itself Medical opinion leans to 
 the theory of some previous weakness due to age or the result 
 of alchohol, but especially to syphilis, or to the two or three 
 combined. Were there no exposure to severe and unexpected 
 strain the weakened heart and aorta of the middle-aged work- 
 man would probably serve his purpose quite well for many 
 years to come. My own opinion is that it is quite possible 
 
INDUSTRIAL DISEASES AND ACCIDENTS 33 
 
 for a comparatively healthy heart, free from valvular disease, 
 to be taken unawares during severe strain, so that an injury 
 is inflicted whereby either an aortic aneurism develops, or 
 there is produced regurgitation through the aortic valves. 
 The lesion is certainly traumatic, for at the autopsy the torn 
 but otherwise healthy valve can be found. Aortic regurgita- 
 tion originating under these circumstances is an accident for 
 which a claim under the Workmen's Compensation Act 
 might quite honestly be supported, provided always it was 
 known that previous to the strain the aortic valves were 
 healthy. I have known several instances of men whose heart 
 was presumably healthy, for in them, although sought for, 
 no cardiac bruit had been detected, becoming suddenly 
 seized with precordial pain and faintness after lifting a 
 heavy weight, and in whose chest a little time after the 
 accident an aortic diastolic murmur could be heard. Trau- 
 matic aortic regurgitation has certain features that distinguish 
 it from incompetence, the result of chronic endocarditis. The 
 illness, for one thing, runs a much more rapid course ; it is 
 more quickly fatal and less liable to be compensated. Many 
 of the patients, the subjects of this accident, die within two 
 years of the injury. Aortic incompetence cannot be simu- 
 lated, but a workman who is suffering from this malady 
 might claim compensation for an alleged injury received 
 at work which previous knowledge of the heart of the indi- 
 vidual by his medical practitioner, especially as regards 
 alcoholic excesses and syphilis, with a statement of previous 
 illnesses, might fail to support. It must be borne in mind 
 that heart disease, of even the most dangerous nature, e.g.^ 
 aortic regurgitation, can exist for years and not give rise to 
 symptoms until some sudden strain is experienced or some 
 intercurrent illness, such as bronchitis, arises to break the 
 balance of the circulation. 
 
 Digestive Troubles^ Vomitings Colic^ &c, — The extension 
 of the Workmen's Compensation Act so as to include metallic 
 poisoning is bound to give rise to litigation between em- 
 ployed and employer. Vomiting and colic, although frequent 
 and very important symptoms of lead poisoning, are symp- 
 toms of such a large number of other diseases that care will 
 
34 DISEASES OF OCCUPATION 
 
 necessarily have to be exercised in regard to setting a proper 
 value upon them. Vomiting is often a hysterical symptom, 
 and is often very resistant to treatment, while pain after meals 
 is a subjective sensation, and, unless in its severest forms and 
 attended by other signs, such as collapse, has to be weighed 
 by the physician carefully before being accepted. The pres- 
 ence of such other symptoms as hyperaesthesia, hyperalgesia, 
 and diminished field of vision, would favour the diagnosis of 
 hysteria and neurosis. There would be required an examina- 
 tion of the vomited matter, for sometimes in these hysterical 
 cases it is found that the solids are expelled while the liquids 
 are retained. So far as colic is concerned, the presence of 
 a blue line on the gums, the absence of sulphocyanide of 
 potassium in the saliva, and the presence of indican in the 
 urine, would point to lead poisoning. The diagnosis would 
 be complete if lead were found in the urine. Constipa- 
 tion, although usual in lead workers, may be replaced by 
 diarrhoea, while workers in mercury and antimony, also 
 brassfounders, usually suffer from looseness of the bowels. 
 Within recent years cases of lead colic have been mistaken 
 for appendicitis, and vice versd, in regard to which the absence 
 of fever on the one hand and the presence of a blue line on the 
 gums suggest plumbism. 
 
 It is desirable to call to our aid all the assistance we pos- 
 sibly can to enable us to distinguish between pain of organic 
 origin and pain that is hysterical or due to neurosis. Possibly 
 in watching the pupil of the eye some help might be thus 
 obtained. In a healthy person the pupillary reflex to pain 
 consists in a fairly rapid dilation of the pupil which had been 
 previously contracted, the amount of dilatation being propor- 
 tional to the intensity of the pain. On cessation of the pain 
 produced by pressure for experimental or test purposes the . 
 pupil gradually returns to its normal dimensions. In hysteri- 
 cal or neurotic patients complaining of pain, firm pressure upon 
 the parts of the body referred to as the seat of pain is not 
 followed by dilation of the pupil. It is an interesting fact, 
 moreover, that when a neurotic patient becomes the subject 
 of an organic painful affection he too may exhibit the 
 pupillary reflex to pain when the tender part is pressed upon, 
 
INDUSTRIAL DISEASES AND ACCIDENTS 35 
 
 but he will fail to exhibit the reflex phenomenon when the 
 so-called hysterical points are compressed. Without being 
 an infallible guide the pupillary reflex enables us to dis- 
 tinguish with quasi-certitude pain of an organic nature 
 from pain that is imaginary or hysterical. 
 
 Phosphorus and Lucifer Match Making: Sesquisulphide 
 of Phosphorus 
 
 Commercial phosphorus is obtained from bone ash by 
 treating it with sulphuric acid, filtering and evaporating the 
 product, heating this with charcoal, and afterwards distilling 
 it. Two kinds of phosphorus are in the market — the white 
 ox yellow, discovered by Brandt, of Hamburg, in 1669, and the 
 redox amorphous, discovered by Schroter, of Vienna, in 1845, 
 and obtained from white phosphorus by exposing it in a 
 closed vessel for some time to a temperature of 250° C. It is 
 the white or yellow phosphorus that is dangerous. From it 
 until recently, both in this and other countries, all the "strike- 
 anywhere " matches were manufactured. When pure this 
 form of phosphorus is colourless and transparent, but when 
 exposed to the light it becomes yellowish. It glows in the 
 dark owing to absorption of oxygen. The greenish-white 
 light, or phosphorescence as it is called, can be checked by 
 such essential oils as turpentine and eucalyptus. The glow 
 of phosphorus is an indication that oxidation is taking place, 
 and that phosphorous and phosphoric oxides are being formed 
 along with, in all probability, ozone. Yellow phosphorus has 
 to be kept in water, as it is extremely inflammable, and ignites 
 at a temperature of 34° C. It is, too, extremely poisonous. 
 Red or amorphous phosphorus can be handled with impunity. 
 It does not take fire when rubbed on a rough surface ; it is 
 non-volatile, and when swallowed is, comparatively speaking, 
 non-poisonous. One to three grains of white phosphorus will 
 cause death, but fairly large doses of amorphous phosphorus 
 can be given to animals without any bad symptoms following. 
 Swedish, or safety matches, are manufactured from red phos- 
 phorus. These only strike on the box, upon a specially pre- 
 pared surface. The matches themselves do not contain the 
 red phosphorus. This is present along with antimony sul- 
 phide in the paste that has been applied to the side of the 
 
36 DISEASES OF OCCUPATION 
 
 match-box. The match heads contain potassium chlorate, 
 or chromate, and other compounds rich in oxygen, from 
 which the oxygen required to induce conflagration is evolved. 
 Although the Swedish matches made from red phosphorus are 
 safer, both from the poisonous point of view and from danger 
 of fire, the fact remains that until recently only three and 
 a half tons of red phosphorus were used per year in Great 
 Britain in the manufacture of matches, whereas sixty tons of 
 white phosphorus were consumed. 
 
 The manufacture of white phosphorus is a small industry. 
 It is carried on at Oldbury, near Birmingham. Few of the 
 men employed have suffered in health, owing largely to the 
 precautions that are observed and the fact that, as the sub- 
 stance is prepared in closed vessels, the workmen are not 
 brought into direct contact with it. White phosphorus is 
 used in the manufacture of the ordinary strike-anywhere 
 matches. The match industry is an important one. The 
 twenty-two match manufactories in Great Britain give 
 employment to upwards of four thousand persons, of whom 
 three- fourths are females. It was the death of a lucifer 
 match maker in London about eleven years ago, and the 
 announcement in the daily papers of a considerable amount 
 of ill-health in lucifer match makers, that brought the subject 
 of industrial phosphorus poisoning before the public and 
 gained for the trade an unenviable reputation. Out of the 
 human suffering that was then experienced and the stigma 
 under which the trade laboured good has come. The subject, 
 after having been much discussed in Parliament, was re- 
 ferred by the Home Secretary, Sir Matthew White Ridley, 
 to a small committee, composed of Prof. T. Thorpe, of the 
 Government Laboratory, Dr. Geo. Cunningham, and myself, 
 to make an inquiry into and report upon (i) the nature and 
 extent of the dangers attending the use of yellow and white 
 phosphorus ; (2) the means whereby these can be lessened ; 
 and (3) the practicability of discontinuing the use of yellow 
 and white phosphorus. The report to the Home Secretary 
 is published as a Blue Book. 
 
 The malady of the lucifer match maker that is most 
 dreaded is what is known in this country as phosphorus 
 necrosis, or " phossy jaw," and in France as mal chimique^ a 
 
INDUSTRIAL DISEASES AND ACCIDENTS 37 
 
 localised inflammatory affection of the jawbone, extremely 
 painful in the early stages, which lasts a long time, and 
 invariably ends in death of the bone. As it is only within 
 the last few years that cases of phosphorus necrosis have been 
 reported to the Home Office, it is difficult to say how many 
 lucifer match makers in this country have suffered. The 
 total number of cases of industrial phosphorus poisoning 
 reported in this country until the year 1899 was 102, of 
 which nineteen were known to have terminated fatally. 
 Three other cases occurred in 1900, so that 105 cases of 
 phosphorus necrosis are known to have occurred during the 
 latter part of last century. Since then only eight or nine 
 fresh cases of phosphorus necrosis have been notified.^ 
 
 The origin of the lucifer match is shrouded in obscurity. 
 Several countries compete for the honour. There is the 
 statement that the first lucifer match was made in Stockton- 
 on-Tees. I have taken some pains to investigate this matter, 
 for until recently I was of the opinion that lucifer matches 
 were invented in Vienna ; but it would now appear as if the 
 Austrian capital had been in the early years of the match trade 
 rather concerned with the production than the discovery of 
 lucifer matches. A closer study of the subject leads me to 
 regard England as the home of the industry, and John Walker, 
 a dispensing chemist of Stockton-on-Tees, as the inventor of 
 the lucifer match. Almost for equal recognition stands out 
 Sir Isaac Holden, M.P. Mr. Walker died at 12, The Square, 
 Stockton-on-Tees, May i, 1859, at the age of ^S. For several 
 years before his death he had realised a good income from 
 the sale of his matches. I have seen facsimiles of the 
 matches. They are narrow, flat, wooden splints, 3 inches in 
 length, and have a red-tipped head J inch in length. The 
 matches were sulphur-tipped as well. Walker's first friction 
 matches were made of cardboard, and were sold at the rate 
 of fifty matches for a shilling. Subsequently he substituted 
 wood for the cardboard. A piece of sandpaper shaped like a 
 
 * Dr. T. M. Legge, Medical Inspector of Factories, informs me 
 (Dec, IQ07) that since 1900 inclusive there have been twelve cases of 
 phosphoros necrosis notified, and of these five proved fatal. In 
 Great Britain all cases of phosphorus necrosis, whether mild or severe, 
 are reported. It is this circumstance which renders a comparison 
 between British statistics and those of other countries difficult. 
 
38 DISEASES OF OCCUPATION 
 
 cocked hat was sold with the matches, into which the match 
 was inserted and drawn quickly to get the necessary explosion. 
 Walker's books are still in existence, and in these are con- 
 tained entries of sales with the names of the purchasers and 
 dates. From these books we learn that he was making 
 matches for sale in 1827. Sir Isaac Holden has been 
 credited with priority as to the invention ; but in an auto- 
 graph letter dated May 2, 1892, Sir Isaac says his own 
 match was not invented until November, 1829, and that at 
 this date he was not aware of Walker's discovery. Sir Isaac 
 (then Mr.) Holden never attached to his own invention the 
 importance he might, nor did he take out a patent for it. In 
 the Leeds Mercury^ January i, 1894, is a detailed account of 
 a meeting held at Oakworth House to present Sir Isaac 
 Holden, Bart, M.P., with an address from his constituents 
 of the Keighley Parliamentary Division of Yorkshire. In 
 the course of his reply the venerable parliamentarian said he 
 had almost given up claiming any credit for the invention of 
 lucifer matches, as he had been anticipated in that discovery 
 by another inventor by about two years. By this renounce- 
 ment of the claim the honour of the discovery rests with John 
 Walker, the dispensing chemist of Stockton-on-Tees, whose 
 body is buried in Norton Churchyard, a mile and a half from 
 Stockton. Walker was never the recipient of any Royal 
 favour, nor during his life was any special notice taken of 
 the great service he rendered to mankind. As with other dis- 
 coveries, many minds were directed to the same subject at 
 the same time. Walker outstripped others both at home and 
 abroad, and was selling matches in Stockton years before they 
 were being made and sold in Vienna. Stephen Romer, a 
 merchant in Vienna, is believed to have been the first to have 
 made phosphorus stable in the air and incandescent by friction 
 when mixed with incombustible substances. Romer is sup- 
 posed to have bought the invention from a young Hungarian, 
 Bartholomaus Irinyi, who was a student of chemistry at the 
 time in Vienna. This was in 1832. France has also advanced 
 a claim to the invention. Whatever doubt surrounds the 
 origin of the lucifer match, it was certainly in Austria that in 
 the fourth decade of last century the manufacture became an 
 industry on a large scale. For a period Vienna controlled 
 
INDUSTRIAL DISEASES AND ACCIDENTS 39 
 
 the markets of Europe. The manufacture of matches had 
 gone on for a few years without any mishap occurring, until 
 1838, when Dr. Lorinser, of Vienna, diagnosed phosphorus 
 necrosis in a female worker, Marie Jankovits. This is the 
 first authentic case of industrial phosphorus poisoning on 
 record. Three years previously the manufacture of lucifer 
 matches had been forbidden by several of the German States 
 as being too dangerous, not so much to the health of the 
 workpeople as to the safety of the community on account of 
 fire. Shortly after 1838, Dr. Knolz having reported other 
 cases of the malady, the Austrian Government appointed a 
 commission to make an inquiry into the conditions of work 
 in the seven match factories that at the time existed in Vienna. 
 Although certain recommendations were made by the com- 
 mittee and were given consent to by the States Council in 
 1846, they never became effective, for between 1866 and 
 1875 there occurred 126 cases of phosphorus necrosis in the 
 hospitals of Vienna alone. 
 
 That is the story as it bears upon Austria, and to which, as 
 concerns its industrial aspects, we shall immediately return ; 
 but, as already stated, other countries had advanced a claim 
 to having invented the lucifer match. England's share in the 
 discovery has never been fully recognised, hence these details 
 of the invention. In 1 83 1 Charles Sauria, a student at the Col- 
 lege of Arc, at Dole, showed that matches could be made from 
 a mixture of phosphorus, sulphur, and chlorate of potassium ; 
 but as he had no money to proceed with his invention, he 
 detailed the processes of manufacture to his teacher of physics, 
 Professor Nicolet, who in a moment of enthusiasm for his 
 pupil carried the information to Johann Friedrich Kammerer, 
 then a political prisoner in the Hohenasperg of Wurtemberg, 
 who subsequently established a match works in Germany. 
 Meanwhile Sauria, having finished his studies, had settled 
 down as a doctor of medicine in St. Lothain, in Jura ; but as 
 he was not successful in the practice of his profession, an 
 appeal was made by friends in 1884 to M. Jules Grevy, 
 President of the French Republic and a compatriot of 
 the inventor, for pecuniary assistance to Sauria, who, 
 after enjoying the pension a few years, died in 1895 at 
 the age of 84. Sauria's lucifer match was far from being 
 
40 DISEASES OF OCCUPATION 
 
 perfect. Binoxide of lead was substituted by him for 
 potassium chlorate in order to soften the character of the 
 explosion on striking the match. In the works carried on by 
 Sauria, as phosphorus necrosis was not unknown among the 
 workmen, an attempt was made to eliminate phosphorus 
 altogether from the factory, and to make lucifer matches out 
 of chromate and chlorate of potassium, peroxide of lead, and 
 sulphide of antimony. In 1902 old students of the College 
 of Arc appropriately placed on record on a commemorative 
 tablet the invention by Sauria, while the town of Dole, the 
 birthplace also of the illustrious Pasteur, named one of its 
 streets after him. 
 
 Between 1835 and 1845 the production of lucifer matches 
 increased with great rapidity over the whole of Europe. At 
 the latter date, according to the interesting historical informa- 
 tion supplied by Dr. Ludwig Teleky,i there were in Nurem- 
 berg four match factories, giving employment to 1 50 to 200 
 workmen, and three factories in Lyons. There were also 
 works in Berlin, Stuttgart, Zurich, Strasburg, and Paris, but 
 as a manufacturing centre Vienna remained supreme. The 
 three large factories of Romer, Preshel, and Siegl in Vienna 
 had a large export trade, in which smaller factories shared. 
 As the smaller works, for want of capital, could not compete 
 with the larger and better equipped, the smaller places 
 gradually dropped out of existence, a fate from which the 
 larger works were subsequently also not spared, for by 1854 
 there were only eight factories in Vienna and Lower Austria, 
 giving employment to 280 men and 1,450 women. Even at 
 this period attempts were being made to find in potassium 
 chlorate a safe substitute for the dangerous white phosphorus. 
 The match industry in Vienna gradually declined, but not 
 on account of the character of the products, for at the 
 Paris Exhibition in 1855 the three first prizes awarded for 
 lucifer matches went to Vienna. In consequence of the 
 dearness of the wood required for the splints the in- 
 dustry migrated to Bohemia and Styria, where wood was 
 cheap, and where, as also in Galicia, it still gives employment 
 to large numbers of persons. In 1855 Austria exported two 
 ^ " Die Phosphornekrose Ihre Verbreitung in Osterreich und Dehren 
 Ursachen," Wien, Franz Denticke, 1907. 
 
INDUSTRIAL DISEASES AND ACCIDENTS 41 
 
 million florins' worth, or 22,000 cwt. of matches; in 1866 
 the export trade reached its highest point, viz., 57,000 cwt. 
 From this date the Austrian manufacture of matches has 
 steadily declined in the face of Swedish competition, with its 
 cheaper wood, and the imposition of high protective duties 
 by countries to which Austria had hitherto exported. For 
 wood, which in Sweden cost only four to five florins, the 
 match manufacturers in Bohemia had to pay seventeen to 
 eighteen florins, while Sweden, with its easy access to the sea 
 and cheaper freights, gradually captured markets previously 
 held by Austria. This has certainly been the case as concerns 
 the Eastern Asiatic and China markets, where, too, within 
 recent years, a formidable opponent has arisen in the com- 
 mercial activity of Japan. The rise and fall of the Austrian 
 match industry is an interesting social and international study, 
 since to-day there is no longer even one match factory in or 
 near Vienna. What part in the future Japan will play as a 
 competitor in the lucifer match industry it is impossible to 
 say. Her maritime ascendancy and proximity give her special 
 privileges so far as the Chinese and even Indian markets are 
 concerned, while the cheapness of wood in the island, the low 
 wages, children's labour, and low freights enable her to com- 
 pete in even distant markets with some of the older lucifer 
 match-producing countries of Europe. In 1904 Japan 
 produced 28 million francs' worth of matches, and gave 
 employment to 21,400 workpeople (6,070 men and 15,335 
 women and young persons) ; whereas Great Britain, with 
 her eighteen factories in 1901, gave employment in this 
 industry to 3,100 women and 1,500 young persons. The 
 following table, taken from Dr. Teleky's monograph, is not 
 without interest in support of the opinions that have just 
 been expressed and the facts stated. In the lucifer match 
 industry — 
 
 Japan employs 21,400 workpeople. 
 
 15,668 
 
 Russia „ 
 
 Italy 
 
 Sweden 
 
 Germany 
 
 Austria 
 
 Hungary 
 
 Great Britain 
 
 , 6,700 „ 
 
 5,655 
 
 4,815 
 4,611 
 
 2,175 
 4,150 
 
42 DISEASES OF OCCUPATION 
 
 In 1905 Japan, with her production still increasing, sent 
 to Australia and the United States of America 23,000 francs' 
 worth of matches, and 1 3,400 francs' worth to Egypt. 
 
 When a member of the Lucifer Match Committee, it was 
 my duty and privilege to visit match works in England, Scot- 
 land, Belgium (including Flanders), France, and Germany. 
 Most of the recently built factories are up-to-date buildings, 
 but there are a few that are quite out of keeping with modern 
 requirements. It was because the manufacture of lucifer 
 matches at the commencement of the industry required, prac- 
 tically speaking, no machinery, but only a small amount of 
 plant, and matches were made by hand, that any kind of 
 dilapidated building seemed to be considered good enough for 
 the purpose of a match factory. Hence the wretched struc- 
 tural conditions of some of the factories I have visited, also 
 the circumstance of the manufacture of lucifer matches being 
 clandestinely carried on as a domestic industry and attended 
 by serious consequences to the workers. 
 
 Most countries have consumed the matches manufactured 
 within their own borders, but others, such as Norway, 
 Sweden, Belgium, and Great Britain, have been large ex- 
 porters as well. Japan, as already stated, manufactures and 
 exports a large quantity of matches. It is difficult to 
 ascertain to what extent lucifer match making is a home 
 industry in Japan. Two kinds of matches are made there, 
 (i) the ordinary strike-anywhere, and (2) safety matches. 
 The work is carried on under certain regulations. There are 
 no such factory laws in Japan as we have in this country, and 
 yet among the requirements it is insisted that there shall 
 be a separation from each other of the different departments, 
 namely, dipping, drying, and boxing, the provision of ventila- 
 tion by hoods and fans, the prohibition of employment of 
 persons when their teeth are decayed, the interdiction of 
 food taken into and eaten in the factory, and of the presence 
 of a larger percentage of phosphorus in the paste than 10 per 
 cent. In Japan no match factory can be built without the 
 consent of the Government, and no workers can be employed 
 under sixteen years of age. 
 
 The head of an ordinary strike-anywhere match contains 
 
INDUSTRIAL DISEASES AND ACCIDENTS 43 
 
 glue, phosphorus, chlorate of potassium, powdered glass, and 
 magenta, or some such colouring agent. The paste, or 
 " composition," contains on an average 5 per cent, of phos- 
 phorus. Into this compound, when spread out moist and 
 slightly warmed, one end of the wooden matches, or splints, 
 is dipped, several hundreds of them at a time. These are 
 then taken to a drying chamber. After drying, the frames 
 containing the matches are stripped and the matches are 
 boxed. It is in the mixing of the paste when done by hand 
 in open vessels, and in the dipping and boxing of matches, 
 that the workpeople are exposed to fumes that become a 
 menace to health. The mixing of the paste ought always 
 to be done in closed vessels, mechanically if possible, and 
 the dipping and boxing of the matches carried on close 
 to a running fan. During the process of dipping, the 
 fumes of the phosphorus are quite visible. They can be 
 seen rising for a few inches above the dipping plate and 
 travelling towards the fan. These fumes are rich in phos- 
 phorous oxides. Professor Thorpe exposed decayed human 
 teeth to the fumes of phosphorus for twelve hours, and he 
 found that they lost 0*37 per cent, of their weight, and that 
 carious teeth when exposed to a dilute solution of phosphoric 
 acid (i per cent.) lost 8*9 per cent, of their original weight. 
 The atmosphere of an ill-ventilated lucifer match factory 
 simply reeks with the garlicky odour characteristic of phos- 
 phorus. Thorpe found 0'02 milligramme of phosphorus in 
 100 litres of air in the dipping room of a match factory, and 
 in the same quantity of air in the boxing room 0'I2 milli- 
 gramme of phosphorus. Since during several hours of each 
 working day the dippers and boxers are inhaling this 
 poisoned atmosphere, the fumes become dissolved in the 
 saliva of the mouth and exercise a solvent action upon the 
 teeth. It is not alone the air breathed that is the source of 
 danger. The poison clings to the fingers and hands of the 
 workpeople. On examining the hands of a boxer they are 
 seen to be deeply stained by the dye given off by the heads 
 of the matches, and they emit the characteristic garlicky 
 odour. They glow in the dark. On analysing the water in 
 which twenty-two workpeople had washed their hands on 
 
44 DISEASES OF OCCUPATION 
 
 leaving the factory, Thorpe found 37-3 miHigrammes of phos- 
 phorus, an amount equal to 4*2 milligrammes of phosphorus 
 per person for each ten hours' work. 
 
 Phosphorus necrosis, or phossy jaw, is the unique malady 
 of lucifer match makers. It is a localised manifestation of 
 phosphorus poisoning. That the system, generally speak- 
 ing, is also affected as well is more than probable. French 
 physicians describe a general morbid condition of the body, 
 or a cachexia, met with principally in female workers, charac- 
 terised by pallor of the face, dyspepsia, albuminuria, and a 
 tendency to bronchitis, to which the term phosphorisme has 
 been applied. During my visits to the French match works 
 I had the opportunity of discussing with Dr. Arnaud, of 
 Marseilles, the liability of young female workers to bron- 
 chitis, as it is not a common affection in this country. In his 
 opinion 28 per cent, of the young women suffered from 
 bronchitis, but there was no tendency for the disease to 
 become tuberculous. Arnaud did not find, as some French 
 physicians have maintained, that there is a greater predispo- 
 sition on the part of the pregnant lucifer match maker to 
 miscarriage than women employed in other occupations. 
 My experience confirms that of the Marseilles physician. 
 This is an interesting and important point, because phos- 
 phorus in the form of a decoction of match heads is frequently 
 resorted to by women for the purpose of inducing abortion, 
 always with extremely painful consequences, and often with 
 a fatal result. 
 
 In Great Britain phosphorisme, or the constitutional form 
 of phosphorus poisoning, is not of common occurrence. The 
 malady that is dreaded is phosphorus necrosis. The presence 
 of decayed teeth predisposes a match maker to the disease, 
 for the phosphorus fumes penetrate carious teeth, and readily 
 induce a periostitis, or acute inflammation of the covering of 
 the jaw-bone. The gum becomes swollen, and both it and 
 the jaw-bone painful. Sooner or later pus forms, and 
 although the tooth, or teeth, are extracted, the pain continues, 
 but in a less severe form. The inflammation gradually 
 extends to the bone, which undergoes a process of slow 
 destruction. For months pus keeps oozing out into the 
 
INDUSTRIAL DISEASES AND ACCIDENTS 45 
 
 mouth in minute quantities, some of which is swallowed, and 
 tends to induce a chronic toxaemia. By means of the use of 
 antiseptic mouth-washes the morbid process gradually ceases 
 by a piece of dead bone being thrown off, or the decayed 
 bone is removed by surgical operation, when the patient 
 recovers, with or without facial deformity. 
 
 Opinions are divided as to the cause of phosphorus necrosis 
 in lucifer match makers. Is it the result solely of phosphorus 
 fumes acting upon the jaw-bone through decayed teeth 
 setting up inflammation of the bone, and allowing therefore 
 the micro-organisms present in the mouth to carry the morbid 
 processes further ; or is phosphorus necrosis, as Professor 
 Stockman, of Glasgow, informs us, a tuberculous affection of 
 the jaw-bone, and due to infection by the tubercle bacillus ? 
 My own opinion is that the disease of the bone is the result 
 of a mixed infection, and that phosphorus fumes, by primarily 
 inducing pathological changes in the teeth and jaw-bone, 
 make it possible for micro-organisms to carry on their baneful 
 operations. 
 
 There is, however, something peculiarly human in phos- 
 phorus necrosis. Dr. L. v. Stubenrauch, of Munich, tried to 
 produce phosphorus necrosis in dogs by exposing them to 
 the vapours given off from burning phosphorus, but without 
 any untoward results. Other dogs, some of whose teeth had 
 been extracted, were exposed in the boxing rooms of large 
 match factories for six months without any evil consequences. 
 Experience and experiment alike show that it is practically 
 impossible to reproduce in animals the picture of phosphorus 
 necrosis exhibited by man. Stubenrauch maintains that the 
 first stage in the morbid process is thrombosis of the small 
 blood-vessels of the bone {Archiv. /. Klin. Chir.^ Berlin, 
 April 7, 1899). Lewin, of Berlin, does not believe that it is 
 primarily necessary for a lucifer match maker to have decayed 
 teeth. The phosphorus fumes, in his opinion, inflame the 
 gums in the first instance, and as a consequence there is 
 induced a septic gingivitis, which is followed by disease 
 of the bone. In Wegner's experiments with phosphorus 
 upon animals the cancellous part of the bone became 
 hard and sclerosed. Although phosphorus has some special 
 
46 DISEASES OF OCCUPATION 
 
 predilection for bone, the fact that in animals exposed to it 
 necrosis of the jaw-bone does not follow suggests that in the 
 human subject there is probably, over and above phosphorus 
 fumes, some other factor in operation. 
 
 Phosphorus when absorbed is only slightly altered in the 
 blood. When exposed to the air phosphorus is slowly 
 oxidised, but this occurs hardly at all in the blood-vessels. If, 
 for example, to freshly drawn arterial blood phosphorus is 
 added, and the glass tube is hermetically sealed, the bright 
 red arterial colour is not lost earlier than in a control experi- 
 ment where none of the metalloid is used. Phosphorus, 
 therefore, cannot be said to absorb oxygen from the blood, so 
 that the amount of phosphoric acid formed in the blood must 
 be too small to cause poisoning. The blood loses its power 
 of clotting, probably owing to the action of phosphorus upon 
 the blood ferment. 
 
 Lucifer match makers are liable to another affection of the 
 bones, one which has a special relation to the constitutional 
 effects of phosphorus poisoning. When visiting the match 
 works in Grammont, Belgium, I had the opportunity of 
 meeting Dr. Brocoorens, who has had large experience of 
 match makers and their diseases. He drew my attention to 
 the fact that several of the men who had been employed 
 as dippers in the factories, and who in their earlier years had 
 suffered from phosphorus necrosis and had recovered, ex- 
 hibited an unusual tendency to fracture of their long bones, 
 especially the femur, often on the slightest exertion. The 
 town of Grammont contains six match factories, which give 
 employment to upwards of i,ioo persons. During the thirty 
 years Dr. Brocoorens has resided there he has treated 
 upwards of thirty cases of spontaneous fracture of the long 
 bones consequent upon such simple muscular effort as that 
 required when walking to lift the foot from the roadway to 
 the pavement. Spontaneous fracture of the bones has not 
 occurred in England with anything like the frequency as 
 in Belgium, but Dr. Garman, of Bow, for many years medical 
 officer to Messrs. Bryant & May's works, informs me that 
 he has known of nine cases, and Dr. Dearden, of Manchester 
 {Brit, Med, Journ.^ 1899, vol. ii. p. 270), has reported the 
 
INDUSTRIAL DISEASES AND ACCIDENTS 47 
 
 occurrence of the accident in two dippers, " each of whom 
 has had separately and at different times both thighs broken 
 in a ridiculously simple fashion." Dr. Kocher, of Berne, has 
 had experience of a match maker who broke his thigh-bones 
 five times. The readiness with which the long bones snap in 
 match makers indicates that the bony tissue is in some way 
 or other influenced by phosphorus or its compounds, where- 
 by they are unable to withstand external violence. It is 
 Dearden's opinion that the bones of match dippers contain 
 an excess of phosphoric acid, which combines with the pre- 
 existing neutral phosphate of lime to form a slightly acid salt 
 and thereby to cause the fragilitas ossium of lucifer match 
 makers. 
 
 In Great Britain less than i per cent, of the match makers 
 have suffered from phosphorus necrosis, in Switzerland it 
 was formerly v6 to 3 per cent., and in France 2 to 3 per 
 cent. Of 51 cases of phosphorus necrosis communicated to 
 me by Dr. Garman 9 ended fatally. Eighty-three per cent, 
 of his patients recovered and returned to work. Of the 51 
 cases 31 were females and 20 were males. In the women 
 the upper jaw was affected 15 times and the lower 16. In 
 the men the numbers were respectively 11 and 9. Dr. 
 Brocoorens found that the dippers were more liable to 
 necrosis of the upper jaw, and that in boxers, who are 
 usually females, it was the lower jaw that was more frequently 
 affected. When phosphorus necrosis has attacked the upper 
 jaw the inflammatory process is apt to extend to the brain and 
 induce a septic inflammation, which in every instance has 
 been fatal. A person may follow his occupation in a match 
 works for years without suffering, or he may have left the 
 works for two years or more when unexpectedly symptoms 
 and physical signs of phosphorus necrosis show themselves. 
 The ages at death of Garman's patients were 19, 19, 21, 
 22, 22, 22, 23, 27, and 27. It does not always require an 
 exposure of many years to the fumes of phosphorus for 
 a fatal result to follow. In two of the patients included 
 above pulmonary consumption doubtless contributed to the 
 fatal result. 
 
 The questions submitted by the Home Secretary to Pro- 
 
48 DISEASES OF OCCUPATION 
 
 fessor Thorpe and myself were briefly whether anything 
 could be done to render lucifer match making from white 
 phosphorus a more healthy employment and whether a 
 harmless substitute could be found for the dangerous metal- 
 loid. Since it has been recognised that the fumes of white 
 phosphorus by penetrating carious teeth must play some 
 part in causing necrosis of the jaw-bone, periodical examina- 
 tion of the teeth of the workpeople by a qualified dentist, 
 and treatment when necessary, improved ventilation of the 
 workrooms, reduction of the amount of phosphorus in the 
 paste for heading the lucifers, and suspension from the 
 factory of all workers on the slightest appearance of symp- 
 toms, have done much to diminish phosphorus necrosis in 
 match makers. Only twelve cases of phosphorus poisoning 
 have been reported to the Home Office since 1900, and in 
 three of these the disease probably existed before the new 
 rules were drafted. The introduction of machinery whereby 
 the wooden splints are cut, the matches dipped, dried, and 
 boxed without being handled by the workers, has in the 
 Diamond Match Works, Liverpool, been followed by the 
 greatest success. When these processes are carried on in 
 large, well-ventilated workrooms and the mixing of the 
 paste takes place in covered iron vessels provided with 
 ventilating shafts, the risk from phosphorus necrosis is con- 
 siderably diminished. The fact remains, however, that so 
 long as white phosphorus is used absolute freedom from risk 
 to health cannot be assured. 
 
 Manufacturers have, therefore, been obliged to turn their 
 attention to the use of a harmless substitute for white phos- 
 phorus. The difficulty at first was to produce a satisfactory 
 strike-anywhere match, for valuable as the Swedish or safety 
 match is, the public demand for this kind of match does not 
 increase in the same proportion as for the ordinary lucifers. 
 The workpeople on the Continent have suffered from phos- 
 phorus necrosis as much as, if not more than, our own match 
 makers. Denmark, Switzerland, and Holland have for a few 
 years interdicted the use of white phosphorus and the sale 
 of matches made from it. These countries only manufac- 
 tured for home consumption. They never exported to any 
 
INDUSTRIAL DISEASES AND ACCIDENTS 49 
 
 extent, if at all. In France, where the manufacture of 
 matches is a State monopoly, and where the workers had 
 to be compensated for injury to health in consequence of 
 their occupation, the claims for compensation had a few 
 years ago risen to such a height that the Government was 
 obliged to make an effort to improve the lucifer match 
 industry. Much of the ill-health complained of by the 
 workpeople was doubtless in no way the consequence of 
 their occupation. The figures are interesting. In the match 
 works at Pantin-Aubervilliers, near Paris, there were reported 
 32 cases of phosphorus intoxication in 1894; in 1895, 125; 
 in 1896 the number rose to 223, or one-third of the effective 
 force of the factory. At these dates the paste for heading 
 the matches often contained, in addition to small quantities 
 of lead, 20 to 30 per cent, of phosphorus. In one year, 
 January i to December 31, 1896, the State paid to the 
 workpeople at the Pantin-Aubervilliers match factories 
 400,000 francs, or 630 francs per person employed over 
 and above his wages. Apart from this undesirable drain 
 upon the Treasury it was felt that the time had come when 
 something would have to be done to alter the conditions 
 of labour in French match works. Meanwhile the Belgian 
 Government had offered a prize of 50,000 francs to any 
 person who would invent a safety strike-anywhere match 
 free from white phosphorus. France solved the problem. 
 After many trials MM. Sevene and Cahen demonstrated 
 that in sesquisulphide of phosphorus was to be found a sub- 
 stitute practically capable of accomplishing all that white 
 phosphorus could do without causing symptoms of poisoning. 
 These scientists gave daily 3 centigrammes (frd grain) to 
 guinea-pigs over a considerable period without producing 
 symptoms of intoxication, whereas 3 milligrammes (gV^h 
 grain) of white phosphorus similarly introduced killed 
 guinea-pigs very rapidly. 
 
 It was thought at first that matches made from sesqui- 
 sulphide of phosphorus would not carry well across the 
 ocean and that they would not keep well in all climates, 
 but experience has not confirmed these forebodings. The 
 sesquisulphide is almost an inodorous powder, and is, prac- 
 
50 
 
 DISEASES OF OCCUPATION 
 
 tically speaking, non-poisonous. It may contain a trace of 
 red or amorphous phosphorus and at times give off a slight 
 odour of sulphur. The results of the substitution of phos- 
 phorus sesquisulphide for the harmful white phosphorus at 
 Pantin-Aubervilliers were at once apparent in the improved 
 health of the workpeople and in the cessation of monetary 
 claims for injured health. Dr. Courtois-Suffit, Medical 
 Inspector of the French match factories, informs me that 
 lucifer match making is no longer regarded as a dangerous 
 trade by his Government. The sesquisulphide has found its 
 way into Great Britain, and its use has been followed by 
 success. One good, but quite unexpected result of the 
 substitution of the harmless for the dangerous form of 
 phosphorus in match making is the diminution in the 
 severity of symptoms and in the number of cases of fatal 
 suicide due to the use of matches. Phosphorus poisoning, 
 which was the cause of a few deaths every year in the Royal 
 Infirmary, Newcastle, has, practically speaking, disappeared 
 from our statistical tables, and in the patients admitted the 
 symptoms are usually less serious, a circumstance which 
 shows that in this city, at any rate, the matches that are sold 
 have been mostly prepared from the sesquisulphide. The 
 paste from which these non-poisonous matches are made is 
 as follows : — 
 
 Sesquisulphide of phosphorus 
 Chlorate of potassium 
 Oxide of zinc 
 Red ochre 
 Powdered glass 
 
 Glue 
 
 Water 
 
 6 parts. 
 24 
 
 6 
 
 6 
 
 6 
 18 
 34 
 
 Since the introduction into France of the manufacture of 
 the sesquisulphide match there has not been in the factories 
 one case of phosphorus poisoning, nor has there been any 
 explosion or fire in any of the match works. The slight 
 trace of sulphuretted hydrogen given off by the new material 
 has not produced illness of any moment. Readiness to catch 
 
INDUSTRIAL DISEASES AND ACCIDENTS 51 
 
 fire and the evolution of unwholesome gases have been pre- 
 vented by the regulations requiring that the sesquisulphide 
 shall contain 3 to 4 per cent, of red phosphorus ; this prevents 
 the formation of unstable subsulphides. In the manufacture 
 of matches by phosphorus sesquisulphide, machinery is fast 
 replacing hand labour, the economic advantages of which 
 change are readily apparent, while the health of the workers 
 is in all respects improved. For the last seven years the new 
 method of manufacture has been in use at Pantin, where with 
 the improved machinery 2,500,000 matches are made every 
 day. This has reduced the number of workers employed, 
 but it has purified the industry. 
 
 In our own country a similar improvement has been 
 observed. Mr. Bartholomew, managing director of Messrs. 
 Bryant & May's works, London, writes to me that " We are 
 well satisfied with our long trial of the new composition. 
 There has not been, and there cannot be, from the nature 
 of the composition, any sickness among the workpeople." 
 In the future we shall hear less and less of the frightful 
 ravages of white phosphorus. The manufacture of lucifer 
 matches is therefore an illustration of at least one industry 
 which, from being of a dangerous and unhealthy nature, has 
 become by vigilance and scientific invention comparatively 
 speaking healthy. This change for the better has been 
 secured without great cost to the manufacturers, for it has 
 not necessitated any great change of plant, and yet what a 
 gain it has been to hundreds of workpeople who have to 
 earn their living in the trade ! 
 
 Although in preceding pages sesquisulphide of phosphorus 
 has been extolled as against white phosphorus, it is only right 
 to mention that while its use in the manufacture of matches 
 has so far been free from danger, it acts in some instances as 
 an irritant, causing conjunctivitis and oedema of the eyelids, 
 also eczema of the skin. To obviate this the workpeople in 
 France engaged in the manufacture of the sesquisulphide 
 bathe their eyes, and douche their nostrils, twice a day before 
 leaving the factory v/ith an alkaline solution of bicarbonate of 
 soda, and since adopting this preventive line of treatment 
 the inflammatory troubles have ceased to exist. At first the 
 
52 DISEASES OF OCCUPATION 
 
 workmen refused to adopt these precautionary measures, but 
 this initial difficulty having been overcome the workpeople 
 themselves are now feeling the benefit of them. 
 
 The treatment of phosphorus necrosis is mainly preventive. 
 New workers on being taken on at the factory should be 
 medically examined, special attention being paid to the state 
 of their teeth. There ought to be periodical examination by a 
 dentist of the teeth of all workers in a match factory, with 
 power to suspend when necessary. Personal cleanliness is a 
 requisite, and the frequent use of antiseptic mouth-washes a 
 desideratum. The workrooms should be well ventilated, and 
 fans should be running to withdraw all fumes away from the 
 face of the workers. Washing accommodation should be 
 ample, hot and cold water being provided along with plenty 
 of soap and towels. On complaint of pain in the jaw, the 
 mouth should be examined by a dentist, loose and carious teeth 
 should be extracted and the use of antiseptic mouth-washes 
 encouraged. Once phosphorus necrosis has developed the 
 malady may be treated simply by keeping the affected part 
 clean as far as possible by mouth-washes and by maintaining 
 the general health of the patient by good food and fresh air ; 
 but healing is a slow process, for the disease may go on for 
 several months before it is arrested or the piece of dead bone 
 thrown off. To expedite recovery surgeons occasionally 
 remove by operation the dead bone. Eighty per cent, of the 
 cases of phosphorus necrosis recover, whether dealt with 
 surgically or treated by antiseptic washes. The most fatal 
 cases are those where the disease extends from the upper jaw 
 into the base of the skull and sets up septic meningitis, or 
 those in which, owing to rather profuse and protracted sup- 
 puration of the jaw-bone, pus keeps escaping into the mouth, 
 mixes with the food, and causes toxaemia or gains access 
 to the respiratory canals and lights up pulmonary disease. 
 
 The question of the total prohibition of white phosphorus 
 has frequently been discussed. Elsewhere I have expressed 
 the opinion that nothing short of its total abolition will 
 render the manufacture of lucifer matches a safe industry 
 from a health point of view, but there are economic and 
 commercial considerations which cannot be altogether ignored 
 
INDUSTRIAL DISEASES AND ACCIDENTS 53 
 
 even in the lucifer match trade. Only by international 
 agreement can this question be settled. At the Berne 
 Congress (1906) the representatives of the British Govern- 
 ment did not see their way to join in the abolition movement 
 unless other large exporting countries co-operated. Readers 
 need only refer to the figures and facts given in an early part 
 of this chapter which deal with the rapid industrial advance 
 of Japan, and to remember the unwillingness of Japan at 
 the Berne Congress to co-operate with other countries in the 
 movement for the abolition of white phosphorus, to find an 
 explanation of the attitude assumed by the British repre- 
 sentatives in regard to this subject. 
 
 In these pages I have dealt with the signs and symptoms 
 of industrial phosphorus poisoning. When persons have 
 accidentally swallowed phosphorus, or drunk a solution of 
 match heads with suicidal intention, they have usually 
 become jaundiced by the third day, and most of them have 
 died shortly afterwards from toxaemia. After death the 
 liver and kidneys have been found to have undergone fatty 
 degeneration. Recently a child two years of age was 
 admitted into the Royal Victoria Infirmary, Newcastle, who 
 had sucked several match heads. She died within 30 hours 
 of the event, and although she was never jaundiced, there 
 was yet found at the autopsy advanced fatty degeneration of 
 the liver and kidneys. The case is exceptional as regards 
 the rapidity of death, absence of jaundice, and the presence 
 of extreme fatty degeneration of the internal organs in the 
 short time. The matches had been made in Flanders and 
 contained white phosphorus. The case serves to illustrate 
 this other important point — that should Great Britain inter- 
 dict within her own borders the manufacture of matches from 
 white phosphorus. Parliament would at the same time have 
 to prohibit the importation of " strike-anywhere " matches 
 made from white phosphorus ; and while this might be done in 
 the interests of the health of the people, it would be regarded 
 by some persons as a form of protection to which, commercially 
 at any rate, this country has not yet committed itself. 
 
CHAPTER II 
 
 DISEASES DUE TO GASES, VAPOURS, HIGH TEMPERA- 
 TURES, ETC. 
 
 Carbon Dioxide ; Carbonic Acid (CO2) 
 
 AS a poisonous gas carbonic acid can hardly be com- 
 pared with carbon monoxide, (CO) the symptoms of 
 poisoning by which develop with great rapidity. Carbonic 
 acid is, fortunately, a more feeble poison. More people 
 are brought under the influence of CO2 than CO, since 
 it is the gas which is present in badly ventilated dwelling- 
 rooms, workshops, and factories. When exposed to small 
 quantities of this gas for a long period the vital resistance 
 of the organism is reduced and the way is paved for disease. 
 CO2 is found in ordinary atmospheric air to the extent 
 of '04 per cent., but it must be present in larger quantities 
 to cause such symptoms of poisoning as headache, vertigo, 
 buzzing in the ears, heavy sleep, and loss of consciousness. 
 Three per cent, of CO2 in the air causes difficulty of 
 breathing, 6 per cent, causes palpitation and headache, 
 while upwards of 10 per cent, induces unconsciousness. In 
 poisoning by CO2 the breathing is at first quickened : it is 
 short and gasping, the beat of the heart becomes slower, the 
 extremities cold and cyanosed, and death comes with or 
 without a convulsion. It is the mode of termination of life 
 in many cases of heart disease. There are few instances in 
 which carbonic acid without the presence of other gases at 
 the same time— ^.^., carbon monoxide — is breathed in 
 sufficient quantity by men and women at work as to become 
 an immediate source of danger. CO2 is one of the impurities 
 
 54 
 
DISEASES DUE TO GASES, VAPOURS, ETC. 55 
 
 of the air in tunnels and occasionally in coal-mines, but so 
 long as there is an adequate quantity of oxygen present at 
 the same time respiration can go on pretty well. 
 
 Our knowledge of the harmful effects of CO2 has been 
 largely obtained from Paul Bert, who showed that when the 
 atmosphere in which an animal is placed is not renewed it 
 dies. The tension of the oxygen falls until it is insufficient 
 for the needs of respiration and there occurs anoxaemia 
 followed by asphyxia. In closed spaces where CO2 is allowed 
 to accumulate and at the same time sufficient oxygen is 
 introduced, the animals die when the CO2 has become 
 excessive, owing to the high CO2 tension in the air preventing 
 the escape of CO2 from the blood. Cartell ^ showed that the 
 heart of a frog beating vigorously would cease at the end 
 of 10 minutes if plunged into an atmosphere of CO2, whereas 
 the heart of another frog would go on beating for ij hours 
 if placed in an atmosphere of pure nitrogen, which is an 
 inert gas. Liebeg and Paul Bert have confirmed the harm- 
 ful action of CO2 upon the muscular fibres of the heart. 
 During respiration it is not so much the carbonic acid in the 
 air breathed that is dangerous, as the CO2 in the blood 
 obtained from the tissues not being allowed to escape. COa 
 poisons both the muscular and nervous tissues. 
 
 There are few industrial operations in which large 
 quantities of CO2 are given off in a chemically pure form. 
 The gas is evolved from vats in breweries during the 
 fermentation of beer, and is present in the malt-house, the 
 air of which should be renewed before entering. It is formed, 
 too, during fermentation in starch works, is met with in paper 
 works owing to fermentation of the paste, and in sugar refineries 
 during the carbonisation of the juice of beet-root. Years 
 ago it was a frequent source of accident and occasionally 
 the cause of death of workmen engaged in making wine, from 
 fermentation of the grape juice and the cleaning out of 
 wine vats. CO2 is given off from lime kilns, and is often 
 present in unused cellars and in the galleries of mines. 
 
 Carbonic acid calls for attention since it is the gas which 
 is present in the air of factories and workshops, and the per- 
 * " Encyloped. d' Hygiene," p. 547. 
 
56 DISEASES OF OCCUPATION 
 
 centage of which is taken as a measure of the impurity of the 
 air breathed by the workers. The Home Office regulations 
 require 250 cubic feet of atmospheric air per individual 
 during ordinary working hours, and 400 during overtime, i.e.^ 
 beyond a ten hours' day. Ordinary atmospheric air is 
 composed of 20*93 P^i" cent, of oxygen, 79*04 of nitrogen 
 with argon, and 0*03 to 0*04 of carbonic acid, with a small, 
 quantity of water. The human body is constantly adding to 
 the amount of CO2 in the atmosphere of a factory, and when 
 there is also added to this the CO2 given off by artificial lights, 
 the necessity for the frequent renewal of the air in factories 
 and workshops is apparent. A tolerance to CO2 is created, 
 as is seen in the case of the poorer working classes, among 
 whom there is overcrowding with little or no ventilation of their 
 dwelling-rooms. The breathing of an atmosphere vitiated 
 by carbonic acid is a cause of headache and a feeling of 
 malaise to those who are unaccustomed to it. In the case 
 of the poorer working classes it cannot but reduce their 
 vitality and predispose them to disease. Expired air not 
 only contains an excess of CO2, it is ladened with certain 
 volatile organic products which cause the air to have an 
 offensive odour. It is this organic material in expired air 
 which has a slight reducing power upon potassium per- 
 manganate, and is regarded by some physiologists as the 
 poisonous material in the air. Haldane and Lorrain Smith 
 did not find the injection into animals of large doses of 
 water condensed from expired air followed by any bad 
 effects, but Brown-Sdquard and D'Arsonval ^ found that the 
 volatile alkaloid contained in expired air, and to which they 
 gave the name of anthropotoxine or zootoxine^ was capable of 
 causing the death of animals. It caused the death of 17 out 
 of 18 animals when injected under the skin. When the liquid 
 was injected into the lungs death came preceded by inflam- 
 mation of those organs. 
 
 It is desirable to maintain a standard of purity of the air 
 of factories. In 1897 Sir Henry Roscoe's Committee re- 
 commended a standard of 9 volumes of CO2 per 10,000 of 
 air for cotton cloth factories. This was considered lenient 
 * Academie des Sciences, February 11, 1899. 
 
DISEASES DUE TO GASES, VAPOURS, ETC. 57 
 
 from the hygienic point of view. A Departmental Com- 
 mittee of the Home Office subsequently fixed the standard 
 of carbonic acid as 12 volumes per 10,000 of air during 
 daylight or where the electric light is used, and where gas or 
 oil is used for illuminating purposes the proportion was not 
 to exceed 20 per 10,000. The Association of Certifying 
 Factory Surgeons, taking 4 volumes of CO2 as the pro- 
 portion in outside air, and 6 as the proportion in in- 
 side air, per 10,000, recommended that 9 volumes of CO2, 
 i.e,^ 5 volumes of CO2 per 10,000 in excess of that found 
 in the outside air, would be a fairer proportion to allow 
 during daylight and that double this amount might easily be 
 allowed during gas light. From these divergent opinions 
 and recommendations it is apparent that a fairly wide and 
 reasonable margin must be allowed. It is not desirable on 
 the one hand to adopt such a low standard of atmospheric 
 purity as to perpetuate a bad condition of the air in factories, 
 nor on the other hand is it wise to insist upon conditions that 
 are with difficulty obtained by employers. 
 
 Under ordinary circumstances CO2 is removed from the 
 blood during expiration. The presence of the gas in the 
 blood stimulates the respiratory centre so that deeper breaths 
 are taken and the lungs are better ventilated. It is the 
 partial pressure of the CO2 in the pulmonary alveoli that 
 regulates the ventilation of the lungs. At normal atmo- 
 spheric pressure there is about 6 per cent, of CO2 in the air 
 spaces of the lungs. While CO2 under ordinary circum- 
 stances does not cause any serious symptoms, it is otherwise 
 when the gas is present in excess and an animal or man is 
 breathing the gas in a compressed-air chamber, such as a 
 caisson. I have found when small animals, e.g.^ mice, have 
 been exposed for half an hour or longer to 5 atmospheres of 
 compressed atmospheric air containing i per cent, of CO2, 
 that while the animals on being taken out of the air chamber 
 might appear to be somewhat somnolent and disinclined to 
 move, they shortly afterwards recovered, but that many of 
 them a few days afterwards, even as long as 10 or 12 days 
 afterwards, died unexpectedly, and that the cause of death in 
 some of them was acute inflammation of the lungs. In other 
 
S8 DISEASES OF OCCUPATION 
 
 instances rats, which seemed to be quite well on being re- 
 moved from the caisson, died a few hours afterwards, and as 
 no naked-eye morbid appearances were presented by the 
 various organs at the autopsy except slight congestion of the 
 brain, death must have been due to poisoning of the nerve 
 centres by CO2. Excess of CO2 in the air is probably more 
 dangerous when breathed in the compressed form than at 
 ordinary pressure. 
 
 Carbon Monoxide ; Carbonic Oxide {CO) 
 
 Carbon monoxide, one of the products of the incomplete 
 combustion of carburetted gas, also of coal and explosives, is 
 met with in subterranean galleries, e.g.^ coal-mines where blast- 
 ing has been effected by dynamite or gunpowder. It forms 
 7 to 10 per cent, of ordinary 'illuminating gas and is the source 
 of the blue flame seen on the surface of ordinary coal fires. 
 The gas is given off in large quantities from coke ovens. It 
 is to the breathing of this gas during sleep that the death of 
 tramps drawn to the coke ovens by their inviting warmth on 
 a winter's night is attributed. Carbon monoxide is per se a 
 colourless and inodorous gas. It has an affinity for the 
 colouring matter of the blood, varying according to physio- 
 logists from 140 to 250 times greater than that of oxygen. 
 It forms a remarkably stable compound with the haemoglobin, 
 which is with great difficulty dissociated, and to which 
 circumstance the extremely poisonous properties of the gas 
 are due. The presence of such small quantities as O'l per 
 cent, in air is sufficient to cause unpleasant symptoms, such 
 as headache and a sense of tiredness attended with difficulty 
 of walking. When the percentage rises to 0*4 the atmosphere 
 becomes dangerous to animal life. 
 
 The gas is evolved from blast furnaces in the smelting of 
 iron, the charging of furnaces and their tapping ; also in the 
 manufacture of illuminating gas, the Leblanc process of soda 
 manufacture, in explosions in coal-mines, in cement and 
 brick works, and in the making of tunnels. 
 
 As we are dealing in these pages with the effects of several 
 poisonous gases, it may not be out of place to discuss here the 
 general aspect of the subject from the physiological point of 
 
DISEASES DUE TO GASES, VAPOURS, ETC. 59 
 
 view. The purpose of respiration is to carry oxygen into the 
 body and to remove waste products from it, mainly carbonic 
 acid and water. In ordinary respiration the oxygen of the 
 atmospheric air enters into chemical combination with the 
 colouring matter, or haemoglobin, of the red corpuscles 
 of the blood. The oxygen thus absorbed in the lungs 
 is quite irrespective of pressure. From these corpuscles as 
 they circulate with the blood, oxygen is given up to the 
 tissues. In addition to the oxygen taken up by the colouring 
 matter of the red blood corpuscles, a smaller amount of 
 oxygen is also absorbed by the blood in accordance with 
 Dalton's law of pressure. The oxygen absorbed by this 
 method is so lightly retained that the whole of it will escape 
 when the pressure falls below a certain level. Heat also 
 favours the dissociation. Carbon monoxide is one of those 
 gases which so act upon the blood corpuscles as to displace, 
 volume for volume, the oxygen fixed by the coloured 
 corpuscles, and having accomplished this the CO itself is so 
 firmly retained by the haemoglobin as to be displaced only 
 with the greatest difficulty. A gas behaving in this manner 
 is said to be toxic ; it is a poison. The rapid action of 
 poisonous gases can be readily understood when there is 
 taken into consideration the enormous surface for absorption 
 presented by the lungs, for in the myriads of their capillary 
 blood-vessels the blood is brought almost into direct contact 
 with the gas. Poisonous gases are of two kinds, (i) the 
 purely toxic, Ululated by carbon monoxide, and (2) irre- 
 spirable gases. Both kinds cause asphyxia. For the 
 respiratory functions to be carried on normally it is necessary 
 that there shall be no obstacle to the blood reaching the 
 lungs, also when there that it shall be brought into close 
 contact with the inspired air. The blood corpuscles them- 
 selves must be healthy and be present in proper numbers to 
 absorb oxygen. Many toxic gases act as a direct poison to 
 the red blood corpuscles and unfit them for taking up oxygen ; 
 other gases destroy or irritate the lining membrane of the 
 pulmonary alveoli, i.e., the air spaces of the lungs. On the 
 other hand a gas like pure hydrogen or nitrogen is irrespir- 
 able because it contains no oxygen. 
 
6o DISEASES OF OCCUPATION 
 
 Blast Furnaces and Carbon Monoxide Gas 
 
 Several cases of serious illness and a few fatalities have 
 occurred during the charging of blast furnaces in ironworks 
 and in consequence of the escape of crude blast-furnace gas 
 from the flues. The open-top blast furnaces have been a 
 frequent source of minor poisoning to the men who charge 
 them. Through the kindness of Dr. C. Stanley Steavenson, of 
 Middleton St. George, Co. Durham, to whose professional 
 care the patients had been entrusted, I had two years ago the 
 opportunity of seeing the effects of carbon monoxide poisoning 
 upon two blast furnacemen. In these men there were at first 
 great sleepiness and headache, followed by incomplete loss of 
 power in the limbs, and on the subsidence of the acute symp- 
 toms it was observed that speech was affected, much in the 
 same way as in general paralysis. There was a distinct 
 articulation defect when I examined the men two or three 
 months after the commencement of their illness. The power 
 of walking properly had not been regained ; the gait was 
 slow and stepping, the grasp of the hands feeble, and the 
 pupils were dilated. There were nystagmus (a peculiar 
 oscillatory condition of the eyeballs) and a degree of nervous 
 excitement and exaltation, such as is seen in the worst cases 
 of hysteria. One of the patients would burst out into 
 hilarious laughter now and again without the slightest 
 provocation. The simplest questions addressed to him 
 seemed to cause amusement. Although the general physique 
 of these men is good, their nervous system has been so 
 thoroughly poisoned by the blast-furnace gas that they are 
 likely never to do any further work. In confirmation of this 
 statement I have recently learned that the mental condition 
 of these men remains the same although it is fully two years 
 since their illness began. These records are extremely 
 interesting, for there have been few cases published of such 
 permanent effects having been left by blast-furnace gas. 
 That the particular constituent of the blast-furnace gas 
 which poisoned these men was carbon monoxide there is 
 little doubt when attention is given to the analyses of the 
 gas. Analysis of the gas on two occasions from the blast 
 
DISEASES DUE TO GASES, VAPOURS, ETC. 6i 
 
 furnace at which the men worked showed the presence of 
 large quantities of carbon monoxide (CO). 
 
 Carbonic acid 
 Carbon monoxide 
 
 Hydrogen 
 
 Arsenic 
 Sulphur 
 Nitrogen 
 
 In order to make a comparison between the gases given off 
 by the blast furnaces in this particular neighbourhood and 
 those from furnaces in another part of the North of England, 
 I obtained, through the manager of one of our largest iron- 
 works, the following analysis : 
 
 A. 
 
 B 
 
 4 
 
 7 
 
 36 
 
 32 
 
 2 
 
 5 
 
 0.1 
 
 — 
 
 trace 
 
 — 
 
 58 
 
 55*3 
 
 Carbonic acid 
 
 
 
 12-4 
 
 Carbon monoxide 
 
 
 
 27-5 
 
 Carburetted hydrogen 
 
 
 
 0-2 
 
 Hydrogen 
 
 
 
 27 
 
 Nitrogen 
 
 
 
 57*2 
 
 It cannot be anything but the high percentage of carbon 
 monoxide that constitutes the danger in blast-furnace gas. 
 This gas flows away at the end of a slag-tapping, and 
 although present at that time in very small proportion, 
 I per cent, it is liable to accumulate in dangerous quantities 
 near the furnace boshes, so that isolated workmen ought not 
 to be allowed to remain near the boshes when the blow-out 
 period of slag-tapping takes place. Blast-furnace gas may 
 escape through a crack in a flue, and penetrating the soil it 
 loses its impurities and its odour as it passes onwards. It may 
 find its way into inhabited houses and cause the death of the 
 inmates. As an illustration of subtle poisoning by carbon 
 monoxide gas I need only mention the following : At Pelton 
 Fell, a mining village in Co. Durham, some shale which had 
 been tipped at the edge of a ravine caught fire. The carbon 
 monoxide gas given off" during the combustion travelled 
 through the soil, and entering two houses in different streets 
 fully thirty feet away, caused the death of two elderly people. 
 
62 DISEASES OF OCCUPATION 
 
 Inhalation of carbon monoxide causes headache and a 
 sense of loss of power in the lower extremities. It is this 
 latter circumstance which explains many of the cases of 
 poisoning in confined places. The workman feels that he is 
 being poisoned, but in attempting, as in a coal-mine, to make 
 his way out into purer air his limbs simply refuse to carry him, 
 and he falls down in a state of insensibility, poisoned by the 
 gas. Death under these circumstances is painless. When 
 acute poisoning by sulphuretted hydrogen, for example, 
 occurs screaming is heard, as in the case of the men working 
 at Hebburn-on-Tyne, to which in another part of this book 
 I have drawn attention. I have not seen mention made of 
 screaming in connection with carbon monoxide poisoning. 
 It occurred in a young dog which had breathed for only a 
 few minutes a high percentage of carbon monoxide gas in 
 atmospheric air. The animal at first showed a little foam 
 on its mouth and then uttered two screams. It was at once 
 taken out of the chamber in a state of unconsciousness. 
 There were slight rigidity of the neck, spasmodic twitching 
 now and then of the hind limbs, and irregular long-drawn 
 breaths. By degrees the breathing became regular, and after 
 ten minutes' exposure in the fresh air the animal, which 
 seemed intoxicated, tried to raise] itself. It was weak in the 
 hind limbs and rocked somewhat when attempting to walk. 
 Five minutes later it was able to walk without much stagger- 
 ing. Within an hour after the development of symptorris 
 the animal was running about as if nothing had happened, 
 and shortly afterwards no trace of carbon monoxide was, on 
 spectroscopic examination, found in the blood. 
 
 Many of the deaths that occur in a coal-mine after a fire 
 or an explosion are due to carbon monoxide poisoning. It 
 is not a normal constituent of what is ordinarily spoken of 
 as mine gas, but it is a product of the incomplete combustion 
 of coal ; it is found in the gases from underground fires and 
 smoke, and "its percentage increases in proportion as the 
 amount of fresh air supplied to the fire decreases. It also 
 forms a constituent of the after-damp produced by an 
 explosion of fire-damp when the percentage of methane 
 exceeds 9*5, because then the proportion of air no longer 
 
DISEASES DUE TO GASES, VAPOURS, ETC. 63 
 
 suffices for the complete combustion of the methane " (Otto 
 Brunck). Fortunately very small quantities of carbon mon- 
 oxide do not cause immediate poisoning. Miners who have 
 had experience of the gas and of the headache caused by 
 breathing it can, if their limbs will carry them, usually make 
 their way out of the place where the gas is present. 
 
 Sy7nptomatolGgy of Carbon Monoxide Poisoning 
 
 Giddiness, headache, throbbing of the temples, and ringing 
 in the ears, accompanied by a sense of tiredness, are the 
 symptoms usually experienced by persons who have been 
 exposed to carbon monoxide gas. In severe cases there may 
 be convulsions and loss of consciousness. When the gas 
 enters a bedroom and is inhaled by persons who are asleep, 
 the sleep only becomes deeper ; a profound narcosis is 
 developed from which, in many instances, there is no 
 awaking. Should perchance the accident be discovered early, 
 and the persons treated, there are occasionally observed on 
 recovery inability to swallow and muscular tremor. The 
 patient awakes as if from deep sleep ; he is dazed for a time 
 and does not recognise his surroundings. He may bring up 
 a little blood-stained mucus from his bronchial tubes. One 
 of the most important after-effects is an alteration or a loss 
 of speech. 
 
 Pathology of Carbon Monoxide Poisoning 
 
 When death has occurred the face of the cadaver may be 
 pale, livid, or rosy-looking as in health. The face wears a 
 calm expression, showing that no suffering had been experi- 
 enced. The pupils are dilated. If the body is examined 
 shortly after death, the blood has a beautiful cherry-red 
 colour. Small haemorrhages may be found in the skin, 
 muscles, lungs, brain, and mucous membrane of the stomach. 
 On spectroscopic examination the blood exhibits two distinct 
 bands between D and E, the yellow and the green lines, 
 similar but not identical to those given by oxyhaemoglobin, 
 the normal colouring matter of the blood. The blood in 
 
64 DISEASES OF OCCUPATION 
 
 carbon monoxide poisoning differs from that in health in so 
 far as it cannot be reduced by such a reagent as ammonium 
 sulphide or Stokes' fluid,i and it is upon this circumstance 
 that the spectroscopic test of blood in carbon monoxide rests. 
 The gas forms such a stable compound with the colouring 
 matter of the red corpuscles of the blood that it is difficult to 
 subtract the oxygen from it, hence the occurrence of death 
 by asphyxia in these cases. Although there is neither 
 immediate irritation of the lungs caused by the inhalation of 
 carbon monoxide nor marked difficulty of breathing, yet a 
 few days after an apparent recovery death may come pre- 
 ceded by signs of acute congestion of the lungs. At the 
 time the tendency, rather, is for the higher cerebral centres to 
 become benumbed and for sleep to follow. On microscopical 
 examination of the brain and medulla in fatal cases minute 
 haemorrhages are frequently found. 
 
 Can Carbon Monoxide Penetrate into the Blood of a Cadaver? 
 
 An interesting paper has been published by Strassman and 
 Schultz,2 raising the questions as to whether the detection of 
 carbon monoxide in the blood proves unmistakably that 
 poisoning by the gas had occurred, or whether death might 
 not have been*due to other causes, and that, since the corpse had 
 been placed in an atmosphere containing carbon monoxide, 
 there had not been absorbed a sufficient quantity of the gas 
 to complicate the diagnosis of suicidal or accidental poisoning 
 or death from some other cause. When carbon monoxide is 
 found in the blood the natural inference is that it was inhaled 
 into the lungs during life and in this way entered the circula- 
 tion. In 1902 Wachholz and Lenberger immersed the 
 bodies of stillborn children in an atmosphere of pure 
 carbon monoxide gas, and in half an hour the deep livid 
 patches observed in the skin of the cadavera had become of 
 a red rose colour, and in the blood the presence of carbon 
 
 ^ Stokes' fluid must be freshly prepared when required. It is a 
 solution of ferrous sulphate to which a little tartaric acid is added and 
 then ammonia till the reaction is alkaline. 
 
 ^ Berlin. Klin, Wochens., 1904, No. 48. 
 
DISEASES DUE TO GASES, VAPOURS, ETC. 65 
 
 monoxide was determined by the spectroscope — not only- 
 then, but as late as seven days afterwards, in the blood 
 removed from the heart. The longer the time that had 
 elapsed between death and placing the cadaver in the gas 
 the less likely was carbon monoxide to be absorbed. Strass- 
 man and Schultz are of the opinion that carbon monoxide can 
 penetrate into the blood of a dead person through the skin 
 and external coverings, and that the amount of carbon 
 monoxide in the superficial and more exposed blood and 
 tissues is always greater than that found in the deeper and 
 more central parts. 
 
 It is certainly desirable that an answer should be returned 
 to the question as to whether when carbon monoxide is pre- 
 sent in the blood of a dead person the gas has penetrated 
 during life or after death. Mirto maintains that in the 
 diffusion of the gas post mortem there is a distinct difference 
 between the anterior portion of the liver, which is rich in 
 carbon monoxide, and the posterior portion, which is of a 
 deeper colour and contains less of the gas. It is stated that 
 this difference is not observed when death has come by 
 poisoning. The blood in the deeper parts of the body con- 
 tains less carbon monoxide than the vessels at the periphery. 
 Strassman and Schultz found in their experiments upon the 
 corpses of old men that there was no part of the body, 
 practically speaking, into which carbon monoxide did not 
 penetrate, provided there was a sufficient length of exposure 
 to the gas. These observers, too, also noticed the difference 
 between the anterior and posterior portions of the liver to 
 which Mirto had drawn attention, also that in cutting 
 through the tissues the blood nearest the skin always con- 
 tained the greater amount of carbon monoxide. Such a dif- 
 ference would not occur in a case of poisoning by inhalation of 
 carbon monoxide, since the blood would be equally affected 
 all through the body. The weak point in Strassman and 
 Schultz's experiments is that they do not state what the 
 quantity of carbon monoxide found in the blood was. The 
 importance of this remark is at once apparent when it is 
 known that very minute quantities of carbon monoxide may 
 be present in the blood in normal conditions. The possi- 
 
66 DISEASES OF OCCUPATION 
 
 bility of the diffusion of carbon monoxide into the blood and 
 tissues of a corpse is a matter of great importance from a 
 medico-legal point of view, as the following case shows. In 
 Berlin (Feb., 1904) a woman was found dead in her room 
 with one end of an indiarubber pipe in her mouth and the 
 other attached to a gas pipe, the valve of which was open. 
 The room smelt strongly of coal-gas. Everything seemed to 
 favour the theory that death was suicidal, but at the last 
 moment the father of the dead person intervened and asked 
 for a delay in the interment, as he believed an operation for 
 the induction of abortion had taken place at the instigation of 
 the husband, and that in order to raise the question of suicide 
 the tube had, in order to mislead, been placed in the woman's 
 mouth. An inquiry was ordered, and Strassman and Schultz 
 found that no abortion had taken place, and that there were 
 all the typical signs of poisoning by carbon monoxide on the 
 lines stated in the earlier paragraphs of this article. 
 
 The bodies of persons poisoned by carbon monoxide 
 retain their colour and frequently resist decomposition 
 longer than under ordinary circumstances. This has been 
 observed in some coal mining disasters, so that when the dead 
 bodies are brought to the surface the comrades of the dead 
 men, under the impression that death had recently taken 
 place, are not slow to state that the men might have been 
 saved had the rescue work been more timely. Knowledge 
 of the preservative power of carbon monoxide upon the 
 tissues is taken advantage of by butchers abroad to preserve 
 meat by killing the animal by means of carbon monoxide, 
 or after destroying the animal by cutting up the flesh and 
 exposing it to an atmosphere containing carbon monoxide and 
 sulphuric acid vapour (" Les Empoisonnements," Brouardel, 
 p. 283). The meat thus treated does not putrefy, but it 
 undergoes a peculiar decomposition and becomes black and 
 unwholesome. All such methods of treating butcher meat 
 are to be deplored and should be interdicted. 
 
 Can living bodies become accustomed to carbon mon- 
 oxide? This is a subject which Nasmith and Graham^ 
 
 ^ The Journal of Physiology, December 29, 1906, vol. xxxv., Nos, 
 I and 2, 
 
DISEASES DUE TO GASES, VAPOURS, ETC. 67 
 
 have tried to solve by means of experiments. Carbon 
 monoxide, as already stated, causes death by destroying 
 the oxygen-carrying power of the blood. Nasmith and 
 Graham allowed guinea-pigs to inhale carbon monoxide until 
 there occurred a 25 per cent, saturation of the colouring 
 matter of their blood with the gas. The animals received 
 daily for several weeks carbon monoxide. None of the 
 animals decreased in weight — on the contrary, most of them 
 gained; and although they were living with 25 per cent, of 
 their haemoglobin saturated with carbon monoxide they were 
 just as happy and active as those living in ordinary atmo- 
 spheric air. As these animals were living with only three- 
 quarters of their haemoglobin available for oxygen-carrying 
 purposes, it was thought they would suffer in health and 
 that anaemia would follow ; but instead of this occurring, the 
 red blood cells increased in number, just as in people who 
 live at very high altitudes, and as if a proliferation of new 
 cells had taken place to compensate for the degeneration 
 of some of the red corpuscles. "With 25 per cent, of its 
 blood rendered useless for oxygen-carrying purposes by 
 its union with carbon monoxide the guinea-pig is capable 
 of compensating and will manufacture new red blood cor- 
 puscles until it has reached a total of about 8,000,000 with 
 a corresponding haemoglobin of 105 per cent." The normal 
 number of red blood cells in the peripheral circulation of 
 guinea-pigs is about 6,000,000 per c.mm. of blood, with 88 per 
 cent, haemoglobin. The animal with true compensation has 
 still three-fourths of its blood corpuscles and three-fourths of 
 its haemoglobin available for carrying oxygen. To counteract 
 the effect of carbon monoxide a guinea-pig will manufacture 
 2,000,000 additional blood corpuscles per c.mm. in from three 
 to four weeks, and this increase continues for several weeks 
 after the animal is placed in the open air. Nasmith and 
 Graham carried their experiments further so as to produce 
 35 and 45 per cent, saturation of the haemoglobin. "The 
 effect of depriving an animal of the use of part of its 
 haemoglobin by allowing it to unite with CO is also in 
 many respects similar to depriving it of part of its blood 
 by bleeding." We have seen that the effect of chronic CO 
 
68 DISEASES OF OCCUPATION 
 
 poisoning is similar to that which occurs at high altitudes. 
 The similarity is explained by the lack of oxygen being 
 the chief cause of the changes in the blood. When a normal 
 animal was put in an atmosphere sufficient to cause 45 per 
 cent, haemoglobin saturation it would die in three to four days, 
 while the acclimatised animals remained in good health. 
 In addition to the red the white corpuscles of the blood 
 are increased as well. There is therefore a leucocytosis 
 called forth in the guinea-pig by saturating the blood with 
 the gas. Lack of oxygen produces an auto-intoxication. 
 Carbon monoxide poisoning is nothing else than a toxaemia 
 caused by lack of oxygen. When the colouring matter of 
 the blood is saturated with CO it cannot take up oxygen. 
 In proportion as CO-haemoglobin is formed so does the 
 blood lose its power of giving up oxygen to the tissues 
 and death therefore ensues. The CO tends to drive out the 
 oxygen from the haemoglobin and the "final result is an 
 expression of the balance struck between the two conflicting 
 processes." Haldane has shown that when a person remains 
 exposed to a moderate percentage of CO the blood ceases 
 after a time to take up more CO. In the case of the living 
 body it is roughly estimated that "with about "oS per cent, 
 of CO in the air the haemoglobin will finally become about 
 half saturated with CO while with -04 per cent, it will 
 become a third saturated, and with '16 per cent, two-thirds 
 saturated." ^ Men, like animals, can within limits become 
 acclimatised to CO ; and since after a time the blood ceases 
 to take up more CO, it is a question whether men who 
 in their occupation might unexpectedly be called upon to 
 inhale CO should not train themselves to this acclimatisa- 
 tion and bring about that compensation in the blood which 
 we have seen occurs in the guinea-pig. Its effects are the 
 same as living at high altitudes and it does not appear 
 to be attended by any inconvenience. By gradual habitua- 
 tion I have been able to expose dogs to 0'8 per cent, of CO 
 in compressed air for several hours without any bad effects. 
 Probably man could be similarly trained. 
 
 * " The Investigation of Mine Air," Haldane, p. 145. 
 
DISEASES DUE TO GASES, VAPOURS, ETC. 69 
 
 FerrO'Silicon 
 
 Owing to the death of four persons on a Swedish ship 
 which had been carrying a cargo of ferro-silicon, attention 
 has been drawn by Professor Cronquist to the dangers 
 incidental to the transport of this material. The inquiry 
 showed that poisonous gases are given off by ferro-silicon. 
 During the last few years high-grade ferro-silicon has been 
 produced on a large scale. While in ordinary pig-iron there 
 may be only 2 to 3 per cent, of silicon, in the softer forms 
 of pig-iron there may be as much as 15 per cent, of this 
 material. The presence of silicon tends to reduce the 
 amount of carbon that molten iron can absorb, and to 
 favour the decomposition of any combination which carbon 
 may have effected with iron. In iron ore and quartz there 
 is frequently present a large amount of phosphate which in 
 presence of carbon and a high temperature forms phosphide, 
 e.g.^ calcium phosphide if calcium is present. If arsenic 
 is also contained in the ore, calcium arsenide might in 
 addition be formed. When ferro-silicon is brought into 
 contact with moisture phosphuretted and arseniuretted 
 hydrogen gases are evolved, both of which are powerful 
 poisons and capable of causing serious symptoms when 
 inhaled. In addition to these poisonous gases, explosions 
 have occurred on board ship the cause of which has not 
 yet been absolutely determined. The dangers incidental 
 to the transport of ferro-silicon are not alone to the per- 
 sons on the ship, but also to the dock labourers employed 
 in unloading the vessel. Since moisture is the cause of 
 poisoning, owing to the liberation of gases, the greatest care 
 should be exercised so as to prevent the entrance of moisture 
 into the receptacles which contain ferro-silicon. 
 
 Illuminating Gas : Water Gas 
 
 The risks to life and danger to health from coal gas as an 
 illuminant, also from water gas, depend less upon their 
 manufacture than upon the uses to which these gases are 
 put. Although composed mainly of hydrogen and car- 
 
^o DISEASES OF OCCUPATION 
 
 buretted hydrogen, coal-gas contains as much as 7 to 10 per 
 cent, of carbon monoxide. It is to this ingredient that the 
 illuminant owes its poisonous character. Owing to its dis- 
 agreeable odour coal-gas can be readily detected, but should 
 it escape from a pipe outside a house or factory and make 
 its way into a living-room or into a workroom, the gas in 
 passing through the soil loses its odour but still retains the 
 poisonous carbon monoxide. People may thus unknowingly 
 be breathing a poisoned atmosphere. When a fracture of a 
 large gaspipe in a roadway has occurred and coal-gas has 
 been escaping for some time, the soil for a considerable 
 distance around may become so impregnated with the gas 
 that, apart from the risk of explosion through men working 
 at the spot with naked lights, the labourers who overturn 
 the soil may be so overcome by the gas that they become 
 unconscious, or they experience severe headache and suffer 
 from vomiting and giddiness so that they are obliged to 
 retire and seek purer air. I have known workmen who had 
 been thus employed suffer in their nervous system for weeks 
 after exposure to the gas, and in one instance I attributed a 
 temporary glycosuria in a workman to this cause. Eleven 
 parts of coal-gas per 100 of ordinary air form an explosive 
 mixture. The mixture is still explosive up to 30 per cent, 
 but ceases to be so after 60 per cent. 
 
 Water gas^ which is obtained by passing steam over 
 red-hot coke, is occasionally added to ordinary coal gas to 
 improve its illuminating properties, and since carbon 
 monoxide is frequently present in water gas to the extent 
 of 30 per cent., this addition of carburetted water gas 
 increases considerably the dangers of the ordinary illu- 
 minant. Water gas, although much more dangerous, has 
 not the disagreeable odour of ordinary coal gas. Its escape, 
 therefore, into a living-room or factory is less likely to be 
 perceived. In a memorandum issued by the Chief Inspector 
 of Factories, dated September, 1904, which deals with the 
 use of water gas and other gases in factories, attention is 
 directed to the manufacture and distribution for heating and 
 lighting purposes of any poisonous gas that does not contain 
 a distinct and pungent smell. It is recommended that in the 
 
DISEASES DUE TO GASES, VAPOURS, ETC. 71 
 
 manufacture of Mond gas, not only should the quantity of 
 carbon monoxide in the gas be lim ted to 14 per cent, but 
 that the gas should be strongly scented, so that its presence 
 may be readily detected. The importance of this recom- 
 mendation is apparent when it is stated that between the 
 years 1899 and 1903 there were reported to the Home Office 
 51 cases of poisoning from carbon monoxide gas (including 
 17 deaths) in manufacturing premises traceable to leakages 
 from pipes conveying gas, and the cleaning of tanks or flues 
 before sufficient time had been allowed for the gas to 
 become dispersed. It is a regulation of the Home Office 
 that printed bills, calling the attention of the workpeople 
 to the deadly nature of the gas and the best means of 
 rendering first aid, shall be posted on the walls, also that 
 persons with a diseased heart or lungs should not be allowed 
 to be in charge of an engine worked by gas, that the valves 
 and connections of engines should be frequently examined 
 for leakages, and that all flues should be well flushed out by 
 fresh air before the men enter them. Men employed in 
 factories should have a training in ambulance work, so that 
 should an occasion arise when some of their comrades have 
 become overpowered by the gas, they may at once be 
 capable of resorting to artificial respiration and of following 
 this up with oxygen inhalation from cylinders of compressed 
 oxygen, which ought always to be at hand. 
 
 I have alluded to some of the permanent effects produced 
 upon the central nervous system by the inhalation of coal gas. 
 It is not so widely known as it ought to be that peculiar mental 
 conditions may be a consequence of coal-gas asphyxiation. 
 Dr. Sanger Brown, of Chicago,^ draws attention to this 
 subject. The patient, a male, had been found in a sitting 
 posture, leaning against a wall near a gas stove, from 
 which gas was freely escaping. He was unconscious, but 
 by means of artificial respiration and inhalation of oxygen 
 he regained consciousness three days afterwards, and in 
 three weeks he was able to be up and about. His pulse 
 remained high — 140 per minute — and there was difficulty of 
 
 ' journal of the American Medical Association, Chicago, April 28, 
 1906. 
 
72 DISEASES OF OCCUPATION 
 
 breathing on the slightest exertion. The patient's expression 
 was dull and stolid. The red blood cells numbered 5,224,000 
 per c.mm., and the haemoglobin, or colouring matter of the 
 blood, was 80 per cent. The time, from thirty-six to forty- 
 eight hours, before he was discovered was a complete blank 
 to him. Memory for recent events was practically anni- 
 hilated, although he could repeat incidents of his childhood 
 well and discuss with friends events immediately previous 
 to his asphyxiation. He would read the newspaper, but 
 could not discuss current topics. The mental condition 
 never having improved, he died suddenly, eight months after 
 exposure to the gas. At the autopsy no gross changes were 
 found in the brain or spinal cord, nor was there anything 
 present in the other organs beyond slight dilatation of the 
 heart to explain the sudden death. It is more than probable 
 that some physical change had occurred in the brain cells of 
 this patient, whereby they were no longer able to retain new 
 impressions in the same way as previous to the accident. In 
 a similar manner, in all probability, had the nerve cells which 
 control the beat of the heart become affected. 
 
 Greidenberg ^ reports three cases, one of which terminated 
 fatally. In the other two patients, a male and female, 
 recovery was slow. There were loss of memory, interference 
 with the power of speech, incontinence of urine and faeces in 
 the male, and subsequently dementia. Other observers have 
 reported cases in which, after recovery from the acute symp- 
 toms, there were headache, pains in the limbs, weakness of 
 memory, staggering gait, incontinence of urine, exaggerated 
 knee jerks, tremor of muscles, and death from broncho- 
 pneumonia. In the nervous system there have been found 
 small haemorrhages in the brain and spinal cord, patchy 
 softening of the spinal cord, blocking of the small blood- 
 vessels in the optic thalamus, fatty degeneration of the 
 endothelial lining of the small blood-vessels of the central 
 nervous system, chromolytic and atrophic changes in the 
 large motor nerve cells, and thickening of the pia mater 
 covering the brain. 
 
 ' "Ueber Psychosen n. Kohlenoxydgas," Vratsch (Russian), 1898. 
 
DISEASES DUE TO GASES, VAPOURS, ETC. 73 
 
 Nickel Carbonyl: Ni{CO\ 
 
 In the manufacture of nickel carbonyl from nickel copper 
 oxide workmen have died in such a rapid manner and under 
 such unexpected circumstances that the Home Office and 
 factory owners felt themselves called upon to make a careful 
 inquiry into all the attendant circumstances. Nickel carbonyl 
 is made in air-tight closed iron chambers. The deaths that 
 occurred were in some instances almost instantaneous, while 
 in others the men died a few days afterwards from in- 
 flammation of the lungs. Nickel carbonyl is a very volatile 
 liquid: it boils at 43° C. (109*4° F.). It is obtained from 
 finely divided nickel oxide by first passing hydrogen gas 
 over it. After the water has been removed from the nickel 
 compound, carbon monoxide is brought into contact with 
 the residue ; the resulting product is nickel carbonyl. 
 
 In the case of one man who died after three days' illness 
 the lungs were found to be oedematous and intensely con- 
 gested ; in another the lungs were inflamed and consolidated 
 as in pneumonia. In the minor forms of poisoning, the men 
 complain of giddiness, difficulty of breathing, vomiting, and 
 unsteadiness in their gait. Opinions are divided as to the 
 cause of sudden death and the ill-health of the workmen, but 
 as there have usually been found small quantities of carbon 
 monoxide gas in the immediate vicinity of where the men had 
 been working, due to an accidental escape of the gas from a 
 leak in the machinery, the symptoms have been regarded as the 
 result of CO poisoning. In a nickel carbonyl worker who died 
 eight days after the commencement of his illness, numerous 
 haemorrhages were found in the brain and cerebellum, and 
 the nerve cells of the respiratory nucleus in the medulla 
 oblongata showed distinct chromolytic changes. A rabbit 
 which had breathed on two occasions an atmosphere 
 impregnated with the gas given ofl" by 10-15 drops of 
 nickel carbonyl, and which seemed well on removal from 
 the bell jar, was found dead in its hutch a few days after- 
 wards. I sent the brain to Dr. Mott, Laboratory of the 
 Metropolitan Asylums Board, to whom and to his committee 
 I am indebted for a microscopical examination of the same. 
 
74 DISEASES OF OCCUPATION 
 
 Numerous small haemorrhages were found in the brain and 
 medulla, with acute chromolytic changes of the cells in the 
 medulla oblongata.^ The lesions found in the body after 
 death from nickel carbonyl poisoning are the same as those 
 found in carbon monoxide poisoning, and as lOO cc. of 
 nickel carbonyl give off 7-3 litres of carbon monoxide gas, 
 this circumstance and the fact that in the case of nickel 
 carbonyl workers who have become ill there have always 
 been found small quantities of CO in the factory close to 
 where the men had been working, at first sight suggest that 
 the cause of poisoning in these cases is carbon monoxide. 
 It is doubtful as to whether after all CO is the toxic agent 
 in Ni(CO)4 poisoning. Langlois found on shaking up 
 blood with Ni(C0)4 that the oxygen of the haemoglobin was 
 replaced by nickel carbonyl, and Vahleen showed that when 
 circulating in the blood vessels Ni(C0)4 split up into CO and 
 nickel, and he concluded that Ni was the cause of death. 
 H. W. Armit2 after a series of carefully conducted experi- 
 ments is also of opinion that the poisonous effects of Ni(C0)4 
 are due to nickel and not carbon monoxide. 
 
 Fe7'ri Carbonyl, 
 
 or iron carbonyl, a light sherry-coloured liquid, is, like 
 nickel carbonyl, extremely volatile and equally poisonous. 
 A rabbit exposed for fifteen minutes to the vapour given 
 off by ten drops of the fluid, although at the time apparently 
 nothing the worse for the inhalation, was found dead in its 
 hutch on the following day. The lungs showed intense 
 congestion, with rupture of several of the pulmonary 
 capillaries and escape of blood into the air-cells. 
 
 Sulphuretted Hydrogen Gas {H^S) 
 
 This gas when breathed is extremely destructive to 
 animal life. It causes death almost instantaneously if 
 inhaled in large quantities. In the Lancet, January 24, 1903, 
 
 ^ See my Harben Lectures, Royal Institute Public Health, 1905 ; 
 also Archives of Neurology, vol. iii., 1907, p. 258, paper by Dr. F. W. Mott. 
 =* journal of Hygiene, July, 1907. 
 
DISEASES DUE TO GASES, VAPOURS, ETC. 75 
 
 I reported the death of four workmen caused by the inhalation 
 of H2S. Upon two of the bodies I made a post-mortem 
 examination. The findings at the autopsy were, practically 
 speaking, nil. Beyond a dark and fluid condition of the 
 blood and slight oedema of the lungs, nothing distinctive was 
 found. The men had been employed in making excavations 
 for a dock on the banks of the River Tyne, close to some old 
 refuse from a chemical works, and from this refuse there was 
 a constant trickling of water rich in H2S. The water had 
 made its way into the iron cylinder in which the men were 
 working. One hundred volumes of the water on being boiled 
 gave off 12-2 volumes of H2S. 
 
 Three of the men lost their lives in an incredibly short 
 time. One of the workmen had got into the iron cylinder, 
 and shortly afterwards, a cry having been heard, a comrade 
 ran to his rescue, and after entering the open caisson he 
 too gave a cry. This brought a third workman to the 
 cylinder, and on his attempting to reach the men he too was 
 overpowered by the gas, and fell dead upon the lifeless bodies 
 of his mates. 
 
 Struck by the rapid death of these men by inhaling H2S 
 gas, I determined to ascertain in what proportion the 
 presence of sulphuretted hydrogen in atmospheric air became 
 poisonous. In submitting a healthy dog to an atmosphere 
 containing 0'02 per cent, of H2S, no effect followed, nor did 
 anything happen until the quantity of HgS rose to 0*15 per 
 cent, when the animal suddenly became rigid and fell 
 apparently lifeless, its breathing having ceased. On removing 
 the animal, a feeble beat of the heart could now and then be 
 heard through the stethoscope. By means of artificial 
 respiration the animal in 2J minutes was quite itself again. 
 The action of H2S is extremely rapid. A few seconds after 
 exposure to an atmosphere containing even a small per- 
 centage of H2S, it is noticed both in men and animals that 
 the respiration becomes somewhat gasping, and almost 
 immediately afterwards, without further warning than the 
 utterance of a cry, the individual falls down dead in a state 
 of extreme rigidity or in a condition of suspended 
 respiration. 
 
76 DISEASES OF OCCUPATION 
 
 Sulphuretted hydrogen gas causes death by its action upon 
 the respiratory centre. There is no warning; death is sudden 
 and painless. Occasionally a scream is uttered, but by the 
 time the poisoned workman is reached death has taken place, 
 or the breathing has ceased, and only a faint and intermittent 
 beat of the heart can be heard, for it cannot always be felt. 
 After death no characteristic lesion is found in the body to 
 explain the fatal result from H2S. Along with Dr. R. A. 
 Bolan I exposed blood serum to the vapour of H2S, and we 
 found that the colouring matter, or haemoglobin, was slowly 
 converted into methaemoglobin, but to obtain this there is 
 required an exposure of several minutes. Death takes place 
 with such rapidity in H2S gas poisoning that to this circum- 
 stance must be attributed the absence of methsemoglobin 
 from the blood of men who have been suddenly overpowered 
 by the gas. 
 
 H2S is the cause of the sudden death of workmen 
 employed in the sewers of large cities. The danger is most 
 likely to occur when the sewers have become blocked. The 
 presence of o*2 to 0*4 per cent, of H2S in the air is 
 extremely dangerous to men working in sewers. Other 
 poisonous gases than H2S are frequently met with in sewers, 
 such as carbon monoxide from the escape of coal-gas, 
 carbonic acid, ammonium sulphide, &c. 
 
 The rapidly fatal action of H2S is due to the effects of the 
 gas either upon the respiratory centre or upon the terminal 
 endings of the pneumogastric nerves in the lungs. Liebeg 
 thought that poisoning by H2S was due to the formation of 
 sulphide of iron in the blood by the abstraction of iron from 
 the colouring matter of the red corpuscles, but if this takes 
 place at all it can only be in those extremely slow forms of 
 poisoning where death comes by coma, for death, as a rule, 
 comes too suddenly for such a possibility to occur. 
 
 Since H2S is one of the products formed during the putre- 
 faction of organic matter containing sulphur, the gas is found 
 in privies, the mud of marshes, and in collections of filth 
 manure. There are only a few industrial undertakings in which 
 H2S may be met with, such as chemical and gas works, the 
 black bronzing of metals by means of sulphide of arsenic, 
 
DISEASES DUE TO GASES, VAPOURS, ETC. 77 
 
 the cleaning out of boilers, in certain processes of soap- 
 making where large quantities of fat are decomposed, and in 
 the preparation of Prussian blue during the decomposition of 
 ferro-cyanide of potassium by sulphate of iron. 
 
 The symptoms met with in the minor forms of industrial 
 sulphuretted hydrogen gas poisoning are nausea, vertigo, 
 headache, and general malaise, all of which soon disappear if 
 the workman goes into the open air. In poisoning by H2S 
 the workman should be brought at once into the fresh air and 
 artificial respiration immediately resorted to, and continued 
 until perhaps a cylinder of compressed oxygen can be 
 obtained. 
 
 Bisulphide of Carbon (CS2) 
 
 This colourless volatile liquid with a disagreeable and 
 repellent odour is used in the manufacture of waterproof 
 goods and in the vulcanisation of indiarubber, owing to the 
 rapidity with which it parts with its sulphur. It is an active 
 and penetrating solvent. It is the vulcanisation, or " curing," of 
 indiarubber goods that is the dangerous process in an india- 
 rubber works. Vulcanisation of indiarubber goods enables 
 them to withstand alterations of temperature and exposure 
 to the weather. Owing to the inflammability of CS2, the 
 work has to be carried on in rooms in which there are no fires 
 and no naked lights. 
 
 The vapour given off by CS2 has not only a most un- 
 pleasant odour, it is dangerous when inhaled. It causes 
 headache, vomiting, and vertigo. These symptoms, if only 
 slight, will disappear if the worker goes into the fresh air. 
 In the deeper forms of poisoning more serious symptoms 
 are observed, e.g:, staggering when walking as if the indi- 
 vidual were intoxicated, a sense of extreme tiredness, and loss 
 of appetite. When acting as medical expert on the 
 Dangerous Trades Committee of the Home Office, I visited 
 several of the large indiarubber manufactories of England, 
 and found that there had been a considerable amount of 
 sickness and ill-health among the men and women employed 
 in those departments where CS2 had been made use of. 
 
78 DISEASES OF OCCUPATION 
 
 Some of the men whom I saw had been off work for 
 months, and were just recovering from paralysis of the arms 
 and legs due to peripheral neuritis. On young women 
 whose work consisted in dipping such small goods as 
 children's balloons, tobacco pouches, toys, &c., into a bath of 
 bisulphide of carbon the vapour had peculiar effects. 
 Occasionally on their way home at nights from the factory 
 the girls would stagger and fall, and on reaching home would 
 sit down by the fire and fall asleep without touching food. 
 Next day they would feel shaky and tremulous, like men 
 after a debauch, and they would only recover their steadiness 
 after they had again inhaled for a little the vapour from the 
 carbon bisulphide. In other instances the CS2 would cause 
 acute hysterical symptoms. A worker would become talka- 
 tive, irritable, excited, and the subject of causeless outbursts 
 of laughter. Acute delirium may occur, attended with 
 delusions. In the more chronic form of poisoning there 
 have been observed weakening of the memory, difficulty of 
 speech, loss of muscular power and of sensation in the arms 
 and legs. Women, if pregnant, frequently miscarry. Occa- 
 sionally there occurs amblyopia, or loss of vision. 
 
 G. Hauft,^ having met with two cases of accidental 
 poisoning by carbon bisulphide in men, tried the effects of the 
 vapour upon animals. There were the usual symptoms of 
 excitation followed by paralysis, and at the autopsies the 
 liver cells were found sometimes healthy, at other times 
 diseased, the kidneys the seat of an interstitial nephritis, and 
 the lungs the seat of a pneumonia. The central nervous 
 system failed to show any naked-eye appearances to explain 
 the progressive paralysis, which, commencing in the extremi- 
 ties, subsequently involved the muscles of respiration, and 
 finally the heart. There is a general opinion that CS2 
 converts the colouring matter of the blood into haemoglobin, 
 but, on the contrary, A. Chassevant maintains that it has 
 the power of transforming methaemoglobin into haemoglobin. 
 
 Improved ventilation of the workrooms and the adoption 
 of means to draw the vapours downwards and away from the 
 workpeople have done much to diminish the number of 
 ^ Archives Internal, de Pharmacodynamie, 1903, t. xi. p. 155. 
 
DISEASES DUE TO GASES, VAPOURS, ETC. 79 
 
 cases of bisulphide of carbon poisoning in indiarubber 
 works ; but as CS2 is a dangerous and a subtle poison the 
 hours of work should not be too long at a stretch, and it 
 would be well if employers could alternate from time to time 
 the occupation of the workers. 
 
 Acetylene Gas 
 
 Acetylene gas is formed when calcium carbide (CaCa) is 
 brought into contact with water. The gas has illuminating 
 properties superior to those of ordinary gas, and as it can 
 be readily prepared it has come to be sought after as an 
 illuminant for country houses. When purified from calcium 
 sulphide and phosphate the ethereal odour of the gas is not 
 unpleasant. Small quantities of acetylene can be inhaled 
 without any bad effects. When the gas is present in the 
 atmosphere of a room to the extent of 40 per cent, by 
 volume, it is capable of causing death, but when inhaled in 
 the open air it produces little harm, since the poisonous 
 action of acetylene is feeble so long as the blood is at the 
 same time supplied with air containing a proper amount of 
 oxygen. Brociner^ found that icx) volumes of blood dis- 
 solved 80 volumes of acetylene. The blood showed no 
 characteristic spectrum, and, like normal blood, it was readily 
 reduced by ammonium sulphide. Professor Mosso, of Turin, 
 and his assistant Ottolenghi in their experiments found that 
 acetylene was toxic to dogs and guinea-pigs, and that air 
 mixed with 20 per cent, proved fatal within half an hour, but 
 that when the symptoms developed the animal would recover 
 if taken into the open air. In my own experiments upon 
 rabbits I found that so long as ordinary atmospheric air was 
 freely supplied along with acetylene no symptoms developed, 
 but when ordinary air was excluded or a very high per- 
 centage of acetylene was present, symptoms gradually de- 
 veloped. 2 Symptoms of poisoning by acetylene are more 
 slowly induced than in ordinary coal-gas poisoning. An 
 animal on becoming intoxicated would fall on its side, ap- 
 
 ^ Boston Med. and Surg, journal, July 30, 1896. 
 ' British Medical journal, April 23, 1898. 
 
8o DISEASES OF OCCUPATION 
 
 parently in a profound sleep which would pass into coma, but 
 even in this condition a few breaths of fresh air were sufficient 
 to restore it. If the inhalation of acetylene gas were pushed 
 signs of asphyxia would show themselves, and the animai 
 would become at first temporarily cyanosed and subsequently 
 pale. In the deeper stages of acetylene poisoning the blood- 
 vessels are extremely contracted, so that it is difficult to 
 obtain a few drops of blood from them for examination. 
 Once the stage of asphyxia has been reached recovery is 
 more difficult, and yet the blood on spectroscopic examina- 
 tion shows the two well-marked and characteristic bands of 
 oxyhaemoglobin and on the addition of ammonium sulphide 
 and heat is readily reduced. Instead of entering, like carbon 
 monoxide, into chemical combination with the colouring 
 matter of the red corpuscles of the blood, acetylene is 
 probably dissolved in the liquid part of the blood, hence the 
 fact of its being less harmful than coal-gas, and of its being 
 so much less poisonous than water-gas. 
 
 When persons are overcome by acetylene gas they should 
 be taken at once into the open air and artificial respiration 
 resorted to if necessary. Oxygen should be administered if 
 the patient is recovering slowly, the limbs should be well 
 rubbed and the extremities kept warm. A hypodermic 
 injection of a minute dose of strychnine may be necessary, 
 or an injection of strong hot coffee by the rectum. 
 
 Quickly drying Spirit or Inflammable Paints 
 
 Several cases have been reported of men becoming 
 unconscious when working with quickly drying paints, also 
 of men becoming seriously burned as the result of the 
 accidental firing of the vapour given off by the paints. The 
 introduction of rapidly drying or spirit paints is of recent 
 date and is an illustration of the undue haste and hurry 
 of modern times. When a ship puts into port for a few 
 days the vessel can be docked and painted inside and 
 outside to the extent required and be able to leave the dock 
 again in less than two days owing to the use of rapidly 
 drying paints. Half an hour after the application of one 
 
DISEASES DUE TO GASES, VAPOURS, ETC. 8i 
 
 coat of paint another covering can be made. To the owners 
 of the ship time is money. The danger arises when the 
 workmen have to cover in a short time an extensive surface 
 with the paint, and especially in confined spaces. 
 
 The colours which form the bases of the paints, instead 
 of being ground with oil, are mixed with methylated or 
 petroleum spirit or with benzine, and while it is the 
 spirit which confers upon the paints their quickly drying 
 properties, it at the same time renders them extremely 
 dangerous to the workmen, both by inhalation of the 
 vapour and its extreme inflammability. Men when 
 painting the interior of a ship's bunks have frequently 
 had to be removed by ropes in a state of uncon- 
 sciousness. In other instances, when working with naked 
 lights, the vapour from the paints has caught fire and serious 
 injuries have been inflicted. One man whom I saw was 
 extensively burned on the arms, trunk, and face, and he 
 ran the risk of dying from blood-poisoning. When men 
 are working in a confined space they are frequently so 
 overpowered by the spirit vapour that they are unable to 
 extricate themselves from their perilous position. Many 
 of them go to sleep and are found in a state of narcosis 
 or coma. Dangerous as is the use of these rapidly drying 
 paints in the interior of ships, their use externally is equally 
 attended by risk. Sometimes, and without any explanation, 
 unless it be that a soft gust of wind had fanned a naked 
 light or blown a spark, the outside of a ship which men are 
 painting is suddenly and for a moment or two enveloped 
 in flames. After painting bunkers with quickly drying 
 paints the men often complain of headache, dizziness, and 
 unsteadiness in walking. They feel as if they were intoxi- 
 cated. After vomiting they obtain relief. When men have 
 been hauled out of the bunks in a state of unconsciousness 
 they have generally been found to be pale and to look ill, 
 the breathing has been difficult, and there has occurred bleed- 
 ing at the nose. By degrees the symptoms improve with 
 the exposure of the men to the fresh air, but for a day 
 or two they remain shaky and nervous. On getting the men 
 home they should be put to bed and given warm drinks. 
 
82 DISEASES OF OCCUPATION 
 
 To prevent such accidents as have been alluded to, naked 
 lights should not be allowed where quickly drying paints 
 are used. The electric light is safer. The greatest ventila- 
 tion possible should be obtained. No man should work 
 in a ship's bunk for more than an hour or two at a time : 
 he should come out into the fresh air now and then or be 
 visited periodically by a foreman to see that all is right. 
 On undertaking the work for the first time the men ought 
 to have all the dangers pointed out to them, both as regards 
 the risks from inhalation of the vapour and the risks from fire. 
 
 Dry Cleaning by Means of Benzine 
 
 The dry cleaning of goods by benzine is now an estab- 
 lished industry and gives employment to large numbers 
 of people. For cleaning gloves and stained garments 
 nothing is better than benzine. Naphtha is occasionally 
 used for larger clothes. The soiled articles are usually placed 
 first in a revolving drum containing naphtha and soap 
 and subsequently in naphtha alone. The work is carried 
 on in iOut-buildings in which no naked lights are allowed. 
 Instead of naphtha, benzine may be employed. This may 
 be a petroleum spirit obtained from mineral oil or from 
 coal-tar. The two dangers incurred by the use of these 
 spirit compounds are intoxication of the workers and risks 
 from fire. Before any wearing garments that have been 
 sent to be cleaned are placed in the revolving drum the 
 pockets have to be carefully searched for matches ; these and 
 all brass buttons have to be removed, for explosions have 
 occurred owing to friction or electricity or the accidental 
 ignition of the spirit by lucifer matches concealed in the 
 clothing. As there is always a danger from fire the men 
 are not allowed to smoke in the building. Once the 
 garments have been sufficiently rinsed in the hermetically 
 closed revolving benzine cylinder, they are removed and 
 placed in a machine known as a hydro-extractor for the 
 removal of excess of spirit. On being taken out of the 
 hydro-extractor the garments are rinsed in clean spirit, 
 are again placed in the hydro-extractor, removed, dried 
 and finished. 
 
DISEASES DUE TO GASES, VAPOURS, ETC. 83 
 
 In ways that are quite unaccountable fires often break out 
 in dry cleaning establishments. In one dry cleaning shop 
 which I visited fires and explosions had on eight occasions 
 occurred during fifteen years. These fires often break out 
 on a hot summer sultry evening several hours after the 
 workpeople have left the buildings, a circumstance which 
 has led several persons to believe that benzine has a 
 tendency to undergo spontaneous combustion. At any 
 rate, in most instances the origin of the fire has remained 
 a mystery. Too great care, therefore, cannot be taken in 
 regard to the manipulation and storage of benzine. 
 Materials that have been soaked in it or scrubbed by it 
 should on no account be brought near a naked light, and 
 the waste naphtha and benzine should not be allowed to 
 pass directly into the drains and sewers, for as they give 
 off vapour and as men with naked lights are often obliged 
 to enter sewers, explosions might readily occur. 
 
 Benzine vapour affects people differently. Young persons, 
 and especially young females, are more liable to be 
 influenced by it than other people. They become hysterical 
 and excited — they feel as if they were intoxicated. Sub- 
 sequently they complain of headache and they vomit. On 
 going out of the workroom into the fresh air the symptoms 
 may pass away. Upon some persons benzine produces 
 a heavy, sleepy feeling, a sense of languor and weakness 
 of the limbs. In the severer forms of poisoning by benzine 
 women have suffered from blindness, multiple neuritis 
 attended by loss of power in the limbs, alteration of the gait 
 known as " steppage," accompanied by loss of the knee-jerk, 
 difficulty of speech, and mental depression or hallucinations. 
 Recovery may be incomplete, for memory is often impaired. 
 Naphtha produces similar symptoms but no serious 
 permanent effects. Workers in the naphtha departments 
 of indiarubber works often become anaemic and suffer from 
 headache. Their headache is relieved by going out into the 
 open air. The women become anaemic often through being 
 unable to take food ; the taste of the naphtha vapour 
 lingers long in the mouth, so that the workers are unable 
 to eat. 
 
84 DISEASES OF OCCUPATION 
 
 Allusion has been made to the necessity of ventilating very 
 freely all places where benzine and naphtha are employed. 
 No food should be taken into the workroom. Provision 
 should be at hand for extinguishing fires. There ought to 
 be an automatic fire extinguisher on the revolving drums in 
 which the garments are agitated along with the benzine ; 
 also plenty of loose sand ought to be lying at hand, and 
 plenty of blankets ready to throw around any person whose 
 clothes have caught fire. The outer garments worn by the 
 workpeople should be made of wool. Where dry cleaning 
 establishments are several storeys high there ought to be fire- 
 escapes in accessible places. 
 
 There are not many cases of fatal poisoning by benzine on 
 record, but in a case reported by Santesson of Stockholm the 
 lesions found after death were — fatty degeneration of the 
 heart, liver, kidneys and of the endothelial lining of the small 
 blood-vessels. In "Poisons Industriels," p. 54, mention is made 
 of a patient of Lenoir and Claude. The man, who was a 
 dyer, aged 27, in consequence of inhaling the vapour of 
 benzine died from purpura haemorrhagica. He had also 
 bleeding from the nose and gums, and haemorrhages into his 
 pleural cavity. The experiments carried out by MM. A. 
 Chassevant and Marcel Garnier, and reported in Archiv 
 Ifiternat. de Pharmacodynamie et de Therapie^ 1905) show 
 what a poisonous liquid benzine is. They injected small 
 quantities into the peritoneal cavity of guinea-pigs. Three 
 to five minutes after an injection of benzine there was 
 general muscular tremor, so that the animal would lie down 
 on its side. The amplitude of the convulsions became 
 greater as time went on, accompanied by a complete loss of 
 the muscular tonus, so that the animal's body could be bent 
 in all directions. This hypotonus did not appear at the 
 same time as the convulsive tremors — generally half an hour 
 afterwards. There was also a marked fall of the temperature 
 of the body. If the dose was sufficiently poisonous to lead 
 to a fatal termination, the symptoms mentioned continued 
 until death, but even with small doses there was always a fall 
 of temperature. With a small toxic dose death came from 
 eight to nine hours after an injection, but if the dose was 
 
I 
 
 DISEASES DUE TO GASES, VAPOURS, ETC. 85 
 
 large the animal died in less than three hours, usually after a 
 severe convulsive seizure and complete hypotonus. 
 
 On making a post-mortem examination of animals poisoned 
 by the injection of benzine into the peritoneal cavity there is 
 detected a strong odour of benzine when the abdomen is 
 opened. Occasionally there is a small quantity of a reddish 
 liquid in the peritoneal cavity, the serous membrane of which 
 is frequently congested, and shows numerous small 
 ecchymoses or minute effusions of blood. The abdominal 
 organs are usually of a dark red colour, although the liver here 
 and there shows a few white spots. The mucous membrane 
 of the stomach along the great curvature is found to be the 
 seat of numerous small brown patches and ecchymoses ; 
 sometimes there is ulceration. Since the benzine under 
 these circumstances was not swallowed, it is evident that 
 as the minute haemorrhages in the stomach bear a distinct 
 relation to the course of the arteries, they are due to the 
 elimination of the poison from the blood by the mucous 
 membrane of the stomach. In acute poisoning by benzine 
 the earliest symptoms are on the side of the nervous system, 
 viz., convulsions, loss of muscular tone, and extreme depression 
 of the body temperature. Death may come from the nervous 
 system alone ; but, as already stated, if life is spared for a few 
 hours, the gastro-intestinal canal becomes implicated, for the 
 lesions found therein bear strong evidence of an effort on the 
 part of the organism to eliminate the poison by the mucous 
 membrane of this canal. 
 
 Petrol 
 
 As a consequence of exposure to the vapour given off by 
 petrol, workmen at the end of the day, especially if they have 
 been working in a confined space, often complain of head- 
 ache, vertigo, nodding of the head, and discomfort in 
 breathing. These symptoms are extremely apt to occur in 
 men employed in the distillation and refinement of petrol. 
 In cleaning out the tubs for holding petrol men have become 
 asphyxiated. Wielczyk states that among the miners em- 
 ployed at the petrol springs in the Carpathian mountains 
 asphyxia is not unknown. Petrol vapour, like that of benzine, 
 
86 DISEASES OF OCCUPATION 
 
 destroys the colouring matter of the blood. To this circum- 
 stance may be attributed the anaemia occasionally observed 
 in the workmen. 
 
 Owing, among other things, to the prosperity of the motor- 
 car industry, the demand for petrol within recent years has 
 much increased. Special steamers have been built for 
 bringing petrol from Sumatra and other places to this 
 country. Some of these steamers carry enormous quantities 
 of petrol, as much as 12,000 tons. A certain risk attends not 
 so much the filling of the tanks and the transport of the 
 material, as the cleaning out of the tanks after the cargo has 
 been discharged. The petrol is shipped in specially prepared 
 tanks, and care has to be taken that the tanks are well filled. 
 Ventilating shafts run from these tanks to the mast-head of 
 the ships. After the ship has been docked and the petrol 
 removed, men descend to clean the tanks. Peculiar 
 symptoms have developed in the workmen. In the minor 
 forms of petrol poisoning the men have become intoxicated 
 and excited, others have become hysterical ; while in the 
 deeper forms of poisoning the men have been so overcome 
 by the vapour that they have passed into a state of coma, in 
 which they would probably have died had they not been 
 hauled on deck and allowed to breathe fresh air. The men 
 become asphyxiated by the vapour, and on recovery often 
 vomit and complain of severe headache. In order to prevent 
 such accidents it is necessary, before allowing men to go into 
 the tanks, to close down all the hatches and to introduce 
 steam into the tanks. By this means the petrol vapour 
 seems to be robbed of its power for harm, so that men can 
 enter and by means of tow clean out the tanks. Owing to 
 the inflammable nature of petrol vapour all fires and naked 
 lights on the ship have to be extinguished during the 
 emptying of the cargo. 
 
 Blanket'Stoving 
 
 Blanket-stoving was not considered to be an unhealthy 
 occupation by a committee appointed by Mr. Asquith, when 
 Home Secretary, nor by Dr. I. A. E. Stuart, of Batley, who has 
 
DISEASES DUE TO GASES, VAPOURS, ETC. 87 
 
 had a large experience of the workers, since he finds that the 
 mean age at death of the men employed is 64*1 years. The 
 men suffer from an irritating cough, occasionally accompanied 
 by the expectoration of a small quantity of blood, during and 
 after the removal of the blankets that have been exposed 
 to the fumes of brimstone in the stoving-house. Most of this 
 part of the work, the object of which is to bleach the 
 blankets, is carried on in the winter months. During the 
 summer the blankets are dried outside, and as this work 
 necessitates the fixing and stretching of the blankets upon 
 tenter posts it entails considerable physical effort on the 
 part of the workmen. There is a common belief in the 
 district where the work is carried on, that the men who are 
 exposed to the sulphur fumes do not become the subjects of 
 tuberculous lung disease, an opinion which medical experi- 
 ence rather confirms than otherwise. A similar immunity to 
 infectious diseases is also conferred. The men drink beer in 
 large quantities, owing, it is said, to dryness of the mouth 
 and throat, caused by work in the drying-house and the 
 heavy perspiration which this causes. From the nature of 
 their employment, the inhalation of sulphur fumes and 
 alternating exposure to heat and cold, several of the men 
 become the subject of chronic bronchitis and emphysema of 
 the lungs. Although there is a remarkable freedom from 
 tuberculous lung disease, yet phthisis and pneumonia are not 
 unknown among the workmen. Taking the work generally, 
 it cannot be said to shorten life, since the average age at 
 death of blanket-stovers in 64*1. Efficient ventilation and 
 machinery for raising and stretching the blankets upon 
 tenters would help to make the employment even healthier 
 than it is. 
 
CHAPTER III 
 
 DISEASES DUE TO WORKING IN CAISSONS AND 
 COMPRESSED AIR 
 
 ENGINEERING science has done much for the comfort 
 of man and played no unimportant part in the cause 
 of civilisation. By the extension of railways national barriers 
 have been broken down and physical difficulties overcome 
 that well-nigh seemed insuperable. A century ago, when it 
 was necessary to span a river by a bridge, the sustaining piers 
 in the centre and sides of the river often rested upon huge 
 piles of wood that had been driven into the soil, but in 
 modern days the bed of the river is attacked by engineers in 
 quite a different manner. Men work on the bed of the river 
 and below it in closed iron cylinders, or caissons, into which 
 compressed air is driven by means of powerful machinery, 
 and as excavation proceeds the caisson sinks by its own 
 and superadded weight until solid rock is reached, or a 
 condition of soil is attained capable of sustaining the caisson, 
 which, when filled with concrete, becomes the substructure of 
 the pier of the bridge. Although all the required operations, 
 mining and engineering, are carried out in harmony with 
 physical laws, yet the conditions under which the men work 
 are unnatural, and are therefore attended with considerable 
 risk to the health and life of the workmen, hence the terms 
 "caisson disease," or "compressed-air illness." 
 
 A caisson in its simplest form is, when in position, an iron 
 cylinder, somewhat bell-shaped, and open at its lower 
 extremity. Its upper extremity is closed in by an iron roof, 
 but this is really the floor of a smaller superadded chamber, 
 part of the roof of which along with the floor already men- 
 
CAISSONS AND COMPRESSED AIR 89 
 
 tioned is movable so as to allow of the passage of the 
 buckets filled with the soil removed by excavation. This 
 upper chamber is known as the " material " chamber. Built 
 on to the outer side of the upper part of the caisson is an 
 iron chamber, entrance into which is guarded by a strong iron 
 door. Leading out of this chamber is a doorway that con- 
 ducts into the interior of the caisson. This entrance into the 
 caisson is also guarded by a strong iron door. The chamber 
 just described is that through which the men enter and leave 
 the caisson. It is known as the " air-lock." By means of 
 strong iron pipes connected with a compressor engine, atmo- 
 spheric air is pumped into the caisson, which drives the water 
 out of the caisson and keeps it out, so that men can work in- 
 side the iron cylinder on the bed of a river and remove the soil. 
 The workmen enter the caisson through the air-lock. Once in 
 the air-lock the outer door is closed, either by the men them- 
 selves or by some one outside. The inner door which leads 
 from this chamber into the interior of the caisson is at this 
 time also closed ; it is kept thus by the pressure of the 
 compressed air within the caisson. When the men have 
 got comfortably into the air-lock, compressed air from the 
 caisson is, by means of an air-cock, allowed to escape into 
 the air-lock. The air-cocks which admit the high-pressure 
 air are made purposely small so as to prevent too rapid 
 compression which, if it occurred, might give rise to 
 troublesome symptoms. As soon as the pressure in the 
 air-lock comes to equal that inside the caisson the inner 
 iron door opens, practically speaking, of itself, when the men 
 enter the caisson or working chamber, and by means of an 
 iron ladder descend to the bed of the river. During the short 
 time the men are in the air-lock preparatory to entering the 
 working chamber, they are undergoing what is spoken of 
 as "compression." The stop-cocks are manipulated by 
 trained men inside and outside the air-locks. Men who are 
 undertaking the work for the first time occasionally experience 
 considerable discomfort during the process of compression. 
 As the pressure rises within the air-lock the drum of the ear 
 is forcibly driven in, and some men not only become deaf 
 but experience severe earache, and headache attended by 
 
90 DISEASES OF OCCUPATION 
 
 dizziness. Men who are used to the work obviate all of these 
 by swallowing air and passing it up the Eustachian tube into 
 the middle ear, so that by the presence of this air-pad on the 
 internal side of the drum of the ear the painful depression 
 of the membrana tympani is prevented. In some instances 
 where such preventive measures have not been employed the 
 drum of the ear has ruptured. During compression the 
 blood keeps absorbing the gases of the air until the tension 
 ot the gases in the blood becomes equal to that in the com- 
 pressed air. Once this equilibrium has been attained 
 immunity from immediate troubles is secured. Barring 
 accidents, the men can work in the caisson for hours with- 
 out experiencing any inconvenience, the amount of work 
 done in a given time being equal to that which the men 
 could do if similarly employed outside a caisson. The 
 opinion has been expressed that the work inside is not so 
 fatiguing. Formerly caissons were illuminated by naked 
 lights, but the smoke from the lamps and the consumption of 
 the oxygen of the air polluted the atmosphere. The electric 
 light has supplanted all other illuminants. When the buckets 
 have been filled with soil they are hauled up to the material 
 chamber, part of the floor of which slides so as to allow them 
 to pass through. The sliding doors are at once closed by the 
 men in the caisson who superintend this transport of the soil. 
 For the next few moments the "material-lock" is a compressed- 
 air chamber. After a brief period of decompression the roof 
 of this chamber is opened by men outside the caisson, when 
 the bucket is lifted by a crane, emptied, and returned, and when 
 the roof again closes compressed air is turned on, the floor 
 slides, and the bucket descends. So perfectly do the movable 
 doors fit and so adaptable are the manipulations, that there 
 is, practically speaking, no escape of the compressed air. 
 
 At the close of a shift, or when the men inside the caisson have 
 finished their work for the day, they ascend the ladder, enter the 
 air-lock, and close the door which separates the caisson from 
 the air-lock. As the men are still in compressed air the outer 
 door remains firmly closed. By means of a stop-cock air is 
 allowed to escape into the external atmosphere, and by degrees 
 the pressure in the air-lock falls. When the pressure inside 
 
CAISSONS AND COMPRESSED AIR 91 
 
 the air-lock equals that of the external atmosphere the outer 
 door readily opens, and the men emerge enveloped in a thick 
 mist or fog, for during decompression the air in the air-lock 
 becomes extremely cold and saturated with aqueous vapour. 
 It is while the men are coming out of the air-lock, or shortly 
 after having undergone what is known as " decompression," 
 that there occur the dangers to health and risks to life. 
 The caisson just described is such as is used in subaqueous 
 excavations in vertical positions ; but large caissons may be 
 employed with two or three shafts, each fitted in its upper 
 extremity as already stated. In making tunnels under a 
 river, or under the streets of a large town, caissons are also 
 employed ; these differ slightly in construction from those 
 used on rivers, but the principle is the same. 
 
 To enable the men to do their work well when in the 
 caissons pure air, and an abundant supply of it, ought to be 
 pumped in by the compressor engine. There has generally 
 been a considerable amount of sickness among the workmen 
 when the supply of atmospheric air has been insufficient, or 
 when it has been rendered impure by gases given off from 
 the soil the men are excavating. In sinking the foundations 
 for the piers of the King Edward Bridge at Newcastle-upon- 
 Tyne the greatest amount of sickness among the men occurred 
 when they were passing through a layer of soft coal below 
 the bed of the river. Probably small quantities of carbon 
 monoxide gas were given off, or sulphuretted hydrogen, for 
 the men complained of a disagreeable odour. The ventila- 
 tion of the caissons should be kept free by an excess of 
 air pumped in at the upper extremity of the caisson and 
 allowed to force its way outwards by the lower extremity. 
 The air inside the caisson becomes vitiated by the respiratory 
 products of the men, of whom, according to the size of the 
 working chamber, there may be as many as from three to 
 forty inside. In the large caissons on Tyneside thirty-five 
 men worked at one time. As the men when inside the 
 caisson work hard and consume large quantities of oxygen, 
 the necessity for an abundant supply of air is apparent. 
 At the Blackwall Tunnell, Snell ^ found that while the esti- 
 I " Compressed-air Illness," E. Hugh Snell, M.D. 
 
92 DISEASES OF OCCUPATION 
 
 mated number of cases of illness for loo days was 80*9 when 
 less than 4,000 cubic feet of fresh air per man per hour were 
 supplied, and 22*5 when the amount was 4,000 to 8,000 cubic 
 feet, the numbers fell to 8*5 when upwards of 8,000 cubic 
 feet of air were supplied. It is Dr. Snell's opinion that the 
 amount of illness varies inversely with the amount of fresh 
 air supplied. Experience to some extent confirms this theory, 
 but the actual part played by carbonic acid gas in the pro- 
 duction of caisson disease has yet to be demonstrated. It goes 
 without saying that the health and safety of the workmen 
 are enhanced by the supply of air being abundant and pure. 
 As compressed air is hotter than ordinary atmospheric air, 
 the temperature at which the men are working in the caisson 
 is considerably higher than that of the outside air, conse- 
 quently a layer of cold water should be kept circulating 
 round the cylinder of the compressor engine to keep the 
 temperature low and the air cool, and only high-flash oils, 
 500° F. and upwards, should be employed, so as to pre- 
 vent the possible contamination of the air by the decompo- 
 sition products of an over-heated oil. The surplus air escapes 
 in tremendous volumes by the cutting edge of the caisson, or 
 that part which rests upon the soil, but should, perchance, 
 the bell-shaped expansion of the caisson settle down upon 
 a bed of clay, and no air escape, as what occurs in what is 
 called a " water-tight " stratum, there would be danger were 
 there no safety-valves present in the upper part of the caisson 
 to act automatically when the pressure rises too high. Safety- 
 valves, too, are provided on the compressor engine, so that 
 the "cut out" acts immediately the pressure has risen too 
 high. There should always be at least duplicate compressor 
 engines. Owing to the large size of the caissons employed 
 by the Cleveland Bridge Company on the river Tyne, their 
 extreme weight, and the possibility as they keep sinking of their 
 tilting over on one side, or of suddenly sinking into the soil 
 and crushing the men between the soil on the one hand and 
 the roof of the working chamber on the other, strong iron 
 girders were built transversely across the interior of the 
 caisson, and the men were never allowed to work underneath 
 a girder. Two such girders spanned the interior of each of 
 
CAISSONS AND COMPRESSED AIR 93 
 
 the large caissons on the Tyne and divided it into three 
 chambers. Through a large circular opening in the girders 
 the men could pass from one chamber to another, and in the 
 event of such an accident happening as the sudden tilting of 
 the caisson, the air supply and the ventilation would hardly 
 have suffered. As the caisson sinks it is steadied by a large 
 amount of concrete that surrounds it. Mr. Frank Davis, the 
 manager of the Cleveland Bridge Company's operations on the 
 River Tyne, informs me that some of the caissons when filled 
 with concrete, and that which is superposed, weigh upwards of 
 10,000 tons. In bridge building the caissons are not removed ; 
 they are filled with concrete and become the substructure upon 
 which the masonry is reared. They form the piers of the future 
 bridge. As the men inside the caisson can readily communi- 
 cate by means of knocks with the men outside, there is no 
 necessity for having telephones inside the working chambers. 
 Fortunately accidents happen but rarely inside the caissons ; 
 still it would be well to have inside the caissons a sling 
 or other suitable appliance whereby injured men could be 
 hoisted to the level of the air-lock should the need arise. 
 As the caissons keep sinking owing to the removal of the 
 soil, fresh lengths have to be added to the shafts, but air- 
 locks must be always above high-water level mark. The 
 pressure within the caisson has to be regulated according to 
 the depth at which the men are working and the circum- 
 stance as to whether in tidal rivers the water-level mark 
 is high or low. 
 
 It requires i lb. of air pressure to displace 2 feet 4 inches 
 of water. Ten metres of water are equivalent to one atmo- 
 sphere of pressure. For every 33 feet of water a pressure 
 of + 1 5 lbs. to the square inch, or i atmosphere, is required 
 to keep the water out of a caisson. Men, if working at a 
 depth of 100 feet, would require a pressure of + 3 atmo- 
 spheres, or 45 lbs. in the caisson. 
 
 Among the earliest cases of " compressed-air illness " to be 
 reported were those of Pol and Watelle in 1854, whose experi- 
 ence was gained while in charge of sixty-four men who were 
 working in caissons at 48 lbs. pressure on the River Loire. 
 The men worked only four-hour shifts, and the time spent in 
 
94 DISEASES OF OCCUPATION 
 
 decompression was half an hour. Forty-seven of the men 
 stood the work well, twenty-five had to be discharged through 
 ilhiess, and two died. The serious cases numbered sixteen, 
 all of which occurred after decompression. 
 
 Caissons were first employed in England at Rochester in 
 185 1, by Hughes, during the construction of a bridge over 
 the Medway, and shortly afterwards by Brunei at Chepstow 
 and Saltash. At Saltash one man died shortly after coming 
 out of a caisson in which he had been working at a depth of 
 of 87-5 feet and under a pressure of 40 lbs. At the St. Louis 
 Bridge, on the Mississippi, 600 men were employed in sink- 
 ing the foundations. Of these 600 men, 119 suffered from 
 caisson disease, 14 of whom died. At the Brooklyn Bridge, 
 New York, there were no cases of compressed-air illness, 
 with 3 deaths. The Forth Bridge and the Blackwall Tunnel 
 were the first works using high pressures which were com- 
 pleted without a fatality. No death from caisson disease 
 occurred in the Baker Street and Waterloo Railway tunnel 
 works in London. At the King Edward Bridge, Newcastle- 
 upon-Tyne, one man died from the effects of caisson disease 
 attended by complications. 
 
 Symptoms of Compressed-air Illness 
 
 The pathological effects of compressed air occur at two 
 different periods, (i) when the men are undergoing pressure, 
 and (2) during or after leaving the pressure. The symptoms in 
 the first instance are mostly mechanical, as, for example, the 
 pains in the ears already referred to and due to the pressure 
 upon the membrana tympani, also pains in the frontal and 
 maxillary sinuses. By inflating the middle ear through the 
 Eustachian tube the men can prevent these unpleasant symp- 
 toms. Unless the drum of the ear ruptures and is followed 
 by acute inflammation, the symptoms require no treatment. 
 It is otherwise with those that belong to the second category. 
 These may develop while the men are in the air-lock under- 
 going decompression. This is a rare event inside the air- 
 lock, but it occurred in one of my own patients, the only case 
 occurring in Newcastle-on-Tyne that proved fat^l. In some 
 
CAISSONS AND COMPRESSED AIR 95 
 
 instances the men have had to be lifted out of the air-lock in 
 a condition of unconsciousness. These are always serious 
 cases, especially if the coma is attended by convulsions. 
 Usually the symptoms do not show themselves for some 
 time — a few minutes, half an hour, or several hours after the 
 men have come out of the air-lock. In an ordinary way the 
 men complain mostly of severe pains in their muscles and in 
 their joints, which they call " bends." The knee-, elbow-, and 
 hip-joints are, as regards frequency, individually affected in 
 the order mentioned, but they and other joints may be 
 simultaneously affected. Often the pains are excruciating 
 and cause the strongest men to writhe in agony. The earlier 
 the pains develop after the workmen emerge from the air- 
 lock the more severe they are. "Bends" may continue for a 
 few hours or for two or three days. 1 have frequently 
 grasped the aching limbs of the men suffering from " bends," 
 but neither pressure upon them nor friction of the joints 
 seemed to aggravate the pains. Occasionally the men after 
 decompression bleed at the nose, or they complain of severe 
 abdominal pain and vomiting. In many instances it is only 
 after the men have left their work and are on their way 
 homewards that they are seized with extreme pains, or they 
 become paralysed in their limbs and fall. It is the lower 
 extremities that are paralysed. The loss of power in the 
 legs may come on several hours after decompression, and 
 may be transitory or permanent. This paralysis is accom- 
 panied by retention of urine, requiring the use of the catheter. 
 Vertigo is not an uncommon symptom. Under its influence 
 workmen may be seen to stagger and stumble as if intoxi- 
 cated. One of my patients was the subject of acute delirium 
 for a few days, two others were enfeebled mentally, and for 
 a time were childish and almost imbecile, while several others, 
 again, were nervous and appeared to be the subjects of un- 
 accountable fear. Occasionally there is temporary but partial 
 blindness without opthalmoscopic changes in the retina to 
 explain the loss of vision. Double vision, and loss of hear- 
 ing with facial paralysis, have occurred. Some of the men 
 become nervous and hysterical. In other instances it is 
 difficult to say whether they are not malingering. In the 
 
 V 
 
96 DISEASES OF OCCUPATION 
 
 minor forms of caisson disease the muscular system and 
 joints are most affected ; in the severer forms it is upon the 
 central nervous system that the brunt of the illness mostly 
 falls, the spinal cord more than the brain. 
 
 What are the Symptoms due to ? 
 
 Inside the caissons the men are working under abnormal 
 conditions. The air-pressure is high and the work is hard. 
 There are no signs of illness so long as the men are in the 
 compressed atmosphere if the air is good. It is after the 
 men return from a high to a low pressure that symptoms 
 arise. The length of time spent in the working chamber, the 
 purity of the air, the height of the pressure, and muscular 
 fatigue are predisposing circumstances. Men who are work- 
 ing a four or five hours' shift are more likely to become 
 affected than other men working at the same pressure for 
 only half the time. In this country the men seldom work 
 under pressures higher than 35 lbs. to the square inch; 
 to this must be added the ordinary atmospheric pressure 
 of 15 lbs. Since i lb. of air pressure is required to dis- 
 place 2\ feet of water, the pressure just mentioned would 
 correspond to a depth of 70 to 80 feet below high-water level 
 mark if the work was being carried on under a tidal river. 
 The pressure is caused to vary with the rise and fall of the 
 tide. According to the depth at which the men are working, 
 and therefore the pressure^ so should be the length of the 
 shift. The higher the pressure the shorter ought to be the 
 shift. It was when the men were digging through a layer of 
 soft coal below the River Tyne that there was experienced 
 an unpleasant odour and there was the greatest amount of 
 sickness, and at the Forth Bridge it was when the men were 
 removing the soft silt on the bed of the river that Dr. 
 Hunter had the largest number of men off ill. Impurity 
 of the air is a factor in causing illness, not necessarily 
 of the typical character of caisson disease, but which 
 places the individual hors de combat. It is difficult to 
 estimate the part which excess of carbonic acid, for example, 
 
CAISSONS AND COMPRESSED AIR 97 
 
 plays. Snell's observations on this point are perfectly clear. 
 The amount of sickness was found to be proportional to the 
 quantity of carbonic acid in the air. An increase of carbonic 
 acid from "04 per cent, to o*i per cent, at 30 lbs. pressure was 
 always the forerunner of much illness. Dr. F. R. Wainwright, 
 who had medical charge of the men employed at the Baker 
 Street and Waterloo Railway tunnel, found that " from 
 May 23rd to October 4th, with an average of 6,000 cubic feet 
 (of air) to each man per hour, there were 34 cases (of illness), 
 say 8 cases per month. Following this with an average of 
 1,700 cubic feet to each man per hour, there were 13 cases in a 
 period of 12 days," and the cases occurring during the latter 
 period came on sooner after decompression and were more 
 severe than those that occurred when the ventilation was 
 better. On the River Tyne the amount of fresh air pumped 
 into the caisson was only 1,320 cubic feet per man per hour, 
 and yet there were very few cases of illness. At the 
 Brooklyn Bridge the air in the caissons contained 0*33 per 
 cent, of carbonic acid, but at the Baker Street and Waterloo 
 Railway tunnel it was o*o6 to 0*07 per cent. Even when the 
 men were working at a maximum pressure of 36 lbs. at 
 Brooklyn, Dr. Smith, who was in medical charge, reported 
 1 10 cases of compressed-air illness in four months, whereas 
 at Baker Street, with eight-hour shifts, there were only 47 
 cases in five months. Dr. Smith does not attach much 
 importance to the ventilation, for he remarks that "this 
 amount (0*33 of CO2) of vitiation was found not to affect the 
 men unfavourably." Snell's and Wainwright's observation, 
 theoretical considerations, and the Brooklyn Bridge statistics, 
 suggest the existence of some relation between volume of air 
 supplied with the quantity of CO2 contained in it, and the 
 amount of sickness in the men, but precisely what that 
 relation is it is difficult to say. Wild rats which I exposed 
 to 50 lbs. pressure of atmospheric air, containing quantities 
 of CO2 varying from 0*6 to 1*04 per cent, for seven hours, 
 behaved differently : some experienced little or no incon- 
 venience, while two or three, although on removal from the 
 caisson they were apparently quite well, yet died a day or 
 two afterwards. On examining their lungs microscopically 
 
98 DISEASES OF OCCUPATION 
 
 there were found evidences of patchy congestion with 
 small haemorrhages, also congestion of the liver. A dog, on 
 the other hand, was on several occasions for seven hours in 
 compressed air which contained 0*3 to 2* 16 per cent, of 
 carbonic acid, and under a pressure of 50 lbs. without ill- 
 effects. He kept falling asleep in the caisson, but beyond 
 that nothing was observed. 
 
 On the River Tyne the amount of carbonic acid present in 
 one of the caissons on working days varied between 20 and 
 30 volumes per 10,000, while the ordinary atmospheric air 
 in the neighbourhood of the caisson contained 5 volumes of 
 CO2 per 10,000 : the amount varied between 0'2 and 0*3 per 
 cent, and yet it cannot be said that there were many cases of 
 compressed-air illness, notwithstanding the fact that only 
 1,320 cubic feet of air per man were being pumped in. On 
 the particular day in which the most serious case of illness 
 occurred in the caisson the amount of carbonic acid was less 
 than usual. There have been several fatal cases of com- 
 pressed-air illness at the Hudson River Tunnel, New York, 
 but on carefully going into the figures and comparing them 
 with the percentage of carbonic acid in the air of the tunnel, 
 there does not appear to be such a constant relationship 
 between the two as to imply a causal connection. Notwith- 
 standing this it is desirable that the air in the caissons should 
 be kept as pure as possible. 
 
 It is interesting to remember that even oxygen, which is 
 of all the gases the most important, from a vital point of 
 view, becomes a poison when breathed in excess and in a 
 compressed form. It produces toxaemia and inflammation of 
 the lungs. Paul Bert, on exposing dogs to high pressures of 
 oxygen and rapidly decompressing them, found that the 
 animals became convulsed and that the amount of carbonic 
 acid in the blood became markedly diminished owing, he pre- 
 sumed, to the excess of oxygen arresting the metabolism of 
 the tissues. Assisted by Dr. Alfred Parkin, I carried out a 
 series of experiments at the Newcastle College of Medicine, 
 with mice. Exposing them to high pressures of oxygen, say 
 10 atmospheres and upwards, some of them died in con- 
 vulsions even when brought into ordinary atmospheric air, 
 
CArSSONS AND COMPRESSED AIR 99 
 
 while others that came out of the compressed oxygen died 
 a few days afterwards from acute congestion of the lungs. 
 Pneumonia is one of the consequences of breathing oxygen 
 under high pressure. Professor Lorrain Smith, of Owen's 
 College, has suggested that inflammation of the lungs might 
 be the cause of caisson disease, but as some of the worst cases 
 of compressed-air illness on the Tyne occurred when the men 
 were working at rather low atmospheric pressures, and there- 
 fore not exposed to high-tension oxygen, and the lesions in 
 caisson disease are more in the nervous system than in the 
 respiratory organs, it does not appear that oxygen tension 
 nor congestion of the lung is the cause of compressed-air 
 illness. Under the atmospheric pressures at which the men 
 are working in the caissons, the oxygen tension is not high 
 enough to cause pulmonary congestion. The convulsions 
 produced in animals by high oxygen tension are in all 
 probability the result of the toxic effect of oxygen upon the 
 central nervous system. 
 
 Parkin and I found that mice behaved differently in high 
 pressures of oxygen and compressed air. Exposed to + 10 
 atmospheres of oxygen, mice in seven or eight minutes 
 became convulsed, but when exposed to even higher 
 atmospheres of compressed air for the same period no con- 
 vulsions occurred, owing, probably, to the length of time 
 being too short for intoxication to occur from the oxygen in 
 the air. With high oxygen pressures convulsions develop 
 during the period the animal is in the compressed-air chamber: 
 the convulsions are, therefore, in all probability toxic in origin, 
 but with high pressures of atmospheric air symptoms do 
 not arise until the animal has been decompressed, when the 
 more sudden the decompression the greater the tendency for 
 symptoms to develop. The symptoms in the latter instance 
 are due to quite a different cause, viz., frothing of the blood 
 in the small vessels. During the time men are working in 
 compressed air the circulation of the blood is, practically 
 speaking, unaltered. The pulse may be quickened at first, 
 but this is temporary. On the other hand, some of the air 
 the men are breathing is pressed into the blood under the 
 high pressure and is held therein in solution, the solution of 
 
lOO DISEASES OF OCCUPATION 
 
 the gases being proportional to the pressure in accordance 
 with Dalton's law. Since nitrogen forms four-fifths of the 
 air we breathe, it is this gas which is found dissolved in the 
 largest quantity in the blood in compressed-air illness. 
 Leonard Hill ^ tells us that on one occasion when a com- 
 pressed-air chamber suddenly burst, the dog which was the 
 temporary tenant of the chamber was killed, and that the 
 blood removed from the right side of the heart of the animal 
 yielded, on analysis, 15*2 per cent, of carbon dioxide, 82*8 of 
 nitrogen, and 2 per cent, of oxygen. Nitrogen of itself is a 
 harmless gas : 100 cc. of blood under i atmosphere of 
 pressure will absorb 1*23 cc. of nitrogen and under 4 atmo- 
 spheres 4*92 cc. When decompressed from 4 to i atmosphere 
 the same blood will give up 3*69 cc. of nitrogen. It is 
 estimated that the whole of the blood in the body of a man 
 weighing 70 kilogrammes would give up 1 30 cc. of nitrogen, 
 but his tissues and fluids would probably yield ten times 
 more. 
 
 When the air in a caisson contains a larger percentage of 
 carbonic acid than usual, there is the danger of a larger 
 amount of carbon dioxide being pressed into the blood under 
 these circumstances. The effect of the sudden decompression 
 of a man who has been exposed to a high atmospheric air- 
 pressure is exactly the same as what occurs when a bottle of 
 soda-water is opened — effervescence occurs : the blood as it 
 escapes from the heart of an animal killed by rapid decom- 
 pression can be seen frothing. On exposing pithed frogs to 
 high atmospheric pressures and watching through a microscope 
 the circulation in the web of their feet, it was noticed that 
 while for a moment the circulation was quickened, the flow 
 of blood gradually returned to the normal and remained thus, 
 nothing abnormal being detected as regards the calibre of the 
 blood-vessels. When decompression is suddenly induced no 
 immediate change occurs in the circulation. Two or three 
 minutes afterwards, however, the blood stream is observed to 
 become slower and slower, subsequently it oscillates in the 
 vessels — now forwards, now backwards — and then there 
 appears a bubble of air inside one or more of the capillary 
 ' Lancet, July i, 1905, p. 4. 
 
CAISSONS AND COMPRICSSED AIR loi 
 
 blood-vessels. Another bubble or two of air presently 
 appears, and these coalescing fill a considerable part of a 
 capillary. Where in the vessels there was previously blood 
 there is now air, and the circulation in that particular vessel 
 ceases. Occasionally there is a rupture of small blood-vessels, 
 when air and blood escape into the tissues. It is the sudden 
 setting free of the gas previously dissolved in the blood which 
 is the cause of the frothing of the blood seen in an animal 
 that has been killed by rapid decompression, and is the 
 explanation of caisson disease or compressed-air illness in 
 men who have been working at high air pressures and been 
 too rapidly decompressed. The bubbles of air are for the 
 most part nitrogen, simply because nitrogen is the largest 
 constituent of atmospheric air and more of it is absorbed 
 than of the other gases. While possibly carbon dioxide 
 and carbon monoxide may be more dangerous to health 
 when inhaled in the compressed form, and predispose to 
 the development of certain symptoms, yet caisson disease 
 is not so much the result of a toxaemia or poisoning as 
 of the sudden liberation of gas and the presence of air 
 emboli in the blood, rupture of capillary vessels, and the 
 presence of free air and blood in the tissues. The symptoms 
 are largely the result of mechanical causes. Frothing of 
 the blood is the main cause of caisson disease. The longer 
 the workmen are in the caisson and the greater the muscular 
 fatigue, the higher the pressure and the rapidity with which 
 decompression is effected, the more likelihood is there of 
 caisson disease developing. As already stated, the symptoms 
 are met with mostly on the side of the muscular system and 
 the joints ("bends"). As concerning the central nervous 
 system, coma and convulsions point to the brain as being 
 affected, and paralysis of the legs to a lesion of the spinal 
 cord. Of all the cerebro-spinal symptoms paralysis is the 
 most common, owing to the lower portion of the spinal cord 
 being that which is the most frequently affected. Why this 
 particular portion of the spinal cord should be so frequently 
 selected has never been adequately explained. It has been 
 attributed to the length of the small arteries in this part of 
 the nervous system and the comparative absence of external 
 
10^. DISEASES OF OCCUPATION 
 
 support to their walls. The following attractive theory 
 has recently been advanced by Dr. H. M. Vernon at a 
 meeting of the Royal Society. In carrying out a series of 
 experiments to determine the solubility of air in various fats, 
 Vernon found that at body temperature the fat of mammals 
 probably dissolves five times as much nitrogen as water or 
 blood plasma. It is known that for caisson work men of spare 
 build bear rapid decompression better than stout men. The 
 spinal cord is rich in fat-like substances (20 per cent). 
 Vernon suggests that this circumstance may account for the 
 frequency with which spinal cord lesions occur in caisson 
 workers, and if it could be shown that the bulk of the 
 nitrogen is absorbed by the tissues and not by the blood, the 
 view put forward by Vernon would be considerably strength- 
 ened. It is said that no actual intercellular or intracellular 
 liberation of air has been definitely proved to occur, but in 
 my experiments upon pithed frogs bubbles of air were fre- 
 quently seen outside the capillary blood-vessels as well as 
 inside of them, a circumstance which points to the absorption 
 of the dissolved gas and its subsequent liberation in gaseous 
 form by the intercellular liquid or lymph. The presence of 
 gaseous emboli in the blood-vessels is acknowledged to be 
 the main cause of the symptoms of caisson disease, but 
 microscopical examination of sections of liver and brain show 
 that the tissues themselves and the lymph that bathes them 
 had absorbed the gas, judging from the large number of 
 circular spaces created by the bubbling forth of the gas. 
 Vernon is of the opinion that the special liability of fat or 
 adipose tissue to injury on rapid decompression is probably 
 a resultant of two factors — " its greater solvent power and 
 relatively limited blood supply." More gas would be dis- 
 solved, which, owing to the scanty supply of blood-vessels, 
 would with difficulty be removed. 
 
 It was Paul Bert — a Frenchman — who put the pneumatic 
 theory of caisson disease upon a scientific basis. The bubbles 
 of air usually appear first in the venous side of the circulation. 
 When decompression is carried out slowly, nature provides 
 for the gradual escape through the lungs of the gases that 
 have been dissolved in the blood. This gradual escape 
 
CAISSONS AND COMPRESSED AIR 103 
 
 of gas through the lungs is the saviour of the individual. 
 The danger incurred by workmen in passing rapidly from a 
 high to normal atmospheric pressure is that bubbles of air 
 are liberated in the blood-vessels and in the tissues, that the 
 tissues are thereby starved or torn, and as a consequence 
 function is lost. This explains the paralysis of the limbs. It 
 would suggest, too, that if more time were spent over decom- 
 pression fewer accidents would occur, a view of the relation- 
 ship which we cannot but support. And yet serious cases of 
 compressed-air illness have occurred when men have not 
 worked under high pressures, say only 12 lbs., and when neither 
 the shifts have been too long nor decompression too rapid. 
 It is these cases that are difficult to explain, and towards the 
 elucidation of which Dr. George W. F. Macnaughton ^ has 
 submitted the theory of frictional electricity as a factor in 
 caisson disease. As the work of a caissonier is hard there is, 
 in consequence of the muscular exertion, a repleted condition 
 of the visceral veins as well as those of the cerebro-spinal axis. 
 When there is added to this circumstance the influence of the 
 two or three extra atmospheres of pressure in which the men 
 are working, the over-distended vessels create a local pressure 
 which interferes with the nutrition of the nerve cells ; to this 
 malnutrition the accumulation of the products of metabolism 
 in the perilymph contributes. There is thus induced, accord- 
 ing to Macnaughton, a local rise of acidity which is a stimulant 
 to the discharge of energy by those cells. Some writers have 
 attributed the muscular pains and " bends " to the accumula- 
 tion of carbonic acid and toxins generated during muscular 
 exertion. It is maintained that the caisson atmosphere is 
 charged with electricity carried in by droplets of water- 
 vapour. The man who is working in this atmosphere 
 " accumulates upon the body surface electricity which either 
 by directly permeating the tissue reaches, amongst others, 
 the nerve centres, or by acting upon the peripheral nerve 
 filaments or muscle end-plates stimulates these centres from 
 the afferent side. Although the amount of electricity be in- 
 sufficient to produce a conscious effect upon the exterior, the 
 nerve cells are thrown into a state of excessive activity, mani- 
 ' Lancet, August 18, 1906, p. 435. 
 
I04 DISEASES OF OCCUPATION 
 
 festing itself in discharges of a purposeless motor and sensory 
 nature, the 'bends' . . . the individual becoming polarised 
 in the caisson. When decompression in the air-lock takes 
 place, the rapid decomposition of electricity accompanying 
 this and the fall of electric potential cause a similar effect." 
 The personal equation is an important factor, for only thus 
 can be explained the circumstance of one man after an 
 exposure of one hour to a pressure of + 12 lbs. per square 
 inch suffering from caisson disease, while another may be 
 working for four hours in a pressure of 30 lbs. and not suffer 
 at all. The electricity of the atmosphere in the caisson is 
 hydro-electric in origin, and is due to the ordinary atmo- 
 spheric air which is sucked in through valvular openings 
 becoming compressed and propelled along several feet of 
 metal tubing, wherein through friction of the more or less 
 moist air against its walls, electricity is generated. The air 
 which at ordinary temperature and pressure is a feeble con- 
 ductor of electricity, obtains under pressure a heightened 
 conducting power, a power which is greater if the air be 
 moist. When men who had been tested by means of a 
 Kelvin galvanometer before going to work in a caisson were 
 examined after having been therein one hour, the deflections 
 of the mirror were always much increased. Macnaughton, 
 recognising the difficulty of explaining by the pneumatic 
 theory compressed-air illness occurring in men one to two 
 days after decompression, is of the opinion that the lesions in 
 the brain and spinal cord are the result of rupture or the 
 pressure effects of over-distended lymph vessels, an over- 
 distension which is the conjoined result of pressure upon the 
 body surface and the effect of muscular action upon the 
 circulation. There is great similarity, he maintains, between 
 the symptoms of a non-fatal lightning stroke and an attack 
 of caisson disease, the return shock of lightning being physi- 
 cally comparable to the changes which follow a too rapid 
 decompression after long exposure in a caisson. 
 
 Dr. Smith, of New York, attributed the illness to congestion 
 of the brain and spinal cord, while Dr. Corning, in the New 
 York Medical Record^ 1890, attributes it to anaemia of the 
 cord. It is clear from what has been stated in these pages 
 
^ CAISSONS AND COMPRESSED AIR 105 
 
 that there is still much to learn as regards the causes of 
 caisson disease. 
 
 In this country men seldom work in caissons in higher 
 pressures than 30 to 35 lbs. per square inch. That men can 
 endure much higher pressures has been proved by the experi- 
 ments of Messrs. L. Hill and M. Greenwood, junr.^ Pressures 
 varying from 75 to 90 lbs. were borne without any serious 
 discomfort or distress so long as the Eustachian tubes were 
 open and air could be swallowed. The period of compression 
 extended over 54 minutes, and the period of decompression 
 lasted 2 hours 17 minutes. Notwithstanding the length of 
 time spent in decompression neuralgic pains in the arms 
 were experienced. There was also considerable itching of 
 the skin of the arms. On one occasion a purpuric rash 
 appeared on the chest. Hill and Greenwood are of the 
 opinion that to prevent symptoms the men on undergoing 
 decompression should move their muscles and flex and extend 
 their joints so as to aid the capillary circulation. These 
 physiologists maintain that men can be submitted to a total 
 pressure of seven atmospheres, or 105 lbs., without any un- 
 toward effects so long as decompression is effected gradually. 
 
 Treatment is preventive and curative. The Dutch Govern- 
 ment has drawn out a series of excellent regulations for work 
 in caissons. Having visited the tunnelling operations in 
 Amsterdam necessary for the construction of a new railway 
 viaduct, and having inspected the caissons and seen the 
 conditions under which the men are working, I can bear 
 testimony to the care which is taken of the workmen by 
 the contractors, and have little hesitation in saying that the 
 Dutch regulations are well up to date. A similar remark 
 applies to the carefully drawn-up regulations which the 
 French Government has prepared for the guidance of 
 employers and workmen. Professor Langlois's paper is an 
 important literary contribution to the subject of compressed- 
 air illness. 
 
 At the time of writing the works at Amsterdam are not 
 yet finished. Dr. G. Waller has kindly favoured me with the 
 
 ^ Proceedings of the Royal Society, Series B, vol. 77, April, 1906, 
 p. 444- 
 
io6 DISEASES OF OCCUPATION 
 
 following facts. One hundred and twenty-five men have 
 been working in the caissons ; of these 55 have had slight 
 illness, most of these " bends," 9 have had ear trouble, i 
 symptoms of Meniere's disease, and i is deaf An important 
 innovation has been introduced whereby the compressed air 
 sent into the caisson is cooled by an ammonia process as in 
 the making of ice. This has answered most satisfactorily. 
 Men who are the subjects of nasal or laryngeal catarrh or 
 who, on medical examination, are found to have diseased 
 lungs or a weak heart, ought not to undertake caisson work, 
 nor should any one who is known to be an alcoholic be allowed 
 inside a caisson. All men ought to be primarily examined 
 by a doctor. Young men between the ages of twenty and 
 thirty, whose tissues are still elastic, men who are of rather 
 spare than stout build and who are of regular habits, are 
 the best subjects for caisson work. After the age of forty- 
 five experience has shown that the liability to caisson disease 
 increases. Too great attention cannot be paid to the evil 
 effects of alcohol as predisposing to compressed-air illness. 
 I have been particularly struck by this in looking over the 
 statistics and history of the fatal cases of caisson disease at 
 the River Hudson tunnel works. Workmen on being taken 
 on for the first time should have the dangers of the operations 
 fully explained to them. Since caisson disease is the result 
 of the liberation of gas in the blood and tissues, consequent 
 in many instances upon too rapid decompression, contractors, 
 engineers, and physiologists have given considerable attention 
 to this part of the subject in the hope of finding a remedy. 
 The greater the depth men are working at and the longer 
 the shift, the longer ought to be the time spent in decom- 
 pression. The difficulty is to get the men to conform to this. 
 Coming off the shift fatigued they are eager to get home, 
 and as the process of decompression is attended by a very 
 marked fall of temperature, the men, who are usually per- 
 spiring, feel chilly in the air-lock. In Amsterdam I found 
 the owners provided the workmen with a blanket to wrap 
 round their bodies in coming out of the air-lock. There is 
 no reason why this chamber should not be heated. This 
 would remove one of the causes of discomfort the men 
 
CAISSONS AND COMPRESSED AIR 
 
 107 
 
 complain of. Experienced workmen who know the dangers 
 of rapid decompression are careful enough, but inexperienced 
 men are disposed to run risks. One minute for every 
 5 lbs. of pressure was the time allowed at the King Edward 
 Bridge on the Tyne for decompression. It is short compared 
 with that recommended by Hill and Macleod, viz. : — 
 
 Atmosphere. 
 
 Pounds. 
 
 Shift. 
 
 Decompression Period. 
 
 + 2 
 
 30 
 
 4 hours 
 
 30 minutes to i hour 
 
 + 3t0 4 
 
 45 to 60 
 
 4 hours 
 
 I hour to 2 hours 
 
 + 5 
 
 75 
 
 I hour 
 
 I hour to 2 hours 
 
 + 6 to 7 
 
 90 to 105 
 
 i hour to I hour 
 
 2 hours 
 
 It would be difficult to restrain workmen this length of 
 time in the air-lock undergoing very gradual decompression. 
 The time spent by the workmen in the air-lock undergoing de- 
 compression should count as part of the shift. Wainwright, 
 although of the opinion that rapid " locking-out " is a cause 
 of caisson disease, and that if the process were sufficiently 
 prolonged it would probably prevent subsequent symptoms, 
 yet thinks that the three-quarters of an hour required to be 
 spent in coming out of a pressure of 30 lbs. is, from an 
 economic point of view, impracticable. He fails to see upon 
 what grounds the precise mathematical rules drawn out by 
 some writers are based. Slow decompression is most cer- 
 tainly called for, and yet it is known that men have made a 
 practice of suddenly passing from high to low pressure by 
 coming out of the caisson through the " material " or " muck " 
 lock without experiencing any bad effects. It is facts such 
 as these that the workmen point to as arguments against 
 gradual decompression and which make them impatient 
 when in the air-lock, and yet it would be unwise to allow 
 knowledge of the freedom from symptoms in workmen who 
 have occasionally adopted this unofficial method of exit 
 
io8 DISEASES OF OCCUPATION 
 
 from the caisson to alter our recommendation of slow 
 decompression. One minute for every 5 lbs. of pressure 
 worked well enough on the Tyne — one minute for every 
 3 lbs. of pressure would even be safer. Wainwright says 
 that at the Baker Street and Waterloo Railway tunnel 
 it was possible to "lock-out" of 30 lbs. pressure in one 
 and three-quarter minutes during the first three months of 
 the excavating, but that afterwards the exit tap was altered, 
 so that in order to leave the same pressure it required six and 
 a half minutes. The alteration did not in the slightest degree 
 alter the number or the severity of the cases. Snell, at the 
 Blackwall Tunnel, had similar experience of the men under- 
 going rapid decompression without suffering. 
 
 When " bends " or more serious symptoms appear in men 
 after they have left the air-lock, the best thing to do is to 
 recompress them. At all works there ought to be a medical 
 lock sufficiently large, so that the workmen can be laid in 
 the horizontal position, and it should be sufficiently heated, 
 so that all harmful influences of low temperatures may 
 be avoided. Immediately upon the development of severe 
 symptoms the workman should be placed in the medical 
 lock and recompressed. The treatment is so successful for 
 even muscular pains or " bends " that the men, knowing the 
 relief they obtain from it, frequently ask to be placed in the 
 medical lock and recompressed. Relief is often obtained 
 after the pressure in the medical lock has risen to 18 lbs. ; in 
 other instances not until it has risen to 25 lbs., or i or 2 lbs. 
 higher per square inch than the men had been working in. 
 After a patient has been recompressed for some time, the 
 pressure having risen to 20 or to 24 lbs., decompression 
 should be extremely slow — an hour or even more should be 
 spent in the process; or in other words, three minutes for 
 every i lb. of pressure. The fact that symptoms do not 
 develop for an hour or more after a workman has left the 
 caisson, probably when he has got home, is no reason why 
 he should not be taken back to the works, in a conveyance 
 if possible, and placed in the medical lock and recompressed. 
 Where no medical lock exists the ordinary air-lock can be 
 utilised for the purpose of recompression, but the chamber 
 
CAISSONS AND COMPRESSED AIR 109 
 
 ought to be heated. Where patients are being treated at 
 home or in hospital for *' bends," the muscular pains may 
 sometimes be so severe as to require the administration of 
 morphia hypodermically. Other symptoms must be treated 
 on their own merits. 
 
 It has been suggested by H. Von Schrotter that caisson 
 workers should wash out the nitrogen absorbed during their 
 work in high-air pressures by breathing pure oxygen for 
 five minutes before entering the air-lock of decompression. 
 Theoretically correct, the method has been proved to be 
 experimentally efficient in preventing death from air em- 
 bolism. It would be unsafe to allow oxygen to be used 
 if men were working at pressures above 50 lbs., since 
 symptoms of oxygen poisoning in the form of convulsions 
 might develop. 
 
 Divers 
 
 Men who are engaged in diving for pearls and sponges, 
 who are employed in searching for treasure in sunken ships 
 or in deepening harbours by blasting rocks, run risks to 
 health and life. When native pearl divers have once got 
 over the initial pains in the ears and discomfort in the head, 
 which all these men more or less experience, they can remain 
 below the water for a sufficient length of time without 
 artificial assistance in order to secure a few oysters, but they 
 have to be careful of an open oyster closing and gripping 
 their hand, for the grip when it occurs may mean to these 
 men death by drowning. 
 
 Pearl divers off the coast of Australia occasionally go to a 
 depth of 100 to 125 feet, but at this depth they can only 
 remain a very few minutes. Salvage divers have recovered 
 treasure at a depth of 160 feet without injury. Dr. Alfred 
 Parkin, of Newcastle-on-Tyne, in his "Thesis on Caisson 
 Disease," states that the greatest diving feat ever accomplished 
 is that by Hooper, who made seven descents to depths of 
 201 feet (87 lbs. pressure to the square inch), and on one 
 occasion remained underneath 42 minutes. In order to 
 become accustomed to changes of pressure and to obviate 
 immediate risks to life, a certain amount of time has to be 
 
no DISEASES OF OCCUPATION 
 
 allowed both in descending and ascending. Neither must be 
 rapidly done. Two feet per minute is the recommendation 
 for the descent and ascent of divers when the depth does not 
 exceed 80 feet, but as the depth increases so longer time 
 must be allowed. A few minutes longer should be spent 
 in ascending than in descending. 
 
 Sponge seekers, the scaphandriers of French authors, also 
 run considerable risks. Not a year passes without several 
 lives being lost. Through the kindness of Dr. Stef Zog- 
 rafidi, surgeon to the Royal Grecian Navy, who has been 
 in charge of the temporary hospital at Tripoli, Africa, 
 and whose microscopical sections and drawings of the 
 pathological lesions met with in the spinal cord of deceased 
 sponge divers I have had the opportunity of examining, 
 I am able to give some of the information he has gained 
 in his researches upon 290 clinical observations and seven 
 post-mortem examinations. It was Leroy de M^ricourt, of 
 the French Navy, who, in 1869, first drew attention to the 
 dangers incurred by sponge divers by too rapid atmospheric 
 decompression. Scaphandriers wear the diving dress in- 
 vented by Denayrouse. Zografidi speaks of three forms of 
 disease occurring in sponge divers as the result of rapid 
 decompression, {a) the acute or lightning form, which ends in 
 death ; or {b) passes into the chronic state, accompanied by 
 spasms ; and {c) the mild form, which is fleeting in its 
 duration. In the acute form death may be immediate, or if 
 life continues for a time, there is a typical myelitis or 
 inflammation of the spinal cord with fever and complete 
 paralysis of the limbs. This form also usually ends in rapid 
 death, or it is succeeded by chronic spasm of the limbs 
 attended by loss of power. In the milder form of the 
 malady the phenomena may pass away without leaving any 
 trace of their existence. After a long stay at the bottom of 
 the sea under a high pressure, the sponge diver, if he makes 
 too rapid an ascent to the surface and thus undergoes 
 too sudden decompression, may die immediately. In the 
 worst forms of this malady the whole body is swollen and 
 emphysematous, owing to the presence of air in the tissues ; 
 blood oozes from the nose, mouth, ears, and eyes, and there 
 
CAISSONS AND COMPRESSED AIR iii 
 
 are small haemorrhages into the skin. These cases, fortu- 
 nately, are rare. A less acute form, on the other hand, is not 
 uncommon. Sponge divers descend three or four times a 
 day, with the exception of Sunday, to depths varying from 
 lOO to 250 feet. Under a low pressure they remain working 
 for 40 to 60 minutes, under a higher pressure they stay a 
 shorter time, but under all circumstances, Zografidi says, 
 they come up far too quickly. The men live on board of 
 small ships, and overcrowding is common. The ventilation 
 of their sleeping-rooms is bad. Fatigued with the hard work 
 of the day performed under the rays of an African sun, badly 
 fed, for they live upon preserved foods which are highly 
 salted and cause constipation, these unfortunate men, during 
 six months of the year, follow a dangerous occupation both 
 on the surface and at the bottom of the Mediterranean. 
 The accidents to which they are liable are the same as those 
 met with in caisson workers. Under high pressures the 
 atmospheric air is dissolved in the blood and tissues, and 
 during sudden decompression there is a rapid disengagement 
 of the gas in the form of bubbles, which block the blood- 
 vessels and tear the tissues. It is during decompression that 
 danger is incurred. Sponge seekers who ascend too quickly 
 to the surface of the water frequently complain of intense 
 pain throughout the body, especially in the trunk, of derange- 
 ments of sight and hearing, tingling in the limbs, followed 
 shortly afterwards by paralysis. If it is a more severe attack 
 there is loss of consciousness. After persisting for a few 
 hours, the paralysis in some instances disappears for half an 
 hour or longer, during which the sponge diver may get up 
 and walk about feeling well, but a few minutes afterwards the 
 tingling in the limbs returns, followed by loss of power in the 
 limbs. For the next two or three weeks the patient lies a 
 helpless wreck, paralysed in his lower extremities and with 
 sensation abolished, complaining of a painful girdle sensation 
 round the waist and retention of urine followed by inconti- 
 nence. Fever develops, pus appears in the urine, and bed- 
 sores form. The man dies from exhaustion and septicaemia, 
 and in his spinal cord are found areas of inflammation and 
 softening similar to those met with in caisson workers, and 
 
112 DISEASES OF OCCUPATION 
 
 due to the presence of bullae of air and small haemorrhages 
 the result of the sudden liberation of gas. Dr. Zografidi says 
 that the lightning form of the malady is always fatal, that in 
 the acute form the mortality is 70 per cent, while in the 
 mild form recovery is the rule. As regards treatment, there 
 is, practically speaking, none beyond attention to general 
 details. Oxygen is without any special influence. Zog- 
 rafidi has administered the gas to patients, who have died, 
 and he has withheld it, and patients have recovered. The 
 treatment of the paralysis is simply that of symptoms as 
 they arise. Prevention is better than cure. When the 
 decompression is not too rapid there are no accidents. 
 Owing to the special mechanism of the diving apparatus 
 invented by M. Shidlowski, of the Russian Navy, decom- 
 pression in this apparatus can only occur slowly and 
 gradually. Its use has been attended by good results. 
 
 The divers attached to the British Navy, and the men who 
 follow diving for a living, wear a special dress and helmet. 
 The dress may be either a " close " or " open " suit. The 
 close suit is an air-tight indiarubber costume the shape of the 
 body. Upon the upper part is screwed the headpiece with 
 its window for seeing through. Attached to the headpiece is 
 a conduit pipe for the fresh air, which is pumped in under 
 pressure. By means of a valve the escape of the surplus and 
 foul air is provided for. The whole body is under the 
 influence of compressed air ; but in the " open " suit, only the 
 head of the diver is covered by a helmet screwed on to a 
 jacket, and, as a consequence, the abdominal viscera may be 
 exposed to considerable pressure. The air escapes from 
 underneath the jacket too, so that if a diver falls his life is 
 endangered. 
 
 Diving is now a recognised requirement in the British 
 Navy. Before men can become qualified as divers they must 
 give evidence of having dived to the depth of 1 20 feet and have 
 shown themselves capable of being able to bear a pressure of 
 52 lbs. to the square inch. Apart from possible accidents 
 arising through failure of the pumped-in air reaching the 
 diver when at work, the principal danger lies in the ascent 
 being made too quickly. When this has taken place, the 
 
CAISSONS AND COMPRESSED AIR 113 
 
 change from a compressed to ordinary atmospheric pressure 
 has been too sudden, and, as a consequence, divers become 
 unconscious or are found paralysed in their extremities, hence 
 the name given of divers' paralysis to the malady. When 
 divers have been pulled up too rapidly on board of ship 
 some of them have died, and at the post-mortem examination 
 the blood in the body has been found to contain bubbles of 
 air. The spinal cord on section has been found lacerated, 
 its small blood-vessels torn and bubbles of air readily 
 recognisable. 
 
 In the Statistical Report of the Navy for 1900, Fleet- 
 Surgeon Archibald McKinlay, R.N., tells of a man who 
 dived for a torpedo in 24J fathoms of water at Lamlash, 
 Arran. He took 40 minutes to go down, remained at the 
 bottom 40 minutes, and took 20 minutes to come up. The 
 ascent was made by the seaman himself slowly, steadily, and 
 without any hurry. He climbed up the ladder on the side of 
 the boat himself On the removal of the face-plate of the 
 helmet the diver said he felt all right. He began to give a 
 detailed account of what he had done ; was sensible and 
 cheerful and joked with the other men. About 8 minutes 
 after coming out of the water he was suddenly seized with 
 pain at the stomach and begged that the doctor might be 
 sent for. Immediately afterwards he slid down and became 
 unconscious. When Fleet-Surgeon McKinlay saw him he 
 was comatose, "skin was cyanosed and his breathing ster- 
 torous, laboured, and difficult. His lips were blowing and 
 covered with froth." He died about 1 5 minutes after coming 
 out of the water, i.e., 7 minutes after the commencement of 
 his symptoms. At the post-mortem examination, which was 
 made on the following day, a large quantity of dark fluid 
 blood escaped from the vessels on the surface and base of the 
 brain. Nothing abnormal was detected in the substance of 
 the brain itself, but the veins of Galen, those on the surface 
 of the brain and of the choroid plexus contained bubbles of 
 air. The lungs were absolutely healthy and not the least 
 engorged. The veins on the surface of the heart had a 
 beaded appearance due to bubbles of air within them. On 
 opening the right ventricle of the heart air came out with a 
 
114 DISEASES OF OCCUPATION 
 
 puff, and internally there was found a small quantity of black, 
 frothy blood. The left heart was empty ; the heart itself 
 and valves were healthy. The liver was dark and engorged ; 
 on section the cut surface exuded large quantities of froth. 
 The spleen was dark and contained frothy blood. From the 
 cellular tissue in the subcutaneous fat of the body there 
 escaped bubbles of air. 
 
 This man had been working at a pressure equal to 4J 
 atmospheres. It is interesting to note that two days previous 
 to the occurrence of this accident another able-bodied seaman 
 of the same battleship — H.M.S. Howe — descended to exactly 
 the same depth, was at the bottom for 22J minutes, took 
 18 minutes to ascend, experienced no inconvenience at the 
 time, and had no bad effects afterwards. 
 
CHAPTER IV 
 
 DISEASES DUE TO DIMINISHED ATMOSPHERIC PRESSURE 
 
 ON the surface of the earth at ordinary levels man is 
 living under a pressure of 15 lbs. aerial pressure to 
 the square inch. He is no more conscious of this weight 
 than when bathing he dives a few feet below the surface of 
 the water. So elastic is the vital resistance of the human 
 body that man can ascend to considerable heights or descend 
 to great depths without discomfort, and even without serious 
 risks, so long as certain precautions are observed. There are, 
 however, limits to these attainments. The man who is 
 climbing an Alpine peak has to lift his body a few thousand 
 feet through an atmosphere that becomes rarer as he ascends, 
 and as a consequence his heart beats more vigorously and 
 even unpleasantly, and there is a sense of difficulty of 
 breathing. There are added to the muscular effort of lifting 
 the body through space the difficulties of getting oxygen 
 into and carbonic acid out of the system. On reaching the 
 summit men have been known to bleed from the nose. 
 Although it cannot be stated that death has been caused by 
 diminished atmospheric pressures at great heights, yet it has 
 been shown experimentally in animals that coma is induced 
 which may end in death. It is just a question how far the 
 sudden supervention of cardiac and cerebral symptoms in 
 mountain-climbers may not be responsible for some of the 
 fatal accidents that occur from time to time on the Alps. 
 
 Altitude modifies the ordinary functions of the body in 
 many ways. Such influences are in operation, for example, 
 as diminution of atmospheric pressure or of oxygen tension, 
 
 115 
 
ii6 DISEASES OF OCCUPATION 
 
 cold, atmospheric electricity, and luminosity. The effect 
 of luminosity is not exactly known. At high altitudes 
 the atmosphere is more highly charged with electricity 
 than is the air of the plains. It is not known what is 
 the effect of this upon the body, nor of the light of high 
 altitudes, which is rich in ultra-violet rays, the chemical 
 activity of which is intense — a circumstance which, while 
 explaining the frequency of the inflammatory redness of 
 the skin of Alpine climbers, confers upon mountain air its 
 purity and its freedom from germs. By these rays the 
 air is rendered sterile. High up on a mountain-side the air 
 is less dense, so that the same volume of air represents a 
 smaller quantity of oxygen than in the plain. One might 
 well ask, in view of this new respiratory medium, whether 
 there is any change in the chemistry of respiration. To 
 answer the question it is necessary to distinguish between 
 respiration in the state of repose and in movement. Accord- 
 ing to Zuntz, Lowy, Miiller, and Caspari ^ the number of 
 respirations in a state of repose is not increased, but the 
 amplitude of the respiration is augmented. The volume of 
 air inspired is greater per minute, but the quantity of oxygen 
 absorbed, if its volume is reduced to a pressure of 760 mm. 
 of mercury, does not vary. During muscular exercise the 
 number of respirations increases. The volume of air inspired, 
 and consequently the volume of oxygen absorbed, reduced to 
 760 mm. of mercury, is much greater at high altitudes than 
 it is in the plains for the same effort. Zuntz's experiments 
 offer a physiological explanation of the breathlessness that 
 occurs at high altitudes. Fatigue is increased not only from 
 the fact of the chest being in one sense overworked, but 
 because the products of organic combustion are increased 
 and the circulation of these waste products in the system is 
 a cause of fatigue. Auto-intoxication due to overwork 
 readily develops after excessive exercise and betrays itself 
 by insomnia and loss of appetite. It is apparent that if the 
 effort which is exerted at high altitudes is greater than that 
 required in the plains, the demand must be met by increased 
 
 * "Hohenklima und Bergwanderungen in ihrer Wirkung auf den 
 Menschen," Berlin, 1905. 
 
DIMINISHED ATMOSPHERIC PRESSURE 117 
 
 food, less of the nature of albumins than of carbohydrates 
 and fats. At very high altitudes the quantity of oxygen in 
 the air is insufficient for breathing purposes. In a similar 
 way when men undergo too violent exercise the demand 
 made by the body for oxygen is so great that the lungs 
 cannot inhale air quickly enough. The result is the same in 
 the two cases. There is anoxaemia, or what is sometimes 
 called "le mal des montagnes." 
 
 Professor Mosso, of Turin University, whose work on 
 " Fatigue " is well known, is rather opposed to the interpreta- 
 tion of the results by Zuntz. At great heights the respiration 
 occasionally takes on the Cheyne-Stokes type, i.e.^ a series of 
 short and rapid inspirations gradually becoming slower and 
 deeper and finally ceasing for a few seconds, only for a series 
 of similar cycles to be repeated. This peculiar type of 
 respiration has been attributed by Professor Mosso to a 
 diminution of carbonic acid in the blood, for by giving 
 inhalations of carbonic acid Cheyne-Stokes' respiration dis- 
 appears. According to Mosso "le mal des montagnes," or 
 mountain-sickness, is due to a deficiency of carbonic acid in 
 the blood — a condition named by him acapncea. Zuntz, on 
 the other hand, maintains that there is sufficient carbonic 
 acid in the blood to excite the respiratory centre to action, 
 and that inhalations of carbonic acid do not dispel the 
 symptoms of mountain-sickness. Oxygen alone can do this. 
 At high altitudes man consumes more oxygen. The 
 increased frequency of respirations is one of the most striking 
 manifestations of the need of oxygen, and the increase in the 
 number of the beats of the heart is a physiological conse- 
 quence. To send the oxygen all through the body the heart 
 must beat faster. In repose the heart beats slowly and at 
 a certain rate — say 64 to 72 per minute — but a man has 
 only to undertake a fatiguing walk for the pulse to rise 
 to 120 or more per minute. Living at high altitudes is 
 difficult and trying to persons who are the subjects of 
 valvular disease of the heart. In health the heart and lungs 
 at high altitudes adapt themselves to the rarefaction of the 
 oxygen, and the blood behaves in a similar manner. By 
 degrees there is established an increase in the number of the 
 
ii8 DISEASES OF OCCUPATION 
 
 red corpuscles of the blood, as well as of their colouring 
 matter or haemoglobin. 
 
 If I were to seek for an application of this physiological 
 knowledge I could not do better than refer to the experience 
 of persons who have travelled in trains at great altitudes. 
 Some of the mines in Peru and Bolivia are high up on the 
 mountains. Mr. Thomas Thomson, mining engineer of the 
 firm of Messrs. Pearson and Company, London, tells me 
 that in order to reach the great tableland of Peru the train 
 rises i in 25 to 15,600 feet, and that at 13,500 feet mountain- 
 sickness commences in the railway travellers with a sense of 
 headache followed by a feeling of sickness, but there is no 
 vomiting. There is a rush of blood to the head and flushing 
 of the face, which travellers feel would be relieved if the nose 
 would only bleed. Mr. Thomson's own pulse usually rose 
 to 88 per minute and the respirations were proportionately 
 quickened. 
 
 The men who work at the copper-mines at Cerro de Pasca, 
 situated 16,000 feet above the sea-level, cannot follow the 
 occupation long. They can only work for a few months at a 
 time, when they are obliged to cease and return to their 
 farms. The men work an eight hours' day in the mines. 
 The influence of acclimatisation and heredity is noteworthy. 
 The native labourers, who are Spaniards or of Spanish 
 descent and who have been born at, comparatively speaking, 
 high altitudes, bear the work better than other men. They 
 can work longer without breaking down in health. White 
 men, Europeans, cannot work at all in these mines, but they 
 can superintend the work for about a year. The ordinary 
 miners do not die from the effects of working under these 
 conditions ; they relinquish the work too soon for functional 
 or organic disease to be established. At Cerro de Pasca the 
 miners call the mountain-sickness sorroM, The 50 to 100 
 feet that the men go down into the mines has little effect 
 in diminishing the effects of the great altitude already 
 mentioned, viz., 16,000 feet. 
 
 What has been said of mountain climbing and of living 
 and working at high altitudes applies to some extent to 
 aeronauts. The only difference is the absence of muscular 
 
DIMINISHED ATMOSPHERIC PRESSURE 119 
 
 fatigue, but against this must be placed the rapidity of 
 change of atmospheric pressure. If the ascent is made very 
 rapidly the system may have some difficulty in accommo- 
 dating itself to changes of pressure. There is, too, the 
 influence of exposure to greater cold. Persons ascending in 
 balloons should dress warmly, and they ought to take with 
 them cylinders filled with compressed oxygen. It remains 
 yet to be seen what part balloons will play in military 
 warfare. Both in the French and German Armies there have 
 been several deaths of soldiers from poisoning by arseniu- 
 retted hydrogen. The hydrogen used for inflating balloons is 
 obtained by acting upon zinc with sulphuric acid, but as the 
 sulphuric acid is manufactured from pyrites which fre- 
 quently contains 2 to 5 per cent, of arsenic, the impure 
 hydrogen cannot but be inhaled during the filling of the 
 balloons, and to this circumstance must be attributed the 
 poisoning that occurs. The symptoms commence with a 
 sense of malaise and nausea, followed later on by jaundice. 
 The urine becomes dark and blood-coloured, and may 
 contain albumen. Only pure hydrogen should be used for 
 the purpose of inflating balloons. 
 
CHAPTER V 
 
 CHEMICAL TRADES 
 
 UNDER the heading of chemical trades will be in- 
 cluded principally the manufacture of chloride of 
 lime, bleaching powder, sulphuric and hydrochloric acids. 
 These are usually produced in one and the same factory 
 as parts of one process. It is unnecessary to describe in 
 detail the methods of manufacture known as the Le 
 Blanc process, the Weldon and the Deacon process. Only a 
 brief mention is possible. In the manufacture of soda or 
 salt cake common salt is acted upon by oil of vitriol 
 (sulphuric acid). When these are mixed together and 
 raked on the bed of a furnace large quantities of hydro- 
 chloric acid are evolved, the vapour of which when breathed 
 has a strong irritating influence upon the respiratory 
 mucous membrane. This circumstance renders it impossible 
 for the workmen to remain exposed to the vapour for any 
 length of time, or to the gas which is given off when the 
 salt cake thus formed is raked from the furnace into the 
 barrows and wheeled away to undergo another operation 
 in a different part of the factory. In order to protect 
 himself from the hydrochloric acid fumes the workman 
 wears folds of flannel round his face, for the acid fumes 
 quickly destroy the teeth. As the work in the furnace 
 department is hot the men perspire freely, and conse- 
 quently run the risk of becoming chilled and of catching 
 cold. When the chemical industry on Tyneside was more 
 prosperous and gave employment to a larger number of 
 persons than at present we were seldom without chemical 
 labourers in the Royal Infirmary as in-patients. They 
 were the subjects of chronic bronchitis with asthma and 
 
CHEMICAL TRADES 121 
 
 emphysema of the lungs. The hours of the men em- 
 ployed in chemical factories are long, and in their work 
 they are exposed to high temperatures. There are, there- 
 fore, many inducements to the men to become intemperate 
 as regards the use of alcohol. Many of the men drink 
 freely, for their wages are good. 
 
 After the salt cake leaves the furnace it is mixed with 
 limestone and coal in a black ash furnace, and after being 
 heated and stirred in the furnace a sufficient length of time the 
 mixture is poured out in a molten form, cooled, broken up, and 
 the soda dissolved out from it. This soda may be converted 
 into soda-ash, soda crystals, or caustic soda. For the produc- 
 tion of caustic soda the operations required involve boiling, 
 furnacing, and other processes. When the caustic soda is 
 in solution in large iron cauldrons and is hot it is apt to 
 spurt and cause serious burns. In order to prepare bleaching 
 powder slaked lime must be exposed to the freshly prepared 
 chlorine gas obtained from hydrochloric acid given off during 
 the operations at the salt-cake furnace. For a bleaching 
 powder to be successful it ought to be capable of retaining 
 38 per cent, of chlorine gas. This is not readily secured ; 
 besides, when it is obtained the bleaching powder keeps 
 constantly parting with its chlorine. Bleaching powder with 
 less than 35 per cent, of chlorine does not sell well. It is, 
 therefore, most important for the manufacturers to succeed in 
 obtaining the extra 2 or 3 per cent, of chlorine. In the 
 manufacture of bleaching powder by the Weldon process 
 there is always a high percentage of chlorine present in the 
 gas, and the method of manufacture is slightly different. 
 Lime is spread upon the lead floor of large chambers, into 
 which chlorine gas is passed. The doors are closed for three 
 days, during which chlorine enters. The gas is absorbed. 
 When the conversion of the lime into bleaching powder has 
 been effected workmen enter the chamber. The mouth is 
 protected by several rolls of flannel, but the nostrils are free. 
 Leather goggles are worn to protect the eyes. The men 
 shovel the powder through holes in the floor into casks under- 
 neath. The packing of the bleach is an unpleasant occupa- 
 tion. The men wearing the rolls of flannel round their face 
 
122 DISEASES OF OCCUPATION 
 
 take care to breathe through the mouth, and only allow the 
 expired air to escape through the nostrils. Thus protected, 
 and accustomed to breathe in the manner stated, a man may 
 be able to stay in a bleach chamber for twenty minutes 
 to half an hour or longer, during which time he is shovelling 
 the bleach powder, but it is desirable that the workman 
 should come out of the chamber into the open air every half 
 hour and stay outside a short time before returning. 
 
 Most of us are familiar with the odour of chlorine. The 
 gas has not only an irritating effect upon the respiratory 
 mucous membrane, which may continue for several days, but 
 it may also cause vomiting. In what is called the "gassing" 
 of chemical workers, the symptoms are irritation of the 
 bronchial tubes, a feeling of suffocation, and vomiting, 
 symptoms fortunately of temporary duration, but which if 
 often repeated may lead to structural alterations of the 
 bronchial tubes and emphysema of the lungs. 
 
 Sulphuric acid is usually manufactured in the same 
 chemical factories as soda. Sulphur, or sulphide of iron, is 
 burned with the liberation of sulphuretted hydrogen. This 
 gas is carried away into lead chambers, where it is brought 
 into contact with air, steam, and nitrous fumes obtained 
 by acting upon sodium nitrate with sulphuric acid. Although 
 this is not such a hard occupation as the making of salt cake, 
 the men who work at the pyrites furnace where the sulphur is 
 given off are exposed to some extent to sulphur dioxide and 
 to occasional nitrous fumes. These gases are irritating to 
 the respiratory mucous membranes, and have much the 
 same effect as chlorine and hydrochloric acid. 
 
 The Le Blanc process has had a lengthened career, but 
 soda and chlorine can be produced by other methods, such 
 as the electrolysis of salt. The passage of an electric 
 current through salt solution breaks up the salt into 
 chlorine and caustic soda, and when this decomposition 
 has been effected the liberated chlorine can be led away 
 for the purpose of making bleaching powder. Methods of 
 manufacture die hard. There are indications that so long 
 as there is the great demand for salt cake for making glass 
 the Le Blanc process will probably continue. 
 
CHEMICAL TRADES 123 
 
 Electrolytic methods are, however, gradually making pro- 
 gress in the manufactures, for by them there is often a saving 
 of time. They are not always free from risk to health. In 
 the manufacture of chloride of calcium, also of chloride of 
 sodium and potassium by electrolysis, a peculiar skin eruption 
 appears on the workmen. This dermatitis, which has only 
 been detected during the last six or seven years, was first 
 noticed among the men employed at Griezheim Factory in 
 Germany. Since then the workmen employed at Motte- 
 Breuil, in France, have also suffered. The malady is attri- 
 buted to the hypochlorite of soda that is formed. The 
 dermatitis usually affects young workers who have been in 
 the factory a few days or weeks. It commences on the face 
 by a crop of acne spots, and is attended by redness and 
 oedema recalling erysipelas. The redness and swelling are 
 pretty evenly distributed all over the face ; the lobule of the 
 ears is implicated and the eyelids are cedematous. Once 
 the dermatitis has obtained a thorough hold the eruption 
 may last for as long as fifteen days, and in disappearing 
 leaves behind a few hard nodules and comedones on the 
 skin. The swollen eyelids frequently become itchy and 
 secrete a thin, purulent liquid, while the whites of the eyes 
 becomes red and cedematous. Cough with laryngeal and 
 bronchial irritation may be present. There is dyspepsia 
 with loss of appetite. Emaciation is progressive, and there 
 is extreme muscular and nervous debility. So marked is the 
 tendency to sleep that many of the patients can hardly keep 
 awake. The best treatment is the open air. As preventives, 
 the ventilation of the factory should be good ; the men 
 should freely use soap, and wash in water acidulated with 
 sulphuric acid, before leaving work. The application of 
 vaseline to the unprotected parts of the body when at work 
 is also well worthy of a trial. 
 
 Taking chemical workers as a whole it may be said that 
 the younger men are not an unhealthy class. They become 
 bronchitic and asthmatic as they grow older, and this too at 
 a comparatively early age. Chemical workers on the whole 
 enjoy good health until the age of 35, but after this the 
 death-rate rises so that by the time they reach the ages of 45 
 
124 DISEASES OF OCCUPATION 
 
 to 55 the mortality rate of chemical workers is double that of 
 men who follow an out-door occupation. Diseases of the 
 respiratory system contribute largely to the high death-rate. 
 
 Nitrous and Nitric Acid Fumes 
 
 In the process known as "carotting" in the manufacture 
 of felt hats from rabbits' skins the teeth of the workers 
 become much affected {vide article " Mercury "). The skin 
 is stretched upon a bench, and rubbed vigorously by the men, 
 who keep dipping their brushes into a solution of nitrate of 
 mercury. Occasionally the workmen make their own solution 
 of mercury by dissolving 8 parts of quicksilver in 64 of 
 nitric acid and then adding 4 of arsenic and 4 of corrosive 
 sublimate. In preparing the solution the nitrous vapours 
 that are evolved cause considerable cough and irritation of 
 the lining membrane of the bronchi and lungs, and this may 
 sow the seeds of future pulmonary trouble. 
 
 The acid fumes are of themselves dangerous. I can recall 
 the occasion of a large fire in a chemical stores in New- 
 castle, when one of the firemen who were exposed to the 
 nitrous and nitric fumes died a few days afterwards from a 
 peculiar form of inflammation of the lungs. Most of the 
 serious cases of nitric acid poisoning have arisen from acci- 
 dental breathing of gases containing fumes. In chemical 
 factories the men who work at the pyrites burners, in 
 addition to being exposed to heat and cold, are brought into 
 contact with sulphur dioxide, nitrous fumes, and other gases, 
 all of them more or less irritating to the throat and lungs. 
 Men employed in the manufacture of arsenic, arseniate of 
 soda, picric acid, and in the manufacture of jewellery, 
 especially the refining of the precious metals, are occasionally 
 brought into contact with the fumes of nitric acid, but in a 
 large proportion of the cases in which poisoning by fumes 
 has taken place it has been through the accidental and 
 unexpected escape of the vapour, inhalation of which causes 
 cough, dryness of the throat, and sense of suffocation. A 
 man who has inadvertently inhaled the fumes of nitrous or 
 nitric acid may not exhibit any symptoms immediately, and 
 
i 
 
 CHEMICAL TRADES 125 
 
 yet within from 24 to 48 hours he dies from acute con- 
 gestion of the lungs, preceded by an abundant expectoration 
 of thin, yellow material. The intelligence is retained to the 
 last. At the post-mortem examination of the body the 
 lungs are found to be intensely congested ; there may be 
 patches of reddish brown discoloration, in other words a 
 patchy distribution of congestion which is always suggestive 
 of the action of a toxic gas. The blood that is squeezed 
 from the lungs is blackish brown. Nitrogen peroxide (NO2) 
 is clearly, therefore, a strong and dangerous irritant to the 
 bronchial and pulmonary mucous membranes. It produces 
 small foci of pulmonary congestion, and it causes the blood 
 to become of a deep brown colour. The treatment — and it 
 is seldom successful — is to overcome the painful condition of 
 the throat and windpipe by the use of soothing gargles, 
 and the bronchitis and pneumonia by the inhalation of 
 oxygen. 
 
 Aniline 
 
 In the black dyeing of alpaca goods, aniline oil, when acted 
 upon by hydrochloric acid, gives off fumes which cause the 
 workmen to be ill. This method of dyeing cotton goods 
 has been, in consequence, almost entirely abandoned. 
 Aniline salt, which is obtained from aniline oil and is a 
 dirty yellow-white crystalline substance, is instead usually 
 mixed with the hydrochloric acid. In the Manchester 
 factories the solutions used are aniline salt, prussiate of soda, 
 and chlorate of soda as an oxidising agent. The cotton web, 
 after passing through a trough containing the solution, 
 travels onwards through a long, heated chamber. At this 
 particular stage of the dyeing the men frequently suffer from 
 the great heat and from the dust that is given off from the 
 cloth. This part of the machinery ought to be protected 
 by a hood, up which there should be a strong draught of 
 air. The cotton cloth does not at once become black on 
 being passed through the solution, but as it travels onwards 
 it becomes black by exposure. The cloth, in travelling 
 through an oven of indigo and steam, undergoes what is 
 known as " ageing." From this it passes through a solution 
 
126 DISEASES OF OCCUPATION 
 
 of bichromate of soda. It is after receiving this immersion 
 that the black colour becomes fixed in the cloth. On exam- 
 ining the hands of the men who work at the bichromate 
 trough I have not found evidence of any induration of the 
 skin or of cracks upon their hands. The colour can be fixed 
 by such other substances as tannin and tartar emetic. In 
 one of the large dyeworks near Paris which I had the oppor- 
 tunity of visiting the process was slightly different. The 
 cotton web passed first through a solution of aniline salts, 
 and after travelling a short distance passed through a second 
 bath containing chromate of soda. Afterwards it kept 
 moving onwards through hot chambers to be dried. Where 
 more expensive aniline dyed goods are wanted the cotton, 
 after its dip in the aniline salt solution, travels onwards 
 through a heated chamber, and in doing so the cloth be- 
 comes olive green in colour through oxidation by the hot air. 
 It is then dipped in the chromate bath and dried. The 
 product thus obtained is said to be more durable than that 
 got by the first method. 
 
 In what is called para red dyeing, the ingredients used 
 frequently cause symptoms similar to those induced by 
 aniline oil. The men experience headache, become sick, and 
 are mildly intoxicated. They have to be taken out into the 
 fresh air. The para red powder used in English dyeworks 
 is a proprietary chemical compound obtained from Germany. 
 The men who mix this material in the dyeworks, as well 
 as those who throw the plastic stuff upon the cloth, suffer. 
 The former are obliged, when scooping out the dry powder 
 from the casks, to wear respirators. Para red is used for 
 dyeing flannelette, which is nothing else than cotton cloth, 
 one surface of which has been picked by sharp points and 
 caused to be fluffy like flannel, but in which there is 
 no wool at all. As I have mentioned flannelette, I need 
 only add that it is an extremely inflammable substance 
 and as it is cheap and frequently forms the underwear and 
 nightdresses of children, it has been, and still is, every year, 
 unfortunately, the cause of death of large numbers of 
 children by their garments catching fire. 
 
 The symptoms of aniline poisoning are headache, drowsi- 
 ness, a feeling of sickness with loss of appetite, shortness of 
 
CHEMICAL TRADES 127 
 
 breath, palpitation, and a tingling sensation in the feet and 
 legs. Dr. Walter Maiden ^ on examining the blood of aniline 
 workers did not find that it gave the spectrunn of met- 
 haemoglobin, but this is not surprising, as the band of 
 met-haemoglobin can hardly be detected unless this sub- 
 stance is present in at least the proportion of i to 10 
 of oxy-haemoglobin. Nor was there evidence of blood 
 destruction to any extent, judging from the fact that the 
 blood counts showed a normal average of red corpuscles. 
 The colouring matter was reduced in amount, but the 
 proportion of white corpuscles was not excessive. Maiden 
 is of the opinion that if there is a destruction of red 
 corpuscles in aniline poisoning it is counter-balanced by a 
 renovation of corpuscles, which, as it proceeds more rapidly 
 than the formation of haemoglobin, causes the colour index 
 to be lower than in health, while the presence of basophil granu- 
 lations in the red corpuscles points to imperfect formation of 
 these cells or suggests that they are undergoing degeneration. 
 
 The health of workers in aniline has of late years much im- 
 proved. During the summer months the workmen are apt to 
 suffer most. The severe headache, vertigo, and sickness may 
 not come on until they have left the factory and reached home. 
 
 Attention has frequently been drawn to the sudden develop- 
 ment of rather alarming symptoms, especially in young 
 children, the cause of which for a long time was obscure, but 
 which is now known to be the use of a liquid rich in aniline oil 
 for polishing the brown and fawn coloured boots and shoes 
 that are so much worn at present. Children, when out 
 walking with their nurses, have become rapidly blue in the 
 face (cyanosed), the subjects of difficulty of breathing and of 
 extreme muscular debility followed by somnolence. The 
 symptoms occasionally assume a serious aspect, and the 
 patients for the time being are really very ill owing to the 
 poisoned condition of the blood. Exposure to the fresh air 
 is, on the whole, the best treatment. The occurrence of these 
 alarming symptoms has been generally traced to the use of 
 a boot polish containing aniline oil. 
 
 Relm,2 a German surgeon, has drawn attention to the 
 
 * The journal of Hygiene, October, 1907. 
 
 * " Berliner Klinische Wochenschrift," vol. li., No. 19. 
 
128 DISEASES OF OCCUPATION 
 
 occurrence of twenty-one cases of tumour in the bladder 
 among men employed in aniline works. Some of the men 
 had worked 29 years — others only 5 years. The tumours 
 were of a papillomatous or warty type in 3 of the men ; in 
 18 the growths were sarcomatous or carcinomatous. Owing 
 to the malignant nature of most of the growths, 1 1 of the 
 patients had died at the time Relm published his paper. 
 
 Nitro and Di-nitro-Benzene ; Di-nitro- Benzol 
 
 Owing to the odour of bitter almonds given off by nitro- 
 benzene, this substance is made use of in the manufacture of 
 perfumery and in cooking. It is also used in the manufacture 
 of aniline. Workers in nitro-benzol factories are liable to 
 attacks of giddiness and of unconsciousness, accompanied by 
 blueness of the face or cyanosis. Inhalation of air mixed with 
 nitro-benzol induces difficulty of breathing, and obliges the 
 workmen to leave the factory and go out of doors. In the 
 chronic form of poisoning there are headache, dizziness, and 
 temporary loss of consciousness with cyanosis, symptoms 
 which disappear when the men keep off work for a few days, 
 provided they leave their working clothes behind them in the 
 factory. Return to work is frequently followed by a reap- 
 pearance of symptoms. The urine is dark, and the men are 
 overcome by a desire to sleep. Muscular pains are com- 
 plained of, and fatigue is readily induced. The eyesight is 
 frequently affected. On examining the urine, traces of 
 di-nitro-benzene will be found therein. In chronic cases of 
 poisoning the di-nitro-benzene breaks up the red corpuscles 
 of the blood, and alters its colour from a bright red to a 
 chocolate brown. Maiden ^ found di-nitro-benzene to be 
 more toxic to the workmen than aniline and that the first 
 recognisable sign in the blood of poisoning by di-nitro-benzol 
 is the presence of basophil granulations in the red blood 
 corpuscles followed by a diminution in the number of the 
 corpuscles by I to \\ millions per cmm. of blood. He 
 found in chronic cases an increase in the number of white 
 corpuscles, especially lymphocytes, also in the more severe 
 * The Journal of Hygiene, October, 1907. 
 
CHEMICAL TRADES 129 
 
 forms of poisoning a few nucleated red corpuscles and a trace 
 of met-haemoglobin as revealed by the spectroscope. 
 
 Benzene is converted into nitro and di-nitro-benzene, or 
 myrbane, by the action of sulphuric and nitric acid. 
 Myrbane is reduced to aniline by hydrochloric acid and 
 iron. 
 
 In the manufacture of some of the high explosives, naphtha- 
 lene and the aromatic nuclei, benzene and toluene, are made 
 use of. The higher the nitration of the aromatic bodies is 
 carried, the more dangerous becomes the manipulation of 
 these substances. Di-nitro-benzene is a powerful poison, 
 whether inhaled, swallowed, or injected into the circulation. 
 
 Dr. Prosser White, of Wigan, in " Dangerous Trades " gives 
 a very full account of poisoning by di-nitro-benzene. When 
 ordinary precautions are taken by the workmen, there is 
 little risk to health. The workrooms must be well ventilated. 
 It is desirable that the factory should be situated in the 
 country. Cleanliness of the workroom and personal cleanli- 
 ness of the men are requisites. Handling of the com- 
 pounds should be avoided as far as possible, and everything 
 done automatically and in closed-in machinery. Washing 
 appliances and towels with soap should be ample. The 
 temperature of the workroom should be kept low and dry, 
 since moisture is usually followed by increase of sickness. 
 In the winter months it is noticed that the amount of sickness 
 usually declines. The workmen should wear special clothing 
 and caps, and as the dust is liable to be deposited on the hair 
 of the head and on the beard, it is better for the men to be 
 clean shaven and for the hair to be worn short. There 
 should be a medical inspection once a week, and all new 
 hands should be medically examined before being allowed to 
 work. As it is work that women sometimes follow, anaemia 
 should be regarded as disqualifying. A similar remark 
 applies to pregnancy. When symptoms of poisoning occur, 
 the workpeople should be taken out of the factory into the 
 open air, and if the cyanosis is well marked, it may be neces- 
 sary to resort to the inhalation of oxygen, the application 
 of warmth to the extremities, and the introduction of warm 
 drinks by the mouth or rectum. 
 
CHAPTER VI 
 
 EXPLOSIVES AND THE EFFECTS UPON HEALTH OF 
 THE GASES EVOLVED 
 
 BY the term " explosives " is meant substances, solid or 
 liquid, which through the chemical action induced in 
 them by the application of heat or some other cause, 
 become rapidly converted into gases which occupy a much 
 greater volume than the original substance, and which become 
 subsequently still further expanded by the enormous heat re- 
 sulting from the chemical reaction. All kinds of ammunition 
 are included under this designation, e.g.^ gunpowder, nitro- 
 glycerine, dynamite, gun-cotton, blasting powder, fulminate of 
 mercury, &c. The chemical reactions that occur are explosion 
 reactions. Once started in an explosion the reaction is pro- 
 pagated from molecule to molecule throughout the mass, and 
 as the rate of the rapidity of this propagation varies between 
 wide limits, it produces ordinary combustion when it pro- 
 gresses slowly, an explosion when it is relatively very rapid, 
 and detonation when its velocity is almost infinite. These 
 terms, however, are relative, for no hard and fast rule can be 
 drawn between them, since in many instances the same explo- 
 sive under different physical or mechanical conditions, or 
 differently confined or ignited, may develop any of these 
 phenomena. In order to produce their full effects, explosives 
 of the gunpowder type require to be strongly confined, where- 
 as with the more violent types of explosives, such as gun- 
 cotton and nitro-glycerine, the degree of confinement can be 
 very much less. An explosive reaction may be induced by 
 friction or percussion, by contact with a heated or ignited 
 body or by using a sensitive composition ignitable by percus- 
 
 130 
 
EXPLOSIVES AND THEIR EFFECTS 131 
 
 sion or friction, and which in turn ignites the explosive. The 
 effect produced varies with the particular manner in which the 
 explosive reaction is induced. By the percussion of a small 
 quantity of fulminate of mercury imbedded in nitro-glycerine 
 or gun-cotton, an effect is produced which is much greater 
 than the ordinary explosion of either substance itself. There 
 is the almost instantaneous conversion of the whole mass of 
 the explosive into gas or vapour. To this mode of explosion, 
 as already stated, the term detonation is applied. Generally 
 speaking an explosion is a form of combustion, but detona- 
 tion cannot be explained quite in the same way. Heat alone 
 will not produce detonation, a sudden shock is also required. 
 Detonation is the effect produced by combined chemical and 
 dynamical reaction. 
 
 According to the purposes for which they are employed 
 explosives are called high and low^ but these terms are 
 purely relative. In high explosives the chemical trans- 
 formation is very rapid and energetic : they are usually 
 fired by detonation, and the effect is more or less local. 
 High explosives contain a large percentage of oxygen, and 
 are usually definite chemical compounds. When the chemical 
 reactions are transmitted comparatively slowly through the 
 mass the effect produced is a propulsive one and the sub- 
 stances employed are called low explosives. Propulsive 
 explosives are employed to impart motion to projectiles 
 so that they travel with great rapidity through the air. 
 For the purpose of our immediate inquiry it is with the 
 "disruptive" explosives, or those which are used in mines 
 and quarries and which produce crushing or shattering 
 effects, that we are mostly concerned. 
 
 Explosive compounds contain carbon, hydrogen, oxygen, 
 and nitrogen, the last named being always feebly combined 
 with the oxygen in whole or in part. It is this instability 
 of chemical equilibrium that is so essential, for when an 
 explosion occurs the nitrogen molecule " readily parts with 
 its oxygen to the carbon and hydrogen, for which it has a 
 great affinity, forming carbonic acid, carbon monoxide gas, 
 and water." ^ The hydrogen produces by its combustion an 
 
 I* " Treatise of Service Explosives," 1906- 
 
132 
 
 DISEASES OF OCCUPATION 
 
 extremely high temperature, so that the water which is pro- 
 duced is in the form of greatly expanded steam. 
 
 Gunpowder has during the last five centuries of its use in 
 Europe varied little in its composition. It is a compound 
 of saltpetre, charcoal, and sulphur. It is not the manu- 
 facture of gunpowder that concerns us, but the gases that 
 are formed after its explosion and the effects of those gases 
 upon men working in mines and quarries. During the 
 decade ending 1899 there occurred the following number 
 of accidents in the handling and use of the 
 explosives (" Dangerous Trades," p. 605) : — 
 
 various 
 
 Nature of Explosive. 
 
 No. of 
 Accidents. 
 
 Number ( 
 Killed. 
 
 )f Persons 
 Injured. 
 
 Gunpowder 
 
 Nitro-glycerine compounds 
 Ammonium nitrates 
 
 Detonators 
 
 Fireworks... 
 
 244 
 376 
 
 44 
 143 
 
 41 
 
 94 
 
 135 
 
 12 
 
 3 
 19 
 
 294 
 440 
 
 41 
 193 
 
 96 
 
 Total 
 
 848 
 
 263 
 
 1,064 
 
 Total in manufacture during same 
 period ... 
 
 175 
 
 44 
 
 204 
 
 Until recent years gunpowder was extensively used as an 
 explosive in British coal-mines owing to its comparatively 
 slow action, but it is deficient in oxygen, and should the 
 carbon which it contains be only partially burned carbon 
 monoxide is formed. The amount of carbon monoxide 
 formed varies from 2*4 per cent, upwards. The drawbacks 
 to the use of gunpowder in coal-mines are the heavy odour 
 of sulphur that remains after the firing, also the smoke and 
 development of carbon monoxide. 
 
 Gun-cotton^ discovered by a German chemist, Schonbein, 
 
EXPLOSIVES AND THEIR EFFECTS 133 
 
 in 1846, has been proposed as a substitute for gunpowder 
 owing to the fact that it possesses the power of burning 
 without creating smoke and without leaving any residue. 
 The explosive is prepared by immersing carded cotton in 
 strong nitric acid and then carefully washing it. So many 
 fatal accidents and explosions occurred during its manipula- 
 tion that for several years the manufacture of gun-cotton was 
 abandoned, but by removal of the free acid or any nitro- 
 genous material that might be present there have been 
 fewer accidents. Gun-cotton has neither smell nor taste. 
 It retains the appearance of the cotton from which it is 
 made, only it is slightly harsher to the touch. 
 
 Nitro-glycerine, discovered in 1847 by an Italian chemist, 
 A. Sobrero, of Turin, remained more or less a chemical 
 curiosity until the well-known Swedish engineer, Alfred 
 Nobel, began to manufacture it in large quantities for 
 blasting purposes. For years it met with very limited 
 success. After long research and many experiments Nobel 
 succeeded in mixing nitro-glycerine with an inert substance, 
 kieselguhr^ a porous infusorial earth, which rendered it less 
 sensitive and enabled it to be transported with safety. This 
 compound is known as dynamite. By substituting for the 
 kieselguhr an active explosive like nitro-cotton another 
 explosive is obtained, viz., blasting gelatine. When blasting 
 gelatine is frozen it is much more liable to be exploded 
 by a blow. It is a more powerful explosive than dynamite. 
 From mixtures of nitro-glycerine and soluble nitro-cellulose 
 ballastite and cordite are obtained. 
 
 Pure nitro-glycerine is a clear, heavy, oily liquid, almost 
 colourless, without smell at ordinary temperature, and with 
 a sweet taste. When inhaled its vapour causes intense head- 
 ache, which exposure to the fresh air or a cup of strong 
 black coffee usually relieves. Nitro-glycerine can be easily 
 detonated by friction or percussion. The readiest method 
 of detonating it is by a fulminate percussion cap. It is not 
 easily ignited by a flame. 
 
 Tonite consists of gun-cotton and nitrate of barium in 
 almost equal proportions. 
 
 Lyddite is obtained from picric acid. The stories that 
 
134 DISEASES OF OCCUPATION 
 
 were in circulation at the time of the South African War 
 as to the destructive effects upon the enemy of the explosion 
 of lyddite shells and of the poisonous character of the fumes 
 that were liberated were much exaggerated. The lyddite 
 shells when they exploded threw up great clouds of sand 
 and stones and produced a greenish-yellow smoke. At 
 Paardeburg the shells exploded harmlessly in the mud 
 on the soft banks of the river in which the enemy had 
 burrowed. " The whole of Cronje's laager was mapped out 
 with great yellow patches of picric acid powder, but few 
 casualties were attributable to lyddite." At Bergendal, an 
 irregular kopje of rocks protected by earthworks, the 
 Johannesburg Zarps made a good stand. Lyddite shells 
 were rained upon the place until it became untenable. On 
 the third day the Boers hurriedly fled from the position, 
 leaving twelve dead and a few men wounded. One of the 
 prisoners seemed at first as if he had jaundice — the skin of 
 his face and hands was of a bright yellow colour, and he was 
 labouring under intense nervous fear. In a few days all his 
 nervous symptoms had disappeared. Lyddite appears to 
 have little destructive effect in the open, but in a confined 
 space its effects can be extremely severe. 
 
 Accidents in the Manufacture and Use of Explosives 
 
 There is no industry in which the possibility of sudden 
 death and complete annihilation is greater than in the 
 manufacture of explosives, and yet the number of victims 
 claimed by the industry is fortunately small. Legislation 
 has accomplished much. The men and women employed 
 in explosives factories belong to the better class of work- 
 people. Knowledge of the dangerous nature of their calling 
 causes them to exercise the greatest care and cleanliness. 
 Major Cooper Key, H.M. Inspector of Explosives, tells 
 us in "Dangerous Trades," p. 602, that there are 11,098 
 persons employed in this country in the manufacture of 
 explosives. During 1899 there were 54 accidents in the 
 factories, in which 3 persons were killed and 24 injured. 
 The deaths per 1,000 persons employed in the manufacture 
 
EXPLOSIVES AND THEIR EFFECTS 
 
 135 
 
 of explosives for the ten years ending 1899 are given by 
 Majoir Cooper Key as follows : — 
 
 Injured. 
 
 Gunpowder 
 
 Nitro-glycerine 
 
 Ammunition, exclusive of 
 
 detonators 
 Fulminate Composition ... 
 Fireworks ... 
 
 1*2 
 
 1*4 
 
 2'2 
 
 2-9 
 
 While death by accident in the manufacture of explosives 
 is possible, there is no danger to the health of the operatives. 
 In the manufacture of nitro-glycerine the persons employed 
 often suffer from headache for the first few days on com- 
 mencing work. With renewed experience this tends to 
 disappear, but will reappear should the individual absent 
 himself from work for a few weeks. The women who mix 
 the kieselguhr and nitro-glycerine, although they must 
 absorb nitro-glycerine, do not seem to suffer to any extent. 
 
 Accidents occur during the storage of explosives, but it is 
 during their use that accidents are more likely to happen, for 
 familiarity in this instance too often seems to breed contempt. 
 Particularly is this the case in mining. During 1899 there 
 were no less than 29 persons killed in mines and 195 persons 
 injured by explosives. Several of the accidents were due to 
 men scraping out the detonators with pins, thawing dynamite 
 over the fire, driving dynamite and gunpowder into roughly 
 drilled holes, and boring out misfires. 
 
 Setting aside these accidents, many of which are the result 
 of carelessness, we have to deal with the effects upon miners 
 working in confined spaces of the gases liberated during 
 detonation. Many of the miners complain of violent head- 
 ache and vomiting. They suffer from palpitation of the 
 heart, become more or less collapsed, and only recover after 
 they have been taken into the fresh air. When brought to 
 bank the men are pale and look ill. Soon the symptoms pass 
 
136 DISEASES OF OCCUPATION 
 
 off, especially if vomiting has taken place, but in many 
 instances the patients have to be taken home, put to bed, 
 given warm drinks, and have warmth applied externally. 
 Many of the miners whom I have examined a few days or 
 weeks after the " gassing " have been the subjects of ex- 
 treme nervousness and of a sense of dread attended by want 
 of confidence in themselves. Inhalation of the fumes given 
 off by those high explosives disturbs the nervous mechanism 
 of the heart. The beat of the heart is excessively rapid, and 
 the men complain of unpleasant sensations in the precordial 
 region. Some of the men are more liable to be affected than 
 others. There is an idiosyncrasy to the fumes given off 
 during an explosion of nitro compounds. No doubt some of 
 the men have themselves to blame for becoming gassed, as 
 they return to the particular part of the mine too soon after 
 the explosives have been fired, and time is not given for the 
 fumes to be cleared away. 
 
 In the manufacture oi fulminate of mercury there is the 
 double danger of inhaling harmful emanations and the risk of 
 explosion. On the addition of alcohol to a solution of acid 
 nitrate of mercury, there is produced in the liquid mass con- 
 siderable seething, during which there rises the vapour of 
 nitrous ether. It is this vapour which, on account of its 
 ready inflammability, has been the cause of numerous fires, 
 and which exercises upon the men who breathe it a harmful 
 influence, for the workmen complain of severe headache 
 coming on suddenly, vertigo, loss of consciousness, numbness 
 of the extremities, and a sense of constriction of the chest, 
 which may be accompanied by cyanosis. 
 
CHAPTER VII 
 
 DISEASES DUE TO METALLIC POISONS, DUST, FUMES, ETC. 
 
 Industries in which Lead is Employed :— Lead Poisoning ; Saturnine 
 Poisoning; Plumbism; Painters' Colic 
 
 General Review of the Subject 
 
 THE evil effects of lead have been known for centuries. 
 More deaths have been caused by lead than by any 
 other metal, partly because no other metal enters so largely 
 into the arts and industries as lead, also because of the silent 
 and insidious manner in which the poisoning occurs. Lead 
 exerts its malign influence with a rapidity and severity greater 
 in young persons than in old. Young adults especially are 
 quickly brought under its sway. As a form of industrial 
 poisoning it is met with among persons who inhale the dust 
 and fume, who manipulate soluble lead compounds, or 
 handle the metal itself. Metallic lead per se has less 
 poisoning power than its salts, and of its compounds the most 
 important in this respect are the carbonate, oxide, and chro- 
 mate, because these are most employed in the industries. 
 The death-rate from lead poisoning, directly and indirectly, 
 is high. As an indirect cause of death the association of 
 the two is not always recognised. Usually it is easy to 
 diagnose plumbism in its early stages, when it presents such 
 symptoms as colic and is accompanied by the presence of a 
 blue line on the gums, but as a cause of chronic ill-health, 
 disease of internal organs, and slowly developed structural 
 changes in the nervous system, the relationship may not in 
 many instances even be suspected. The evil effects of lead 
 poisoning are often widely spread through a community, for 
 
 137 
 
138 DISEASES OF OCCUPATION 
 
 owing to the use of lead pipes for conveying drinking-water 
 into dwelling houses, the use of lead cisterns for storing water, 
 the cooking of food in lead enamelled utensils, the consump- 
 tion of tinned meats and fruits frequently contaminated by 
 the lead dissolved out of the solder, also the large number of 
 industries in which lead in one form or another is made use 
 of, the metal and its compounds have many opportunities of 
 exerting their harmful influence upon man. 
 
 Plumbism the result of drinking contaminated water and 
 consuming tinned food does not come within the scope of this 
 article. All that need be said of this part of the subject — and 
 the remark applies to lead poisoning generally — is that the 
 metal, when taken into the system in small quantities and in 
 a soluble form for a period, operates so insidiously that the 
 individual, hardly conscious of the gradual loss of health, 
 ultimately feels that his health and strength have become so 
 undermined that he can no longer work, or without any 
 warning he is suddenly seized with acute abdominal pain or 
 with a paralysis that persists for weeks or months. 
 
 Owing to foreign competition and the greater richness of 
 foreign ores in silver, lead mining in England is no longer 
 the source of wealth or of industrial activity of bygone days, 
 and as a consequence fewer men are employed in the mines 
 than formerly. With certain foreign ores it pays the British 
 smelter to extract the silver and treat the lead as a by-product. 
 The lead-miner does not suffer from plumbism owing to the 
 fact that the ore contains lead in almost a pure metallic state, 
 but at the Broken Hill mines in Australia the ore contains lead 
 in the form of carbonate, and several of the miners there have 
 died from saturnine encephalopathy, or the cerebral type of 
 lead poisoning attended by convulsions. Lead is also found in 
 nature in the form of sulphate. It is an interesting fact that at 
 the Broken Hill mines, owing to the fumes from the smelting 
 furnaces, the vegetation in the immediate neighbourhood is 
 scanty and ill-grown, and that the common fowls which pick 
 their way about the grounds a large proportion die from lead 
 poisoning. Dr. Macdiarmid, who has been living at the lead 
 mines at Linares, Spain, informs me that fowl-keepers in that 
 district complain of the hens laying eggs without a firm 
 
METALLIC POISONS, DUST, FUMES, ETC. 139 
 
 supporting shell. I have never succeeded in producing this 
 tendency in hens, although, like other animals, they can be 
 readily poisoned by lead. Fowls lose the power of walking, 
 they stagger a good deal and frequently fall, and their urine 
 contains albumen. In lead-smelting districts, e.g., Leadhills 
 in Scotland and in the dales of County Durham, the fumes 
 from the furnaces poison the pasturage of the neighbourhood, 
 and cattle grazing thereon have died from lead poisoning. 
 At Bleiberg, in Belgium, I found the same accidents had 
 happened, and that the owners of the works had had to pay 
 heavy compensation to the farmers for the loss of their cattle. 
 While hatching fowls in an incubator I found that if a portion 
 of a hen's e^gg is painted with a neutral solution of lead acetate 
 development of the chick is arrested and on opening the egg 
 that the embryo is dead. Painting the surface of other eggs 
 in a similar way with a strong solution of lime is not attended 
 by death of the embryo. While lead is destructive to the 
 higher forms of life, it is not so to all of the lower forms. In 
 an interesting paper on the " Immunity of Some Low Forms 
 of Life from Lead Poisoning," Mr. T. W. Hogg ^ gives the 
 results of a series of examinations which he made on earth- 
 worms which inhabited a waste bark heap in a large lead 
 works. The heap consists chiefly of the old bark taken from 
 the white lead stacks with sweepings from the yards, and 
 amounts to 20,000 tons, as it is the accumulation of over 
 sixty years. The bark is impregnated with lead, varying 
 from i'5 to 2*5 per cent., and away from the surface it is in a 
 damp, pulpy condition. To a great extent it has become 
 converted into a kind of vegetable mould. Notwithstanding 
 the large amount of lead present in the bark, the waste heap 
 in the summer months teems with animal life, especially 
 with the common earthworm. The bark contains nutritive 
 material. In the intestines of the worms there is usually 
 found a considerable quantity of finely divided bark, so that 
 when worms are desiccated and dried at 100° C. the quantity 
 of lead found corresponds closely with that present in the bark 
 itself. Earthworms consist approximately of 80 per cent, of 
 water and 20 per cent, of organic and mineral matter. Hogg 
 ' Society of Chemical Industry, Newcastle Section, February 28, 1895. 
 
I40 DISEASES OF OCCUPATION 
 
 found that the amount of lead, estimated as lead protoxide, 
 present in the organisms varied from 0*37 to 0*52 per cent. 
 This is a large quantity of lead, but when the intestines were 
 freed from their contents and thoroughly washed the amounts 
 varied from 0*009 to o'OiS per cent., a circumstance which 
 shows that only very small traces were retained in the cel- 
 lular lining of the alimentary canal. Although an extremely 
 small quantity, even this amount of lead is greater than that 
 which is found in the internal organs of men and women who 
 have died from industrial lead poisoning. Professor Bedson, 
 of the Armstrong College of Science, made for me several 
 analyses of the brain, liver, and kidneys of male and female 
 lead workers who died under my care in the Newcastle Infirm- 
 ary, and while the largest amount of lead was usually found 
 in the liver, the proportion present in the grey matter of the 
 brain was in some instances only 0*00053 P^^^ cent. Hogg on 
 microscopically examining earthworms treated with a solu- 
 tion of ammonium sulphide found that the only part of the 
 body which became dark and therefore showed the presence 
 of lead was the intestinal wall. Beyond that the metal did 
 not appear to pass. An interesting question therefore arises 
 as to how it is that earthworms possess an immunity to lead. 
 The answer is probably to be found in the operation of their 
 calciferous glands. On squeezing out the secretion of these 
 glands and treating it with ammonium sulphide no trace of lead 
 was detected. How this secretion should offer any protection 
 it is difficult to say. When serving with Professor Thorpe on 
 the Pottery Commission we learned that there was an opinion 
 widely held by the workmen in Staffordshire that those 
 who drank a particular ale did not suffer from plumbism. 
 In this ale Professor Thorpe found a fairly large percentage 
 of sulphate of calcium. That calcium salts confer immunity 
 I am not prepared to say. In the pottery worker the im- 
 munity above referred to is probably rather the result 
 of slow absorption, owing to the conversion of soluble lead 
 compounds in the alimentary canal into the less soluble 
 lead sulphate, than of any real protection that is afforded. 
 Darwin estimated that a single worm ejected 20 ounces of 
 soil per year. Given the same immunity from lead poisoning 
 
METALLIC POISONS, DUST, FUMES, ETC. 141 
 
 as that possessed by an earthworm weighing 22 to 25 grains, 
 a man would be able to swallow annually several times 
 his own weight of white lead, and to retain continually one 
 pound of it in his system without exhibiting symptoms of 
 poisoning. It may be that this immunity of the earthworm 
 is part of a resistance begotten by successive generations 
 or it is an illustration of a similar power which other organ- 
 isms possess of growing luxuriantly in poisonous media, as 
 witness certain moulds in arsenical and mercuric solutions, 
 also of the power which certain birds possess of eating the 
 deadly strychnos nux vomica with impunity. 
 
 Lead Mining : Smelting : Desilverising 
 
 Lead miners do not in this country suffer from lead 
 poisoning, but, as the mines are badly ventilated, are often 
 wet, and entrance into and exit from them can only be effected 
 by means of ladders, the men suffer in their general health and 
 from rheumatism. In the dales of Durham, house accom- 
 modation near the lead mines is difficult to obtain. Con- 
 sequently many of the men have long distances to walk from 
 and to home. At the end of a day's work, when heated and 
 fatigued, they are thus exposed in winter to the cold winds 
 that sweep along the valleys. Bronchitis and lung diseases 
 claim a large number of victims. The deadliest enemy is tuber- 
 culosis. Formerly, when lead mining was more of an industrial 
 success than it is to-day, the men were housed in barracks 
 close to the mines, and returned to their homes at the week- 
 ends. These barracks were overcrowded and badly venti- 
 lated, and were hotbeds of tuberculosis. In the sleeping- 
 rooms not only was the air space insufficient and the beds too 
 close to each other, but the windows were never opened, and 
 miners who were the subjects of bronchial catarrh and 
 tuberculous lung disease simply expectorated on the floor of 
 the dormitories. Overcrowding, the breathing of foul air and 
 of the dust-laden atmosphere of the sleeping-rooms favoured 
 the spread of tuberculosis. As a consequence of these and of 
 exposure to severe weather, also inattention to " colds on the 
 chest," lead miners, although living in healthy districts, have 
 
142 DISEASES OF OCCUPATION 
 
 succumbed to phthisis in much larger numbers than other 
 persons living in the same district. 
 
 So far as industrial plumbism is concerned, the danger to 
 health commences with the smelting of the lead ore. During 
 the year 1906, 38 cases of lead poisoning occurred in smelting 
 works, 24 of which were in lead works. The fumes which are 
 given off, if not carried away from the face of the workmen, 
 are apt to cause poisoning. Since furnacemen therefore run 
 considerable risk, all furnaces should be hooded. The fumes 
 are often caused to travel a great distance through flues, 
 often high enough for a man to stand in them, and some- 
 times half a mile in length, before being allowed to escape. 
 From each ton of metallic lead that is smelted 130 lbs. 
 of lead will be given off as fume. It is the fume from 
 lead-smelting furnaces which poisons the pasturage and 
 causes the death of cows and sheep that graze on the 
 fields in the neighbourhood. Smelters occasionally suffer 
 from lead poisoning and its consequence — kidney disease. 
 There is an idiosyncrasy to plumbism, more marked in some 
 persons than in others. I have known member after 
 member of a family — all strong, healthy young men who 
 had been employed as smelters — die from lead poisoning and 
 its sequelae, while their comrades escaped. Animals are 
 rapidly destroyed by flue dust. The cleaning out of the 
 flues is a most dangerous occupation, for the dust is nearly all 
 oxide and sulphate of lead, and unless the passages are freely 
 ventilated men cannot work in them for more than two hours 
 at a stretch without suffering from severe headache and 
 becoming generally ill. After cleaning out the flues the men 
 should have a warm bath. 
 
 Instead of allowing lead thus to escape, which is a loss to 
 the manufacturer, the fumes could be passed through water 
 under pressure, and much of the lead thereby recovered. It is 
 impossible to recover by rapid methods all the lead. At the 
 Mies Works, in Austria, the fumes, after passing through 
 leaden chambers to be cooled, pass on through fifty chambers 
 which are kept wet with sprays of water in order to precipitate 
 the lead and absorb the sulphur. From these chambers the 
 fumes are led through wooden tubes and through a portion 
 
METALLIC POISONS, DUST, FUMES, ETC. 143 
 
 of a disused mine. Notwithstanding all this attempt to 
 recover the lead, the fumes on escaping are found to contain 
 14 per cent, of sulphur and 4 per cent, of lead. At other 
 works the liquid from the spray chambers is passed over 
 limestone, whereby the sulphur and any arsenic that may be 
 present are absorbed and the lead precipitated in the lime, 
 from which it is obtained by drying. 
 
 Since lead contains a fairly large quantity of silver, this 
 has to be extracted by means of making an amalgam of lead 
 with zinc in the molten state. This method of desilverising, 
 which is known as the Pattinson process, is not attended by 
 lead poisoning to any great extent ; still, I have met with cases 
 of plumbism in desilverers. A fatal case of plumbism in a 
 desilverer was reported to the Home Office in 1906. Although 
 the men are exposed to high temperatures, and the ladling out 
 of the molten metal is rather laborious work, yet it cannot be 
 said that the men — generally a better class of workmen — 
 suffer as much as the nature of their employment might 
 lead one to expect. The melting down of old scrap lead, 
 tea lead, old lead pipes, &c., is attended with greater risk to 
 health than the use of the pure metal, partly because proper 
 precautions as regards hooding of the melting pots and 
 ventilation are not taken, the amount of fume is considerable, 
 and there is more litharge (oxide of lead) dust raised during 
 the ladling of the molten metal. 
 
 Red Lead : Litharge^ Massicot, Lead Oxide 
 
 In the manufacture of red lead the metal is simply roasted 
 in a reverberatory furnace and raked from time to time. A 
 considerable amount of fume escapes from the mouth of the 
 furnace, and unless this is hooded and a strong draught pro- 
 vided to carry it away, the workmen may become poisoned. 
 The red lead is removed in large pieces, placed in barrows, and 
 allowed to cool. It requires seven to eight hours to convert 
 metallic lead into litharge. During the grinding of red lead 
 large quantities of fine dust are raised. To inhalation of the 
 dust, as well as to the fumes, must be attributed the symptoms 
 of plumbism met with in the workmen. Red lead workers 
 
144 DISEASES OF OCCUPATION 
 
 form from i to 2 per cent, of all the cases of plumbism 
 reported to the Home Office. 
 
 When litharge which has been washed and dried is again 
 placed in the furnace, roasted afresh, and raked so as to 
 become further oxidised, it is converted into what is known 
 as yellow litharge. 
 
 In red lead works the furnaces are placed along one side of 
 the building, but it would be an advantage to have them in the 
 centre of the room, so that men could walk round the furnaces ; 
 to have the building lit from above and not at the sides, and to 
 have the roof high and the walls smooth, so that as little dust 
 as possible might collect upon them. The floors should be 
 made of cement or bricks, and not, as in too many instances, 
 the ordinary soil. Iron floors are objectionable on account 
 of their slipperiness. The advantage of cement floors is that 
 they can be brushed or swilled with the hose. In England 
 most of the walls of red lead factories are rough and begrimed 
 with dust ; in Germany the regulations are that the walls 
 shall be painted, so that they can be washed ; while in Austria 
 two whitewashings per annum are regarded as sufficient. 
 Young adults should not be allowed to work in white lead 
 works nor in the red lead furnace, grinding, and packing 
 departments, nor ought women to be employed therein. 
 
 A few years ago at Klagenfurt White Lead Works, in 
 Austria, during a period of scarcity of adult labour, the 
 men begged the employers to allow their sons to work in 
 the factory. Lads under eighteen years of age were con- 
 sequently given employment. These youths, all of them of 
 good physique, well-developed, and healthy looking, were 
 examined medically before entering the factory, and yet, 
 notwithstanding this precaution, so great was the amount of 
 lead poisoning amongst them, and in such a short time, too, 
 that the employers were obliged to dismiss them. 
 
 The use of tobacco under any form should be prohibited 
 in the factory. Disregard of this regulation should be visited 
 by a penalty. There should be a special room set aside for 
 the clothes of the workmen. In Great Britain the wear- 
 ing of overalls in dusty departments is required, but in 
 Austria a Commission which sat in Vienna in 1905 recom- 
 
METALLIC POISONS, DUST, FUMES, ETC. 145 
 
 mended the provision of three suits of clothes, (i) for ordinary 
 use, (2) for cleaning purposes, and (3) for reserve. The re- 
 commendation of the Austrian Committee could hardly be 
 carried out in England, owing to the large amount of casual 
 labour in lead factories. Both in white and red lead works I 
 have always been in favour of alternation of employment, i.e.^ 
 the undesirability of allowing workmen to remain too long 
 in dangerous departments, and the gain to health obtained 
 by shifting them from inside to outside work, and vice 
 versdy has been considerable. I have seen the advantages 
 of this in the large white lead works of Messrs. Expert 
 Besangon & Cie., in Paris, where the men follow out a 
 scheme of alternate employment. The registers of Messrs. 
 Besangon's factory contain a carefully kept biographical 
 account of each workman and of the number of weeks 
 spent in each particular department, so that years after- 
 wards, by referring to the register, information is at once 
 obtained as to what a workman was doing on a particular 
 date. One of the effects of supplanting hand labour by 
 machinery is that, as fewer hands are required, it is more diffi- 
 cult to carry out alternate employment. The wearing of a 
 simple moist respirator, fixed by a band round the head, is a 
 safeguard in dusty processes. It has been recommended that 
 an apparatus should be worn such as that used in mines after 
 an explosion or in places containing foul air. If this were to 
 be adopted a simpler and less expensive form of apparatus 
 would have to be invented. Too great stress cannot be laid 
 upon the necessity for personal cleanliness. It is the want of 
 personal cleanliness which makes casual labour in lead works 
 more dangerous than constant employment. In England and 
 Scotland white lead workers are taken from the poorest and 
 most indigent classes : many of them, having lost their regular 
 employment through intemperance, gladly seek work in lead 
 factories, but they are not fit subjects for the occupation. 
 Allusion has been made to the provision of clothes for the men 
 
 I when in the factory. These clothes — blouses and loose trousers 
 narrowed at the foot — ought to be washed regularly once a 
 peek, and the washing should be done by machinery. I have \^ 
 Iknown several instances of women whose duty it was to wash \ 
 
 I 
 

 
 146 DISEASES OF OCCUPATION 
 
 the clothes of the workmen employed in lead factories losing 
 the power in their hands and suffering from acute lead poison- 
 ing. Bath-rooms should be provided at the works, otherwise 
 it is impossible for the men to have a warm bath, owing to the 
 poor condition of their homes. The men should be obliged 
 to take a bath at least once a week, oftener if they have been 
 engaged in dusty processes. Washing the hands in water 
 containing a small quantity of acetic acid and various forms 
 of soap have been recommended. What is required is 
 cleanliness, even to the removal of the dust from underneath 
 the finger-nails. Unsatisfactory as the lead industry is from a 
 health point of view, much good has been effected in recent 
 years by enforcing the regulations and by the monthly medical 
 examination of the workers, with power given to the factory 
 surgeon to suspend when necessary. This examination is 
 shirked by several of the employes, and especially by the 
 casual workers, to whom the shilling fee is a matter of some 
 importance. Where the medical examination has been 
 systematically carried out nothing but good has resulted, 
 but even this procedure does not confer complete immunity, 
 for experience shows that workers who have passed the 
 doctor and who have been pronounced as satisfactory have 
 the same day been taken ill with symptoms of acute 
 plumbism. 
 
 Lead Industries. Manufacture of White Lead 
 
 Notwithstanding the progress of science and the improve- 
 ments in modern industrial methods, poisoning by lead and 
 its compounds continues to be a disconcerting fact to legis- 
 lators, a disappointment to employers, and a source of ill- 
 health to a large number of the working classes. Reference 
 has already been made to the insidious manner in which 
 plumbism develops. It cannot be too strongly asserted that 
 some of the worst types of lead poisoning are more frequently 
 the result of the daily entrance into the system of minute 
 quantities of lead than of large doses. This is probably due 
 to the fact that lead in minute quantities is more likely to be 
 absorbed, and is an explanation of the fact that by the time 
 symptoms develop the workman has already received into his 
 
METALLIC POISONS, DUST, FUMES, ETC. 147 
 
 system a fair quantity of the metal or its salts. Attempts have 
 been made to underestimate the amount of industrial lead 
 poisoning, and to attribute a share of the plumbism in certain. \ | 
 manufacturing districts to women swallowing diachylon pills \ Pn!. 
 for the purpose of procuring abortion, while by other writers 
 several of the accidents of saturnism have been regarded 
 as the outcome of indulgence in alcohol. In my Goulstonian 
 Lectures on lead poisoning I give the results of a series of 
 experiments upon animals, to which alcohol as well as lead 
 was administered in the food, and it was conclusively demon- 
 strated that alcohol precipitated attacks of plumbism, a fact 
 which in the human subject clinical experience has again 
 and again confirmed. There is not the least doubt that 
 alcoholic intemperance predisposes to lead poisoning. In a 
 lead worker, who is also the subject of alcoholism, it is not 
 always easy to differentiate between the symptoms caused by 
 alcohol and those due to lead. In consequence of this fact 
 there has been among certain writers a disposition to assign 
 to intemperate habits a special role in the development of 
 symptoms which, unless due care is taken, may mislead, 
 since the symptoms may, after all, be the result of occupa- 
 tion. Double wrist-drop is one of the common phenomena 
 of lead poisoning ; on the other hand, paralysis of the feet 
 and legs is of frequent development in chronic alcoholism, the 
 wrists usually being spared. Occasionally, however, these 
 may suffer. The nerves selected and the muscles affected 
 are in the two forms ofpoisoning quite distinct, and yet incon- 
 sequence of loss of power in the hands in white lead workers 
 and house-painters it is sometimes stated that the men 
 following these avocations are more intemperate than others 
 of the working classes. With no wish to brand one class of 
 workmen as intemperate compared with another, the habits 
 of the working classes of different districts are interesting 
 in regard to lead poisoning. In a Report on the white lead 
 industry presented to the French Senate by M. Treille a 
 marked difference is shown to exist between the northern 
 and southern divisions of France. The intemperate habits 
 of the working classes of Normandy and Brittany are well 
 known. These two districts give employment to one-third 
 
148 DISEASES OF OCCUPATION 
 
 of the total number of house-painters in France, and yet 
 within their borders the death-rate from plumbism is 
 more than one-half that of France. Chronic cases of lead 
 poisoning are much more prevalent in the north than in the 
 south. Normandy alone with its heavy consumption of 
 alcohol has more than one-half of the total cases of lead 
 paralysis in France. The influence of alcohol in these 
 cases, as in all, is to reduce the vital resistance of the nerve 
 cells of the workman, to render him careless as to the 
 necessity for cleanliness, and thereby to render him more 
 prone to plumbism. Another circumstance which predisposes 
 to lead poisoning is working in lead before having breakfasted. 
 If there is one fact which the experiments carried out on 
 my behalf by Professor Bedson demonstrate, it is that if 
 food is present in the stomach at the time a workman com- 
 mences work in a white lead factory in the morning, he runs 
 much less risk of lead poisoning than his comrade who goes 
 to the factory without having broken his fast. Owners of 
 white lead factories would not only be doing a humane act, 
 but rendering an economic service, if they provided their 
 hands with hot coffee, tea, or milk and bread before com- 
 mencing work in the early morning. 
 
 The prevalence of lead poisoning in Great Britain and 
 Ireland, and the influence exerted by Home Office regula- 
 tions and medical inspection may be seen from the table on 
 page 149, extracted from the Annual Report of the Chief 
 Inspector of Factories for the year 1906. 
 
 There has been a discontinuous diminution in the number 
 of cases of industrial lead poisoning since 1899, and in no 
 branch of industry is this more apparent than in the manu- 
 facture of white lead. It was largely on my recommendation 
 — when a member of the White Lead Commission — that the 
 Home Office by regulations abolished female labour in the dan- 
 gerous processes of white lead manufacture. Although the 
 recommendation was opposed at the time by almost every 
 white lead manufacturer in the country on economic grounds 
 as well as those customarily connected with the trade, em- 
 ployers now admit that nothing has so purified the lead in- 
 dustry of what was to them a source of worry and a cause of 
 
METALLIC POISONS, DUST, FUMES, ETC. 149 
 
 dissatisfaction to the public as the removal of women from the 
 stripping of the white beds, washing of the white lead, filling 
 and emptying of the stoves, and other dangerous processes of 
 manufacture. Notwithstanding the exclusion of women from 
 work in the white beds of a white lead factory, there is still a 
 large number of women employed in the works, whose condi- 
 tion. Miss Paterson, H.M. Inspector of Factories, tells us, calls 
 for constant supervision. Manufacturers are not considering 
 their own interests, nor the reputation of the trade, when 
 they employ females in the factory. Knowing how ex- 
 
 
 Number of Cases Reported. 
 
 Disease and Industry. 
 
 
 
 
 
 
 
 
 
 
 1906. 
 
 1905. 
 
 1904. 
 
 1903. 
 
 1902. 
 
 1901. 
 
 1900. 
 
 1899. 
 
 Lead Poisoning 
 
 632 
 
 592 
 
 597 
 
 614 
 
 629 
 
 863 
 
 1,058 
 
 1,258 
 
 Smelting of metals 
 
 38 
 
 24 
 
 33 
 
 37 
 
 28 
 
 54 
 
 34 
 
 61 
 
 Printing 
 
 16 
 
 19 
 
 15 
 
 13 
 
 19 
 
 23 
 
 18 
 
 26 
 
 File-cutting 
 
 15 
 
 12 
 
 20 
 
 24 
 
 27 
 
 46 
 
 40 
 
 41 
 
 Tinning and enamelling 
 
 18 
 
 16 
 
 13 
 
 18 
 
 14 
 
 19 
 
 16 
 
 24 
 
 White lead 
 
 108 
 
 90 
 
 116 
 
 109 
 
 143 
 
 189 
 
 358 
 
 399 
 
 China and earthenware 
 
 107 
 
 84 
 
 106 
 
 97 
 
 87 
 
 106 
 
 200 
 
 249 
 
 Litho transfers 
 
 5 
 
 5 
 
 3 
 
 3 
 
 2 
 
 7 
 
 10 
 
 II 
 
 Glass 
 
 4 
 
 3 
 
 
 4 
 
 8 
 
 II 
 
 7 
 
 8 
 
 Electric accumulators ... 
 
 26 
 
 27 
 
 33 
 
 28 
 
 16 
 
 49 
 
 33 
 
 32 
 
 Paints and colours 
 
 37 
 
 57 
 
 32 
 
 39 
 
 46 
 
 56 
 
 56 
 
 75 
 
 Coachmaking 
 
 85 
 
 56 
 
 49 
 
 74 
 
 63 
 
 65 
 
 70 
 
 65 
 
 Shipbuilding 
 
 26 
 
 32 
 
 48 
 
 24 
 
 15 
 
 28 
 
 32 
 
 30 
 
 Paint used in other indus- 
 
 
 
 
 
 
 
 
 
 tries 
 
 37 
 
 49 
 
 27 
 
 46 
 
 44 
 
 61 
 
 50 
 
 54 
 
 Other Industries 
 
 100 
 
 118 
 
 102 
 
 98 
 
 117 
 
 149 
 
 134 
 
 183 
 
 tremely prone women are to lead poisoning, it is not with 
 astonishment we learn that plumbism is still frequently 
 observed amongst women employed in such subsidiary pro- 
 cesses in white lead works as dusting and washing the 
 "acid" pots removed from the white beds and the dry 
 carbonate boxes from the stoves. I have seen young women 
 die from acute lead encephalopathy within four months after 
 commencing work in a white lead factory. In a case 
 reported by Miss Paterson ^ the girl had worked less than 
 
 ^ "Annual Report of the Chief Inspector of Factories for 1906," 
 p. 212. 
 
ISO DISEASES OF OCCUPATION 
 
 two months when she became the subject of plumbism. 
 Employers cannot be too frequently reminded that the 
 susceptibility of females to lead poisoning is greater than 
 that of males, and that the symptoms are usually of a 
 graver character. Apart from the influence of sex, women's 
 wages are smaller, and they are therefore less able, if 
 fighting the battle of life alone, to obtain proper food, 
 which, as already stated, is a protection to some extent 
 against plumbism. 
 
 Formerly Newcastle and Tyneside were hotbeds of indus- 
 trial lead poisoning. To-day cases of plumbism are few and 
 far between. Until the crusade against lead poisoning there 
 was hardly a week passed without patients thus affected 
 seeking advice at the Royal Infirmary, and scarcely a 
 month went by without there appearing in the daily press 
 the announcement of the death of a lead worker, usually 
 a young female. All this is changed. It is a rare event 
 to have in our Infirmary wards a patient suffering from 
 industrial lead poisoning, and especially a female in- 
 patient. The declension in the number of cases of indus- 
 trial plumbism has taken place without a reduction in 
 the total number of persons employed. In 1892 there 
 were 44 patients admitted into the Royal Infirmary, New- 
 castle-upon-Tyne — 15 males and 27 females ; in igoo 
 there were 14 patients, all males ; since I'goo it has been a 
 rare event to have even one patient the subject of industrial 
 lead poisoning. 
 
 It was in 1898 that the Home Office abolished female 
 labour in the dangerous processes of white lead manufacture. 
 Until that date there is not the least doubt that females 
 had been employed in larger numbers than males in the 
 dangerous processes ; but, apart from this circumstance, 
 females are more prone to plumbism than males. This 
 applies pretty generally to the female sex of all animals. 
 In addition to sexual proclivity to plumbism, there is a 
 family and individual idiosyncrasy to it as well. Members 
 of some families are more predisposed to lead poisoning 
 than others. 
 
 In order to appreciate the difference in the degree of 
 
METALLIC POISONS, DUST, FUMES, ETC. 151 
 
 danger to health in some processes of white lead manufacture 
 compared with others, the methods of manufacture may be 
 briefly described. Most of the white lead sold in this country 
 is made by the old Dutch process, which consists in the trans- 
 formation of metallic lead into the white carbonate by a slow 
 and double process of conversion. Numerous earthenware 
 pots, containing 3 per cent, of acetic acid, are placed on tan 
 in a large three-walled chamber, and upon these pots are laid 
 thin strips of metallic lead, and subsequently planks of wood. 
 Tier after tier of pots, resting on bark and covered with metallic 
 lead and wood, are thus superimposed until the chamber, 25 
 to 30 feet in height, is filled to within 6 feet from the top. 
 This chamber, known as the " blue " bed, is now closed in front 
 by wooden planks or doors, and kept closed for fourteen 
 weeks or longer. Fermentation occurs in the blue beds, the 
 temperature rises, and carbonic acid is evolved from the 
 bark, escape of the excess of which is provided for at 
 the top. The acetic acid vapour acts upon the lead and 
 converts it into acetate of lead, while the carbonic acid 
 evolved from the bark changes the acetate into carbonate, 
 the well-known white lead of commerce. Usually there is 
 little danger run by persons employed in making up a blue 
 bed, and yet a little while ago in one factory there were 
 eleven out of twelve cases in women who had inhaled the dust. 
 It is when the conversion of the metallic lead into carbonate 
 has occurred that the first danger in the manufacture is en- 
 countered. This occurs during the emptying or stripping of 
 what is now called the " white " bed, and if sufficient time has 
 not been given for the very soluble acetate to have become 
 changed into the carbonate the danger is thereby greater. 
 The white beds should not be disturbed until the conversion 
 is complete, nor should men be allowed to empty the white 
 beds as piece work, as they are sure to hurry over the task, 
 careless in regard to raising dust and heedless of the necessity 
 of spraying with water. 
 
 During the stripping of the white beds there is a consider- 
 able quantity of dust raised, a large part of which is white 
 lead, and unless spraying with water is effectually carried 
 out the workers cannot avoid inhaling the dust. Formerly 
 
152 DISEASES OF OCCUPATION 
 
 the stripping of the white beds was mostly done by female 
 labour, but on account of the large amount of sickness 
 among the women so employed the work had to be aban- 
 doned. In emptying a white bed the lead carbonate is 
 found as a thick white incrustation on the metallic lead, 
 for all the metal is not completely converted. This is picked 
 off and conveyed to the wash tubs, where it is put through 
 rollers and washed. The material is collected, placed in jars 
 or boxes, and subsequently carried to the " stove," a chamber 
 composed of shelves, and upon which the jars containing the 
 washed white lead are deposited. When filled the door of 
 the stove or drying chamber is closed, and the temperature 
 gradually raised to 70° C, and kept thus for forty-eight 
 hours. The temperature of the stove must not be raised 
 too quickly, otherwise some of the lead carbonate will be 
 changed into lead oxide, as shown by the presence of a 
 delicate pink colour. In two days the stove, after having 
 cooled down, is emptied. After its removal the white lead is 
 ground and mixed with oil to make paint, or it is packed 
 into casks and sold as dry white lead. The filling of the 
 barrels is a dusty process, and ought to be carried on in a 
 closed chamber freely ventilated. 
 
 The drawing of the stove is a dangerous process, and ought 
 not to be undertaken until the temperature has fallen. In 
 removing the jars filled with dry white lead there is a con- 
 siderable amount of dust raised. It is work for which women 
 are ill-suited on account of their dress raising dust, and yet 
 the drawing or emptying of stoves was, until 1898, almost 
 entirely effected by females. I have known healthy young 
 women, after a few days' work in the stoves, so completely 
 shattered in health as to be obliged to relinquish the work 
 permanently. 
 
 Knowing the proclivity of women to plumbism, I have 
 always felt that I was justified from a medical and social point 
 of view in having pressed for the abolition of female labour in 
 the white beds, stoves, and the dusty processes of white lead 
 manufacture ; and while at the time I was much abused for 
 my pains, it is gratifying to know that, by excluding women 
 from these processes, death has been averted, much human 
 
METALLIC POISONS, DUST, FUMES, ETC. 153 
 
 suffering spared, and that there has not been the dislocation 
 in the trade employers feared, nor the difficulty of obtaining 
 male labour, which was advanced as a reason against the 
 change. As bearing upon the greater danger to health 
 in some processes of the manufacture compared with others, 
 the figures of the Medical Inspector of Factories are of 
 interest. Between January and October, 1898, there were 
 reported to the Home Office 191 cases of lead poisoning. 
 Of these the stoves supplied y6 patients and stripping of 
 white beds 31. The ages of the patients were: — 
 
 Under 20 years. 20-30. 30-40, 40-50. 50-60. Over 60. 
 
 7 84 58 24 IS I 
 
 In four-fifths of the total cases the malady took the form 
 of colic, and in the remaining one-fifth there were paralysis 
 and cerebral symptoms. On February 17, 1898, the Home 
 Secretary (Sir M. White Ridley) announced in the House of 
 Commons that there had been 37 cases of lead poisoning 
 in factories and lead works among boys under 18 years 
 of age which had proved fatal. Work in a white lead 
 factory is not an occupation for young persons of either sex : 
 the employment of young persons has consequently been 
 largely discontinued. It is interesting to know that neither 
 dogs nor cats can live in a white lead factory. Machinery 
 is replacing hand labour in white lead works. Formerly 
 women could be seen carrying on their head at a time 
 from one department in the factory to another two or 
 three boxes filled with white lead, also one box under each 
 arm. All this has, fortunately, been abolished. The work is 
 done by mechanical means, and with good results, as will be 
 mentioned later on. 
 
 Much of the danger in white lead works is explained by 
 the circumstance that, since most of the work is unskilled, 
 considerable dependence has to be placed upon casual labour. 
 This, with irregularity of employment, is an element in the 
 problem of industrial plumbism that must not be overlooked. 
 Men who are regularly employed in a white lead factory 
 know the dangers to health, and while admitting that 
 even with them familiarity often breeds contempt, still 
 
154 DISEASES OF OCCUPATION 
 
 these men, notwithstanding their lengthened service, are less 
 frequently ill than newcomers who do not appreciate the 
 danger. Dr. T. Morison Legge found that of 1,463 persons 
 employed off and on in white lead works, the incidence of 
 lead poisoning was 6 per cent, of the average number regu- 
 larly employed, and in those casually employed 39 per cent. 
 Out of 13 factories with regular employment, 4 had no 
 cases of plumbism to report, even although in one of these 
 factories no persons were employed; whereas from two 
 factories in which there was a large amount of casual 
 employment 50 cases of plumbism were reported. This is 
 quite in keeping with my own hospital experience. The 
 largest number of patients admitted into the Newcastle 
 Infirmary always came from one particular factory — one, too, 
 not always employing the largest number of hands. The 
 explanation is not difficult. Apart from greater structural 
 defects in one factory compared with another, also more lax 
 supervision of the workers and deficient provision of washing 
 appliances, th.Q personnel oi the workers is of some importance, 
 for casual labourers are careless in their habits and wanting 
 in personal cleanliness, they frequently indulge in alcohol 
 to excess, they chew tobacco when at work, and as many of 
 them have been out of work for some time they have not had 
 the means to obtain proper food. These, singly and com- 
 bined, predispose to industrial lead poisoning. 
 
 It is unnecessary to detail other processes of white lead 
 manufacture, since they are not made use of to any extent in 
 this country. In the chamber process acetic acid is placed 
 on the floor and strips of metallic lead are suspended on 
 wooden frames ; the carbonic acid is obtained from burn- 
 ing coke and is conveyed directly into the chamber, the 
 windows and door of which are hermetically sealed. In 
 eight or ten weeks the conversion is complete. In this 
 method the use of tan is done away with, but there is 
 the same danger incurred in removing the lead carbonate 
 from these chambers as in stripping the white beds. Spray- 
 ing with water is necessary. The precipitation process 
 of white lead manufacture calls for only the briefest de- 
 scription. It is made use of in France, where it is known 
 
METALLIC POISONS, DUST, FUMES, ETC. 155 
 
 as Thenard's method of white lead manufacture. Basic 
 acetate of lead is first formed. This is subsequently de- 
 composed by means of carbonic acid, but the white lead 
 thus produced is not amorphous, and is altogether an in- 
 ferior product compared with that obtained by the Dutch 
 method. In America white lead is made by electrolysis. 
 Nitrate of soda is decomposed by electrolysis in presence of 
 a lead salt. Nitrate of lead is the result. This is acted upon 
 by means of caustic soda so as to form lead hydroxide. By 
 acting upon the hydroxide with sodium bicarbonate white 
 lead is obtained, but it has inferior covering powers, and is 
 too crystalline compared with that produced by slower 
 methods. In this country there is a strong feeling in favour 
 of white lead made by the old Dutch method. Since it is 
 generally regarded as a finer product, it usually commands a 
 higher price. 
 
 So far as the manufacture of white lead is concerned, the 
 processes that are dangerous to the workpeople are those in 
 which the atmosphere is dusty, for the dust, being mostly 
 white lead, is either swallowed or inhaled. If swallowed, the 
 white lead is converted in the stomach, by the hydrochloric 
 acid of the gastric juice, into a soluble chloride which is 
 readily absorbed into the blood ; if inhaled, the dust is 
 deposited in the alkaline mucus secreted by the respiratory 
 passages and absorbed. Lead may also be absorbed through 
 the skin, as we know from the use of hair dyes and oint- 
 ments containing lead : also through open wounds on the 
 skin. Dust is the enemy to be avoided by the white lead 
 worker. It is raised in the stripping of the white beds, 
 emptying of the stoves, and in packing. Spraying with 
 water, by allaying the dust in the white beds, has rendered 
 this process less dangerous, the filling and emptying of 
 stoves by mechanical means has robbed the stoves of much 
 of their danger, while improved methods of packing, but 
 especially the immediate transference of the white lead from 
 the white beds to the mixing department, where it is ground, 
 washed with water, and subsequently mixed with oil, and 
 thus converted into paint straightaway without ever having 
 been handled at all, has rendered the manufacture of white 
 
156 
 
 DISEASES OF OCCUPATION 
 
 lead and paint a much less harmful industry than it used 
 to be. 
 
 In white paint there is, on an average, 75 per cent, 
 of lead carbonate and 25 per cent, of oil. Before it is 
 used house-painters frequently add to it a small quantity of 
 turpentine, or a little oil with some drying agent, such as 
 borate or oxalate of magnesia or burnt alum. The men 
 who mix the paint do not suffer to any extent from 
 plumbism. They do not handle the compounds, but simply 
 lift the finished product with wooden spades. The wet 
 processes connected with white lead manufacture and its 
 compounds are, comparatively speaking, but not entirely, 
 free from danger, as the subjoined figures show. In two 
 white lead factories the workers who suffered from plumbism 
 were made up as follows : — 
 
 Stripping white beds 
 
 Making up blue beds 
 
 Packing dry white lead 
 
 Paint mills 
 
 Casting 
 
 Stoves 
 
 In these factories the stoves had been so modified as to 
 have removed much of the danger incidental to the work 
 carried on therein. That the stoves and white beds can 
 be the cause of lead poisoning to a greater extent than 
 other processes is shown by the following figures obtained 
 from H.M. Medical Inspector of Factories of 192 cases of 
 plumbism : — 
 
 Stoves in conjunction with white beds and rollers ... 76 
 
 White beds alone or in conjunction with blue beds ... 31 
 
 Rollers 16 
 
 Labourers ... 23 
 
 Indefinite 46 
 
 192 
 
METALLIC POISONS, DUST, FUMES, ETC. 157 
 
 Since dust is the enemy to be avoided, the workpeople 
 are recommended to wear respirators. That respirators 
 entangle a considerable quantity of dust was shown by the 
 late Dr. Dupre during the sitting of the White Lead Com- 
 mission, also by Mr. Rogers, H.M. Inspector of Factories, 
 who found in the respirators worn by persons working in a 
 yarn dyeworks 0*0034 gramme of lead when the fans were 
 running and the atmosphere fairly free, and when the fans 
 had been stopped 0*02 gramme. There does not appear to 
 be any particular season of the year during which the 
 number of cases of lead poisoning is greater than in 
 another. 
 
 In no works, from a health point of view, are the good 
 effects of spending money on fresh plant more apparent than 
 in white lead factories. It has been, and still is, in some places 
 the practice for boxes of white lead to be carried by the 
 workpeople from one department of the factory to another, 
 e.g., from the white beds to the wash-tubs and stoves. This is 
 not only a slow method of transit, but a dusty one as well. 
 Mechanical lifters and carriers worked by electricity are used 
 in many factories with greater safety as regards the health 
 of the workpeople and saving as to time and labour. By 
 such means, as well as by mechanical stoves having 
 supplanted hand labour, the gain effected has been consider- 
 able. In the factory of the Union Miniere de Bleiberg the 
 number of cases of plumbism fell, as a consequence of this 
 substitution, from 55*2 to 19*1 over a period of ten years, 
 although the production of lead compounds had more than 
 doubled ; and in the white lead works of Newcastle-upon- 
 Tyne equally satisfactory results have followed the intro- 
 duction of mechanical lifters and carriers. 
 
 Manufacture of Pottery and Earthenware 
 
 Next to the white and red lead industries, the trade which 
 gives the largest number of victims of plumbism is that of 
 china and earthenware. The manufacture of pottery is a 
 good illustration of how an industry becomes rooted in a 
 district. Nine-tenths of the china and earthenware produced 
 
158 DISEASES OF OCCUPATION 
 
 in England are made in Staffordshire, especially in the towns 
 of Stoke-on-Trent, Burslem, Hanley, Longton, Fenton, and 
 Tunstall, collectively spoken of as the " Potteries," and yet the 
 finer clay from which the earthenware is made has all disap- 
 peared from Staffordshire. The coal, however, remains, and 
 cheap fuel is an element in the manufacture of pottery that 
 cannot be ignored. At the present time the fine clay has to 
 be brought from Cornwall. The manufacture of pottery in 
 Staffordshire is an old industry ; it goes back more than two 
 hundred years. At that date clay was plentiful in the neigh- 
 bourhood. The ware was made from yellow or red marl, and 
 glazed with galena, a crushed raw lead ore brought from 
 Derbyshire. In 1680 common salt was substituted for 
 galena in the glaze. In 1759 Wedgwood improved the 
 manufacture of white cream ware, and introduced the green, 
 black Egyptian, and jasper wares. Since then the produc- 
 tion of pottery in Staffordshire has gone up by leaps and 
 bounds. Staffordshire has supplied more of the world's 
 markets with china and earthenware than the pottery dis- 
 tricts of any other country. She feels the keenness of 
 modern competition, and is struggling hard to maintain the 
 supremacy. Upwards of 70,000 tons of ball clay are annually 
 delivered into the " Potteries " from the south of England. 
 Kaolin, the Chinese word for the clay out of which porcelain 
 is made, is in Staffordshire called china, or Cornish clay, and 
 is obtained from ground granite. It is unnecessary to 
 describe at length the manufacture of pottery. Suffice it to 
 say that, so far as domestic ware is concerned, once it is 
 shaped or moulded it is placed in the oven and fired. The 
 ware is then known as bisctdt. Some ware, such as terra- 
 cotta and stoneware, requires only one firing, but all other 
 ware has to be fired twice. Previous to the second firing it 
 is dipped into a liquid glaze, which usually contains a quan- 
 tity of lead. The lead in the glaze may be the ordinary 
 carbonate, i.e., white lead, or the lead compound may first 
 have been fired with other substances and vitrified. This 
 gives it the appearance of glass, and renders the lead more 
 insoluble. The lead in this form is spoken of as having been 
 " fritted." When ground and mixed with fine clay and water it 
 
METALLIC POISONS, DUST, FUMES, ETC. 159 
 
 forms a white liquid like chalk, and is a safer glaze for the 
 workmen than the glaze made from raw lead. By the term 
 " fritted lead " is meant a compound of raw lead (carbonate), 
 silica, and boric acid, &c., fused together at a high temperature. 
 The resulting product is extremely hard, and is sparingly 
 soluble in acids. Into the glaze, no matter how made, the 
 ware is dipped. When dried, each piece is smoothed and 
 cleaned. Where the glaze contains only raw lead, the dust 
 which is given off during the cleaning of the ware contains a 
 large quantity of lead carbonate, and as the dipper's assistants 
 cannot but inhale some of the dust, this is one of the dangerous 
 processes of earthenware manufacture, for many of the hands 
 thus employed suffer from lead poisoning. Once the ware 
 has been smoothed it is carefully packed in saggers, large 
 coarse earthenware dishes, and placed in the oven to undergo 
 a second firing. Owing to the high temperature the glaze 
 on the surface of the dipped article melts, and gives, when 
 cooled, the gloss seen upon cups, saucers, plates, &c. 
 
 China or porcelain differs somewhat from earthenware. 
 The porcelain manufactured in Limoges, France, is made 
 from kaolin, felspar, and quartz ; a softer kind is made at 
 Sevres, near Paris ; while in England porcelain is made from 
 kaolin and Cornish stone, with calcined bone added to it. 
 For hard porcelain the glaze is made from felspar, in which 
 there is always some quartz, while for other kinds of porcelain 
 the glaze usually contains silicate of lead and borax. The 
 presence of lead in any glaze allows of a lower temperature 
 being used for the biscuited ware, and thereby of a saving of 
 fuel being effected. 
 
 Roughly speaking, there are fifty thousand persons em- 
 ployed in Staffordshire in the manufacture of china and 
 earthenware. Ten years ago the large number of cases of 
 lead poisoning in the " Potteries " created a good deal of 
 public interest and dissatisfaction, which found vent in such 
 hostile criticism that the subject was discussed in Parliament. 
 The Home Secretary appointed Professor Thorpe, of the 
 Government Laboratory, and myself in May, 1898, to make 
 a special inquiry into the matter, and to ascertain — 
 
 " I. How far the danger may be diminished or removed by 
 
i6o DISEASES OF OCCUPATION 
 
 substituting for the carbonate of lead ordinarily used either 
 {a) one or other less soluble compound of lead, e.g., a silicate; 
 {b) leadless glaze. 
 
 " 2. How far any substitutes found to be harmless or less 
 dangerous than the carbonate lend themselves to the varied 
 practical requirements of the manufacturer. 
 
 *' 3. What other preventive measures can be adopted." 
 
 Singly or together, Professor Thorpe and I not only visited 
 the potteries in Staffordshire and Scotland, but also several 
 of the leading manufactories on the Continent, e.g., Delft, La 
 Louviere, Maestricht, Copenhagen, Charlottenburg, Dresden, 
 Limoges, Choisy-le-Roi, and Montereau, &c. Our opinions 
 and recommendations to the Home Secretary are embodied 
 in a Blue Book which was presented to the House of 
 Commons in February, 1899. These recommendations were 
 as follows : — 
 
 " I. That by far the greater amount of earthenware of the 
 class already specified, i.e., white and cream-coloured ware, 
 can be glazed without the use of lead in any form. It has 
 been demonstrated without the slightest doubt that the ware 
 so made is in no respect inferior to that coated with lead 
 glaze. There seems no reason, therefore, why in the manu- 
 facture of this class of goods the operatives should Still 
 continue to be exposed to the evils which the use of lead 
 entails. 
 
 "2. There are, however, certain branches of the pottery 
 industry in which it would be more difficult to dispense with 
 the use of lead compounds. But there is no reason why, in 
 these cases, the lead so employed should not be in the form 
 of a fritted double silicate. Such a compound, if properly 
 made, is but slightly attacked by even strong hydrochloric, 
 acetic, or lactic acid. There can be little doubt that if lead 
 must be used, the employment of such a compound silicate — 
 if its use could be insured — would greatly diminish the evil of 
 lead poisoning. 
 
 " 3. The use of raw lead as an ingredient of glazing material, 
 or as an ingredient of colours which have to be subsequently 
 fired, should be absolutely prohibited. 
 
 "4. As it would be very difficult to insure that an innocuous 
 
METALLIC POISONS, DUST, FUMES, ETC. i6i 
 
 lead glaze shall be employed, we are of opinion that young 
 persons and women should be excluded from employment as 
 dippers, dippers' assistants, ware cleaners after dippers, and 
 glost placers in factories where lead glaze is used, and that 
 the adult male dippers, dippers' assistants, ware cleaners, and 
 glost placers should be subjected to systematic medical 
 inspection." 
 
 It was impossible that these recommendations should be 
 received with general approval. We were dealing with an 
 old-established industry. Trade customs die hard and new 
 methods of manufacture are costly. However wishful pottery 
 manufacturers might be to adopt our recommendations, there 
 were financial and economic considerations that could not be 
 ignored. As no unanimity could be arrived at between 
 employers and the Home Office as to the means by which 
 plumbism in the potteries could be diminished, a compromise 
 was effected, but the matter had ultimately to be referred to 
 arbitration. The Court sat at Stoke-on-Trent in November, 
 1 90 1, and was presided over by Lord James of Hereford. 
 Previous to this, however, there had been much that led up 
 to arbitration, as the sequel shows. The use of leadless 
 glazes for certain goods, the more frequent use of fritted lead 
 in the form of a double silicate, abolition of raw lead in the 
 glaze, and the exclusion of young persons and women from the 
 dipping and ware-cleaning departments and as glost placers, 
 were the principal recommendations made by Professor 
 Thorpe and myself. There was not the least doubt that at 
 the time the inquiry was undertaken raw lead had been used 
 by the Staffordshire pottery manufacturers with far too free 
 a hand, and it was clear that this could not go on, judging 
 from the amount of lead poisoning in the trade. As to what 
 the quantity of lead in the glaze should be, the master 
 potters themselves were divided. Some manufacturers stated 
 that 20 per cent, of lead was required, while others thought 
 that 10 per cent, was sufficient. Professor Thorpe found 
 excellent examples of lead-glazed ware in which the lead 
 monoxide did not exceed 1 2 per cent, of the total weight of 
 the glazing materials, while in the liquid obtained from the 
 dipping tubs {i.e.y the glaze solution) of some of the manufac- 
 
i62 DISEASES OF OCCUPATION 
 
 turers he found the lead varied from 13 to 24 per cent, and 
 even higher. Asa result of the trend of events at this date, 
 and of Professor Thorpe's experiments and recommendations, 
 a conference of representatives of manufacturers and of the 
 Home Office was held at the Home Office on October 31, 
 1899. Two months afterwards the Home Secretary (Sir 
 Matthew White Ridley) intimated that he intended after a 
 certain interval to propose that there should be in potteries a 
 standard of insolubility of fritted lead for glazes, the standard 
 of insolubility being that the glaze should not yield more 
 than 2 per cent, of lead when acted upon by hydrochloric 
 acid under certain conditions. The manufacturers considered 
 the 2 per cent, of insolubility too hard a requirement, and 
 suggested 5 per cent, instead. The main object of the 
 inquiry undertaken by us was to suggest means whereby 
 lead poisoning in potteries might be diminished without 
 doing any serious injury to a trade which, both at home and 
 in foreign markets, was severely hampered by unlimited 
 competition. The attention of manufacturers was drawn to 
 the fact that if the standard was fixed at 5 per cent, this 
 would allow of the use of a glaze from which it was possible 
 in one hour to extract one-third of the lead by dilute acid at 
 ordinary temperatures, and that this would only perpetuate 
 the evils that were then existing. Meanwhile employers, 
 working under Special Rules issued four years previously by 
 the Home Office, were doing something to improve the 
 methods of manufacture, so that when the Arbitration Court 
 met at Stoke-on-Trent statistics were put forward which 
 showed that a notable declension in the number of cases of 
 lead poisoning in the potteries had occurred — a fall from 1 2 
 to 3*5 per cent. This circumstance, which of itself was 
 ample proof that the inquiry had been necessary, also showed 
 what could be done by the manufacturers themselves when 
 stirred to action, and was earnest of what might yet be 
 accomplished. This apparently was the view taken by Lord 
 James, for after a five days' sitting of the Court he postponed 
 arbitration for eighteen months, so that manufacturers might 
 have the opportunity of giving the Special Rules a longer 
 trial, that additional experiments with fritted lead might be 
 
METALLIC POISONS, DUST, FUMES, ETC. 163 
 
 made, and that a scheme of mutual assurance might be 
 established between employers and workpeople. 
 
 The adjourned arbitration took place at Stoke-upon- 
 Trent on June 30 and July i, 1903, Lord James of 
 Hereford, as heretofore, acting as umpire. The object of 
 the meeting was to consider and discuss statistics relating 
 to cases of lead poisoning which had occurred in potteries 
 since the meeting held in November, 1901, and to settle 
 upon some definite course in regard to certain points in the 
 rules which had been so hotly disputed eighteen months 
 previously, viz. : (a) the use of fritted lead in the dangerous 
 and dusty processes, {b) no glaze to be used which yields to a 
 dilute solution of hydrochloric acid more than 2 per cent, of 
 its dry weight of lead calculated as lead monoxide, and (c) 
 monthly medical examinations of the workers, with power of 
 suspension by the certifying surgeon. In closing the inquiry 
 Lord James announced that he would give his decision in 
 writing within three weeks. The text of his award became 
 the basis of a series of Amended Rules which were issued by 
 the Home Office, and in which the spirit of compromise is appa- 
 rent. Since the fritting of lead if performed in a slovenly 
 manner is only a false protection, this was not made compul- 
 sory. No glaze was to be used which yielded to 0*25 per 
 cent, solution of hydrochloric acid more than 5 per cent, of 
 its dry weight of lead calculated as lead monoxide, there was 
 to be a monthly medical examination of workers employed 
 in certain specified processes, with power of suspension by 
 the certifying surgeon, casual workers were to be examined 
 at their own expense, a health register was to be kept, over- 
 alls and head coverings were to be provided and maintained 
 by employers for women and young persons employed in 
 certain specified processes, respirators were to be worn by 
 persons in the mixing of unfritted lead compounds and in the 
 preparation of fritts and glazes, drying stoves were to be ven- 
 tilated, the floors of the workrooms were to be sprinkled and 
 swept daily, and a scheme of compensation for lead poisoning 
 arranged. Under these Amended Rules the trade has been 
 practically working since. It would be an advantage if a 
 special room were set aside in the factory for the monthly 
 
164 
 
 DISEASES OF OCCUPATION 
 
 medical examination of the workpeople. Funds and existing 
 arrangements do not admit of the certifying surgeon being a 
 purely Government official, but it would be a gain generally 
 were he such. He would be more independent of employers 
 than the local surgeons who at present discharge this function. 
 The subjoined table supplies information as to the number 
 of cases of lead poisoning in the Staffordshire potteries before 
 arbitration and since : — 
 
 From the North Staf- 
 fordshire Potteries 
 District 
 
 From other Districts in 
 the United Kingdom 
 
 1906. 
 
 1905. 
 
 1904. 
 
 1903. 
 
 1902. 
 
 1901. 
 
 1900. 
 
 1899. 
 
 85 
 
 75 
 
 84 
 
 75 
 
 66 
 
 84 
 
 165 
 
 204 
 
 22 
 
 9 
 
 22 
 
 22 
 
 21 
 
 22 
 
 35 
 
 45 
 
 Taking the total number of cases of lead poisoning 
 occurring in several of the important departments of china 
 and earthenware manufacture and reported to the Home 
 Office, the following statistics, extracted from the Annual 
 Report of the Chief Inspector of Factories for 1906, are of 
 value : — 
 
 TOTAL CASES REPORTED AS OCCURRING IN— 
 
 
 1906. 
 
 1905. 
 
 1904. 
 
 1903. 
 
 1902. 
 
 1901. 
 
 1900. 
 
 1899. 
 
 Dippers {^; 
 
 Dippers' assistants ••• 1 p ' 
 Ware cleaners ...jp' 
 
 23 
 5 
 4 
 
 19 
 
 I 
 18 
 
 12 
 4 
 4 
 
 15 
 3 
 
 14 
 
 20 
 8 
 
 20 
 
 26 
 
 16 
 I 
 6 
 
 18 
 3 
 
 15 
 
 II 
 4 
 3 
 
 12 
 2 
 
 19 
 
 19 
 
 4 
 
 4 
 
 II 
 
 I 
 23 
 
 36 
 5 
 9 
 
 44 
 
 38 
 17 
 13 
 21 
 
 3 
 33 
 
 Total in dipping house p " 
 
 28 
 42 
 
 19 
 
 33 
 
 20 
 54 
 
 25 
 34 
 
 16 
 35 
 
 24 
 
 38 
 
 51 
 72 
 
 54 
 71 
 
 Majolica painters ... p ' 
 
 7 
 
 I 
 
 7 
 
 7 
 
 10 
 
 3 
 
 I 
 5 
 
 8 
 
 25 
 
METALLIC POISONS, DUST, FUMES, ETC. 165 
 PROPORTION OF CASES TO PERSONS EMPLOYED 
 
 
 1906. 
 
 1905. 
 
 1904. 
 
 1903. 
 
 1902. 
 
 1901. 
 
 1900. 
 
 1899. 
 
 
 
 Per 
 
 Per 
 
 Per 
 
 Per 
 
 Per 
 
 Per 
 
 Per 
 
 Per 
 
 
 
 Cent. 
 
 Cent. 
 
 Cent. 
 
 Cent. 
 
 Cent. 
 
 Cent. 
 
 Cent. 
 
 Cent. 
 
 Dippers ... 
 
 jM. 
 
 •IF. 
 
 2'9 
 
 3-8 
 
 I'5 
 3-0 
 
 2-6 
 6-1 
 
 2-0 
 08 
 
 1-5 
 39 
 
 2-5 
 3'9 
 
 4-8 
 4-9 
 
 50 
 
 16-5 
 
 Dippers' assistants. 
 
 M. 
 • F. 
 
 0-9 
 49 
 
 0-9 
 
 3-9 
 
 5-2 
 
 13 
 
 47 
 
 0-6 
 3-3 
 
 0*8 
 30 
 
 63 
 
 27 
 5-8 
 
 Ware cleaners 
 
 (M. 
 •JF. 
 
 10 
 4' I 
 
 3-0 
 3-2 
 
 5'9 
 
 3-0 
 
 3'4 
 
 2-0 
 
 4-1 
 
 10 
 5-0 
 
 6-0 
 95 
 
 30 
 
 7-2 
 
 Total in dipping /M. 
 
 21 
 
 i'4 
 
 1-5 
 
 1-9 
 
 1-2 
 
 rS 
 
 3-8 
 
 4-0 
 
 house 
 
 .(F. 
 
 4'4 
 
 3-4 
 
 s-t> 
 
 3-5 
 
 3-« 
 
 41 
 
 7-8 
 
 7-6 
 
 Majolica painters . 
 
 (M. 
 • F. 
 
 1-3 
 
 3-3 
 1-3 
 
 1-3 
 
 0-6 
 
 1 0-0 
 
 10 
 
 1-6 
 
 50 
 
 The numbers of persons employed in the dipping-house 
 were, in 1900, 1,336 males and 929 females ; and in 1904, 
 1,336 males and 963 females. The percentages for the years 
 1906 and 1905 are calculated on the return of persons em- 
 ployed in 1904. The total numbers of persons employed in 
 processes in which lead is used were, in 1906, 4,224 males and 
 2,148 females, or a total of 6,372 ; in 1904, 4,394 males and 
 2,300 females, or a total of 6,694 males and females. The 
 number of fatal cases, in which lead poisoning contracted in 
 earthenware and china works is stated to have been directly 
 or indirectly the cause of death, was 16 out of a total of 31 
 from all industries in 1899, 8 out of 38 in 1900, 5 out of 34 
 in 1901, 4 out of 14 in 1902, 3 out of 19 in 1903, 4 out of 
 26 in 1904, and 3 out of 23 in 1905. 
 
 Taking china and earthenware alone, there were reported 
 to the Home Office the following number of cases during the 
 last eight years : — 
 
 1906. 
 
 1905. 
 
 1904. 
 
 1903. 
 
 1902. 
 
 1901. 
 
 1900. 
 
 1899. 
 
 107 
 
 84 
 
 106 
 
 97 
 
 87 
 
 106 
 
 200 
 
 249 
 
i66 DISEASES OF OCCUPATION 
 
 While the preceding tables show an improvement in the 
 health of persons employed in the manufacture of china and 
 earthenware in 1906, compared with 1899, the number of 
 cases of lead poisoning in the potteries is not only higher 
 than it ought to be, but there has not been the declension in 
 recent years that had been hoped for. By loyally carrying 
 out the Special Rules employers and employed have certainly 
 succeeded in reducing the amount of industrial lead poisoning, 
 but what would give the greatest satisfaction to the public 
 would be knowledge of the fact that the manufacturers them- 
 selves were taking greater scientific interest in their work, 
 combined with an increased regard for the health of their 
 workpeople, so that by the introduction of new methods their 
 own regulations would always be in advance of those put for- 
 ward by the Home Office. Instead of following, manufacturers 
 should lead. This brings us to the much-debated question 
 as to whether it is not possible to manufacture china and 
 earthenware without the use of lead glazes. 
 
 Leadless Glaze 
 The use of leadless glazes has been consistently opposed 
 by a large number of the manufacturers on the ground that 
 without the presence of lead in the glaze they cannot get the 
 depth and beauty of colouring which are so much admired. 
 In the Thorpe-Oliver report it is shown that by far the 
 largest proportion of earthenware can be made without 
 lead in the glaze, and that even where special colours are 
 required and the demand for lead insisted upon, a smaller 
 percentage of lead than that hitherto in use is sufficient. 
 An exhibition of leadless glazed pottery was recently held 
 in Westminster House. Those who had the opportunity 
 of inspecting the various products could not be but im- 
 pressed by the high-class character of the goods exhibited, 
 and by the variety, depth, and beauty of the colouring 
 displayed. It is true that leadless glazed ware is more 
 apt to go wrong in the firing, and that at present it is 
 more expensive to produce, but these are trade and economic 
 problems which manufacturers would readily overcome if 
 there was the stimulus of an increasing demand for the goods. 
 
METALLIC POISONS, DUST, FUMES, ETC. 167 
 
 Manufacturers will only make what they can sell. Since all 
 sanitary and office goods can be produced just as well with- 
 out lead as with it, public bodies should set the example in 
 their contracts of asking for leadless glazed ware, and if this 
 were done an increasing public demand for domestic ware 
 similarly prepared would end in creating, through the spirit 
 of competition aroused, a supply that would prove just as 
 satisfactory as lead glazed ware. The greater use of leadless 
 glazes would obviate much human suffering. If manufac- 
 turers have hitherto been slow in moving in this matter on 
 the lines indicated above, now that industrial lead poisoning 
 has been scheduled for compensation under the Workmen's 
 Compensation Act this circumstance may force them to 
 reconsider the subject and to approach it from fresh 
 standpoints. 
 
 The principal objections to leadless glazed ware advanced 
 by manufacturers are the increased cost of production 
 and the unreliability of the ware in passing through the 
 ovens. The goods are said to " craze " more readily, i.e., 
 for the glaze to become cracked, and this means a mone- 
 tary loss which they cannot afford. The exhibition of 
 leadless glazed pottery at Westminster House already 
 referred to was at the time much decried by several of 
 the manufacturers. It was said that it was unfair to 
 expect them to produce at a greater cost leadless glazed 
 ware, which ware, if glazed with lead, could be manufactured 
 at a cheaper rate abroad, and introduced into and sold in this 
 country at a lower figure than it could be made for at home 
 To say nothing of competition in foreign markets, it would 
 spell ruin, so it was said, to the home trade, especially as in 
 other countries there were no restrictions as regards the use 
 of lead in potteries. I question very much whether in France 
 or Germany there has been anything like the amount of 
 lead poisoning in potteries that there has been in Stafford- 
 shire. The subject of plumbism in potteries has, at any rate 
 on the Continent, never become the acute and burning ques- 
 tion it has been in this country owing partly to different 
 methods of production. In England it is not that manu- 
 facturers cannot produce leadless glazed ware, for W. I 
 
i68 DISEASES OF OCCUPATION 
 
 Furnivalji research ceramist and consulting potter, says that, 
 even from the manufacturers' evidence, the production of 
 leadless glazed ware in ''whole ovenfuls exclusively is in 
 certain cases practicable." It is the absence of a demand 
 for it on the part of the public, who are deterred from pur- 
 chasing the ware by its higher price, that is to a large extent 
 the reason why it is not manufactured. That leadless glazed 
 ware has great durability is shown by antiquarian discoveries. 
 Egyptian potters used a glaze composed of silicate of soda 
 without lead, probably because the soil of Egypt, being rich 
 in alkali, did not require the addition of lead. Brongniart, in 
 speaking of the enamelled bricks found in the ruins of 
 Babylon, which go back to not less than 522 B.C., tells us 
 that chippings and scales of these ancient bricks, when 
 examined in the laboratory at Sevres by MM. Salvetat 
 and Lenormant, were found to contain neither lead nor 
 tin. In Assyrian and Persian pottery lead was frequently 
 used, but for durability and colour they are not superior to 
 other pottery in which no lead was employed in the glaze. 
 
 In addition to risks to health from lead poisoning, there 
 are certain departments of china and earthenware manufac- 
 ture that are dangerous from the dust that is created. The 
 bronchial and pulmonary troubles thus caused are dealt with 
 in the chapter devoted to lung diseases caused by dust. Here 
 it is only necessary to say that, taking the death-rate from 
 pulmonary consumption as 100 for agricultural labourers, that 
 of potters for the same disease is 453 ; in other words, for 
 every 2 agricultural labourers dying from consumption there 
 perish 9 potters. 
 
 File Cutting 
 
 File cutting by hand is an unhealthy occupation. The 
 death-rate of file-cutters from pulmonary phthisis and lead 
 poisoning exceeds the mortality standard of ordinary occu- 
 pied males by 90 per cent., and after 35 years of age it 
 is still higher. The explanation of the unhealthy nature of 
 the trade is not far to seek. The work is frequently carried 
 on in small buildings in the rear of dwelling-houses and in 
 
 * " Leadless Decorative Tiles, Faience, and Mosaic," 1904, p. 19. 
 
METALLIC POISONS, DUST, FUMES, ETC. 169 
 
 yards in which there is little circulation of air. In most of 
 the workshops there is no ventilation. The floor is fre- 
 quently the ordinary soil. Men and women work together, 
 and overcrowding is common. In file cutting by hand the 
 man or woman sits astride a " stock." In front of him is a 
 stone block, into the centre of which a piece of steel bar called 
 a " stiddy " is inserted, and on this " stiddy " is placed a piece 
 of metallic lead which is called the " bed." When about to 
 be cut, the file is strapped flat on the " bed." By means of 
 a hammer and chisel fine lines are made upon the file, each 
 line representing a blow from the hammer. As the hammer 
 usually weighs from 7 to 9-J lbs., and on large files there may 
 be as many as 3,800 lines, a considerable amount of muscular 
 eflbrt is exerted by the file-cutter in the course of the day. 
 When one face of the file has been cut it is lifted from the 
 bed, rubbed with charcoal or chalk, and then replaced, cut- 
 face downwards, for the other side to be cut. There is a 
 considerable quantity of dust given off" when the file is 
 rubbed with charcoal, also during the cutting of the file. In 
 an examination of the dust collected from the rafters of a 
 file-cutting shop there were found 2'64 grains of metallic 
 lead; in dust taken from the top of a "stock" 14*82 and 
 22*28 grains per 100, and from the floor under the " stock " 
 2*63 and 4*37 grains per 100. The work is extremely dusty. 
 File-cutters are notoriously wanting in personal cleanliness. 
 To the practice of taking their food into the workshops, 
 and of eating it there without washing, to the disagreeable 
 habit of licking their fingers when at work so as to get a 
 better grip of the chisel, also to bending down towards the 
 " stiddy " when at work and thus inhaling the dust, must be 
 attributed much of their ill-health. Although, in the dust 
 given off, the lead is mostly in the metallic state, still there 
 is always a certain amount of oxidation going on which 
 renders the lead capable of absorption. 
 
 The men and women who follow this occupation soon 
 become anaemic, and many of them suffer from colic. Para- 
 lysis of the extensor muscles of the fingers and wrists is 
 frequently met with in file-cutters. This affects mostly the 
 left hand, since it is by the muscles of this hand that the chisel 
 
170 
 
 DISEASES OF OCCUPATION 
 
 is grasped, and muscular strain and fatigue predispose to para- 
 lysis caused by lead. The hand that wields the hammer does 
 not always escape, so that in many instances the paralysis is 
 bilateral. Frequently in file-cutters lead poisoning assumes 
 the chronic form, so that in persons following this trade the 
 death-rate from kidney disease is unusually high. The 
 number of cases of lead poisoning in file-cutters reported to 
 the Home Office during the last few years has been as 
 follows : — 
 
 
 1906. 
 
 1905. 
 
 1904. 
 
 1903. 
 
 1902. 
 
 .90. 
 
 1900. 
 
 1899. 
 
 File 
 cutting 
 
 1'^ 
 
 12 
 
 20 
 
 24 
 
 27 
 
 46 
 
 40 
 
 41 
 
 In Sheffield alone, which is the principal seat of the file 
 cutting industry, the number of cases of lead poisoning has 
 been falling. In 1903 there were 18 cases; in 1904, 17; in 
 1905, 10; and in 1906, 9. 
 
 Since lead poisoning contributes so largely to the ill-health 
 of file-cutters, various substitutes for the bed of metallic lead 
 have been tried, but without success. File-making by 
 machinery is replacing file-making by hand, and is becoming 
 an important trade in Sheffield. In order to harden files it is 
 customary to dip them into a bath of molten lead. The men 
 who dip the files occasionally suffer from plumbism, due to 
 the fumes of the molten metal, but this can be prevented by 
 ventilation and hooding of the bath. 
 
 Diamond Cutting : Setting of Precious Stones 
 
 Diamond cutting is one of the old industries of Amster- 
 dam. The market for diamonds is London, but the workshop 
 is Amsterdam. A branch of the trade has sprung up in 
 Antwerp. The men who follow the occupation are well 
 paid ; they are intelligent and well-educated. Many of them 
 can make from £dt to £^ a week. The work requires 
 considerable skill, and by demanding close attention it 
 
METALLIC POISONS, DUST, FUMES, ETC. 171 
 
 imposes a good deal of strain upon the eyes. The number 
 of men employed in Amsterdam in diamond cutting is 8,000. 
 Many of the men suffer from lead poisoning. In my visit 
 to one of the largest diamond cutting shops in Amsterdam, 
 giving employment to 400 men, I was struck by the high 
 temperature of the workrooms and the want of fresh air. 
 The large number of gas jets in use explains the over- 
 heated condition of the workrooms, while to the sedentary 
 nature of the work and enfeebled resistance to cold, as in 
 nearly all indoor occupations, must be attributed the defec- 
 tive ventilation and dread of open windows. 
 
 In order to cut a diamond another diamond is required ; 
 hence the saying "diamond cut diamond." After this 
 preliminary cutting the diamond is fixed in a mass of molten 
 metal, about the size of a walnut, containing 60 per cent, 
 of lead and 40 of tin, and the alloy is allowed to cool. 
 Thus securely fixed in the metallic knob, the diamond is 
 subsequently polished by hand or by an iron wheel rotating 
 at the rate of 2,400 revolutions per minute. It is during 
 the fixing of the diamond in the lead alloy and afterwards 
 during the polishing processes that the workmen run the 
 risk of becoming poisoned by lead. The skin of the fingers 
 of the workmen is quite black through coming into contact 
 with the hot metal and the varnishes used, but there is 
 also a good deal of lead dust, probably in the form of 
 lead oxide, floating in the atmosphere of the workroom, 
 inhalation of which is one of the causes of plumbism. 
 Nearly all of the men were extremely pale, and several 
 of them showed the characteristic blue line on their gums. 
 Some of the men had suffered from lead colic and a few 
 of them from loss of power in the muscles of the hands 
 and wrists. The subject of lead poisoning in diamond- 
 cutters was recently taken up by the Dutch Government, 
 and a prize of ;£^500 was offered to any person who would 
 find a reliable substitute for lead to hold the diamond 
 during the polishing of the stone. No prize has as 
 yet been awarded, but the Government is on the eve of 
 making an important announcement in regard to this 
 subject. 
 
172 DISEASES OF OCCUPATION 
 
 Setting and Polishing of Precious Stones 
 
 What has been said of diamond cutting applies with 
 equal force to the cutting and polishing of other precious 
 stones. The Medical Officer of Health of Reichenberg, 
 Bohemia,^ has drawn attention to the large number of cases 
 of lead poisoning in the men employed in polishing precious 
 stones in the workshops of Turnau and neighbourhood. 
 There were 25 men suffering from lead colic and paralysis. 
 These, however, were as nothing compared with those who 
 made the cutting and polishing of gems a home industry. 
 As a consequence of making their living-rooms their work- 
 shop and of sitting down to their meals without washing 
 their hands and face, the men were pale, and nearly all 
 of them exhibited a well-marked blue line on their gums. 
 Their work consists in polishing garnets, and for polish- 
 ing 60 dozen stones the men receive 50 kreutzer (4s. 8d.). 
 The polishing is done on pieces of metallic lead which have 
 from time to time to be remelted in the pot. The men are 
 thus exposed both to the fumes of molten lead and to dust. 
 It is stated that metallic lead is not absolutely necessary, 
 and that in the technical school the fixing of the stones 
 is done by means of copper and zinc. Notwithstanding 
 this fact the workmen at their homes still adhere to the 
 use of lead, and as a result there are many cases of lead 
 colic and paralysis among garnet-polishers. 
 
 Plumbism is also met with in polishers of other kinds 
 of gems and precious stones. 
 
 Enamelling of Iron Plates and Hollow Ware 
 
 The enamelling of iron plates and hollow ware is one of 
 the industries of the " Black Country." It is carried on in 
 Birmingham, Wolverhampton, and the immediate neighbour- 
 hood. Nearly all the large enamelled plates at railway 
 stations announcing the name of the station, also the 
 enamelled advertisements, are made in the districts just men- 
 tioned. The process of manufacture can be told in a few 
 * "Les Industries Insalubres," p. 91. 
 
METALLIC POISONS, DUST, FUMES, ETC. 173 
 
 words. The iron plates are first cleaned, then smeared 
 with a thin solution of gum and subsequently are powdered 
 with metallic dust, or a liquid containing a metallic powder 
 is allowed to trickle over them. The powder used often 
 contains as much as 25 per cent, of a fritted lead com- 
 pound ; in other instances there may be no lead at all. 
 Having received its first coating, the plate is placed in an 
 oven and exposed to a high temperature. On its removal 
 and after having become cooled it is swilled with water. 
 The colours required are put on with brushes, and when 
 this has been done the plate is laid upon hot pipes, moder- 
 ately heated, to dry. Up to this stage all the work has 
 been more or less wet and has not been dangerous to 
 any great extent ; besides, the lead compounds used have 
 been fritted and are therefore less soluble. The alphabetical 
 letters, words, and numbers, &:c., that are to appear on 
 the plate when finished are obtained by placing a stencil 
 with all the letters cut out of it upon the plate, and by 
 women and girls with brushes rubbing off the surface of 
 the plate exposed through the cut letters of the stencil. 
 During this process large quantities of dust are given off, 
 and if down-draughts have not been provided the atmosphere 
 of the workroom becomes so thick that it is impossible to 
 see across the room, while the hair and clothing of the workers 
 become covered with coloured dust. This dust contains 
 varying quantities of lead, which is inhaled, and conse- 
 quently induces lead poisoning in those exposed to it. I 
 have known it cause death in young females by acute lead 
 encephalopathy. 
 
 The stencilling of the plate is generally carried on over 
 perforated tables with a strong down-draught, so that the 
 dust is carried downwards and away from the workers, 
 but unless care is taken to see that the aspiration is 
 powerful enough the dust rises upwards towards the face 
 of the worker. 
 
 After the plate has been stencilled it is again placed in 
 the oven, and if additional letters or words have to appear 
 upon the plate differently coloured from those first inscribed, 
 a similar process to that just mentioned has again to be 
 
174 DISEASES OF OCCUPATION 
 
 gone through, viz., dusting, or sprinkling, drying, stencilling, 
 rubbing-off, and firing. Red lead and other compounds of 
 lead are largely used in enamelling, and these are, as already 
 stated, often present in the powder or solution to the extent 
 of 25 to 35 per cent. Formerly arsenic was used in the 
 enamelling of iron plates, but as it was the cause of serious 
 ill-health among the operatives it had to be abandoned. 
 
 No female under twenty years of age should be allowed 
 to follow this occupation. Only healthy women should be 
 employed, and then only after a medical examination. 
 Periodical medical inspection of the workpeople, with im- 
 proved methods of ventilation, has done much to reduce the 
 number of cases of lead poisoning in the enamelling trade. 
 
 In the tinning and enamelling of hollow ware, which 
 is an industry also confined to the "Black Country," the 
 pot or saucepan to be tinned is first swilled with a mixture 
 of dilute hydrochloric acid and zinc chloride. After it has 
 thus been cleaned or prepared it is dipped in a bath of 
 molten tin and lead, usually a mixture of 40 per cent, of 
 metallic lead and 60 per cent, of tin, but as tin is the more 
 expensive of the two metals the molten liquid frequently 
 contains as much as 70 per cent, of lead and only 30 per 
 cent, of tin. Ware dipped in this bath is sold at a lower 
 price. Unless the metal-pot is hooded so as to remove 
 the fumes, the man who dips the ware in the bath, if he 
 is not cleanly and careful, may suffer from lead poisoning. 
 On an average there are 18 cases of plumbism reported to 
 the Home Office as occurring in this trade every year. 
 Dippers who are intemperate are specially predisposed to 
 lead poisoning. The risk of lead poisoning is not con- 
 fined to the dipper of the hollow ware, but extends to the 
 users of the pots and saucepans, and since it is the poorer 
 working classes who purchase the cheaper ware, nominally 
 ti7ined but really leaded^ they suffer in health owing to 
 eating food that has been cooked in the utensils, the lead 
 in the tinned lining inside the vessel having been dissolved 
 out in the act of cooking. In what is known as the white 
 enamelling of iron hollow ware many manufacturers are 
 now making use of leadless glaze. Occasionally the men 
 
 
xMETALLIC POISONS, DUST, FUMES, ETC. 175 
 
 who manufacture the white enamelled alphabetical letters 
 used for advertising purposes, and which are seen on shop 
 windows and elsewhere, suffer from plumbism. During the 
 acts of "brushing on" and "wooling off" large quantities 
 of dust are evolved from the coloured powders used, and 
 as these often contain large quantities of lead there is 
 danger from inhalation of the dust. 
 
 Electrical Accumulator Works 
 
 Owing to the increasing demand for electricity for lighting 
 and motor purposes, also for telegraphic and telephonic 
 requirements, the manufacture of electric accumulators has 
 become an important industry both at home and abroad. 
 Although the employment of electricity in this country has 
 much increased of late, it is small in proportion to what it is 
 in Germany. In the manufacture of electric accumulators a 
 paste made of red lead and sulphuric acid is rubbed into the 
 openings of perforated metallic plates. Usually the work- 
 man wears indiarubber gloves, but these get thinned, torn, 
 and worn out in time. In the act of mixing the red lead and 
 sulphuric acid so as to make the required paste the workman 
 becomes enveloped in dust. There is no reason why the 
 litharge should not be lifted by some mechanical means and 
 not by a scoop, nor why the mixing should not be done 
 in a hermetically closed chamber with extracting draught. 
 A few years ago the number of cases of lead poisoning in 
 electrical accumulator works in Germany had risen so high 
 that the Imperial Health Office directed an inquiry to be 
 made into the conditions of labour in the works. New 
 regulations were introduced, and since then plumbism has 
 become less frequent. In Great Britain, notwithstanding the 
 vigilance of the Home Office, the number of cases of lead 
 poisoning in accumulator works continues to be higher than 
 it ought to be, as the table on p. 176 shows. 
 
 Mr. Kellet, H.M. Inspector of Factories, states that nearly 
 all the cases of lead poisoning in his district occurred in one 
 electric accumulator works. It would appear that there is 
 a tendency in this country to start accumulator works in 
 
176 
 
 DISEASES OF OCCUPATION 
 
 NOTIFICATION OF LEAD POISONING IN 
 ACCUMULATOR WORKS 
 
 ELECTRICAL 
 
 1906. 
 
 1905. 
 
 1904. 
 
 1903. 
 
 1902. 
 
 1901. 
 
 1900. 
 
 1899. 
 
 26 
 
 27 
 
 33 
 
 28 
 
 16 
 
 49 
 
 33 
 
 32 
 
 premises that are quite unsuitable for the purpose. The 
 result is always unsatisfactory and dangerous from a health 
 point of view. Before such work is begun the premises 
 ought to be inspected by representatives of the Home Office, 
 and not, as is too often the case, when damage to health has 
 been done. In a large electric accumulator works in which 
 the cases of lead poisoning had fallen from 24 in 190 1 to i 
 in 1905, Dr. Hugh Hughes, of Ashton, gives the following 
 report of the 69 cases which had occurred in the factory 
 during the 9 years from 1 897-1905 : — 
 
 Mixers, pasters, 
 
 and labourers 
 
 ... 45 cases 
 
 Lead burners 
 
 ... 
 
 ... 16 „ 
 
 Casters 
 
 ... 
 
 ••• 5 >, 
 
 Lead sawyers 
 
 ... 
 
 2 „ 
 
 Stoker 
 
 ... ... ... 
 
 I „ 
 
 In the Report of the Chief Inspector of Factories for 1906, 
 the occupations of the 26 persons attacked with plumbism in 
 electric accumulator works are as follows : — 
 
 Pasters 
 
 Lead burners 
 
 Casters 
 
 Packers and makers-up 
 
 Mixer 
 
 •• 7 
 
 cases 
 
 •• 5 
 
 jj 
 
 2 
 
 55 
 
 .. 9 
 
 ?> 
 
 I 
 
 )i 
 
 As no mention is made in the last table of the numbers 
 employed in electric accumulator works in this country, I 
 give the following as the experience of one of the large 
 accumulator works in Germany in order to show what are 
 the dangerous processes : — 
 
METALLIC POISONS, DUST, FUMES, ETC. 177 
 
 
 Numbers 
 
 Number of Cases of 
 
 
 Occupation. 
 
 employed. 
 
 Lead Poisoning. 
 
 Percentage. 
 
 Casting 
 
 30 
 
 3 
 
 io"o 
 
 Pasting 
 
 30 
 
 9 
 
 30-0 
 
 Soldering 
 
 16 
 
 6 
 
 37-5 
 
 Trimming ... 
 
 30 
 
 4 
 
 13-3 
 
 Plumbing 
 
 30 
 
 9 
 
 30*0 
 
 Section building 
 
 60 
 
 5 
 
 8-3 
 
 Clearly the soldering, pasting, and plumbing are dangerous 
 departments. Much of the plumbism is preventible. The 
 men on commencing work for the first time should have 
 the dangers and the risks of the employment clearly pointed 
 out to them, also the advantages of personal cleanliness and 
 the use of warm baths. If warm baths are to be taken — 
 and my remarks apply to all factories in which lead is used 
 — the opportunities of doing so must be provided at the 
 works by the employers, who should supply plenty of soap 
 and towels, and the time required for washing should count 
 as time spent at work in the factory. The baths provided at 
 a large number of British factories are a disgrace and not fit 
 for men to go into. It is all very well to say that workmen 
 engaged in lead processes should take baths, but I have seen 
 bath places in British factories and paint shops into which no 
 man with any self-respect could go, and until employers grasp 
 this fact and provide proper accommodation, suitably heated, 
 also towels and soap, they cannot expect workmen to loyally 
 carry out the recommendation in regard to baths. At several 
 of the large works in Germany which I have visited the bath- 
 rooms form a separate part of the factory, are properly warmed, 
 and are under the direction of a special attendant. Discipline, 
 which is such a feature of all German life, may have some- 
 thing to do with the fact that there is no difficulty in getting 
 the workmen to take the baths, but the excellent character 
 of the baths is not without an attractive influence. In some 
 works a patent soap, known as akremnin^ is used. It is said 
 to contain a sulphur compound which precipitates the lead 
 
178 DISEASES OF OCCUPATION 
 
 on the skin as lead sulphide. The case of the lead-poisoned 
 stoker referred to in one of the previous tables is not with- 
 out interest. He had been in the habit of breaking up the old 
 red lead barrels and of burning the wood on the boiler 
 fire. I have known of cases, too, in bakers who heated 
 their ovens in this manner, also in workmen who were 
 engaged in breaking up old railway carriages and burning 
 the wood. 
 
 Printing: Type-foundings Type-settings Linotyping 
 
 Linotyping is rapidly displacing printing by type set by 
 hand. Printing by the old method is not a healthy occupa- 
 tion. The rooms are kept too hot and are badly ventilated. 
 There is a higher death-rate from pulmonary phthisis among 
 printers than in most indoor occupations, and plumbism 
 is not unknown owing to the men handling the type and 
 inhaling the dust that is given off. Type metal is an alloy 
 of lead with J to j^ of antimony. The antimony is added to 
 give hardness to the type. Occasionally tin and copper are 
 added in small quantities. 
 
 Several years ago the opinion was expressed by two 
 French physicians, Tanquerel and Pidoux, that there exists 
 an antagonism between lead poisoning and tuberculosis, 
 i,e.s that the one tends mutually to exclude the other. 
 Experience does not confirm this statement The high 
 death-rate of file-cutters from tuberculous phthisis, who, 
 as a class, suffer much from lead poisoning, is proof to the 
 contrary. From recent annual reports of the Typographical 
 Association and of the London Society of Compositors it 
 would appear that there has been a slight increase in 
 tuberculous disease over the corresponding rate for the 
 whole country, so that it must be admitted that printers are 
 more liable to tuberculous phthisis than men engaged in most 
 other indoor trades. Lead poisoning, therefore, instead of 
 excluding tuberculosis, predisposes to it. A few years ago 
 Hirt showed that pulmonary phthisis is much more fre- 
 quently met with among persons working in an atmosphere 
 containing lead dust than in those exposed to the influence 
 
METALLIC POISONS, DUST, FUMES, ETC. 179 
 
 of iron and copper. While workers in iron and copper 
 supplied 12 per cent, of phthisical patients, lead workers 
 contributed 21 per cent. Twenty years ago a French 
 physician, Leudet, pointed out the rapid development of 
 pulmonary phthisis in persons suffering from chronic lead 
 poisoning. That plumbism reduces the vital resistance there 
 is no doubt. Probably this is the only role that it plays 
 in the development of tuberculosis, for in all the lead 
 industries in which phthisis is met with in excess, other 
 agents are co-operating, such as dust or bad air accom- 
 panied by high temperature and imperfect ventilation. It 
 is certainly the case that pulmonary tuberculosis is oftener 
 met with in lead than in coal and iron miners, but this is 
 not due to the fact that the men are mining lead ore : it 
 is the consequence of working under unfavourable condi- 
 tions as regards ventilation, and of domestic and social 
 conditions more or less accidental to lead mining. White 
 lead workers do not die from tuberculosis in larger numbers 
 than persons engaged in other trades, but file-cutters and 
 printers show a high death-rate from this malady — the former 
 as the result of dust and lead, the latter as the result of bad 
 air and dust. 
 
 The number of cases of lead poisoning notified in printers in 
 Great Britain during 1906 was 16, and for the previous seven 
 years 19, 15, 13, 19, 23, 18, and 26 respectively. In the 16 
 cases for 1906 are included, according to Dr. T. M. Legge, 8 
 compositors, 3 stereotypers, 2 machine operators, and i type- 
 caster. While of the 19 cases reported in the previous year 
 there where 10 compositors, 3 of whom died, i was a stereo- 
 typer, i a linotype machinist, i a type assorter, and i a type- 
 caster. It is the compositors who suffer most. Although the 
 number of cases of lead poisoning among printers is not large, 
 yet the symptoms are often severe. Paralysis is frequent, and 
 the cerebral type of lead poisoning, which is the worst of all, 
 is not unknown. To the fumes given off from the casting-pot 
 or lino melting-pot must be attributed some of the cases of 
 plumbism in printers, but it is impossible to exclude the 
 dust caused by the abrasion of the metal in the compositor's 
 box, also the possibility of absorption through the skin by 
 
i8o DISEASES OF OCCUPATION 
 
 handling the type. The dust in printing-shops created 
 during the wear and tear of type has been found to con- 
 tain as much as 14 per cent, of lead, and it is impossible to 
 avoid inhaling some of this dust. In Newcastle-upon-Tyne 
 there has been during the last few years a marked declension 
 in the number of cases of plumbism in printers. There is 
 nothing like the amount of lead colic and paralysis that 
 prevailed a quarter of a century ago, and for this improve- 
 ment in the health of printers new methods of printing must 
 receive some of the credit. It is just possible that all cases 
 of lead poisoning in printers are not recognised, for the pre- 
 sence of a blue line on the gums, which is of such useful help 
 in the diagnosis of plumbism, is frequently absent in printers. 
 In the Annual Report of the Principal Lady Inspector of 
 Factories for 1906 attention is directed to the absence of a 
 blue line on the gums in 32 women and female young persons 
 engaged in printing, in several of whom there were other 
 symptoms suggestive of lead poisoning. The absence of a 
 blue line on the gums is a circumstance which ought to be 
 borne in mind by medical men and confirmed or otherwise by 
 experience. 
 
 It is undesirable that open metal-pots should be in a 
 general room where type-casting, type-setting, and machinery 
 are all at work. The pots should be hooded and have flues 
 attached to them so as to carry away the fumes into the out- 
 side air, care being taken not to distribute the fumes too near 
 the windows of dwelling-houses or workshops. In cleaning the 
 flues the men should wear respirators, and, where possible, 
 the dust should be kept sprayed with water. One cannot 
 too strongly impress upon printers the necessity there is for 
 having the workrooms well ventilated. In places where the 
 ordinary hand type is used, the type should be cleaned by 
 means of steam and boiled after usage. Printers should 
 avoid eating with unwashed hands. 
 
 Printing by hand is on the decline. Stereotyping and lino- 
 typing are replacing it. The hurry of the age requires that 
 newspapers should be printed quickly. There are several 
 fast printing machines by which this can be done. By 
 means of stamped cylinders, stereotyping makes it possible 
 
METALLIC POISONS, DUST, FUMES, ETC. i8i 
 
 to print without resorting to individual type. Rolls of paper 
 miles in length feed the machines, so that thousands of news- 
 papers can be thrown off in a very short space of time. 
 Type-setting machines capable of automatically distributing 
 the type, and the various forms of linotype machines, have 
 certainly diminished the amount of lead poisoning in printers, 
 but for finish and as a work of art it cannot be said that 
 linotyped printing is equal to that done by hand. 
 
 Glass Polishing 
 
 Glass and crystal, when cut and made into the various 
 products for which there is a market, have to be polished. 
 This is usually done by means of revolving brushes running at 
 high speed. Rouge or putty powder mixed with water is 
 allowed to fall on the revolving brushes. Putty powder con- 
 tains 28-29 per cent, of oxide of tin and 68-70 per cent, of 
 oxide of lead, and as the revolving brushes run at great speed 
 a good deal of spray is thrown off, which falls upon the 
 clothes and hands of the workers and also upon the floors 
 of the workroom. The liquid dries on the floor, and subse- 
 quently, owing to the traffic in the room, the putty powder 
 rises into the atmosphere as fine dust and is inhaled by the 
 workpeople. As to the harmful effects of putty powder on 
 glass polishers I had abundant evidence when on the Dan- 
 gerous Trades Committee of the Home Office. Several of 
 the workers I examined had been obliged to give up work on 
 account of paralysis of the hands and wrists, others had 
 suffered from severe colic. A few deaths from saturnine 
 encephalopathy were reported to us. 
 
 Various substitutes have been tried for rouge and putty 
 powder, but as in some of the substituted powders Prof. 
 Thorpe found arsenic to the extent of 0*13 per cent, esti- 
 mated as arsenious acid, this was only replacing one poison 
 in the powder for another and had, therefore, to be aban- 
 doned. The employment of harmless rouge powders 
 should be encouraged by every possible means, and surely 
 the resources of chemistry are equal to supplying something 
 that will not poison the men. In France metastannic acid 
 
i82 DISEASES OF OCCUPATION 
 
 powder has been found to be particularly serviceable. In the 
 glass works at Baccarat it has been used for the last fifteen 
 years with satisfactory results. Since in England the putty 
 powder has been made containing smaller quantities of lead, 
 the number of cases of plumbism has been fewer, but part of 
 this is due to improved methods of polishing, better aspira- 
 tion, and greater cleanliness on the part of the workpeople. 
 
 Dye Works 
 
 In dye works where yellow colours are got from chromate 
 of lead, the dust given off by the yarn is extremely injurious. 
 The women who handle and pull the yarn become covered 
 with yellow dust. They become anaemic and complain of 
 severe headache. Many of them have sharp attacks of colic, 
 while in others the more serious forms of nerve disorders are 
 met with. In a dye works in which during the cold weather 
 the running of the ventilating fan was stopped, there occurred 
 quite an outbreak of lead poisoning — one of the young 
 women unfortunately died from acute plumbism. On re- 
 starting the fan the health of the operatives again improved. 
 Means should be provided in all dye works for the with- 
 drawal of the dust away from the workers ; the women should 
 wear overalls and caps, otherwise their hair becomes covered 
 with yellow dust. 
 
 In calico printing lead poisoning sometimes occurs owing 
 to the printing of colours on the cotton cloth by means of 
 lead salts. The danger is met with in the drying-rooms, and 
 is due to the inhalation of the dust given off during handling 
 of the dried goods. 
 
 House^ Coach^ and Ship Painting 
 
 Painters are extremely liable to suffer from lead poisoning, 
 especially if working in close and confined spaces. They 
 become affected by inhaling dust during the sandpapering of 
 surfaces, the stithe given off during the burning-off of old 
 paint, also by absorption through the skin, especially if it is 
 cracked. Freshly painted surfaces give off emanations which 
 
 I 
 
METALLIC POISONS, DUST, FUMES, ETC. 183 
 
 are harmful to many persons. Some writers regard these 
 emanations as hurtful owing to the turpentine with which the 
 paint is mixed, but experience and experiment show that 
 they contain traces of lead. If metal boxes freshly painted 
 with white lead are placed in a glass jar, and the air aspirated 
 from the boxes is carried through a 10 per cent, solution of 
 sulphuric acid, traces of lead are invariably found. It is only 
 a trace of lead that is found, for by the delicate test dis- 
 covered by Professor Trillat, of the Pasteur Institute, Paris 
 the presence of the metal can be proved. An acetic acid 
 solution of tetramethylate of diphenylmethane gives a beauti- 
 ful blue colour with binoxide of lead. This test will demon- 
 strate the presence of one three-millionth part of lead so long 
 as steps have been taken to convert the lead previously into 
 binoxide by oxidising the lead salt by an alkaline hypo- 
 chlorite solution. To such emanations, therefore, as are given 
 off from a freshly painted surface part of the lead poisoning 
 of painters must be due. Until recently we did not know for 
 certain in what form the lead is present in the emanations, 
 i.e.^ whether molecular or as vapour. Animals that have 
 been placed in freshly painted chambers and muzzled so as to 
 obviate all chance of licking the surface or of eating the 
 paint suffer from colic, and men and women who have slept 
 in freshly painted rooms have presented symptoms of lead 
 poisoning. 
 
 I have recently been consulted by a house-painter who had 
 been suffering off and on from lead colic, but who has latterly 
 become very ill, especially after mixing the white lead with 
 oil to make paint and also after using the paint. The 
 mixture emitted such a disagreeable odour that he fre- 
 quently vomited after using it. On some occasions it was 
 so disagreeable that he could not go near the paint. The 
 oil mixture without the white lead had not an agreeable 
 odour, but this was as nothing compared with that emitted 
 by the paint. The man's illness was the result of the 
 inhalation of vapours given off from the paint. He would 
 begin the day's work feeling quite well, but as the day went 
 on headache developed, and before leaving his shift he would 
 vomit and feel extremely ill. It was not the turpentine in 
 
i84 DISEASES OF OCCUPATION 
 
 the oil that made him ill, for the oil and turpentine mixture 
 alone did not upset him. Evidently some peculiar com- 
 pound is formed between the terebinthated oil and the 
 white lead, inhalation of which is the cause of the symptoms 
 of poisoning observed in painters. That such emanations 
 from freshly painted surfaces occur has been proved by the 
 experiments of MM. Heim and Hebert, also by M. Trillat, 
 of the Pasteur Institute.^ Heim and Hebert exposed 
 cultures of a mould — Penicillium glaucum — to air in closed 
 bell-jars under different conditions, viz., {a) air alone ; {U) air 
 which might become infected from dry white lead ; and {c) 
 air in contact with fresh paint. In {a) the mould developed 
 by the third day, in {b) shortly after the third day, while in 
 {c) the delay was considerable, and only a few colonies of 
 growth appeared. In another experiment, the growth of a 
 different mould — Aspergillus niger — was arrested by emana- 
 tions from a mixture of lead and oil. In another series of 
 experiments, Trillat found that dry white lead gave forth no 
 emanations to check the growth of cultures, nor did the oil 
 mixture which was used for grinding the white lead, but the 
 fully completed paint checked growth. Emanations from paint 
 are harmful to vegetable organisms, and experience shows 
 that they are also harmful to human beings. A guinea-pig 
 placed in a large bell-jar, the air of which had passed over 
 freshly prepared paint, died eighteen hours afterwards, and 
 in the lungs there were signs of acute congestion. While 
 turpentine is itself toxic and may contribute to the pro- 
 duction of some of the symptoms — headache, lassitude, and 
 sickness — experienced by persons sleeping in freshly painted 
 rooms, additional experiments by Trillat showed that when 
 the paint was made with zinc oxide instead of white lead, 
 although the same amount of turpentine was present, the 
 animal took no harm. There is some peculiar combination 
 formed at the time between the white lead and oil mixture, 
 inhalation of which is dangerous. 
 
 Every year several deaths are reported among painters 
 from plumbism. As notification of cases of lead poison- 
 ing in house-painters " is not obligatory," it is difficult to 
 * Lc Journal Officiel, 4 Aout, 1907, p. 786. 
 
METALLIC POISONS, DUST, FUMES, ETC. 185 
 
 obtain satisfactory data in regard to the amount of plumbism 
 in the trade. Sooner or later compulsory notification of all 
 cases of industrial lead poisoning instead of, as at present, only 
 those trades which come under the influence of the Factory 
 Acts, will have to be made to the Home Office. Although not 
 obligatory, 181 cases of lead poisoning in house-painters and 
 plumbers were reported to the Home Office in 1906, includ- 
 ing 36 deaths, compared with 163 cases for the previous year, 
 including 28 deaths. A special form summarising the infor- 
 mation under the Factory Act, 1901, which requires notifica- 
 tion of industrial poisoning by medical practitioners, has been 
 issued by the Home Office, and while the need for keeping 
 the matter before medical practitioners will probably be 
 lessened by the inclusion of certain notifiable industrial 
 diseases mentioned in the third schedule of the Workmen's 
 Compensation Act which came into force on July i, 1907, 
 upon the certifying surgeon will be laid the important duty 
 of certifying whether a workman is suffering from a disease 
 mentioned in the schedule, for on the "granting or with- 
 holding of such certificate depends (subject to appeal to 
 a medical referee) the power of the workman to claim com- 
 pensation," " as if the disease . . . were a personal injury by 
 accident arising out of and in the course of that employ- 
 ment." The fact that the Workmen's Compensation Act 
 has come into force in no way removes the obliga- 
 tion imposed upon medical men of notifying to the 
 Chief Inspector of Factories cases of industrial lead 
 poisoning. 
 
 The processes of house painting which are unhealthy are 
 the burning-off of old paint and, after the prime colours 
 have been laid on and the puttying done with white lead, the 
 smoothing of the flat surfaces by means of sandpaper. Fume 
 and dust are to be avoided, and in washing off old paintings 
 by means of caustic potash care must be taken that the skin 
 of the workman's hands is not cracked. House-painters 
 should not hold in the palm of their left hand white paint for 
 laying on surfaces by means of a palette knife. If there are 
 cracks in the skin there is the risk of absorption. In one house- 
 painter I found several small inflammatory indurations under 
 
i86 DISEASES OF OCCUPATION 
 
 the finger-nails. Painters suffer more from "lead gout" in 
 London and the South of England than they do in the North. 
 
 In LEcho Medical du Nord, September 9, 1906, Dr. D. 
 Verhaeghe gives an interesting account of an inquiry made 
 into the health of the house-painters of Lille. Of 131 house- 
 painters he found 68 to be in good health, 45 in fair health, 
 and 18 in bad health. The period of life during which the 
 men seemed to ail most was between 30 and 35 years of age. 
 
 There was a close correspondence between the ages of the 
 men and the length of time they had worked at the trade. 
 An attempt has been made by some French writers to 
 explain the symptoms of lead poisoning in house-painters 
 by their excessive use of alcohol. Far from underrating the 
 prejudicial influence of alcohol in precipitating a patient into 
 plumbism I have always maintained that it aggravates the 
 illness, but it cannot in any way be regarded as the cause of 
 plumbism, nor is it quite true that house-painters are a more 
 intemperate class than other workmen, although 27 per cent, 
 of the painters in Lille admitted that they took alcohol. It 
 is not stated that they took it to excess. More than one-half 
 of the workmen suffered from colic and digestive troubles. 
 The few workmen who pass the age of 50 are men who have 
 been careful in their habits and cleanly in their person. 
 Before they reach the age of 50 the intemperate men 
 are weeded out. Of the 131 house-painters examined, 90 
 supplied information concerning their families. Between 
 them these 90 painters had had 467 children. Of those 107 
 had been stillborn and 93 died under 2 years of age, 2>., 
 among painters the still-births formed 22*9 per cent, of the 
 births, while for Lille generally the still-born children only 
 formed 8*2 per cent. Verhaeghe supplies statistics compar- 
 ing the number of still-births before the fathers adopted house 
 painting as a profession and after having done so, and he found 
 that before the fathers became house-painters the still-births 
 formed 6'66 per cent, of the births, and afterwards 2 1 '05 per 
 cent. In Lille, house painting is apparently not so organised 
 a trade as it is in this country, where the men go to it as 
 apprentices and few leave it to change into another trade ; 
 but taking Verhaeghe's facts as they are, they point in an 
 
METALLIC POISONS, DUST, FUMES, ETC. 187 
 
 unmistakable manner to the occupation of the father exer- 
 cising a baneful influence upon the life of his progeny. 
 
 The mixing of paints and colours is equally an unhealthy 
 occupation, unless means are taken to obviate dust. The 
 grinding and mixing of paints and colours, which are 
 admitted to be dusty occupations, accounted for 27 cases 
 of lead poisoning in 1906. On July 9, 1906, Draft Regu- 
 lations for the Paint and Colour Trades were issued from 
 the Home Office. These deal with the mixing, grinding in 
 oil, and sifting of dry lead colours and the provision of 
 exhaust draughts to carry away dust, monthly medical exami- 
 nation of the workpeople, the insertion in a Health Register 
 kept in the factory of the names of all workers in lead 
 processes, wearing of overalls and washing of the same once 
 a week, provision of washing conveniences, and the prohibition 
 of the employment of women and young persons in the 
 manipulation of lead colours in the dry state or in the grind- 
 ing of the colours in oil. It is anticipated that much good 
 will follow adhesion to the Regulations. 
 
 Coach painting is often carried on in confined spaces. A 
 well-finished coach will frequently have received as many as 
 eighteen coats of paint before the varnish is applied. The 
 colours sometimes contain large quantities of lead ; so, too, 
 do the " driers." Coach-painters become the subjects of lead 
 poisoning by inhaling the dust when smoothing painted 
 surfaces with sandpaper. I had recently a coach painter under 
 my care suffering from double wrist-drop, who had become 
 poisoned by painting iron coach frames before they had become 
 quite cool. For the last eight years the following has been 
 the number of cases of lead poisoning in coachmakers notified 
 to the Home Office. In 1906, 85 cases, and for the previous 
 seven years 56, 49, 74, 63, 65, 70, and 65 respectively. The 
 notifications for the year 1906 show a considerable increase 
 over those of the year 1905 : 32 of the cases occurred in rail- 
 way carriage and wagon works, 10 in motor-car works and 43 
 in coach and carriage works throughout the country. Part 
 of the increase in the nunxber of cases of plumbism in coach- 
 painters is due to the prosperity of the motor-car industry, 
 and is the result of inhalation of the dust evolved during 
 
i88 DISEASES OF OCCUPATION 
 
 the sandpapering of the dried coats of paint. Painters of 
 perambulators and men employed in making and painting 
 railway signals are liable to plumbism. 
 
 Substitutes for White Lead 
 
 Recognising the harmfulness of white lead, many efforts 
 have been made, both at home and abroad, to replace it by 
 other pigments. When sitting on the White Lead Com- 
 mission it was one of the subjects to which we gave par- 
 ticular attention. Several inquiries were made, but we found 
 that among house-painters there was no such unanimity of 
 opinion as called for a specific recommendation from us as 
 to the use of white lead for external purposes. As regards 
 internal decoration, opinions were more in agreement that 
 zinc white could replace lead carbonate. A paint to have 
 commercial value must have good covering power and dura- 
 bility ; it must be capable of mixing well with oil, and above 
 all it must not be too expensive. All these properties are 
 possessed to a high degree by white lead made by the Dutch 
 process, and they are only doubtfully possessed by zinc white, 
 for although mixing well with oil and possessing covering 
 power, it is, so far as outdoor decoration is concerned, not so 
 durable, and is more apt to peel off. 
 
 White lead manufactured by the Dutch process is composed 
 of small globules which mix well with oil, forming a soap, 
 whereas most of the other pigments are crystalline and 
 only make a mechanical mixture. One of the drawbacks 
 urged against white lead is that it sometimes becomes yellow 
 in the presence of sulphur in the atmosphere ; hence for 
 internal decorative purposes a mixture of lead carbonate and 
 zinc white is recommended, since the lead gives covering 
 power and durability and the zinc whiteness. In France the 
 substitution of zinc white for lead carbonate has become 
 almost a national question. Bill after Bill for the total sup- 
 pression of white lead as a paint for buildings has been 
 brought before the Chamber of Deputies and passed, but 
 they have been negatived by the Senate. 
 
 It is interesting to know that as far back as 1775 Guy ton 
 
METALLIC POISONS, DUST, FUMES, ETC. 189 
 
 de Morveau, the distinguished rival of Lavoisier, suggested 
 that zinc white should be substituted for white lead ; in 
 1835 Leclaire demonstrated the comparative harmlessness 
 from a health point of view of zinc white and its capa- 
 bility of replacing lead carbonate in the painting of build- 
 ings. When Lacrosse was the Minister of Public Works 
 in Paris in 1849, he caused zinc white to be used instead 
 of lead on Government buildings; in 1852 all the Prefets 
 were circularised by M. Persigny, interdicting the use of 
 lead, and in 1901 this was again done by M. Pierre Daudin. 
 Not one of the injunctions issued has been of the slightest 
 worth. During the last six years, owing to the large 
 number of cases of plumbism in house-painters in France, 
 an aggressive attitude has been assumed by many of the 
 working painters, medical men, and legislators towards the 
 use of white lead. It is difficult for any legislative body to 
 interfere with an old-established trade. France certainly 
 solved the problem of phosphorus necrosis in lucifer match 
 making by substituting the sesquisulphide for the dangerous 
 white phosphorus, but in regard to the use of lead paints 
 versus zinc, opinions are still divided, and arguments are so 
 well put forward by both sides that members of Parliament 
 have a difficulty in coming to a determination as to the 
 proper steps to be taken. In France there is a tendency to 
 make all such industrial questions political, apart from their 
 economic and social aspects. The Comite Consultatif 
 d'Hygiene, a body to which problems relating to industrial 
 hygiene are entrusted by the Government, reported in March, 
 1 90 1, that the manufacture of white lead had become a much 
 less harmful industry owing to the Expert-Besangon process 
 of grinding and mixing the white lead in water, with the 
 subsequent replacement of the water by oil as the paste 
 passes on through the rollers, periodical medical examination 
 of the workmen, alternation of employment, and the careful 
 selection of workmen in the first instance, no intemperate 
 man being received into the works. This is certainly true 
 as far as it applies to the manufacture of white lead. As for 
 the dangers from lead in house painting, the opinion has 
 been expressed that the men were themselves contributory 
 
iQo DISEASES OF OCCUPATION 
 
 factors to plumbism by their intemperance and want of 
 personal cleanliness, but all painters who suffer from plumbism 
 can scarcely be regarded as intemperate men. 
 
 To assist in settling the question as to whether zinc white 
 can replace lead in painting the exterior of buildings, the 
 results of many experiments have been made public in 
 France: these are, it is needless to say,/r<? and con. Mention 
 must be made of the experiments carried out by M. Livache 
 under the direction of the Society of Public Health and the 
 Pasteur Institute. He states that at the end of three years, 
 notwithstanding the objections of architects and white lead 
 manufacturers, it must be admitted that the coatings of zinc 
 exposed to the external atmosphere and to all kinds of 
 weather have lasted as well as those of lead. A committee 
 presided over by M. Rigolot and appointed by a syndicate 
 of the master painters has watched the outside walls of the 
 Pasteur Institute, and has certified as to the equal resistance 
 of the coatings of paint made by white lead and zinc oxide 
 during the years 1903, 1904, and 1905. In consequence of 
 this report the Minister of Public Works sought the opinion 
 of the principal engineers of roads and bridges all over 
 France. Of the 107 reports received, 73 support the 
 opinion of the equal resistance of zinc and lead both for 
 the interior and exterior of buildings. Zinc white is the 
 more expensive, but M. Livache states that the increased 
 cost only amounts to 3 fr. 60 c. in the three coatings over 
 a surface of 100 metres, i,e.^ over a little more than 300 
 yards, and that by the addition of a small quantity of sul- 
 phate of barium to give body to the paint the cost is not 
 greater than white lead. It is only right that I should 
 interpose here the remark that in Great Britain sulphate of 
 barium, owing to its crystalline nature, finds little acceptance 
 with house-painters. The interdiction of white lead in 
 France is not yet an accomplished fact. The Chamber of 
 Deputies has on at least two occasions voted in favour of 
 the total prohibition of lead, and it remains to be seen what 
 action the Senate will again take in the matter. In the 
 French experiments zinc white apparently withstood exposure 
 to the weather to the satisfaction of the experts, but whether 
 
METALLIC POISONS, DUST, FUMES ETC. 191 
 
 in the more trying climate of Great Britain it would have 
 enduring powers equal to white lead is still not proven. My 
 own opinion in regard to the subject, which is based upon 
 the experience gained when a member of the White Lead 
 Commission, is that white lead is superior to zinc as a paint 
 for the exterior of buildings, but that for internal decoration 
 zinc white gives as good results as lead. The opinion of 
 many coach-painters is similar to my own. Experience has 
 convinced them that for the interior decoration of railway 
 carriages and for van-building zinc white is just as satis- 
 factory as white lead. In the manufacture, too, of cornice 
 poles and rings white lead is being discontinued, reliable 
 substitutes having been found in zinc white and in a substance 
 known in the trade as " lithopone." 
 
 Minor Industries in which Lead is Employed 
 
 It would be impossible to enumerate all the industries 
 in which lead in one form or another is employed and in 
 which plumbism may occur. Persons employed in making 
 lead capsules and in fixing them upon the corks of bottles of 
 beverages and proprietary medicines become occasionally 
 the victims of plumbism. In persons employed in making 
 measuring tapes for tailors, also in tailors' cutters, I have 
 known lead poisoning occur through the men holding the 
 tape in their mouth. The manufacture of masonic clothing 
 is not free from risk to health. The machine girls who bind 
 the white skin with ribbon to form the apron complain of the 
 white dust that is given off. This dust frequently contains 
 small quantities of white lead, inhalation of which explains 
 the anaemia of the machine girls, the severe headache they 
 suffer from, and the blue line observed on their gums. Lead 
 poisoning is met with in persons employed in indiarubber 
 works owing to the use of lead carbonate as a whitening 
 agent, also in the painters of safes. It is not necessary to 
 use lead paints for safes. Non-poisonous paints give equally 
 satisfactory results. There has been within recent years a 
 slight increase in the number of cases of lead poisoning in 
 brass works, especially in the dressing of brass castings, and 
 
192 DISEASES OF OCCUPATION 
 
 due in all probability to lead forming a constituent of some 
 of the compositions used in making brass. Men employed 
 in the tempering of the spiral springs of railway buffers have 
 occasionally suffered from plumbism. The springs are 
 dipped in a bath of molten metal containing lead, and during 
 the process of testing the springs in a machine called a 
 " scragg," Mr. Dobson, H.M. Inspector of Factories, Sheffield, 
 found that the men who were thus employed were specially 
 liable to plumbism. 
 
 Symptomatology and Pathology of Lead Poisoning 
 
 While of all the industries which give rise to plumbism 
 the manufacture of white lead is the most important, there 
 are others which do not rank far behind it so far as ill-health 
 of the workpeople is concerned. No matter how plumbism 
 is induced, whether by inhalation of dust, absorption through 
 the skin, or swallowing of soluble lead-salts, the symptoms 
 are the same. One of the principal things to bear in mind 
 is that it is the continuous entrance of very minute traces of 
 lead into the body rather than the occasional entrance of a 
 larger dose that induces the most severe forms of plumbism, 
 for it is of the nature of lead to act slowly, and thus gradually 
 to undermine the health. One of the earliest symptoms is 
 colic, but for some time previous to the onset of abdominal 
 pain it will be found on inquiry that the patient on getting up 
 in the morning had experienced a disagreeable metallic taste 
 in the mouth which prevented him enjoying his breakfast, 
 that he felt headachy and rather sick. His features, too, had 
 been altering, for his face had been gradually becoming paler 
 and more expressionless. To the peculiar pallor of the face 
 and the appearance of the features generally the term 
 "saturnine cachexia" is applied. The increasing pallor of 
 the face is associated with a degree of bloodlessness which 
 tends to become worse. After a few weeks' exposure to lead 
 in a white-lead factory I have seen young healthy women 
 not only lose their ruddy appearance and become quickly 
 pale, but die from saturnine encephalopathy within four 
 months of taking up the work. Some persons are more 
 
METALLIC POISONS, DUST, FUMES, ETC. 193 
 
 predisposed to plumbism than others, but no one is immune. 
 There is both a personal and a family idiosyncrasy to lead 
 poisoning. People who are naturally pale and anaemic, who 
 cannot eat well or who are intemperate in the use of alcohol, 
 are more liable to plumbism than others. Poverty and its 
 accompaniments predispose to it, so does the absence of 
 personal cleanliness. Young adults are more liable to lead 
 poisoning than men and women of maturer age. Females, 
 in my opinion, are not only more susceptible than males, but 
 in them the malady is more apt to assume the worst form, 
 viz., the cerebral type, or what is called lead or saturnine 
 encephalopathy. 
 
 After having experienced headache for days or weeks, and 
 perhaps having suffered from constipation, the patient is 
 seized, often rather suddenly, with severe pain in the abdo- 
 men, in the neighbourhood of the navel, attended by vomiting 
 and usually accompanied by constipation. The pain is not 
 due to constipation, for it does not disappear when the bowels 
 have been freely moved, and besides, instead of constipation 
 there may be diarrhoea. So severe in some instances is the 
 colic that it is difficult to restrain the patient. The pains 
 come and go, and are therefore paroxysmal in character, or 
 they are more constant and are so severe that the patient 
 writhes in agony. Occasionally he gets relief by the external 
 application of warmth and gentle pressure, in other instances 
 the patient cannot bear to have the abdomen touched. The 
 pain is of two kinds. There is a superficial and there is a 
 deep-seated pain, either of which may continue for two or 
 three days, but gradually becoming less. Once the extreme 
 acuteness of the pain has subsided, it is usually found that 
 the pain, as tested by pressure of the examiner's hand, is 
 worse on one side of the abdomen than the other, and that 
 pressure along the course of the pneumogastric nerve in 
 the neck is always more painful on the same side as that 
 on which the abdominal pain is more severe. When the 
 abdominal pain is superficial it is usually paroxysmal and 
 aggravated by pressure : on the other hand, when the pain 
 is more deeply situated, it is more constant, and is rather of 
 the nature of a dull aching than acute pain. The belly, as a 
 
194 DISEASES OF OCCUPATION 
 
 rule, is retracted. The pupils are frequently unequal. The 
 pupil of the eye of the same side as that on which the 
 abdominal pain as elicited by pressure is the more severe 
 is usually, but not invariably, the smaller of the two. The 
 pulse at the wrists is unequal, that on the side of the 
 abdomen which is the more affected being sometimes the 
 stronger, sometimes the weaker of the two. While the 
 abdominal pain persists the sulphocyanide of potassium dis- 
 appears from the saliva, but on the subsidence of the colic 
 there is a reappearance of the sulphocyanide in the saliva. 
 The presence of this salt in the saliva is demonstrated by the 
 development of a reddish-brown colour on the addition of 
 a small quantity of a weak solution of Liquor Ferri Per- 
 chloridi to the saliva. 
 
 It is difficult to say what the colic is due to. In animals 
 that have died from acute lead poisoning I have found the 
 small intestine so firmly contracted in places by muscular 
 spasm as to completely obliterate the calibre of the bowel. 
 Spasm in all probability plays an important part in causing 
 pain, but what is the cause of the spasm ? It may be that 
 lead primarily acts upon the nerve ganglia in the abdomen, 
 or upon the small blood-vessels, and by causing them to 
 contract shuts off some of the blood supply and thereby 
 induces muscular spasm, or it may be that lead acts as a 
 poison to the intestinal muscular fibre and by its direct 
 action causes the small intestine to be constricted in some 
 places and not in others. To this cramp-like contraction 
 the colic is in all probability due. 
 
 Lead colic has sometimes been mistaken for appendicitis, 
 also appendicitis wrongly diagnosed as lead colic, and patients 
 exposed to the risk of a surgical operation when medicinal 
 treatment would have sufficed. With the greatest care pos- 
 sible it is not always easy to differentiate between appendicitis 
 and lead colic. The presence of a blue line on the gums is 
 suggestive of saturnine poisoning, but a house-painter or any 
 other person who is working in lead is just as liable to 
 appendicitis as other people. The difficulty specially arises 
 when the pain of lead colic is referred to the ileo-caecal 
 region, Le.y low down in the right side of the abdomen. 
 
METALLIC POISONS, DUST, FUMES, ETC. 195 
 
 Some physicians maintain that lead as a toxic agent is of 
 itself capable of causing appendicitis, since perforating 
 appendicitis has occurred in plumbism. In cases of obscure 
 abdominal pain the cause of which is not clear, or where a 
 history of lead is obtainable, an opinion should not be given 
 until after very careful examination of the patient and due 
 consideration of all the facts bearing upon the illness. A slow 
 pulse, absence of fever, vomiting and a diminished area of 
 hepatic dulness point to lead colic as against appendicitis. 
 The location of pain in the neighbourhood of the umbilicus 
 is in favour of plumbism. Although this is the usual seat 
 of the pain in lead colic, the pain may not remain confined 
 to this spot but radiate pretty well all over the abdomen. 
 The co-existence of vagal pain in the neck, brought out by 
 pressure, would confirm the suspicion of the abdominal pain 
 being due to lead colic. In the abdominal type of lead 
 poisoning, colic, vomiting and constipation are usually present 
 together, and these three symptoms constitute the saturnine 
 triad. During the height of the pain the radial pulse often 
 becomes so small as to be almost imperceptible ; in other 
 instances it is hard and resistant. The pulse frequently falls 
 as low as forty to the minute. It is seldom that patients die 
 during an attack of lead colic. 
 
 As an indication of the difficulty of making a diagnosis in 
 the acute abdominal illness of a lead worker, let me mention 
 the following. A man about fifty years of age, but who 
 looked much older, a lead worker, was admitted into the 
 Newcastle Royal Infirmary under my care, suffering from 
 faecal vomiting, a dry parched tongue, and constipation. He 
 was sent into the Infirmary under the care of a surgical 
 colleague for operation, as the man was supposed to be 
 suffering from intestinal obstruction. As the patient was 
 extremely ill and in a state of collapse, operation was 
 deferred. When seen by me on the following day there were 
 the symptoms already mentioned, and with these there was 
 present a well-marked blue line on the gums. The vomiting 
 continued, and as no urine had been passed for two days 
 a catheter was passed into the bladder and a small quantity 
 of urine removed. This contained albumen. The diagnosis 
 
196 DISEASES OF OCCUPATION 
 
 of uraemia was made and the vomiting was regarded as due 
 to kidney disease, such as is met with in chronic plumbism- 
 As the urinary secretion was never re-established the patient 
 died a few days after his admission into the Infirmary, and 
 at the post-mortem examination the kidneys were found 
 to be extremely contracted and the seat of marked inter- 
 stitial change. The case, therefore, was one of uraemia 
 occurring in a lead worker and simulating intestinal 
 obstruction. 
 
 On the gums of a patient suffering from plumbism there 
 is usually observed a blue line along the margin of the gums 
 close to the teeth, better marked, as a rule, on the lower than 
 on the upper gum. This line, known as Burton's line, may 
 be present when all the teeth are in excellent condition, 
 although in many lead workers usually several of the teeth 
 are decayed and the gums ragged and slightly ulcerated. 
 Where the, teeth have fallen out or been extracted the blue 
 line is at that particular spot often absent. The blue line is 
 due to a deposit of lead in the form of sulphide in the deeper 
 cells of the epidermis, and is the result of lead combining 
 with sulphuretted hydrogen evolved from the decaying morsels 
 of food between the teeth. In cases where the gum has 
 ulcerated the dark particles of sulphide of lead are found 
 in the large phagocytic cells, also in the fixed cells of the 
 connective tissue of the gum. Now and again a large blue 
 patch can be seen inside the cheek of a lead worker who 
 has at the same time a well-marked blue line on his gums. 
 The patch is generally opposite a decayed tooth. I have 
 also found similar blue patches on the lower part of the small 
 intestine and ascending colon of persons who have died from 
 chronic lead poisoning. Occasionally, too, the upper surface 
 of the tongue is stained blue. The presence of a blue line 
 on the gums, although strong confirmatory evidence of 
 plumbism, is no proof that the person at the time is suffering 
 from lead poisoning, for on examining the gums of all the 
 workmen in a lead factory nearly all of them will show a 
 blue line. It only indicates that lead is deposited in that 
 particular part of the system. When it is accompanied by 
 other symptoms the blue line becomes a valuable sign. 
 
METALLIC POISONS, DUST, FUMES, ETC. 197 
 
 Mention has been made of the peculiar pallor of the face 
 in lead poisoning. This is due to ansemia. On examining 
 the blood microscopically the red corpuscles are found to 
 be fewer in number than in health. Instead of there being 
 5,000,000 red blood corpuscles per cmm. of blood, as there 
 should be in health, there may be two-thirds or only one-half 
 of the normal number. In one of my lead poisoned patients 
 there were 2,700,000 coloured corpuscles and 10,000 white 
 corpuscles. Accompanying this diminution in the number 
 of the red blood corpuscles there is a corresponding fall in 
 the amount of haemoglobin or colouring matter of the blood. 
 The white corpuscles are not increased. Gravitz has drawn 
 attention to a peculiar structural change undergone by the 
 red blood corpuscles and brought out by the use of special 
 staining reagents. They exhibit a distinctly granular 
 appearance, due to the minute granules taking on basic 
 aniline stains. The white corpuscles do not usually show 
 any profound structural change or percentage numerical 
 alteration. In the case just referred to the colourless 
 corpuscles were distributed as follows, viz. : — 
 
 Polymorphonuclear 
 Small lymphocytes 
 Large „ 
 Eosinophile cells ... 
 
 The eosinophile cells were slightly in excess. Occasion- 
 ally a few nucleated red blood corpuscles are found in 
 plumbism. The anaemia has been said to be proportional to 
 the length of exposure to lead, but this is not always the 
 case, for I have seen young women become markedly pale 
 in a very short time. It is the function of the red blood 
 corpuscles to absorb oxygen from the air in the lungs and 
 to carry this gas into all the organs and tissues of the body. 
 A deficiency in the number of these corpuscles implies im- 
 perfect oxygenation of the system, with all its consequences. 
 Workers in lead may, as stated, become anaemic at an early 
 date after exposure to lead : once it is developed the pallor 
 remains for a long time, even after the patient's retirement 
 
 Lead Poisoning. 
 
 In Health. 
 
 66 per cent. 
 
 60-70 per cent. 
 
 20 
 6 „ 
 
 ■15-30 
 
 8 ,, 
 
 5 
 
198 DISEASES OF OCCUPATION 
 
 from the factory. Malassez, a French physician, although 
 admitting that anaemia may rapidly develop, is of the 
 opinion that the bloodlessness of lead workers is propor- 
 tional to the length of time they have spent in the works. 
 According to Malassez, the blood of a painter, which at the 
 commencement of his occupation contains 4,500,000 red 
 blood corpuscles, will after five years contain 3,700,000, at 
 the end of twenty years 2,600,000, and at the end of thirty 
 years 2,200,000 red corpuscles. 
 
 Lead as a poison strikes hard the blood-making powers of 
 the body. It is probably by this fact and the recurrent 
 demands made upon the system by menstruation that the 
 greater susceptibility of women to plumbism is to be 
 explained. The idiosyncrasy is not confined to women 
 alone, for I find it present in the female sex of most 
 animals. The menstrual flow is usually increased in female 
 lead workers, but occasionally there is amenorrhoea. Women 
 who are the subjects of plumbism even so slightly as not 
 to present symptoms, exhibit when pregnant a marked 
 tendency to abort. Several animals under my care have 
 in experimental plumbism miscarried. Lead destroys the 
 reproductive powers of both men and women, but its special 
 influence upon women during pregnancy is the cause of a 
 great destruction of human life. A large percentage of the 
 children born to lead workers die within the first few months 
 of life. The percentage of still-births is as high as mis- 
 carriages are frequent. In towns where the drinking-water 
 has become contaminated by lead the tendency to mis- 
 carriage often assumes an epidemic form. With lead 
 poisoned pregnant women who had been in the habit of 
 miscarrying, I found that the only possible way for them 
 to go to full term and have a living child was to get 
 them to retire from the lead works altogether. Several 
 women on my recommendation did this : they went into 
 the country and took up work in the open air. While 
 following a healthy occupation these women, after having 
 frequently miscarried when working in lead factories, would 
 have two or three living healthy children, but circumstances 
 necessitating the return of these women to town, and 
 
METALLIC POISONS, DUST, FUMES, ETC. 199 
 
 resumption of work in the lead factory, they in each 
 successive pregnancy again miscarried. This loss of 
 offspring is one of the most striking and appalling facts 
 connected with lead poisoning and is beyond all controversy. 
 A few cases taken from my note-book may be of interest. 
 Mrs. H., aged 35, had 4 healthy children born at full time. 
 She went to work in a white lead factory and was there for 
 six years. During that period she had 9 miscarriages and 
 no living child. Mrs. M., aged 30, has had 7 children and 
 3 miscarriages. All the miscarriages occurred after going to 
 the lead works. Mrs. K., aged 34, had 4 children before 
 going into the factory and 2 children after. She then had 
 6 miscarriages in succession, when she came under my care 
 in the Royal Infirmary, having become the victim of 
 plumbism and having lost the power in her arms and legs. 
 She made a slow but good recovery and did not return to 
 the lead works. In her next pregnancy she went to full 
 term and gave birth to a living child. 
 
 Constantin Paul has published the results of 123 preg- 
 nancies where the father and mother had worked in lead. 
 Of these, 64 ended in abortion, 4 were premature confine- 
 ments, 5 were still-births, and 20 of the infants born alive died 
 within the first year. In a series of cases amounting to 43 
 pregnancies in women who were working in lead he found 32 
 of these ended in miscarriage and 3 in still-births ; 2 living 
 children were born, but these were extremely ill-nourished. 
 Malnutrition and mal-development of the offspring are 
 striking features in infants when both parents are working in 
 lead. The product of conception, even when retained until 
 nearly full term, is not much more than half the normal weight 
 of a healthy infant of the same period. Balland gives the 
 details of icx) pregnancies where one or both parents were 
 lead workers. Abortion occurred in 40 instances, 26 of the 
 confinements were premature ; of 32 of the accouchments 
 that came off at term, 60 per cent, ended in still-births. Of 
 the 40 children born alive, 26 died during their first year. 
 Professor Lewin, of Berlin, mentions the fact of 4 women 
 who worked in a factory where type for printing was made 
 and polished. Among these women there were 15 preg- 
 
200 DISEASES OF OCCUPATION 
 
 nancies, but only one of the pregnancies ended in a live 
 birth. He also mentions the case of a woman who at the 
 age of twenty married a house-painter, and in course of 
 time gave birth to a male child, who lived until four years of 
 age. A year after this she entered a lead foundry. Until 
 then her menstruation had been regular. Subsequently she 
 became the subject of lead paralysis, both hands were 
 affected, but although there was marked anaemia, there was, 
 as is frequently the case in type-makers and printers, no blue 
 line on the gums. During the eight years she worked in the 
 foundry she had 8 miscarriages and only once a living child, 
 who died five weeks after birth. It is an interesting fact 
 that while a man who has suffered from plumbism takes a 
 long time to recover, even after withdrawal from the lead 
 works, a woman who has been a lead worker, and in whom 
 during all the period she was in the factory each pregnancy 
 ended in a miscarriage or a still-birth, will, if she gives up 
 working in lead, probably go to the end of term in her next 
 and succeeding pregnancies and give birth to healthy children 
 who survive. The effects of lead in this particular direction 
 are worst when both parents are affected, next when it is the 
 mother alone who has been brought under the influence of 
 lead ; but there is evidence to show that lead impregnation 
 of the male is also extremely prejudicial to the offspring. 
 Rennert has attempted to express in statistical terms the 
 varying degrees of gravity in the prognosis of cases in which 
 at the moment of conception both parents are the subjects 
 of lead poisoning, also where one alone is affected. The 
 malign influence of lead is reflected upon the foetus and on 
 the continuation of the pregnancy 94 times out of 100 when 
 both parents have been working in lead, 92 times when the 
 mother alone is affected, and 63 times when it is the father 
 alone who has worked in lead. Taking 7 healthy women 
 who were married to lead workers, and in whom there was a 
 total of 32 pregnancies, Lewin tells us that the results were 
 as follows : 1 1 miscarriages, i still-birth, 8 children died 
 within the first year after birth, 4 in the second year, 5 in the 
 third, and i subsequent to this, leaving only 2 children out 
 of 32 pregnancies as likely to live to manhood. In cases 
 
METALLIC POISONS, DUST, FUMES, ETC. 201 
 
 where women have had a series of miscarriages so long as 
 their husbands worked in lead, a change of industrial occupa- 
 tion on the part of the husbands restores to the wives 
 normal child-bearing powers. How is it that lead exercises 
 such a harmful influence upon reproduction ? That lead has 
 strong abortifacient powers the cases cited above amply 
 indicate. It is knowledge of this circumstance that causes 
 females of the lower ranks of life to resort in expecting 
 motherhood to the use of diachylon pills (lead) for the 
 purpose of inducing abortion, an ill-advised procedure and 
 a dangerous line of treatment, since it has in too many 
 instances caused the death of the woman herself. Lead 
 causes abortion probably by acting upon the unstriped 
 muscular fibre of the womb and inducing spasm. The poison 
 also passes from the blood of the mother through the placenta 
 to the foetus in utero, and by killing the foetus it thus 
 indirectly brings about abortion. That lead passes thus 
 from a woman to the offspring in her womb is confirmed 
 by the detection of lead in the liver and nervous system of a 
 still-born child upon whom I made an autopsy. The infant 
 was the offspring of parents both of whom were white lead 
 workers. The same remark applies to animals. In the dead 
 foetuses of some of my rabbits that had been fed with lead 
 Professor Bed son on chemical analysis found traces of lead. 
 
 Following up this subject, the experiments of Balland are 
 too valuable to be omitted. On one occasion I had the 
 breast milk of a female lead worker who was nursing her 
 infant examined for lead, but without success — probably 
 because just at that time the woman was not actively 
 engaged in the lead factory. Balland administered daily 
 small quantities of lead to a bitch who on the day previous 
 to the special feeding had given birth to seven puppies. 
 These animals were entirely nourished by the mother's milk. 
 For the first few days after commencing the lead all went 
 well, then subsequently the puppies became anaemic, one or 
 two of them seemed to suffer and become weak in their 
 limbs and dwindled. Two of them were killed 25 days after 
 their birth, and chemical analysis revealed the presence of lead 
 in their viscera to the extent of 5 to 10 milligrammes in one 
 
202 DISEASES OF OCCUPATION 
 
 and 40 to 45 in the other. Balland's experiments clearly 
 demonstrate the transmission of lead to the nursling through 
 the mother's milk and the sad consequences which follow. 
 
 Mention has been made of the fact that the children of 
 lead workers, if born alive, are frequently ill-nourished and die 
 shortly after birth, and that this is particularly the case 
 where the mother is the subject of lead toxaemia. Many of 
 the children die in their first year from convulsions. Although 
 lead destroys the offspring in utero and prevents pregnancy 
 running its proper course, I have found, comparatively 
 speaking, fewer instances of idiocy and imbecility in the 
 children of lead workers than might have been anticipated. 
 I have seen both cretinism and imbecility in infants in whom, 
 as there could have been no possible influence of alcohol, 
 and presumably none of syphilis, the occupation of one or 
 other parent as a lead worker must have determined the 
 imperfectly developed nervous system of the child. The 
 large number of miscarriages and still-births and the short 
 life that is meted out to the children of lead workers show 
 that some peculiarly baneful influence had been stored up in 
 the germ cell of the female and sperm cell of the male before 
 impregnation, whereby in due course life is hit so hard in 
 the earliest months of development that it cannot continue, 
 for such is the blighting power of lead. Salpetriere and 
 Bicetre are large hospitals iu Paris set aside for the reception 
 and treatment of nervous diseases. The experience of the 
 physicians of these institutions is unrivalled. One of the 
 physicians, M. Roques, speaking of the degenerates found 
 in these hospitals, says that slowly induced lead poisoning 
 on the part of both parents or in one or other of them is 
 not only a cause of repeated abortions, high percentage of 
 still-births and high death-rate of infants, but is the cause of 
 convulsions, imbecility, and idiocy in many of the children 
 who survive the first year of existence. Of 19 children born 
 to parents who were lead workers, Rennert found that I 
 child was still-born and that 17 were macrocephalic. In his 
 studies upon hereditary degeneration and idiocy, Bourneville 
 places house-painters in the unenviable first rank of the 
 occupations followed by parents of mentally weak children. 
 
METALLIC POISONS, DUST, FUMES, ETC. 203 
 
 Out of Sy cases relating to unhealthy trades, 51 were con- 
 nected with white lead in some form or another, while 
 syphilis was only responsible for 19. I am of the opinion 
 that there is a larger amount of mental degeneracy in the 
 children of lead workers in France than there is in Great 
 Britain. It would seem, therefore, as if there were other 
 contributory causes in operation than working in lead, but of 
 these proof is difficult to obtain. 
 
 Lead acts directly and indirectly upon the kidneys, liver, 
 and the nervous system. In old standing cases of plumbism 
 the urine contains albumen and the kidneys after death are 
 found to be contracted. Interstitial nephritis has therefore 
 come to be regarded as the typical kidney lesion of 
 plumbism, but in the early stages of the malady it is the 
 epithelium of the tubules and the glomerular epithelium that 
 are primarily affected. It is not uncommon to find albumen 
 in the urine of persons who are suffering from their first 
 or second attack of lead colic, and it may disappear on 
 subsidence of the pain. In young women who have 
 succumbed to saturnine encephalopathy a few months after 
 having worked in a lead factory I have invariably found 
 tubular nephritis, and the same holds good of animals to 
 whom lead had been given in the food. Since in plumbism 
 traces of lead are usually found in the urine, it is natural to 
 suppose that lead, which is a foreign substance, on its 
 elimination by the kidney would induce structural changes 
 in these organs, and as the glomeruli and the epithelium of 
 the tubules are the most sensitive parts, that these would 
 suffer first. Albumen therefore may appear in the urine 
 in plumbism under two different circumstances. It may be 
 transitory and point to a curable condition, or it may be 
 permanent and an indication of diseased kidneys. When 
 the kidneys become affected there is frequently complaint of 
 severe headache and loss of sight due to uraemic retinitis. It 
 is to be remembered, however, that loss of vision may occur 
 in lead workers without any indication of the kidneys being 
 affected, also that lead is capable of lying latent in the 
 body for a few years and then, unexpectedly and in a way 
 difficult to explain, of giving rise to fresh symptoms of 
 
204 DISEASES OF OCCUPATION 
 
 poisoning. I have recently had a good illustration of this. 
 A female patient, M. P., aged 36, was admitted into the 
 Infirmary under my care owing to severe headache, paralysis 
 of the muscles of one eyeball, and defective eyesight. She 
 was a married woman, the mother of six children, one of 
 whom died when young. She had also had three miscarriages. 
 I recognised her as an old patient who before her marriage, 
 while a white lead worker, had seventeen years previously 
 been thrice under my care in the same ward on account of 
 lead colic and ultimately saturnine encephalopathy followed 
 by blindness, which persisted for several weeks. She made a 
 good recovery, never returned to the lead works, but married 
 a few years afterwards, and beyond having her family had 
 enjoyed good health until shortly before her readmission into 
 the Infirmary. Although the patient had not been brought 
 during her married life under the influence of, or even into 
 contact with, lead to her knowledge, she being the only one 
 of the family who was ill, I took the view, in the absence of 
 syphilis and other causes, that her headache and eye symptoms 
 were the result of lead poisoning, and on a chemical exami- 
 nation of the urine being made by Professor Bedson, lead 
 was found therein. As the most careful inquiry failed to 
 elicit the possibility of any new source of poisoning, and 
 under treatment all the symptoms improved, including the 
 disappearance of lead from the urine, I cannot but regard 
 the case as one of lead poisoning relit by the dissolution and 
 reabsorption of the metal which had for seventeen years lain 
 dormant in the tissues. This is the longest latent case of lead 
 poisoning that I know of. Occasionally it has happened in 
 patients suffering from obscure forms of paralysis that the 
 administration of potassium iodide has been followed by the 
 development of serious symptoms which ended in death, and 
 which the data of a post-mortem examination and the facts 
 obtained from relatives showed to have been due to chronic 
 plumbism, that had not revealed itself by any symptoms 
 until the advent of the paralysis. It remains to be seen how 
 far the Workmen's Compensation Act can apply to cases of 
 long latent lead poisoning. It is clear that the greatest care 
 will have to be exercised both in pressing and opposing a claim. 
 
METALLIC POISONS, DUST, FUMES, ETC. 205 
 
 Apart from causing albuminuria, plumbism alters the 
 composition of the urine in other respects, so that in 
 doubtful cases the suspicion of lead intoxication would be 
 strengthened by detecting red or blue indican in the urine. 
 To obtain the reaction equal quantities of a patient's urine 
 and hydrochloric acid are mixed together, and to this a 
 smaller quantity of chloroform is added and the test-tube 
 shaken. If the chloroform becomes blue the urine contains 
 indican or blue indigotine ; should it become red, the colour 
 is due to a product which is the outcome of the oxidation of 
 indigotine, and is named indirubine. I have invariably found 
 indican in the urine of patients suffering from lead poisoning, 
 and while it is occasionally present in the urine of persons 
 other than those suffering from plumbism, indicanuria in 
 lead poisoning is so much more constant that it is of assis- 
 tance in making a diagnosis when other symptoms and signs 
 are deficient. The test is simple and is easy of application. 
 The best proof that a patient is suffering from plumbism is 
 the detection of lead in the urine on chemical analysis, but its 
 absence is no proof of the contrary. 
 
 Lead is thrown out of the system in the faeces as well as 
 by the urine. To Dr. Dixon Mann we are indebted for a full 
 account of the elimination of lead by the intestinal canal. 
 Several methods for the detection of lead in the urine are 
 recommended ; many of them are rather complicated, and 
 can only be carried out satisfactorily in a chemical 
 laboratory. It is not necessary for diagnostic purposes 
 that a quantitative estimation should be made. A very 
 simple method is to suspend in the urine a small bag 
 containing calcium sulphide. If there is lead in the urine 
 the sulphide of calcium will become blackened, owing to 
 the formation of the black sulphide of lead. 
 
 The nervous system is peculiarly prone to be affected by 
 lead. The most dangerous form of lead poisoning is that 
 known as saturnine encephalopathy. Women are more 
 liable to this form of acute poisoning than men. It is 
 usually preceded by severe headache, when often without 
 further warning the patient becomes convulsed and passes 
 into a state of coma. Patients may die on the second or 
 
2o6 DISEASES OF OCCUPATION 
 
 third day without regaining consciousness. During the 
 attack the urinary secretion may fall to as low as three or 
 four ounces, and it may or may not contain albumen. 
 Should the patient recover consciousness and live, it is 
 occasionally observed that vision is lost. This loss of vision 
 may be temporary or permanent. It was not an uncommon 
 event when females were allowed to work in lead factories 
 for most of those who suffered from saturnine encephalo- 
 pathy to lose their sight permanently, and thus women still 
 young in years would be found hopelessly blind and maimed 
 for life. This brain type of lead poisoning may occur in 
 patients without warning and without any of the usual 
 prodromata, such as colic or loss of power in the wrists, and 
 since it develops without the co-existence of albumen in the 
 urine, it is clearly not due to uraemia and kidney disease, as 
 some physicians maintain, but is the result either of the action 
 of the lead itself upon the delicate nerve cells of the brain 
 or indirectly of the lead having primarily interfered with the 
 function of the excretory organs, and through this circum- 
 stance having produced a form of auto-intoxication. The 
 opinion has been advanced that saturnine encephalopathy is 
 the result of the combined action of lead and alcohol a form 
 of mixed toxaemia, but I have seen it occur in, and be the 
 cause of death of, young females who had not taken stimu- 
 lants at all. One of the earliest instances of this was a 
 young female white lead worker who had only been in the 
 factory five weeks and who had drawn only eight stoves. 
 It occurs, too, in young women employed as dippers' 
 assistants in potteries as early as six to eight months 
 after taking up the occupation. M. Mosny, of the Hopital 
 St. Antoine, Paris, attributes the cerebral symptoms of 
 lead encephalopathy to acute saturni-meningo encephalitis. 
 On a few occasions I have seen saturnine encephalopathy 
 preceded by seizures which had all the features of ordinary 
 hysteria. A girl comes home from her work, and it is noticed 
 by her friends that she is more excitable than usual. She 
 is inclined to laugh or is disposed to cry, and is unable 
 to control either her movements or her feelings. To her 
 friends — and even to medical men who have not had 
 
METALLIC POISONS, DUST, FUMES, ETC. 207 
 
 previous experience of such cases — the symptoms do not 
 in any way appear to be serious, and yet within two days 
 after the development of this toxic hysteria the patient will 
 probably be dead. The lesson to be learnt is that we must 
 never allow ourselves to be thrown off our guard by such 
 hysterical symptoms, for they are often the prelude to satur- 
 nine encephalopathy, and therefore conceal a more profound 
 poisoning of the higher brain centres than at first appears. 
 
 I have alluded to loss of eyesight. On examining the 
 eyes there is evidence of neuro-retinitis with or without 
 haemorrhages. Some oculists have attributed the retinal 
 changes to kidney disease, but as similar structural changes 
 are met with in patients whose urine is free from albumen, 
 all cases of blindness in lead poisoning do not own a kidney 
 cause. The blindness may be due to changes in the optic 
 disc and retina consequent upon kidney disease or to the 
 direct action of lead upon the retina, but loss of sight in 
 plumbism may occur without any structural alteration of the 
 retina. Temporary loss of vision is occasionally complained 
 of by patients during attacks of acute colic, and is to be 
 explained by either the influence of the toxaemia or by the 
 high arterial tension which may be present. Sometimes only 
 one-half of the field of vision is lost. 
 
 The affection of the nervous system which occurs most 
 frequently in lead poisoning is "wrist-drop." The muscles 
 of the fingers, hands, and wrists become paralysed, so that 
 the hands hang powerless by the side of the body, and the 
 patient is in a pitiful plight, for he cannot work, much less 
 feed or even dress himself There is paralysis, more or less 
 complete, of the extensor muscles of the wrists and fingers. 
 Although both hands are affected, one hand — usually the 
 one which has done more work — is worse than the other. 
 Wrist-drop may develop rather suddenly, or it may come 
 very gradually, preceded by slight pain in the muscles. 
 Pain, however, is not a prominent symptom. The paralysis 
 may involve the muscles of the forearm, also those of the 
 calf of the leg. All the muscles that are affected become 
 quickly atrophied. In adults lead has a special preference 
 for the extensor muscles of the wrists and fingers, but in 
 
2o8 DISEASES OF OCCUPATION 
 
 children ft is the muscles of the lower extremities that are 
 affected, hence the greater frequency in children of ankle- 
 drop, which is accompanied by loss of the plantar reflex, and 
 is the counterpart of the wrist-drop met with in adults. 
 
 Wrist-drop and paralysis of the muscles of the upper 
 extremities may occur in plumbism without there having 
 been colic or complaint of headache. While it is the 
 extensor muscles of the hand and wrist that are principally 
 affected, the flexor muscles also become weak. Usually 
 in wrist-drop the supinator longus muscle escapes, but when 
 the loss of power involves also the muscles of the upper arm, 
 the supinator longus is also found to be paralysed. In severe 
 forms of lead poisoning the paralysis may involve the muscles 
 of the lower extremities, also those of the trunk. Occasion- 
 ally the muscles concerned in respiration become paralysed, 
 and when this occurs death ensues. Symptoms suggesting 
 general paralysis are sometimes observed : memory to a 
 large extent is lost, the power of walking is impaired, and 
 the ability to write is destroyed. The symptoms are pre- 
 ceded by delirium or by an epileptiform convulsion, after 
 which it is noticed that the speech is defective. Notwith- 
 standing the fact that under other circumstances these 
 symptoms usually betoken a serious affection of the nervous 
 system, the patient will, if the illness is due to lead, in most 
 instances recover. It is this tendency of saturnine pseudo- 
 general paralysis to undergo amelioration which differentiates 
 it from the classic malady. All cases, however, do not 
 recover. When death has taken place the appearances 
 observed in the brain have been those of general paralysis, 
 and on chemical examination of the brain traces of lead 
 have been found therein. 
 
 Lead poisoning occasionally simulates tabes dorsalis or 
 locomotor ataxia. There is incoordination of the muscles, 
 attended sometimes by loss, sometimes by exaggeration, of 
 the knee-jerk. Closure of the eyes so aggravates the muscular 
 incoordination that the patient can hardly stand. In other 
 instances the gait resembles that of a high-stepping horse, 
 owing to weakness of the extensor muscles of the feet. 
 Under proper treatment the patients usually recover. 
 
 I 
 
METALLIC POISONS, DUST, FUMES, ETC. 209 
 
 Since the nervous symptoms in plumbism are widespread 
 and varied, there has been considerable discussion as to 
 whether the lesions are in the peripheral nerves and give 
 rise to a neuritis or whether they are due to changes in the 
 brain and spinal cord. On microscopical examination of the 
 peripheral nerves in chronic lead paralysis there is observed 
 a marked increase of the interstitial tissue, with atrophy of 
 the nerve fibres, but the large cells in the anterior cornua of 
 the spinal cord do not always escape. Although nerve cells 
 are more easily affected by poisons than are nerve fibres, 
 the latter, owing to their distance from the centres of 
 nutrition in the spinal cord, may exhibit greater structural 
 changes. The lesions in the peripheral nerves are due to 
 changes in the cells of the spinal cord as well as to changes 
 in the nerves. Gombault and Charcot consider that lead palsy 
 is a peripheral neuritis only, and due to a segmentary and 
 periaxial degeneration of the nerves. In this form of degene- 
 ration the axis cylinder of the nerve fibre is spared : the 
 structural alteration is confined to a few of the segments of 
 Ranvier, while the nerve fibres above and below the affected 
 parts are healthy; hence the recovery of power which takes 
 place in these cases. Occasionally in periaxial neuritis the 
 axis cylinder undergoes fragmentation. Drs. Laslett and 
 Warrington, of the Liverpool University Pathological 
 Laboratories, have published the results of the micro- 
 scopical examination of the nerves and muscles of the 
 hands of a house-painter who had long suffered from 
 wrist-drop. There was found marked atrophy of the pos- 
 terior interosseous and ulnar nerves and a similar condition 
 of the anterior roots of the sixth, seventh, and eighth 
 spinal nerves, with a normal condition of the correspond- 
 ing posterior roots. Ninety per cent, of the muscle fibres 
 of the extensor muscles of the hand were atrophied, but 
 still retained their cross striation ; the connective tissue 
 was increased, but the muscle spindles were unaltered. In 
 the anterior cornual cells of the sixth and seventh segments 
 of the spinal cord there were evidences of chromatolysis with 
 excentral situation of the nucleus. While admitting that 
 lead acts primarily upon the central nervous system, Laslett 
 
2IO DISEASES OF OCCUPATION 
 
 and Warrington are of the opinion that in their patient the 
 spinal cord lesion was secondary to the peripheral neuritis, 
 and they base their opinion upon the excentral position of the 
 nucleus. Adopting this view, the changes in the anterior 
 cornual cells would not be the result of the action of lead 
 upon the spinal cord, but would be consequent upon a lesion 
 of the axis cylinders of the peripheral nerves ; in other words, 
 would be the result of a " reaction a distance," for a descrip- 
 tion of which we are indebted to Marinesco. 
 
 Asylum records show that lead poisoning may be a cause 
 of insanity. Usually there are some premonitory symptoms, 
 such as headache and toxic hysteria, or the patient appears 
 as if he were intoxicated with alcohol. Sometimes symptoms 
 of acute mania develop suddenly. The delirium is of a noisy 
 character and the patient is with difficulty restrained. There 
 may be intervals of quietude in which consciousness is fully 
 restored. Delirium followed by coma and attended by a 
 rising temperature marks a serious condition, from which the 
 patient rarely, if ever, recovers. 
 
 There are many minor affections that lead gives rise to, i 
 e.g., swollen and painful joints, painful swellings on tendons, 
 enlargement of the submaxillary glands and testicles. The 
 association of lead poisoning and gout has for many years 
 been known, especially in the South of England. In the 
 North we seldom find it. 
 
 When quite unexpectedly the death of a lead worker 
 has taken place, no symptoms of plumbism, or next to none, 
 having shown themselves during life, there may be found 
 few, if any, naked-eye pathological lesions at the post-mortem 
 examination of the body which will enable a physician to 
 say that death has been the result of lead poisoning. The 
 presence of a blue line on the gums should always be looked 
 for ; if found, it is confirmatory evidence. In acute saturnine 
 encephalopathy the brain is sometimes shrunken and firm ; 
 the brain substance may be pale and firm or pale and 
 oedematous as in uraemia. If there has been colic the 
 small intestine may be contracted at places. Dark blue 
 patches should be looked for on the mucous membrane of 
 the large and lower part of the small intestine. In acute 
 
METALLIC POISONS, DUST, FUMES, ETC. 211 
 
 plumbism the kidneys may be normal in size and on 
 microscopical examination exhibit signs of tubular nephritis : 
 in chronic plumbism, on the other hand, the kidneys are 
 small and contracted, the capsule is firmly adherent, and on 
 microscopical examination there are evidences of interstitial 
 nephritis. To the naked eye the lungs, heart, liver, and spleen 
 in acute plumbism often present nothing unusual, so that 
 it is extremely difficult to say, in the absence of a history of 
 the case, and of knowledge of the occupation of the deceased, 
 a chemical examination of the brain and liver, and of any 
 urine that may be present in the bladder, whether lead 
 poisoning was or was not the cause of death. In old 
 standing cases of plumbism the contracted kidneys, 
 diseased arteries — rupture of which in the brain induces 
 apoplexy — and the general malnutrition and pallor, all point 
 to lead as the cause of the structural changes in the body ; 
 but since alcohol, other poisons, and other conditions induce 
 similar pathological results, the post-mortem findings alone 
 can, in the absence of a history of exposure, only suggest the 
 probability of lead as the cause of death. On a chemical 
 examination of the liver and brain being made, lead will 
 probably be found in these organs if the case is one of 
 plumbism. In the brain of one of my patients Professor 
 Bedson found 0*634 grain of lead and 0*819 grain in the 
 liver ; in another female patient he found 0*779 grain of 
 lead in the brain and i grain in the liver. One of the 
 worst cases of acute lead encephalopathy that I have seen 
 was with Dr. Inglis, of Hebburn-on-Tyne, in the person of a 
 young woman patient who had been quite healthy and had 
 only worked thirteen weeks in a white lead factory when she 
 had convulsions, in which she died. In her brain no lead 
 was found. Lead in some instances must enter into chemical 
 combinations with the substance of the brain ; lead-saturated 
 cerebral cells would be incapable of performing normal 
 function, but since death can occur without the slightest trace 
 of lead being found in the brain after death, it would appear 
 as if death under these circumstances was the result of a 
 primary action of lead upon the eliminating organs, such as 
 the liver and kidneys, causing destruction or diminution of 
 
212 DISEASES OF OCCUPATION 
 
 their function and a secondary toxaemia in consequence. 
 Once lead is introduced into the human body the excretory 
 organs do their best to immediately eliminate it. If minute 
 quantities of lead are administered in food to animals, traces 
 of lead will be found in the urine a day or two afterwards. 
 It is when the eliminating organs fail to throw the poison 
 freely out of the system that retention occurs and symptoms 
 of ill-health show themselves. The lead passes out of the 
 blood into the tissues, with which it may form insoluble 
 organic compounds and lie dormant for a long time, years 
 it may be, or the compounds are redissolved, so that in 
 the absence of renewed exposure to the poison the patient 
 becomes, ab intra, the subject of plumbism, and will probably 
 be found passing lead in his urine. 
 
 The treatment of lead poisoning is preventive and curative. 
 So far as the prevention of industrial lead poisoning is con- 
 cerned, allusion has been made here and there in these pages 
 to several of the means to be adopted. The Regulations 
 issued by the Home Office for all kinds of lead factories are 
 a great advance upon those of former years, and if loyally 
 carried out will do much to reduce industrial plumbism. 
 Work in the potteries is still being carried on under the 
 Amended Rules published after the arbitration meeting at 
 Stoke previously alluded to. There must be, however, no 
 standing still as regards the Home Office and its supervision 
 of the lead industries. Experience has frequently demon- 
 strated that an increase in the number of cases of lead 
 poisoning has been the result of carelessness on the part of 
 the workers and non-observance of rules, laxity on the part 
 of employers and foremen, and incomplete medical inspection. 
 To fight successfully such an insidious foe as industrial lead 
 poisoning there must be constant watchfulness by all con- 
 cerned, also frequent revision and extension of Home Office 
 Rules and Regulations. 
 
 Curative treatment concerns the individual. If the colic is 
 not severe, rest in bed, application of external warmth, and 
 the administration of a mild purgative, such as castor oil 
 or magnesium sulphate, may be sufficient. Should the pain 
 be accompanied by vomiting, draughts of warm alkaline water, 
 
METALLIC POISONS, DUST, FUMES, ETC. 213 
 
 the administration of an effervescing soda and bismuth 
 mixture, and washing out of the large bowel by means of an 
 enema of warm water and olive oil, may be tried. When the 
 pain in the abdomen is severe, relief may be obtained by a 
 warm bath. To some patients it may be necessary to give a 
 hypodermic injection of morphia, or of morphia and atropine 
 combined. A mixture of magnesium sulphate and potassium 
 iodide answers remarkably well, but in the treatment of some 
 cases of plumbism the administration of potassium iodide 
 must be made with care, since, as Melsens showed and my 
 own experience confirms, the iodide may redissolve lead that 
 has been lying inert in the body, cause its reabsorption into 
 the blood, and thereby induce fresh symptoms of poisoning. 
 Iodide of potassium is one of the best eliminants of lead. In 
 cases where the symptoms have subsided but health has not 
 been regained, the administration of the potassium salt will be 
 followed by a reappearance of lead in the urine. I have known 
 it cause albuminuria in chronic plumbism, which ceased with 
 stoppage of administration of the drug. In cases where pain 
 continues to linger in the abdomen and there is tenderness 
 on pressure, I have found monosulphite of soda give great 
 relief Mild but lingering abdominal pain and paralysis 
 quickly disappear under the administration of one-third to 
 half a grain given every two hours. It is desirable in all 
 circumstances to get the bowels moved. In due course, under 
 the iodide and magnesium treatment, combined or not with 
 Tinct. belladonna and carminatives, the symptoms of saturnine 
 poisoning will subside, and perhaps no lead be found in the 
 urine. Although free from lead, if the urine contains albumen 
 and the phosphates are markedly diminished, it is more than 
 likely that lead is still lying dormant in the tissues, for on 
 administering iodide of potassium months afterwards lead 
 may again reappear in the urine, the albumen may diminish 
 or disappear, and the phosphates become increased. It is 
 to this retention of lead in the tissues of the body and 
 its redissolution and absorption that the development of 
 fresh symptoms of lead poisoning must be attributed when 
 occurring months after an apparent cure had been effected. 
 In chronic cases of plumbism, where the kidneys are affected 
 
214 DISEASES OF OCCUPATION 
 
 and the patient looks aged and his features altered, it is not 
 always wise to give potassium iodide, but in recent cases of 
 wrist-drop in young subjects the drug ought to be given 
 combined with nux vomica and the administration of a saline 
 in the morning. For paralysis, rest of the affected arm in 
 splints with the daily application of massage and electricity 
 will be found helpful. The constant current acts equally as 
 well as the interrupted. Muscles which exhibit the reaction of 
 degeneration, i.e., which contract only to the direct application 
 of the constant current, can be benefited by a course of 
 induction coil currents. It is not a necessary requirement 
 of electrical treatment that the responsive muscular contrac- 
 tions should be strong. There is the risk in over-stimulating 
 weakened muscles of inducing fatigue. Dr. H. Lewis Jones, 
 of St. Bartholomew's Hospital, recommends the electrical 
 bath with the constant current in cases where it is sought to 
 favour the electrolytic extraction of lead from the tissues. 
 On the other hand, where electrical stimulation of the paralysed 
 muscles is alone required, induction coil currents with or 
 without a water bath are called for. The two methods differ 
 in degree rather than in essence. The extraction of lead 
 from the human body by means of electricity and the 
 deposit of the metal in the form of chloride upon the electro- 
 lyte surrounding the body is more than a probable occurrence, 
 and yet experimental evidence upon this point is not 
 altogether free from error. Treatment of lead paralysis by 
 electricity is both safe and useful. The use of the arm bath 
 with the application of the sinusoidal current is very helpful 
 in cases of wrist-drop. For more extensive lead paralysis, 
 where, for example, the muscles of the legs are also affected, 
 a full-length bath with the use of direct and sinusoidal 
 currents on alternate days is recommended by Dr. H. Lewis 
 Jones as likely to " secure electrolytic effects as well as those 
 of simple stimulation." Warm baths alone do good. For 
 patients who are well off a visit to Bath, along with use of the 
 thermal waters and electricity when there, is well worthy of a 
 trial. Paralysis caused by lead is often slow to disappear, 
 and for a time considerable muscular weakness is left behind, 
 but in many cases the cure is quite complete. 
 
 I 
 
METALLIC POISONS, DUST, FUMES, ETC. 215 
 
 It will fall to the lot of few medical men to treat cases of 
 saturnine encephalopathy. During the convulsions the in- 
 halation of a few drops of nitrite of amyl is of service. When 
 the secretion of urine is scanty a hypodermic injection of 
 pilocarpine is called for. Puncture of the lumbar region of 
 the spinal canal and the withdrawal of one, two, or three 
 ounces of clear fluid like water often relieves the cerebral 
 pressure. Dr. Mosny, of the Hopital St. Antoine, Paris, makes 
 use of lumbar puncture not only as a curative measure, but 
 also for diagnostic purposes. On centrifuging the clear fluid 
 removed from the spinal canal by puncture between the 
 second and third lumbar vertebrae, Dr. Mosny finds in it an 
 excess of leucocytes, which he attributes to a reaction on 
 the part of the cerebro-spinal membranes to the lead. In 
 cases of acute lead colic in which I have punctured the 
 spinal canal and drawn off one to two ounces of clear liquid 
 like water, no trace of lead was found on submitting to 
 chemical analysis the three or four samples, drawn from 
 different patients. 
 
CHAPTER VIII 
 
 diseases due to metallic poisons, dust, fumes, etc. 
 (continued) 
 
 Other Forms of Metallic Poisoning 
 
 Arsenic 
 
 ARSENIC is used in the arts and manufacturers. Until 
 recently it was extensively used as a colouring agent 
 for wallpapers and artificial flowers. It is an ingredient 
 of the " sheep dip " which is sold to kill tic in sheep. 
 Workers in arsenic suffer from painful redness of the eyes 
 and from eczema of the eyelids. More than a quarter 
 of a century ago the Medical Society of London reported 
 upon the unhealthiness of the trades in which arsenic was 
 used. In the form of green arsenite of copper or Scheele's 
 green it is used as a pigment. It is in this form, too, that it 
 was added to wallpapers, in which it was often present to the 
 extent of several grains per square yard, and as it is readily 
 given off in the form of very fine dust, its presence in the air 
 of a sleeping-room can be readily understood, and the ill- 
 health of persons occupying these rooms just as readily 
 explained. The symptoms complained of by persons 
 occupying such rooms are headache, dryness of the throat, 
 loss of appetite, mental irritability, depression, and loss of 
 flesh. Men employed in the manufacture of Scheele's 
 green have frequently painful ulcers on their fingers or on 
 such concealed parts of the body as the groin and scrotum, 
 where the dust has collected. Arsenic acts as an irritant to 
 the skin, setting up eczema and ulceration : it is capable of 
 
 2X6 
 
METALLIC POISONS, DUST, FUMES, ETC. 217 
 
 producing general poisoning as well. Five or six years ago 
 there occurred in the Midlands an outbreak of arsenical 
 poisoning, the result of drinking beer made from glucose 
 which contained arsenic. Much suffering and ill-health 
 followed. Many of the patients suffered from a painful 
 affection of their limbs, neuritis followed by paralysis, dropsy 
 of the limbs, and ulceration of the skin. Arsenical neuritis 
 mainly affects the lower extremities, and in that respect 
 differs from the paralysis caused by lead, which is mostly 
 of the hands and fingers. 
 
 In visiting colour works I have seen ulcers on the hands 
 of the workmen, but in the manufacture of white arsenic 
 I have not noticed any serious ill-health among the employed. 
 White arsenic is made in closed chambers. The only risk 
 occurs during the packing of the finished product. The ill- 
 health of the men employed at the reduction works of the 
 arsenic mines near Tavistock, Cornwall, attracted a few years 
 ago the attention of the Home Office, and was made the 
 subject of an inquiry and a Report by Mr. Edward Gould, of 
 the Home Office, and Mr. Joseph S. Martin, H.M. Inspector 
 of Mines. Several of the smelters suffered from " arsenic 
 pock," an irritation of the skin due to the action of very fine 
 dust upon the perspiring skin ; others suffered from bronchitis 
 and respiratory troubles to a greater extent than the workmen 
 engaged in other trades in the district. In the manufacture 
 of the refined arsenic of commerce, the arsenic ore, or " mis- 
 pickel," is first crushed between rollers, then sieved, and 
 calcined in flat furnaces. The arsenic thus liberated from 
 the ore passes from the furnaces to flues and chambers. 
 These are cleared out and the arsenic soot, so called because 
 it contains coal dust, is collected. This is again submitted 
 to heat in a refining furnace, only anthracite coal and coke 
 being used. The fumes given off settle as a fine white 
 powder, which becomes, when ground, the white arsenic of 
 commerce. 
 
 In the emptying of the flues respirators ought to be worn 
 by the men, and no flue should be entered by the workmen 
 until the temperature has come down to that of the surround- 
 ing media. The bronchitis which arsenic workers suffer from 
 
2i8 DISEASES OF OCCUPATION 
 
 has been attributed partly to the fumes given off by the raw 
 material, which contains a good deal of sulphur. It is also 
 the result of exposure to rapid changes of temperature. 
 
 Men when employed in removing vitriol solution from the 
 depositing tanks in copper works occasionally suffer in con- 
 sequence of the inhalation of arseniuretted hydrogen gas. 
 The symptoms met with are dizziness and collapse, followed 
 by jaundice and bleeding from the kidneys, attended by a 
 rise of temperature. 
 
 An important point in connection with the subject we are 
 discussing is that arsenic, whether taken as medicine, inhaled 
 as dust or vapour, or applied externally to the skin, has 
 apparently the effect, in some persons, of predisposing the 
 tissues to growths of a cancerous nature. Workers in aniline 
 colours which accidentally or otherwise contain small quan- 
 tities of arsenic frequently exhibit patches of brown dis- 
 colouration on their skin and mucous membrane, paralysis of 
 certain muscles, and digestive troubles. Direct contact of 
 the skin of the workpeople with arsenical compounds is a 
 fruitful source of trouble. No matter the channel by which 
 it gains entrance into the human body, arsenic is eliminated 
 into the stomach and intestine, and in passing through the 
 wall it induces marked hyperaemia, with symptoms of irritant 
 poisoning, in the gastro-intestinal tract. The hands of the 
 workmen should be free from cracks and sores. Gloves 
 ought to be worn. If a man must work with his naked 
 hands, all fissures and sores on the skin ought to be covered 
 over by surgical collodion. 
 
 Arsenic is used in the curing of certain furs. Out of forty- 
 two samples of furs recently examined by American chemists 
 eleven were found to be heavily loaded with arsenic. The 
 destructive effects of arsenic upon insect life are well known. 
 Presumably, therefore, the arsenic is added to the furs as a 
 preservative. The amount of arsenic found exceeded the 
 one grain per square yard allowed by American law ; it often 
 reached 170 grains. The presence of such large quantities of 
 arsenic in furs that are to be worn and in rugs for rooms is 
 very dangerous. Occasionally it is found as a pigment in 
 gloves and in textile materials. 
 
METALLIC POISONS, DUST, FUMES, ETC. 219 
 
 Copper 
 
 Opinions are divided as to the harmful effects of copper 
 upon the human body. That some of the workmen who are 
 exposed to the fumes of the molten metal and to the metallic 
 dust suffer from deranged digestion and troubles of the 
 nervous system is only what might be expected ; but there 
 is never anything like the severe attacks of abdominal pain 
 which are met with, for example, in lead smelters. I have 
 known working shoemakers who were in the habit of putting 
 brass nails in their mouth suffer a good deal from colic. A 
 few copper workers have come under my care complaining 
 of nervous depression, dizziness, and a staggering gait when 
 walking. Metallic copper is less injurious than some of 
 its compounds and alloys, such as brass. Symptoms of 
 irritant intestinal derangement occasionally follow the inges- 
 tion of food cooked in copper utensils. In copper workers 
 there can be frequently seen a greenish-blue line on the 
 teeth, and the hair of the older workmen, which otherwise 
 would be white, is quite green. Yet by none of these men 
 is there complaint of feeling ill. On examining the hair 
 under the microscope a thin layer of coloured material can 
 be seen, composed of bluish-green crystals. These develop 
 a deep blue colour on the addition of ammonia. By washing 
 the hair in warm water the crystals are dissolved and the 
 hair again resumes its normal colour, while in the water used 
 for washing copper is found. 
 
 Although in copper ore, or what is known as copper 
 pyrites, there is often a trace of arsenic, it is astonishing how 
 free from symptoms are the copper smelters. I have visited 
 the large copper-mines and smelting works at Kopperberg, 
 in Sweden, and although the whole atmosphere reeks with 
 the sulphur fumes given off during the roasting of the ore 
 and the spire of the church and the roofs of the houses are 
 coloured greenish-blue by the copper, yet the workpeople 
 seemed to suffer no greater inconvenience than, and were just 
 as healthy as, persons following other occupations elsewhere. 
 What has been said of Kopperberg also applies to the smelt- 
 ing works at Swansea ; although the vegetation in the 
 
220 DISEASES OF OCCUPATION 
 
 neighbourhood has been destroyed, the men who work at the 
 furnaces enjoy good health. They are exposed to great 
 changes of temperature, and are not always careful in regard 
 to the use of alcoholic stimulants. In the cleaning out of 
 the flues a great deal of dust is met with, and if the dust has 
 not been previously watered there is apt to be illness among 
 the men. 
 
 Brass 
 
 Brass is an alloy of zinc and copper. Birmingham is the 
 home of this particular trade. During the pouring of the 
 molten alloy into moulds the workroom becomes filled with 
 dense white smoke, composed largely of oxide of zinc. The 
 smoke, after hanging in the atmosphere for a time, ultimately 
 settles down upon the rafters and ceilings of the workroom 
 as a white incrustation. During foggy weather the atmo- 
 sphere in these workshops is thick, and as many of these places 
 are badly ventilated the men frequently suffer from head- 
 ache, dryness of the throat, and a sense of general malaise. 
 Digestive troubles, too, are often complained of, but the 
 special malady from which these men suffer is what is called 
 " brass-founders' ague," a misnomer, since it has no connec- 
 tion whatever with malarial fever, yet an illness attended by 
 shivering, usually by feverishness and sweating, and accom- 
 panied by a feeling of exhaustion. Before the temperature 
 rises, or in what corresponds to the cold stage, there is con- 
 siderable languor, accompanied by a feeling of depression ; the 
 teeth chatter, and, as in the classical form of ague, there are 
 headache and nausea. Occasionally the patient vomits, and 
 obtains relief thereby. The indisposition, which usually lasts 
 from one to two days, usually attacks men beginning work for 
 the first time or who have been absent from it for a period. 
 Owing to the dusty nature of the occupation, bronchitis and 
 pulmonary phthisis are not unknown among the men. It is 
 maintained, too, by some physicians that brass workers are 
 more liable to affections of the nervous system than other 
 workmen. The symptoms complained of by brass workers 
 whom I have seen at the Newcastle Infirmary have been mostly 
 on the side of the digestive organs, such as loss of appetite, 
 
METALLIC POISONS, DUST, FUMES, ETC. 221 
 
 distaste for food, a metallic taste in the mouth, obscure abdom- 
 inal pains, constipation or diarrhoea, a sense of thirst and 
 of dryness in the throat, without any visible signs of pharyn- 
 gitis, also a degree of mental depression often amounting to 
 hypochondriasis, and difficult to remove by medicinal treat- 
 ment. The men become extremely nervous. When protruded 
 the tongue is observed to be the seat of fibrillary tremor, and 
 there is similar tremulousness of the muscles of the cheeks. 
 It is difficult to say which of the two metals, zinc or copper, 
 is the cause of " brass-founders' ague." The late Dr. Green- 
 how attributed the symptoms to the zinc. Dr. Hogben puts 
 them down to the copper. It is more than probable that the 
 symptoms are due to an admixture of the metals. 
 
 The necessity of personal cleanliness on the part of the 
 workmen and of well ventilated workshops is apparent. 
 Means ought to be provided 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 cannot work well in them. Women and persons 
 under eighteen years of age are not allowed to work in the 
 casting shop. 
 
 Zinc 
 
 It used to be thought that the fumes given off from 
 pure zinc were not dangerous, but in the smelting of rude 
 zinc ores which contain i'6 per cent, of lead there is a 
 certain amount of danger from plumbism, and in the 
 similar treatment of blende^ which is a sulphide of zinc 
 and arsenic, the smelters occasionally suffer from the effects 
 of arsenic. Dr. John Tatham's figures show that zinc 
 workers have a higher mortality than the average work- 
 men, viz., 1,198, as against 602 for the agriculturist, and 
 that the death-rate in zinc workers has rather risen within 
 the last decennium. The workmen are exposed to great 
 heat. In men beyond the middle term of life the 
 
222 DISEASES OF OCCUPATION 
 
 mortality from pulmonary phthisis and respiratory diseases 
 generally is more than double the standard figure. In my 
 visits to the large zinc smelting works at Bleiberg, in 
 Belgium, I could not find any evidence of ill-health among 
 the workmen traceable to the zinc itself. Respiratory 
 affections were common, owing to chilling of the body 
 when in a state of perspiration, and rheumatic affections 
 of the muscles and joints were also complained of The 
 dust from the furnaces is stated to be the cause of boils 
 on the skin and of eczema, but these are met with in 
 most industries in which the men are exposed to great 
 heat and perspire freely in an atmosphere containing fumes. 
 Schlockow, who has had large experience of the zinc 
 miners and smelters of Silesia, states {Deulsch. Med. 
 Wochen., 1897, vol. v. p. 208) that in men who have 
 followed the occupation for ten or twelve years there are 
 frequently observed diseases of the nervous system. There 
 is a loss of the sense of touch in the limbs, accompanied 
 by burning sensations in the soles of the feet ; the knee- 
 jerks are exaggerated, the muscular sense is diminished, 
 and walking becomes unsteady, symptoms which Schlockow 
 attributes to a lesion of the anterior columns of the 
 spinal cord, but which other writers regard as due to a 
 polyneuritis the result of lead poisoning. In Silesia the 
 workmen suffer from laryngeal and bronchial catarrh as 
 the result of dust, but tuberculosis is rare. 
 
 Zinc White or Zinc Oxide 
 
 Since zinc white has come to be regarded as a substitute 
 for white lead for house painting, especially in France, there 
 are sure to be in the future greater demands for this material. 
 Zinc white is obtained by the oxidation of zinc vapours, the 
 product being afterwards washed and dried. During the 
 drying, sifting, and packing of the finished product dust is 
 given off, but with ordinary care, such as good ventilation 
 and the filling of the barrels in enclosed spaces provided 
 with fans, the men employed do not appear to suffer any 
 inconvenience beyond slight headache now and then. I did 
 
METALLIC POISONS, DUST, FUMES, ETC. 223 
 
 not find that animals exposed to oxide of zinc in the form 
 of dust, or who received it in their food over a length of 
 time, showed signs of poisoning, but other writers state that 
 dogs succumbed to albuminuria and glycosuria after having 
 shown signs of nausea and disinclination for food, attended 
 by anaemia and a distinct leucocytosis. 
 
 Men employed in printing upon zinc by means of chromic 
 and phosphoric acids incur certain risks. These acids are 
 applied by means of a sponge to cliches of zinc in order 
 to remove all traces of fat so as to give more relief to the 
 drawing. Phosphoric acid when employed alone causes no 
 trouble, but it is not the same with chromic acid. This acid 
 is a frequent source of abscesses and of erosions of the skin of 
 the hands, arms, face, and neck. Some men are so susceptible 
 to the action of chromic acid that they are obliged at an early 
 date to give up the work. In one workshop one-sixth of 
 the men had been off ill with abscesses, from which in some 
 instances it took the men a fortnight to recover. India- 
 rubber gloves have been recommended, but since experience 
 has shown that the employment of these acids is not absolutely 
 indispensable, and that a mixture containing only one of the 
 acids in very small quantity gives equally good results and is 
 free from danger, it would be better to adopt the newer 
 method of printing than to rely upon gloves, the wearing of 
 which can only protect the hands and forearms. 
 
 Mercury 
 
 Mercury, or quicksilver, is found in large quantities in 
 Spain and California. It exists in nature in the form of 
 cinnabar, a sulphide of mercury, from which it is obtained by 
 simply roasting the ore, either alone or by mixing it with 
 lime or iron filings. Mercury in the metallic form is thus 
 given off and readily condenses. Workmen employed in the 
 extraction of the metal frequently suffer from the mercurial 
 vapour, which, quickly condensing, forms droplets that become 
 deposited upon accessible mucous membranes and upon the 
 beard and hair of the men. The metal rapidly becomes 
 oxidised, and is thus rendered easy of absorption. Men 
 
224 DISEASES OF OCCUPATION 
 
 also become poisoned by handling the metal, for the skin 
 becomes creased, and in the depths of the creases fine particles 
 of the oxide of mercury become deposited. Mercury may be 
 inhaled as vapour or as dust in the form of metallic salts. 
 Men with open sores on their body ought not to be 
 allowed to work in mercury. Formerly the metal was 
 largely used in the silvering of mirrors. It was then a 
 prolific source of ill-health among the workmen, but since 
 the introduction of the new method of applying a solution 
 of argentic nitrate to the glass and precipitating the silver by 
 means of tartaric acid, the silvering of mirrors has ceased to 
 be the unhealthy occupation it was in days gone by. 
 
 Mercury is used in the construction of barometers, 
 thermometers, and instruments of scientific precision, 
 while its salts, especially the nitrate, are used in felt hat 
 making and fur dressing. One of the commonest symp- 
 toms of mercurial poisoning is ulceration of the gums 
 attended by fetid breath and excessive salivation. Follow- 
 ing closely upon these come muscular tremor and 
 cachexia. In the process known as "carotting" or the 
 brushing of rabbit skins with an acid solution of nitrate 
 of mercury, the workmen lose the molar teeth of the 
 upper and lower jaws. The remaining teeth become 
 black and loose. Where the teeth have not fallen out 
 they become eroded, owing to the action of the acid 
 vapours. 
 
 The muscular tremor exhibited by workers in mercury 
 has long been known as a symptom of poisoning. Years 
 ago the amount of ill-health in the mercury miners at 
 Almaden in Spain was so great that the mines had to 
 be worked by convicts. These men not only worked, 
 but also lived, in the mines. They were not all cleanly 
 in their habits, and as a consequence the mortality from 
 mercurial poisoning was high. The few free men who 
 were employed at the mines worked intermittently. In 
 the intervals they followed agriculture or worked in their 
 gardens. As these men were more cleanly in their 
 habits they escaped much of the sickness, and on the 
 whole had good health. 
 
METALLIC POISONS, DUST, FUMES, ETC. 225 
 
 Although mercury is no longer employed in the silver- 
 ing of mirrors it is still used in the arts and manufactures 
 to such an extent as to be a source of considerable 
 trouble and ill-health. It is greatly in demand for the 
 separation of gold and silver from their respective ores 
 by means of an amalgam ; in sole stitching by American 
 machinery ; in the manufacture of incandescent lamps, in 
 which mercurial pumps are used so as to create a 
 vacuum ; in water-gilding, where an amalgam of gold or 
 silver, after having been applied to an object, is heated 
 and the mercury driven off by heat, also in bronzing the 
 interior of field-glasses. 
 
 In the extraction of gold from its ore mercury plays 
 an important part. When the crushed auriferous soil has 
 been subjected to several washings there remains a fine 
 siliceous powder in which the gold is occasionally present 
 in very small quantity, and in the form of too fine 
 particles to be isolated by mechanical means. An 
 attempt is therefore made to dissolve the gold in 
 mercury until a rich amalgam is formed, from which the 
 gold is separated by raising the temperature to 400° C. 
 During the process, which aims also at the recovery of 
 the mercury by condensation, the mercurial vapour escapes 
 through the joints of the apparatus into the atmosphere, 
 and as a consequence the workmen occasionally suffer in 
 health. Metallurgists now find that in cyanide of potas- 
 sium they have a good substitute for mercury, one that 
 acts more easily and is attended by less risk to health 
 than mercury. The cyanide process of dealing with 
 gold ores has quite revolutionised the industry, and has 
 made reef mining, which until lately was regarded as 
 altogether a secondary source of gold, more important 
 than alluvial and placer mining. It is an illustration of 
 what can be done by the application of science to an industry 
 that called for all the resources of chemistry. ( Vide p. 236.) 
 
 Mercury volatilises at a low temperature. It is this 
 
 circumstance which creates the danger, and explains the 
 
 risks run by men working in a heated atmosphere containing 
 
 the vapour given off by the metal. Many of the men 
 
 Q 
 
226 DISEASES OF OCCUPATION 
 
 become pale and complain of headache and giddiness. The 
 muscles of the face become tremulous ; so, too, do those of the 
 tongue, also the muscles of the limbs, especially those of the 
 arms. The breath becomes fetid, the gums soft, swollen, and 
 ulcerated, and the teeth loose. The face becomes pale and 
 cachectic, the submaxillary and other glands in the neck be- 
 come painful, and the secretion of saliva excessive. Speech 
 is slow and indistinct, owing to involvement of the muscles 
 of articulation ; the patients lose their power of walking and 
 become depressed and melancholy. Females suffer from 
 suspended menstruation and pregnant women often miscarry. 
 Many of the workers succumb to phthisis and to kidney 
 disease. Others become the subjects of convulsions or are 
 seized with paralysis, or they develop symptoms not unlike 
 those observed in general paralysis, but without the inequality 
 of pupils and the grandiose ideas characteristic of the 
 more classic affection. The children of workers in mercury 
 are often ill-nourished and rickety, and statistics show that 
 they die from pulmonary phthisis in larger proportions than 
 the children of persons employed in other occupations. 
 
 Cases of industrial mercurial poisoning occurring in the 
 practice of medical men must be reported to the Chief 
 Inspector of Factories at the Home Office. So far as the 
 workpeople are concerned, scrupulous attention must be paid 
 to details : personal cleanliness with frequent ablutions is a 
 necessity, the hair and beard should be kept short, overalls 
 should be worn when at work and astringent mouth-washes 
 used — e.g., alum, to which, when the gums are sore, potassium 
 chlorate should be added — respirators should be worn, the 
 sponge in which should be dusted with sulphur, workrooms 
 should be well ventilated, and there ought to be periodical 
 medical examination of the persons employed. In factories 
 where several different processes of manufacture are carried on, 
 those connected with mercury should be relegated to separate 
 rooms, in which the temperature ought never to be high, owing 
 to the ready volatilisation of the mercury. 
 
METALLIC POISONS, DUST, FUMES, ETC. 
 
 Manganese 
 Dr. von Jaksch, of Prague, has drawn attention to chronic 
 poisoning in manganese workers. Three of his patients, all 
 men, in the early stage of the illness exhibited an uncion- 
 trollable desire to laugh and to weep, such as is observed 
 in hysteria, but as these passed away, symptoms indicating a 
 deeper implication of the nervous system showed themselvt\s. 
 A year afterwards the men could not walk properly : they 
 exhibited the peculiar staggering gait met with in locomotor 
 ataxy. Embden, another medical practitioner, has described 
 similar symptoms in four manganese workers. In still 
 another of Von Jaksch's patients there were signs of mental 
 derangement as well as incoordination in walking. The 
 poisoning is attributed to the inhalation of oxides of man- 
 ganese. Experiments upon animals have not given con- 
 firmatory results, but as in Von Jaksch's and Embden's 
 patients it took four years' exposure to develop symptoms, 
 the time spent in experiments was probably too short. In 
 manganese works means should be provided for removal of 
 dust and the ventilation should be ample. 
 
 Iron and Steel 
 Iron ore is seldom found in nature in such a state of purity 
 as not to be required to undergo some such preparation as 
 roasting in order to get rid of foreign material. This is 
 carried on in large furnaces, into which iron and coke, with 
 or without other substances, are placed. Atmospheric air is 
 driven into the furnaces under high pressure. The tempera- 
 ture is raised extremely high, so as to allow of fusion of the 
 metal taking place, after which it is run off in a molten form 
 into pits of sand, the result being bars of pig-iron. In 
 another portion of this book attention is directed to the acci- 
 dental poisoning by carbon monoxide of the men who 
 charge the furnaces and who superintend the tapping pro- 
 cesses. The work of the blast-furnaceman is hard: he is 
 exposed to rapid and great changes of temperature, and as a 
 consequence runs the risk of becoming chilled and of suffer- 
 ing from bronchitis and rheumatism. He frequently gets 
 burned, and on a windy day is often blinded by the sand of 
 
DISEASES OF OCCUPATION 
 
 the pit. As a class, blast-furnacemen are apt to be in- 
 temperate in the use of alcohol. Owing to the arduous and 
 exposed nature of their employment they age quickly. 
 
 In order to produce finished iron, the pig bars are heated 
 in a furnace, where they undergo the process of " puddling." 
 The work of a puddler is extremely hard. It consists in the 
 impure iron being rolled about in the furnace by means of 
 two long iron tools, called " paddle " and " rabble," so as to 
 get rid of the carbon. The iron thus treated forms a large 
 round ball. In this form it is removed from the furnace. 
 Apart from exposure to the excessive heat, the work entails 
 upon the men considerable muscular exertion. They per- 
 spire freely and drink correspondingly. Many puddlers are 
 prematurely old. In consequence of the severe muscular strain, 
 heart disease, especially disease of the aorta and its valves, is 
 common in these men. Puddling is justly regarded as one of 
 the most injurious occupations in an ironworks. In conse- 
 quence of steel having replaced iron in shipbuilding and 
 other industries, the demand for finished iron is becoming 
 less and less, and as a result puddling is a decaying trade. 
 
 In consequence of their hard work blast-furnacemen and 
 puddlers are liable to fatigue and to burns and other 
 accidents. The labourers who remove the large pieces of 
 slag to the tip-heap are occasionally injured by the mass ex- 
 ploding, owing to the vibration caused by the transport or 
 the tension of the gases enclosed within the outer coating of 
 the slag. 
 
 In iron and steel foundries finished steel in a molten state 
 is poured into moulds. The risks incurred by the men thus 
 employed are mostly the results of injuries and the effects 
 of dust. If the moulds are not sufficiently dry — and this 
 remark applies particularly to the large moulds in the pit of 
 Bessemer steel works — explosions may occur and be attended 
 by fatalities. In this country there are few statistics relating 
 to the maladies and deaths of men employed in ironworks, 
 but in Germany statistics show that the deaths are mostly 
 from diseases of the respiratory organs, of which pulmonary 
 phthisis forms 35 to 41 per cent. The average age of moulders 
 who die from tuberculous phthisis is 4r8. 
 
METALLIC POISONS, DUST, FUMES, ETC. 229 
 
 Blacksmiths and forgemen may be dealt with here. The 
 work of hammermen is hard. In the North of England it is 
 a frequent cause of hypertrophy of the heart and disease of 
 the aortic valves. Much of the work previously done by 
 hammermen is now done by machinery. When heavy hand 
 sledge-hammers were more in use than now, there was a form 
 of paralysis of the muscles of the arms known as " hammer- 
 men's paralysis." My surgical colleague at the Royal 
 Victoria Infirmary, Mr. H. B. Angus, tells me that a great 
 many forgemen still seek advice there on account of a 
 painful inflammation of the joints of the wrists and elbows. 
 In regard to " strikers' arthritis " it is interesting to note that 
 the affected joint does not improve rapidly under treat- 
 ment, even after all work is forbidden. Notwithstanding the 
 apparent healthiness of the occupation a considerable propor- 
 tion of the men die from lung diseases, including tuberculous 
 affections. Heart disease, too, is common in the men. 
 
 Although Longfellow in his poem has popularised the 
 brawniness of the blacksmith's arm and on examination a 
 marked degree of muscular hypertrophy is frequently found 
 to exist, still in several instances I have been struck by the 
 feeble physique of many blacksmiths. The introduction of 
 machinery has allowed a feebler class of men physically to 
 enter the trade. Where the work is very hard and there is 
 excessive use of the arm, rupture of muscular fibres of the 
 upper arm and shoulder has been known to occur, followed by 
 inability to use the arm. In consequence of the men stand- 
 ing for many hours daily exposed to high temperatures and 
 subsequent chilling of the body, lumbago is a common 
 complaint. Owing to similar causes I find kidney dis- 
 ease frequent in men employed in iron-fitting workshops. 
 Anaemia, too, is often met with, due to excessive heat ; and in 
 consequence of the carbon and iron dust blocking the pores 
 of the skin, eczema and boils are not unknown. Ironworkers 
 and boiler-makers, especially the latter, suffer from deafness 
 owing to the great shocks to the ears from the loud noises of 
 hammering. How the hammering causes the deafness of 
 boiler-makers, which is as extreme as it is common, it is 
 difficult to say. Probably there is considerable shock to the 
 
230 DISEASES OF OCCUPATION 
 
 liquid in the labyrinth of the ear, and there is induced a 
 brusque displacement of the terminal endings of the auditory 
 nerve : these are either paralysed or become the seat of some 
 abnormal irritation, which is subsequently followed by loss of 
 function. 
 
 Preventive measures consist in putting on adequate cloth- 
 ing after exposure to heat, so as to protect the body from 
 chills. To prevent boiler-makers from becoming deaf the 
 ears might be stopped with cotton wadding. 
 
 Steel Grinding and the Polishing of Metals by Files and 
 Efnery-wheels 
 
 For several decades Sheffield steel-grinders have had an 
 unenviable notoriety on account of their high mortality from 
 pulmonary consumption, and when we consider the nature of 
 their employment this is readily understood. There are two 
 kinds of steel-grinding, the " dry " and the " wet," and as the 
 work is of a special character, only trained men can earn good 
 wages. A period of apprenticeship has to be served. The 
 grinding is done on circular stone wheels driven by steam or 
 water-power. Many of these stones are obtained from 
 quarries in the neighbourhood. Considerable care has to be 
 exercised in their selection, for as they have to be run at great 
 speed the slightest flaw in the stone may cause it to burst, 
 and the fragments, flung in all directions, may inflict serious or 
 fatal injuries on the men in the workshop. Previous to using 
 the grinding-stones they are 7^aced, or run, so as to find out 
 whether any flaws are present. 
 
 So far as the two methods of grinding cutlery are con- 
 cerned, 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 cannot 
 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 
 
METALLIC POISONS, DUST, FUMES, ETC. 231 
 
 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 twenty-nine 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 atmo- 
 sphere 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 carried 
 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 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 respira- 
 tory diseases 182, or collectively 32*6 per cent. Steel-grinders 
 die comparatively young. Dr. Sinclair White, in " Dangerous 
 Trades," p. 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 
 upwards, whereas for every 1,000 of the adult male popula- 
 tion 391 reach 55 years and upwards. Sinclair White is of 
 the opinion that phthisis is not so rife among steel-grinders 
 as formerly. In Dr. Hall's lime the average age at death 
 from phthisis was 29 years ; at present it is 43. 
 
 What has been said of Sheffield is equally true of the 
 dusty steel trades of the German town Solingen, of which a 
 
232 DISEASES OF OCCUPATION 
 
 graphic account has been published by Dr. Arthur Shadwell 
 in ''Industrial Efficiency," vol. i. p. 211, &c. SoHngen is 
 the Sheffield of Germany. In the town of Solingen and the 
 neighbourhood 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 interesting 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 Solingen that it has 
 attracted the attention of the Government Factory Depart- 
 ment. In the ten years 1885-95, 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 approvingly of the methods adopted in 
 some of the Solingen factories to deal with the removal of 
 dust. Oldendorf, in writing about the grinders at Solingen, 
 states that 247 per cent, reached 50 years of age and 33 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 87 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 544 years. 
 Taking all ages, the deaths from tuberculosis per 100 cases 
 were for grinders, 78*3, ironworkers, 59-0, other persons, 46*0. 
 Dr. John Tatham, in "Dangerous Trades," p. 137, is equally 
 outspoken. He says the mortality among cutlers is enormous. 
 At all ages it is very high, but at ages beyond 35 years it 
 exceeds the standard among occupied males generally by 
 from 64 to 72 per cent. The comparative mortality figures 
 for cutlers between 25 and 65 years of age is 1,516, as com- 
 pared with 1,000. It is, in other words, 59 per cent. more. 
 Their mortality figure for phthisis is 382, and for respiratory 
 diseases 518, against 106 and 115 respectively, the figures for 
 agriculturists. 
 
 When we recall the position assumed by the steel-grinder 
 
METALLIC POISONS, DUST, FUMES, ETC. 233 
 
 bending down upon the stone when at work, it is easy to 
 explain, in consequence of the constrained position, the 
 deformity of the chest wall that is occasionally observed in 
 apprentices to the trade. 
 
 As the hulls and grinding-wheels in Sheffield usually 
 belong to property owners, who let off the rooms, often singly, 
 to men who again sublet the stalls to cutlers who are piece- 
 workers, and who contribute their share financially for the 
 motor-power supplied, it has been difficult to determine the 
 proper individual upon whom to fix the responsibility for the 
 provision of fans for the removal of dust, better ventilation, and 
 the maintenance of the rooms in a clean and dry state. There 
 are about wet grinding hulls a dampness and a stagnation of 
 the atmosphere which rather predispose the workmen to pul- 
 monary diseases. The wearing of respirators has been recom- 
 mended, but the men say they find it irksome to work in them. 
 Grinding wheels ought to be provided with hoods connected 
 with fans, which would not only remove dust but would also 
 improve ventilation. As already stated, no grinding-stone 
 should be mounted until after careful examination of the 
 stone by a competent person, and it should be " raced " or 
 tested first, both as to speed and endurance, at a time few 
 workmen are present in the room. Dry and wet grinding 
 should be carried on in separate departments. 
 
 An interesting comparison is made between Solingen and 
 Sheffield by Mr. C. Johnston in the Annual Report of the 
 Chief Inspector of Factories, 1906, p. 106. 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 
 instead of ordinary coal, which entails 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 cleanliness ; the floors are of concrete 
 and the air-space for each worker is 565 cubic feet. All the 
 grinding-stones are protected by guards. The walls of the 
 workrooms are limewashed every year ; the floors are swept 
 clean every evening and damp-wiped once a week. The 
 " racing " of grindstones is never undertaken during working 
 
234 DISEA [ON 
 
 hours except under a stream of water or unless the stone is 
 entirely enclosed in casing except at the working place of the 
 raising tool. One of the features of Solingen is said to be the 
 large number of " home workers." These workmen own their 
 houses, behind which is a garden, and at the rear of this their 
 small factory. There are 1,475 small factories of this type in 
 the district. In these the greater part of the grinding and 
 glazing of scissors and razors is done. The floors are kept 
 clean and provision is made for the removal of the dust 
 during grinding. Cutlery manufacture is recognised as a 
 dangerous trade in Solingen, and in recent years considerable 
 improvement has taken place in the means to prevent dust. 
 With the clean and tidy appearance of these tenement 
 factories those of Sheffield compare most unfavourably. In 
 Solingen the grindstones and polishing-wheels are run 
 towards the worker ; in Sheffield they are run away from 
 the worker, so that the dust has an upward tendency and 
 flies into the room. 
 
 There is a branch of the steel and iron trade which may 
 be causative of phthisis and to which not much attention 
 has been paid medically. I refer to " metal dressing," which 
 consists in chipping off the rough surfaces and removing the 
 incrusted sand from castings, also of smoothing them down 
 by means of chisel and hammer. The work is similar to that 
 of the stonemason and is equally dusty. As several men 
 may be employed in the workshop doing this particular 
 work at the same time, the atmosphere frequently becomes 
 extremely dusty. Inhalation of the dust may lead to 
 pulmonary troubles, especially in men who have a history of 
 phthisis in their family. The disease aflects the base of the 
 lung in the early stages. During the course of the malady 
 I have seen haemoptysis occur. 
 
 Bronzing in Lithographic Works 
 
 The gilding of show-cards, advertisements, and Christmas 
 cards is effected by dry bronzing. Bronze powders are of 
 various colours — red, green, golden, silver, &c. Ordinary 
 bronze powder is composed of copper and zinc with 0'i2 per 
 
METALLIC POISONS DUST, FUMES, ETC. 235 
 
 cent, of arsenic. In the silver powder the copper is replaced 
 by tin and antimony. Bronzing may be done either by 
 hand or by machinery. No matter the method employed, 
 there is a considerable quantity of fine dust raised into the 
 atmosphere, which falls upon the hair, the face, and the 
 hands of the workers. In the visits of the Dangerous Trades 
 Committee to several large establishments where this work 
 is carried on, no specific malady was found which could be 
 attributed to this occupation. The bronze powder which falls 
 upon the skin is apt with some persons to cause considerable 
 itching. The girls frequently complain of headache, and many 
 of them are anaemic, but these symptoms are as much the result 
 of working in close and warm rooms as of the occupation. 
 The dust when inhaled may cause catarrh of the respiratory 
 passages and upset the digestion. Personal cleanliness and 
 free ventilation, with restriction of the work of dry bronzing 
 to a particular room, will obviate many of the complaints. 
 Several employers of their own accord, in the belief that it is 
 a prophylactic or preventive, give milk to the workpeople. 
 
 Wallpaper Staining and Colouring 
 
 The first fatal case of arsenical poisoning from wallpaper 
 occurred in 1858, but prior to that date many of the opera- 
 tives engaged in the trade had suffered in health. Fifty 
 years ago it was not uncommon for wallpaper to contain as 
 much as 59 per cent, of arsenite of copper. In 1877-78 the 
 Medical Society of London reported upon the matter. Since 
 then there has been considerable improvement in the manu- 
 facture and colouring of wallpaper. Vegetable colouring 
 materials have replaced mineral pigments, and as a conse- 
 quence there has been nothing like the amount of sickness 
 amongst the workmen or in people from sleeping in rooms 
 whose walls are covered by coloured papers. It is impossible 
 to visit a factory in which wallpaper is coloured without 
 being overpowered to some extent by the high temperature 
 of the rooms. In some of the rooms we found the tempera- 
 ture to be 890 to 91° F. on a cold winter evening and when a 
 Blackman fan was running. 
 
236 DISEASES OF OCCUPATION 
 
 After the wallpaper receives its " ground " colouring by 
 being passed through troughs containing coloured liquid, it 
 travels onwards through several machines to receive its 
 pattern and different colours. It may have to undergo 
 " flocking," " bronzing," or the laying on of " mica " powder, 
 all of which are more or less dusty processes. The mica 
 dust is composed mostly of silicate of magnesia. 
 
 The dangers of working are mainly those incidental to 
 dusty occupations generally and to exposure to working in 
 overheated rooms. Since the abolition of lead and arsenic 
 as colouring agents wallpaper staining has ceased to be the 
 unhealthy occupation it was a few years ago. 
 
 Personal cleanliness of the workmen and the use of baths, 
 the wearing of respirators in dusty processes, the wearing of 
 overalls and head-coverings, also the free use of fans, have 
 already improved the health of persons following this 
 occupation. 
 
 Extraction oj Gold from the Ore : Cyanide and Mercuriat 
 
 Processes 
 
 Gold is extracted from the ore by the battery and 
 cyanide methods. ( Vide also p. 225.) Over crushed ore 
 which has been placed in a vat a solution of potassium 
 cyanide is poured, varying in strength from 'OS to 0'5 per 
 cent., and after an exposure of from 12 to 24 hours or 
 more, according to the character of the ore, the cyanide 
 solution is run off. The cyanide liquor contains the gold, 
 probably in the form of a double salt. The solution is 
 caused to flow over pure metallic zinc shavings, when the 
 gold is deposited as a slime on the zinc. This slime is 
 removed, roasted, and smelted, when pure gold is obtained. 
 During the earlier operations the hands of the workmen have 
 to be dipped from time to time in the cyanide liquor, and if 
 the immersion is frequent or protracted the skin of the hands 
 and arms becomes the seat of a " scabby " rash. The men 
 are frequently provided with long indiarubber gloves, but 
 these are not always worn, either through indifference or 
 because they get torn. In hot weather the air in the neigh- 
 bourhood of the vats is strongly impregnated with the 
 
METALLIC POISONS,. DUST, FUMES, ETC. 237 
 
 cyanogen vapour, to which some nien, especially white men, 
 appear to be extremely susceptible. Many of the white men 
 employed at the vats suffer from severe headache, nausea, 
 and inability to take food. The dark races do not similarly 
 suffer. The Kaffirs occasionally suffer from the skin eruption 
 on their arms and hands, but they do not experience the 
 severe headache, which in the white men may last for two 
 days, attended by a distaste for food and by insomnia. 
 Aperients relieve these symptoms, but the best results are 
 obtained from antipyrin or phenacetin and caffeine. Owing 
 to the responsible nature of the work and the money value 
 of the product, only one or two white men are allowed 
 regularly to undertake part of the work, but it is the dark- 
 skinned men who have to dip their hands deepest down into 
 the slime and do the cleaning up. 
 
 Gold ore may be treated in another way. After having 
 been crushed it is driven by water upon amalgamated copper 
 plates which have been smeared with mercury. The gold 
 unites with the mercury. This is scraped off at intervals 
 and retorted. During the process of retorting mercurial 
 fumes are given off, the inhalation of which is the cause of 
 the falling out of the teeth and hair of the workmen, the 
 excessive salivation and the tender gums, for which the men 
 are obliged to use mouth-washes and gargles of potassium 
 chlorate. 
 
 Emery-wheels 
 
 In the grinding of steel by emery-wheels large quantities 
 of dust are given off, and occasionally a wheel breaks. When 
 this accident occurs the fragments, owing to the speed at 
 which the wheel is running, are thrown off with very great 
 force, and often inflict serious injury. The wheels are made 
 from emery rock, an extremely hard stone imported from 
 Smyrna and the island of Naxos. The stone is an anhydrous 
 oxide of aluminium with flint, silica, and iron. Grinding- 
 wheels are sometimes made from another stone called corun- 
 dum, which is also an oxide of aluminium, and is as hard as 
 emery. In either instance the rock is ground by heavy 
 
238 DISEASES OF OCCUPATION 
 
 rojlers into fine powder. This is collected. A considerable 
 amount of dust is generated during the crushing, but as this 
 is carried on in encased machinery the workmen are not 
 exposed to the dust to any extent. 
 
 Emery-wheels are made of crushed emery-stone along 
 with such binding substances as shellac, indiarubber, oil, 
 sulphur, and silicate of soda, all pressed firmly together in 
 a mould under hydraulic pressure. Into many of the wheels 
 brass wire-webbing is inserted, so that should a wheel break 
 when running there would be less risk of fragmentation 
 taking place. Emery-wheels have to run at great speed. 
 They frequently make as many as 7,000 revolutions in a 
 minute. The wheels are used for shaping the handles of 
 knives, and as the handles of knives are held together by 
 steel rivets and tangs, large quantities of steel and emery dust 
 are given off, the inhalation of which by the workmen is un- 
 avoidable unless respirators are worn or suction provided for 
 drawing the dust downwards and away from the face of the 
 worker. The emery-wheel — called in the trade the " cutler's 
 glazer" — was introduced into Sheffield about thirty years 
 ago, and it is maintained that since the introduction of the 
 "glazer" cutlers, as a class, have become even more un- 
 healthy than they were in previous years. 
 
 Recently several steel-grinders working at emery-wheels 
 have consulted me on account of soreness and dryness of the 
 throat, which they attribute to the dust given off by the 
 emery-wheels. It is a common complaint among the hands 
 working in a particular shop that even the men who are not 
 employed in grinding suffer equally owing to the dusty 
 atmosphere. The throat becomes dry and sore, and there is 
 created an intense thirst and a desire to drink. The fauces 
 are observed to be dry, red, and irritable. In addition to 
 the dust, the men complain of a very disagreeable odour 
 given off by some of the emery-wheels. I have met with 
 one or two cases of pulmonary phthisis among the younger 
 men, but how far this is related to the work and the throat 
 condition I am not prepared to say. By keeping the men 
 off work for a week or ten days the throat symptoms 
 usually disappear. 
 
METALLIC POISONS, DUST, FUMES, ETC. 239 
 
 Manufacture of Galvanised Iron 
 
 This is an industry which is largely confined to Birmingham 
 and the Black Country. Before being galvanised the sheet- 
 iron and hollow-ware have to be " pickled." This consists in 
 plunging the iron into a solution of hydrochloric acid, which 
 cleanses the iron. During this process pungent fumes are 
 given off which are extremely unpleasant and distinctly 
 irritant. The metal is thereafter plunged into the galvanising 
 bath, which contains molten zinc or spelter. Upon the surface 
 of the molten metal handfuls of ammonium chloride are from 
 time to time thrown to prevent oxidation. When the am- 
 monium chloride is thrown on clouds of thick white smoke 
 arise. By persons regularly following this occupation the 
 fumes given off in both these processes seem to be on the 
 whole well borne, but to a new hand they are extremely 
 irritating and causative of cough. The work is dirty ; there 
 is a good deal of smoke, and the fumes hang long about the 
 workshop. There ought to be very free ventilation. The 
 men who follow this occupation suffer from rheumatism and 
 bronchial affections owing to the work being carried on in 
 buildings that of necessity are more or less draughty. 
 
 Tin-plate Workers 
 
 In the tinning of canisters, iron boxes, &c., the iron is 
 dipped into a bath of molten tin, whereby a lustrous white 
 coating is obtained. The process was introduced into Wales 
 from Saxony more than two centuries ago. Tin-plating 
 is an industry still largely confined to Wales. In Mon- 
 mouth, Glamorgan, and Caermarthen the largest works are 
 to be found. The beautiful valleys of those counties have 
 been spoiled by the smoke from the works. In order to be 
 tinned iron plates have to be specially prepared. They 
 have first to be cleansed by being washed in water, and after- 
 wards they are " pickled," i.e., immersed in a sulphuric acid 
 bath. On removal from the bath the plates are rubbed with 
 dry bran or a mineral powder to remove any grease and to 
 give a polish to the surface. Tin-plate mills are, practically 
 
240 DISEASES OF 
 
 speaking, open to the air, and through them there sweep 
 cold winds, so that the persons employed are exposed to 
 chilling draughts. The lifting and carrying of the iron 
 plates is hard and heavy work. Mr. Whymper, H.M. 
 Inspector of Factories, gave, in the Annual Report of the 
 Chief Inspector of Factories, 1888, a graphic description of 
 an industry which remains to-day what it was thirty years 
 ago. The account of the work furnished by Miss Rose 
 Squire, H.M. Inspector of Factories, is a piece of sorrowful 
 reading. The work is hard, dusty, and wet. In the large 
 mills there is a commingling of the sexes which is beyond 
 supervision. In washing the plates the women become 
 thoroughly soaked. It is impossible for them to keep their 
 skirts, underclothing, and boots dry. An equally wet, un- 
 wholesome, and somewhat degrading occupation is that of 
 the girls who have to carry the iron plates to and from the 
 pickling bath, in which the plates are dipped in sulphuric acid 
 solution. The girls are literally soaked through to the skin 
 by this acid solution, which destroys their clothes. The 
 fumes given off by the sulphuric acid are unpleasantly strong, 
 and pervade the whole of the works. For the removal of 
 the fumes and the steam the workpeople rely upon the 
 draughts through the mill dispersing them. The work- 
 people suffer from inflammatory affections of the eyes, 
 accompanied by a discharge, dryness of the throat, nausea, 
 and giddiness ; the teeth become black in consequence 
 of the sulphuric acid fumes, and the hair falls off. Occa- 
 sionally the girls wear a handkerchief over their mouth as a 
 protection. 
 
 Girls and young persons from fourteen to eighteen years 
 of age are employed in the tin houses in rubbing with bran, 
 or some other powder, the tinned plates, so as to remove 
 any grease that may be present and to give them a polish. 
 Machinery is being gradually introduced into the mills, and 
 is supplanting hand-labour; but no matter by what means the 
 work is done, there will always be a considerable amount of 
 dust raised into the air, which, with exposure to the chilling 
 winds sweeping through the mills, will render the workpeople 
 liable to pulmonary troubles and bronchitis. The heavy 
 
METALLIC POISONS, DUST, FUMES, ETC. 241 
 
 burdens wnich some of the young girls are forced to carry 
 ought to be lightened, as the weights are far beyond their 
 strength and physical development. It is not uncommon to 
 find in the tin-plate works of South Wales girls carrying iron 
 plates from 40 to 100 lbs. in weight. 
 
CHAPTER IX 
 
 DISEASES DUE TO ORGANIC AND INORGANIC DUST, HEATED 
 ATMOSPHERE, ETC. 
 
 Dust 
 
 DUST is the enemy of the workman. Much ill-health 
 and most of the industrial diseases are caused by the 
 inhalation of dust or by the workpeople swallowing it 
 along with their food. Dust, if insoluble, may inflict injury 
 mechanically; if soluble, it may cause poisoning, as in 
 plumbism. In the various industries dust of all kinds is 
 met with. It is inorganic and organic. The dust given off 
 during the chiselling of stone, the grinding of steel, and the 
 packing of pigments is inorganic, while that raised during 
 the manufacture of cotton, silk, and jute is organic. Dusts 
 that are harmful might be spoken of as mechanical and 
 irritative, chemical and toxic, or caustic. 
 
 How to deal with the dust on our roadways and streets is 
 a problem that will sooner or later have to be seriously faced, 
 for the increasing employment of motor-cars, motor buses, and 
 locomotives is the cause of an amount of dust being thrown 
 into the atmosphere such as has never previously taken place 
 in this or any other country. What is said of the open road 
 applies with equal cogency to work on underground railways. 
 The Rapid Transit Railroad of New York runs for twenty- 
 one miles under the city. There is a suspicion that the dust 
 of this subway has an injurious effect upon the men who spend 
 the greater part of the working day therein. Dr. G. A. Soper, 
 Consulting Sanitary Engineer of New York, has, in the 
 Medical Record, April, 1906, published a report upon the air 
 
 and the dust in this subway. The temperature is 5° F. higher 
 
 242 
 
ORGANIC DUST, ETC. 243 
 
 than that of the streets in summer, and in winter it is 16° F. 
 higher. Whether the increased temperature is anything 
 more than disagreeable remains to be seen. There is the 
 risk to passengers, when standing at overheated underground 
 stations, of their becoming chilled by the cold draughts that 
 occasionally blow through the tunnel. Samples of air were 
 taken from the underground railway for analysis and com- 
 pared with those of air from the streets. About eighty oxygen 
 determinations were made ; the average for the subway was 
 20'6 per cent, by volume, and for the outside air 207 per cent. 
 The oxygen difference between the two is therefore small. 
 
 More than 2,000 analyses of the air of the subway were 
 made in order to determine the amount of carbonic acid or 
 carbon dioxide present. At no time was the amount of CO2 
 large ; the greatest amount was 8*89 volumes in 10,000 volumes 
 of air. It is interesting to know that the amount of CO2 
 apparently fluctuates in subways at different hours of the 
 day and night, and that even in the streets there is perhaps 
 a seasonal variation in the amount of CO2 present. Mr. 
 Soper says : " It may be a surprise to many to know that 
 when the trains are moving the air circulates not only in and 
 out of the subway but from station to station with remarkable 
 freedom, and that there is but little more carbon dioxide in 
 the air between the stations than at the stations themselves." 
 There is always a certain amount of air in the subway that 
 is not immediately forced into the streets by the trains. 
 Examinations were made of the number of bacteria present 
 in the air of the underground railway and of the streets. 
 There were 3,200 bacteria per cubic metre in the air of the 
 subway and 6,500 in the streets. The microbes found in the 
 subway probably came from the streets, for they varied in 
 number with those of the streets and were more numerous in 
 the underground near the stairways than at the ends of the 
 stations. The dust, too, that was carried down the stairways 
 by inrushing currents of air always contained more micro- 
 organisms than the dust of the subway, and there were always 
 more bacteria at the end of the station platforms where the 
 trains departed from than at the arrival end. How far these 
 bacteria were pathogenic, and what their origin, it is impos- 
 
244 DISEASES OF OCCUPATION 
 
 sible to say. They are always present in large numbers 
 where human beings congregate, and yet the bacteria were 
 fewer in the underground than in the air of the streets. Some 
 of them are probably harmful. In the absence of sunlight in 
 the subway the longevity of pathogenic micro-organisms is 
 increased. Pneumococci, which are the cause of pneumonia, 
 lived in the subway 21 days but only 4 days in the streets. 
 
 On examining the dust of the underground, it was found 
 on chemical analysis to contain 61*30 per cent, of iron, nearly 
 all of which was in the metallic state, 2r94 per cent, of 
 organic matter of vegetable and animal origin, 15*58 per 
 cent, of silica and other matters insoluble in acid, and i*i8 
 per cent, of oil. There were on an average 6i'6 milligrammes 
 of dust in 1,000 cubic feet of air; the maximum weight was 
 204 milligrammes. Compared with the dust in the streets, 
 that of the subway was 1 1 to 800 per cent, heavier. While 
 some of the dust in the underground is carried in from the 
 streets, much of it is of underground origin, and comes from 
 the gradual wear and tear of the wood, cement, and other 
 materials that have been used in construction, also from the 
 operation of the trains, for the largest percentage is iron dust, 
 and is due to the grinding action of the powerful brakes on 
 the cars. The loss of weight in the brake-shoes alone is 
 estimated to be about one ton per mile per month, and when 
 there is added to this the loss from the wheels and the rail- 
 way track, the origin of the metallic dust is readily explained. 
 It is the finer dust only that rises into the air of the under- 
 ground, but it is the breathing of the fine dust given off in 
 certain trades, e.^:, steel, scissor, and needle grinding, that is 
 the cause of pneuniokoniosis^ or that form of lung disease 
 which terminates in fibroid phthisis. What the effect of the 
 inhalation of the dust is upon the health of the men employed 
 on the underground there has scarcely been sufficient lei.gth 
 of time to show, but the conditions which are present point 
 to the advisability of a railway company which controls both 
 underground and surface running giving alternate employ- 
 ment to the men, so as not to have them always in the subway. 
 Although no serious disease has been found in the men, yet 
 many of them suffer from inflammatory affections of the nose, 
 
ORGANIC DUST, ETC. 245 
 
 throat, and windpipe, and also from "dry pleurisy" unaccom- 
 panied by pain. I have dealt at length with Dr. Soper's 
 article because it is the most complete study of the subject 
 that I have met. 
 
 It goes without saying that some trades are dustier than 
 others. The amount of dust in a cubic metre of air will vary 
 from o mgm. in the clean air of a dwelling-house to 175 mgms. 
 in such an industry as felt-shoe making. In a dusty trade 
 like cement-making Arens ^ found, when no work was being 
 done, 130 mgms. of dust in i cm. of air; and during work, 
 when the crushing machines were running, 224 mgms. 
 According to Hesse,^ a workman following his occupation 
 for ten hours a day would inhale the following quantities of 
 dust in grammes : — 
 
 Horsehair works 
 
 Sawmills 
 
 Flour mills 
 
 Iron foundry 
 
 Tobacco works 
 
 Chemical works 
 
 One of the dangers to health attendant upon following a 
 dusty occupation is the development of lung disease which 
 terminates in fibroid phthisis ; hence the term " stone- 
 masons' phthisis," "steel-grinders' phthisis," and "potters' 
 rot." Inhalation of gritty dust is the cause of the struc- 
 tural changes which occur in the lungs. Calmette, of Lille, 
 has recently disputed the respiratory origin of pneumo- 
 koniosis. He is of the opinion that the fibroid disease of the 
 lungs is the result not of workmen breathing irritating particles 
 of dust, but of swallowing them with their food,- and that the 
 dust particles, penetrating through the lining membrane of the 
 alimentary canal, find their way into the lymphatics and are 
 carried by these canals to the glands in the abdomen and 
 also to the lungs. Calmette pleads for an intestinal as against 
 a respiratory origin of the disease. While in no way denying 
 
 ' Archiv. fiir Hygiene, 1894. 
 
 ' Viertelj.f. Gericht. Med. N.F., vol. 36, p. 329. 
 
 Per Day. 
 
 300 Days per Year. 
 
 0*05 
 
 15 
 
 0*09 
 
 27 
 
 0*125 
 
 37-5 
 
 0-I4 
 
 42 
 
 0-36 
 
 108 
 
 1*12 
 
 336 
 
246 DISEASES OF OCCUPATION 
 
 that, as in the case of pathogenic micro-organisms, dust may- 
 reach the lungs vid the intestinal canal, facts and clinical 
 experience alike point to the respiratory passages as channels 
 also by which dust reaches the lungs. It is only necessary 
 to examine, either by the naked eye or microscopically, the 
 expectoration brought up by a man who has been working 
 in a dusty atmosphere for a few hours. In addition to 
 particles of dust imbedded in the mucus, smaller particles are 
 seen in the interior of the mucous corpuscles and epithelial 
 cells. The respiratory passages are lined by a layer of ciliated 
 epithelial cells, whose function it is, owing to the to and fro 
 movement of their ciliary processes, to waft outwards particles 
 of dust that have been inhaled. Were it not for this pro- 
 tective barrier, dust would reach the lungs much more 
 frequently than it does. The effect of recurrent colds and 
 bronchial catarrh is to cause shedding of these cells, and 
 consequently a loss of their protective influence. With this 
 gone, dust more readily reaches the lungs, and entering the 
 walls of the pulmonary alveoli, it induces a low form of inflam- 
 mation which ends in the transformation of the spongy 
 substance of the lung into hard, unyielding fibrous tissue, 
 quite unfitted for the purposes of respiration. On the dust 
 reaching the lungs several of the finer particles are taken 
 up by large cells which come from the walls of the alveoli, 
 and these cells, known as phagocytes from their power of 
 eating and thereby destroying microbes, have also the power 
 of absorbing dust particles. Phagocytes are endowed with a 
 certain amount of mobility. They pass through the wall of 
 the alveoli and, reaching the lymphatics of the lung, either 
 deposit the pigment within them or in the surrounding tissues, 
 or they carry them to the bronchial glands at the root of the 
 lungs. The fibrotic lung disease that is induced through in- 
 halation of dust extended over a length of time is in the first 
 instance a non-tuberculous disease, but as the malady is of 
 slow development and the man keeps to his work and is 
 thereby exposed to accidental infection, the opportunity is 
 afforded of the tubercle bacillus becoming grafted upon the 
 chronic inflammatory affection and of converting it into one 
 of a tuberculous nature. 
 
ORGANIC DUST, ETC. 
 
 247 
 
 There are various forms of dust diseases of the lungs, or 
 pneuntokonioses^ e.g., anthracosis^ due to coal-dust ; chalicosis 
 and silicosis^ due to sandstone and mineral grit ; siderosis, due 
 to iron ; and byssinosis, to cotton fibres. 
 
 The following table taken from Sommerfield's book on 
 diseases of occupations shows the important part played 
 by dust in causing pulmonary phthisis : — 
 
 
 Number of Deaths 
 
 Number of Deaths 
 
 
 due to Phthisis per 
 
 due to Phthisis per 
 
 
 1,000 Persons. 
 
 1,000 Deaths. 
 
 Occupation without production of 
 
 
 
 dust 
 
 2*39 
 
 381-0 
 
 Occupation with production of dust 
 
 5*42 
 
 480*0 
 
 Population of Berlin of same age ... 
 
 4*93 
 
 332*3 
 
 Trades giving rise to — 
 
 
 
 A. Metallic Dusts : 
 
 5'34 
 
 470-6 
 
 {a) Copper trades 
 
 5-31 
 
 520-5 
 
 (^) Iron „ 
 
 5*55 
 
 4037 
 
 {c) Lead „ 
 
 7*79 
 
 5017 
 
 Trades giving rise to — 
 
 
 
 B. Mineral Dusts : 
 
 4-42 
 
 403-4 
 
 Pottery Workers 
 
 14-0 
 
 59i"o 
 
 Masons 
 
 4-26 
 
 382 
 
 Trades giving rise to — 
 
 
 
 C. Organic Dusts : 
 
 5*64 
 
 537-04 
 
 Dust from Leather, Skins, and 
 
 
 
 Feathers ... 
 
 445 
 
 565-9 
 
 Dust from Wool and Cotton... 
 
 5*35 
 
 554-1 
 
 „ „ Wood and Paper... 
 
 5-96 
 
 507-5 
 
 „ „ Tobacco ... 
 
 8-47 
 
 598-4 
 
 British statistics are equally interesting. In the table on 
 p. 248, which is extracted from Dr. John Tatham's interesting 
 article in " Dangerous Trades," p. 135, we observe that there 
 are several industries in each of which the mortality from 
 phthisis and diseases of the respiratory organs is more than 
 
248 
 
 DISEASES OF OCC: 
 
 io:> 
 
 
 Comparative 
 
 Mortality Figures. 
 
 
 Mortality 
 
 Figures 
 
 (All Causes). 
 
 
 
 Occupation. 
 
 
 Diseases of the 
 
 
 Phthisis. 
 
 Respiratory 
 
 
 
 
 Organs. 
 
 Agriculturist 
 
 602 
 
 106 
 
 115 
 
 Pottery : Earthenware Manu- 
 
 
 
 
 facture 
 
 1,706 
 
 333 
 
 668 
 
 Cutler 
 
 1,516 
 
 382 
 
 518 
 
 FileMaker 
 
 1,810 
 
 402 
 
 423 
 
 Glass Maker... 
 
 1,487 
 
 295 
 
 445 
 
 Copper Worker 
 
 1,381 
 
 294 
 
 406 
 
 Iron and Steel Manufacture 
 
 1,301 
 
 195 
 
 450 
 
 Stone Quarries 
 
 1,176 
 
 269 
 
 307 
 
 Brass Worker 
 
 1,088 
 
 279 
 
 273 
 
 Chimney-sweep 
 
 1,311 
 
 260 
 
 291 
 
 Lead Worker 
 
 1,783 
 
 148 
 
 397 
 
 Cotton Manufacture... 
 
 1,141 
 
 202 
 
 338 
 
 double that of agriculturists, and that in some of the trades 
 the total mortality from these diseases ranges from three to four 
 and a half times that of the agricultural class. 
 
 The opinion is not put forward that the high mortality of 
 dust-producing occupations compared with that of agricultur- 
 ists is due alone to irritation of the lungs caused by dust, for 
 there are doubtless other contributing causes. Still it must 
 be acknowledged that the influence of dust in inducing respira- 
 tory diseases of a purely mechanical and irritative nature is 
 considerable, as witness pottery manufacture, steel-grinding, 
 and file-making. 
 
 Cotton 
 
 If we leave out of consideration the effects of the moisture 
 artificially introduced into weaving-sheds, it cannot be said 
 that the manufacture of cotton is per se an unhealthy 
 occupation. Much of the bad health of the workers has 
 been the result of the reckless manner in which the moisture 
 has been applied. In the preliminary processes of the manu- 
 
ORGANIC DUST, ETC. 249 
 
 facture of cotton, such as emptying the bales of the raw 
 material, "carding," "roving," "spinning" the yarn, and 
 " winding " it, there is often a considerable amount of dust, 
 but the air-space in which the work is carried on is generally 
 good and the ventilation is effective. In the spinning-room 
 the temperature is usually higher and the atmosphere is not 
 so pure as in some of the other departments of the mill. The 
 temperature may rise to 90*^ or even 100° R, and as no mois- 
 ture is added the air is uncomfortably dry. The opinion 
 that previously prevailed as to the necessity of excluding 
 moisture from this department is losing ground, and ventila- 
 tion is being improved. Owing to the fact that dampness is 
 conducive to good weaving this particular process is carried 
 on in one-storied buildings. Factory owners build their 
 weaving sheds as far as possible in damp situations and with 
 only stone flags placed upon the soil to form the floor of the 
 shed. Moist exhalations from the soil are thereby encou- 
 raged. But for moisture and warmth in the mills the cotton 
 threads would become brittle. The roof is formed by a 
 series of bays, and as the buildings receive their light 
 from the north side of the bays no direct sunlight is 
 admitted into the shed. Dr. James Wheatley, in dealing 
 with the health conditions of the cotton- weavers, states that 
 the principal factors concerned are (i) fouling of the air 
 breathed by the workers themselves, combustion of gas, 
 dust, and emanations from the soil; (2) excessive humidity; 
 (3) high temperatures ; and (4) want of cleanliness. To 
 these might be added the risks of sore throat, bronchitis, 
 and phthisis by the habit weavers have of sucking the weft 
 through the shuttle when the thread breaks or on replen- 
 ishing the shuttle. The shuttle might become infected by 
 tubercle bacilli. Several devices have been introduced to 
 obviate the necessity of putting the shuttle to the mouth, 
 but the weavers adhere to the simpler but more dangerous 
 practice. 
 
 During four years of my early professional life spent 
 in Preston, Lancashire, I saw much of the cotton operatives 
 and their work. Thirty years ago the death-rate of cotton 
 operatives from pulmonary phthisis was much higher than 
 
250 
 
 DISEASES OF OCCUPATION 
 
 it is to-day. During the last two decades there has been 
 all through England a diminution in the mortality from 
 phthisis. Workers in cotton mills have shared in this 
 declension, although figures show that only a few years ago 
 they were still suffering from phthisis to a greater extent than 
 persons not similarly employed. The mortality statistics of 
 the town of Blackburn furnished by Dr. Wheatley indicate 
 that as regards phthisis there is a difference which is in favour 
 of the male population of the town not engaged in cotton 
 manufacture. 
 
 Ages. 
 
 Cotton- 
 
 Cotton- 
 
 Occupied 
 
 weavers. 
 
 spmners. 
 
 Males. 
 
 25 to 35 years 
 
 172 
 
 2*48 
 
 1*31 
 
 35 to 45 » 
 
 2*11 
 
 3-09 
 
 2-21 
 
 45 to 55 „ 
 
 r88 
 
 2-94 
 
 1-76 
 
 55 to 65 „ 
 
 375 
 
 o'6 
 
 1*43 
 
 65 upwards 
 
 1-45 
 
 3-95 
 
 0-47 
 
 It is pointed out by Dr. Alfred Greenwood, Medical Officer 
 of Health for Blackburn, that since 1891 there has been 
 a steady diminution in the death-rate of cotton operatives, 
 and that with one excepted age-period affecting female 
 weavers from 45 to 55 years of age, when the rate increased, 
 the death-rate from phthisis has declined. Dr. Greenwood's 
 figures, which deal with the years 1891 to 1905, indicate that 
 the conditions under which cotton operatives are working 
 are better now than at any previous time in the history 
 of the industry, and as a consequence the mortality rate has 
 diminished, the health of the operatives has been better, and 
 there has been a larger output of manufactured goods. 
 
 Persons following dusty occupations occasionally suffer 
 from lung diseases of a distinctly characteristic type, attended 
 by an increase of the fibrous tissue of the organs, to which 
 the term pneumokoniosis is applied. Under this term all 
 lung diseases caused by dust are included. The dust may 
 be of various kinds, e.g.^ organic and inorganic. To the 
 
ORGANIC DUST, ETC. 251 
 
 lung disease caused by the inhalation of cotton particles, 
 the term "byssinosis" is applied, but in cotton operatives 
 a purely dust disease is seldom met with. In Lancashire the 
 deaths from phthisis of cotton operatives were 25 per cent, 
 of the total deaths in the years 1880-82 ; in the years 1890-92 
 the percentage had fallen to ig'6. 
 
 The improvement in the health of the cotton operatives 
 and in the factory conditions during recent years is most 
 gratifying. Prior to the year 1882 cotton yarns were 
 over-sized, and this necessitated the introduction of a con- 
 siderable amount of steam into the weaving-sheds to soften 
 the thread. The over-sizing not only added to the weight 
 of the cotton cloth and was wrong from a moral point of 
 view, but it was harmful to the workpeople owing to the 
 dust and flocculent material which were given off. The 
 excessive use of steam caused the clothes of the workers 
 to become damp and was a source of rheumatism and 
 pulmonary complaints. The Health Committee of the Black- 
 burn Corporation instituted an inquiry in 1888 which con- 
 firmed the statements made by the Medical Officer of 
 Health, Dr. Stephenson, as to the injurious influences of the 
 ineffectual ventilation of the mills and of the excessive steam- 
 ing upon the health of the workpeople. These reports led 
 to the passing of the Cotton Cloth Factories Act in 1889, 
 whereby manufacturers were prohibited from exceeding 
 certain limits of moisture and were obliged to have always 
 two hygrometers in each weaving-shed. Schedule A of 
 the 1889 Act States the maximum limits of humidity of 
 the atmosphere at given temperatures. Although this Act, 
 one of whose requirements is the provision of 600 cubic 
 feet of fresh air per person per hour, was followed by good 
 results from a health point of view, it did not satisfy the 
 Weavers' Associations. The request was therefore made 
 to have " steaming " abolished entirely. A careful and 
 extensive inquiry was made into the whole subject by a 
 Committee composed of Sir Henry Roscoe, Sir William 
 Roberts, and Dr. Ransome, who reported to the Home 
 Secretary in 1897. In the following year the recommenda- 
 tions of the Committee were embodied in a Statutory Order. 
 
252 DISEASES OF OCCUPATION 
 
 The Committee recommended the employment of pure 
 water drawn from a public supply, or such other source 
 as is deemed satisfactory, for the purpose of inducing 
 artificial humidity, and that when the source of the water 
 supply is doubtful measures shall be taken to purify it 
 before introducing it as steam, also that during working 
 hours the proportion of carbonic acid gas in the air shall 
 be not greater than 9 volumes to every io,cx30 volumes of 
 air. No alteration, practically speaking, was made of the 
 amount of moisture previously allowed. Where pains were 
 not taken to regulate the introduction of steam the air of 
 the weaving-shed would become foggy and the steam would 
 condense on the walls and pillars of the weaving-shed. 
 The clothes of the workers too became saturated with 
 moisture, so that on leaving the warm weaving-shed and 
 proceeding homewards on a cold evening, the workpeople 
 frequently got chilled and became liable to bronchial and 
 pulmonary complaints and to rheumatism. Compared with 
 dry air, which is regarded as bracing, moist air is enervating 
 and unfits the individual to bear fatigue, and as several 
 of the cotton operatives are poorly clad and ill-fed the 
 ill-health they suffer from is easily explained. Another 
 risk of getting chilled lies in the fact that when the 
 clothes of the workpeople are damp they become perme- 
 ated with the "size," and as this may contain a fairly 
 large quantity of deliquescent salts the clothes, already 
 damp, become further attractive to moisture. 
 
 Add to the humidity of the atmosphere a high tempera- 
 ture and impure air, and while it is easy to understand 
 how much reduced may be the vital resistance of the 
 cotton operatives, it is difficult to say how much of 
 the ill-health is due to excessive " steaming " and how much 
 to accessories. Work in a hot, moist atmosphere becomes 
 uncomfortable and oppressive simply because the evaporation 
 of the skin is interfered with, and thereby one of the 
 natural methods of cooling the body is prevented. 
 
 Experience has confirmed the wisdom of the recom- 
 mendation of 9 volumes of carbonic acid per 10,000 of 
 air. Although a higher standard of purity might have 
 
ORGANIC DUST, ETC. 253 
 
 been nsisted upon, the regulations have, on the whole, 
 worked satisfactorily. To enable the standard of 0*9 per 
 1,000 to be maintained, it is necessary to introduce more 
 than 2,000 cubic feet of air per head per hour. Generally 
 speaking the ventilation of cotton-weaving sheds is good. 
 It only requires that the electric light should replace other 
 methods of artificial lighting, that effectual means exist for 
 the removal of dust, and due regard be paid to the adequate 
 provision of sanitary conveniences for the workers not closely 
 contiguous to the weaving-sheds, also that the surroundings 
 of these sheds should be as healthy as possible, so that only 
 pure atmospheric air shall enter the factory. 
 
 Flax and Linen 
 
 An old Irish industry, the manufacture of linen, was 
 revived by French Huguenots who settled in Belfast, Lurgan, 
 and Lisburn more than two hundred years ago. Although 
 farmers in the North of Ireland grow flax, they are obliged 
 to buy the seed from Holland and Russia, for owing to the 
 custom of pulling the flax early and of steeping it in water 
 the local growth is all made use of and is not allowed to 
 run to seed. In the spinning-room of a linen factory there 
 is considerable moisture, partly owing to the spray thrown 
 off during the process of " wet " spinning when the yarn 
 is being twisted round the bobbins, and also to the presence 
 of steam jets. As in the manufacture of cotton, the flax 
 yarn, before being woven into cloth, is stiffened or sized 
 by a mixture of caragheen moss, flour, and tallow, and in 
 order to dry the yarn as quickly as possible the temperature 
 of the room is generally high, 90° F. to 1250 F. 
 
 The work in linen factories is hard, the workrooms are 
 hot, and the atmosphere in some of the processes is too 
 moist and in others too dusty. The hecklers, /.^., the men 
 who dress and sort the rough flax converted into tow by 
 having been passed through a machine, frequently suffer from 
 dryness of the throat and bronchitis attended by cough and 
 shortness of breath. In this, as in all dusty occupations 
 where there is dryness of the throat produced by dust. 
 
254 DISEASES OF OCCUPATION 
 
 the men indulge too freely in the use of alcoholic stimulants. 
 The machines in the heckling department are attended by 
 young lads, many of whom are half-timers, and although 
 the occupation is dusty respirators are no longer worn with 
 the same frequency as formerly. Accidents are not unknown, 
 for the lads occasionally get caught in the machinery. 
 Workers in the spinning-rooms suffer from headache and 
 vertigo owing to the great heat. As the workers have to 
 stand all day more or less on wet floors, they frequently 
 suffer from varicose veins in their legs, oedema of the 
 feet, and eczema. Dr. Glibert, Medical Factory Inspector, 
 of Belgium, tells me that in Belgium many of the flax 
 workers suffer from a peculiar abrasion and ulceration of 
 the skin of the palmar surface of the hand owing to the 
 irritant effect of some of the materials in the liquid used 
 for spinning. The skin cracks and is exfoliated without 
 pain or any sense of irritation, but as the true or deeper 
 skin is laid bare painful prickling is experienced. Occasion- 
 ally the ulceration tends to invade the deeper tissues, and 
 while the character of the sores recalls the appearances met 
 with in syphilitic ulceration they are not in any way related 
 to this specific disease. The ulcers are purely the result 
 of a local dermatitis peculiar to flax workers. Dr. H. S. 
 Purdon, of Belfast, who had several years' experience of 
 the maladies of linen workers, states that he is familiar 
 with the eczema observed on the hands of spinners but 
 has never come across the ulcers on the hands to which 
 Dr. Glibert, of Brussels, has drawn attention. The method 
 of preparing the flax is probably different in the two 
 countries. 
 
 Many persons on beginning work in a linen mill for the 
 first time suffer from malaise, known as " mill fever," the 
 symptoms of which are nausea, vomiting, headache, and a 
 rise of temperature. Usually the indisposition lasts two or 
 three days. It is attributed to the disagreeable odour given 
 off by the oil and to the stifling and moist atmosphere of 
 the workrooms. 
 
 Dr. Purdon mentions a peculiar skin eruption, not unlike 
 small-pox, which attacks the forearm, arm, and face of the 
 
ORGANIC DUST, ETC. 255 
 
 doffers, i.e., the boys and girls, usually half-timers, who 
 remove the full bobbins from the spinning frames, and which 
 is the result of the irritant action of the flax, oil, and water 
 upon the skin. Callosities are met with on the index fingers 
 of the hecklers, and are the consequence of the pressure 
 and friction caused by pulling the flax out of the "pins" 
 of the machinery. Many of the spinners suffer from a painful 
 affection of the nails of the great toe. This onychia, or 
 inflammation of the nail, is the result of infection caused 
 by the operatives working barefooted on the wet floor of 
 the spinning-room. The Regulations of the Home Office 
 have done much to improve the health of the operatives 
 and the condition of labour in linen factories in recent years. 
 
 Jute 
 
 Whether the prosperity which has attended the jute trade 
 in the past will be extended into the future it is impossible 
 to say. The manufacture of jute made Dundee one of the 
 most prosperous towns in the United Kingdom. In 
 Dundee is manufactured nearly all the jute that is imported 
 into this country. Roughly speaking this industry gives 
 employment to 40,000 persons. Many of the jute mills were 
 built in the heyday of prosperity and are well equipped. 
 The vegetable fibre from which jute is made comes from 
 India. The plant, an annual, grows in great luxuriance on 
 the mud banks and islands of the great rivers of our eastern 
 dependency. Mr. H. J. Wilson, H.M. Inspector of Factories, 
 has written excellent reports upon the conditions of labour in 
 jute mills. About 3,500,000 bales of jute are exported annually 
 from India to Europe, and it is estimated that 2,900,000 
 bales are used in Calcutta and neighbourhood in the 
 manufacture of cloth and sacking. The jute exported from 
 India is distributed as follows: 1,900,000 bales come to the 
 United Kingdom; 1,000,000 go to the Continent; and 
 500,000 bales are sent to America. 
 
 Jute is used for making sacks and coarse twine. Attempts 
 have been made to manufacture it into carpets, but as these 
 have very little wear in them the utility of jute in this 
 
256 DISEASES OF OCCUPATION 
 
 respect is far outstripped in sack-making. I have never 
 been in such noisy factories as the jute mills of Dundee. 
 The machinery is similar to that employed in linen mills, 
 but judging from the annual returns there are more accidents 
 in jute than in textile factories generally, a circumstance 
 which may be partly explained by the less perfect system 
 of protection adopted. Alterations lately introduced have 
 materially diminished the number of casualties. Some of 
 the processes of manufacture, such as those of preparing and 
 spinning, are extremely dirty and dusty, and as the wages in 
 these departments are lower than in the weaving-rooms, the 
 operatives are of a distinctly inferior class. The dust given 
 off by the raw material is irritating to the respiratory pas- 
 sages, and in order to reduce its effects many of the female 
 hands resort to the use of snuff. The exhaust fans in the 
 carding- and spinning-rooms succeed in removing much of 
 the dust. The temperature of the spinning-rooms is uncom- 
 fortably high, and to cope with it the windows have to be 
 kept open and the fans running. The application of oil to 
 the jute fibre allays to some extent the dispersion of dust, but 
 it often creates an offensive odour and a feeling of closeness 
 of the atmosphere when the temperature is high. 
 
 The manufacture of jute cannot be regarded as an 
 unhealthy occupation except in those departments where 
 considerable quantities of dust are thrown off. Many of the 
 operatives employed therein suffer from bronchial and pul- 
 monary troubles. The statistics of the Dundee Infirmary 
 show that a large number of the workpeople suffer from 
 lobar pneumonia. There are few towns, unless it be the 
 east end of Glasgow, in which the children of the poorer 
 working classes suffer more from tuberculous affections of 
 the glands and bones than in Dundee. This is largely the 
 result of improper feeding and of the imperfect housing and 
 overcrowding that are known to exist in Dundee. 
 
 As a consequence of the excessive noise of the weaving 
 looms and of the spinning frames, aggravated by the 
 diffusion of dust in the air, which aids in the formation of 
 plugs of wax in the ear, deafness is a common complaint 
 of jute workers. The hoarseness observed in persons 
 
ORGANIC DUST, ETC. 257 
 
 employed in the preparing- and spinning-rooms may be 
 the result of dust, and also the consequence of overstraining 
 of the voice in speaking owing to the din of machinery. 
 Many of the new hands suffer from a kind of " mill " fever, 
 of which headache, vertigo, pain in the back, and a sense 
 of extreme tiredness, accompanied by a rise of temperature, 
 are the prominent features. The symptoms continue for 
 two or three days, when they gradually subside with or 
 without treatment. 
 
 Two or three years ago some jute workers in Dundee 
 died from tetanus. On bacteriological analysis the tetanus 
 bacillus was found in dust obtained from the machinery. 
 The micro-organism had come with the vegetable product 
 from India, but the early detection of the microbe and the 
 source from which it came led to an early extinction of 
 the disease. 
 
 Although the manufacture of jute cannot be said to be an 
 unhealthy occupation, since there is no disease specific to the 
 employment, there is something, either about the occupation 
 itself or the home life of the workers, that does not tend to 
 improve the physique of the children born to jute workers. 
 To see a factory " scaling," as it is called, or the employees 
 coming out at the close of a shift, is always an interesting 
 sight, but such an event in Dundee offers the occasion 
 for serious reflection. Many of the young persons employed 
 in the preparing and spinning departments are of diminutive 
 height and of light weight. There are a dwarfiness about 
 them and a degree of imperfect physical development which 
 at once strike the observer. Girls of seventeen and eighteen 
 years of age look from their size and build more like girls of 
 thirteen. Many of them are anaemic and their frame is not 
 well formed. It is difficult to attribute to its proper cause 
 the stunted growth of young jute workers. Female labour 
 in the factories with, as one of its attendant evils, the 
 comparative neglect of the children from a feeding point 
 of view, the entrance of the children upon factory life 
 at an early age, and the overcrowding in the houses are 
 causes not to be ignored. 
 
258 DISEASES OF OCCUPATION 
 
 Boxwood: Ruler and Shuttle Making 
 
 At the Manchester meeting of the British Medical 
 Association, Autumn, 1902, Dr. T. F. Young, of Birkenhead, 
 described certain symptoms which he had observed in men 
 working with a particular kind of wood for making rulers. 
 The men complained of dryness of the throat and of 
 inflammation of the eyes, which lasted two or three days. 
 Some of the workmen were more susceptible than others. 
 The wood is known as Marcaibo boxwood or Zaputeso, 
 and is furnished by a tree known as Tabebuia pentaphylla 
 of the order Bignoniacese. The fine sawdust caused 
 inflammation of the eyes and dilatation of the pupils. 
 
 The symptoms complained of are similar to those 
 mentioned by me ^ as occurring in joiners who saw and 
 chip sequoia wood, and resemble those exhibited by persons 
 who are suffering from a bad cold in the head and chest, viz., 
 a running at the nose, frequent fits of sneezing, irritation 
 in the throat and bronchi, accompanied by cough, laboured 
 breathing and quickened pulse, followed by a sense of 
 oppression at the stomach and accompanied by a smarting 
 sensation in the eyes. The symptoms usually last only a 
 day or two and are mostly observed in men who are working 
 with the wood for the first time. A tolerance seems to 
 be established in regard to it except by men who are 
 liable to bronchitis and asthma. Wounds caused by 
 splinters of the wood invariably suppurate and do not 
 heal readily. The sequoia-tree is a conifer and grows in 
 California. On several occasions I examined the sawdust 
 both chemically and microscopically without finding in it 
 anything to explain the symptoms. The sawdust soaked in 
 water did not give an acid reaction, nor did it produce 
 symptoms in a rabbit, the floor of whose hutch was kept 
 strewn with it. Rats were susceptible to sequoia sawdust. 
 They suffered from a running at the nostrils. 
 
 Certain kinds of wood have a bad reputation among 
 joiners. Some sawdusts are more irritating than others, 
 
 ' ** Dangerous Trades," p. 791. 
 
ORGANIC DUST, ETC. 259 
 
 probably from the larger amount of inorganic matter which 
 they contain. 
 
 In Lancashire the dust given off during the manufacture 
 of shuttles for weaving purposes is a cause of malaise to the 
 workmen employed. Many of them suffer from headache, 
 coryza, excessive secretion of tears, and attacks of asthma. 
 The wood from which these shuttles are made is known as 
 West African boxwood, or Knysna boxwood, Knysna being 
 the port in Africa from which it is exported. From the 
 wood. Professor Harvey Gibson, of Liverpool, and Professor 
 Dixon, of Cambridge, obtained an alkaloid which, when 
 tested experimentally, was found to be a cardiac depressant 
 and also a paralyser of the motor endings of nerve fibres in 
 muscles, similar in this latter respect to the action of the 
 arrow poison, curare. 
 
 The men who suffered presented a pale and jaundiced 
 appearance ; their breath had a peculiar camphor-like odour. 
 Several of them had attacks of difficulty of breathing 
 and of precordial pain accompanied by cold sweating. 
 There was also marked slowing of the heart's action. Since 
 the alkaloid is soluble in weak saline solution, it is more than 
 probable that it becomes dissolved on the perspiring skin of 
 the workmen and is thus absorbed. 
 
 Professor Harvey Gibson ^ has made a careful study of the 
 wood and the alkaloids obtained from it. The wood comes 
 from the Congo basin and the Cameroons. The cutting of 
 the blocks of wood for shuttles is done by machinery and 
 the finishing is done by hand. It is principally during the 
 sandpapering stage of the process that the fine dust is 
 created which is supposed to be the cause of the indisposi- 
 tion of the men. 
 
 Messrs. Brady and Martin, chemists, Newcastle-upon-Tyne, 
 extracted for me alkaloids and glucosides from other forms 
 of African boxwood, a few of which produced dilatation of 
 the pupil but no marked constitutional effects. 
 
 Poisoning by African boxwood is one of the industrial 
 diseases recommended by the Workmen's Compensation 
 Act's Committee of the Home Office for compensation. 
 ' The Bio-Chemical Journal, vol. i., No. i, p. 39. 
 
26o DISEASES OF OCCUPATION 
 
 Workers in teak-wood occasionally suffer from dermatitis. 
 Willmott Evans ^ mentions the case of a joiner who had 
 suffered from a severe form of dermatitis attended by an 
 eruption of an erythemo- vesicular nature and of an extremely 
 itchy character spread over the whole body, but especially 
 abundant on the back of the hands, the face, and neck, and 
 which, in spite of treatment, continued ten days. The eruption 
 only came on after working in teak-wood. Eight years 
 previously the patient had been identically affected after 
 having been similarly occupied. Six of the eight men 
 engaged in the workshop and working in teak suffered in 
 the same manner, although less severely. The symptoms 
 were attributed to the action of an essential oil which is 
 found in the central part of the tree, and which gains an 
 entrance into the body of the workman by the dust raised 
 during the polishing of the wood. One of my own patients 
 who had been employed in teak-wood suffered from vomiting 
 followed by a vesicular eruption on the skin and a desquama- 
 tive dermatitis, which was still in existence six months after 
 the acute attack. 
 
 Shoddy and Rag Sorting 
 
 Shoddy has for its object the extraction of wool contained 
 in rags. The industry is an old one. It is supposed to have 
 been introduced into this country by the Moors of Spain, for 
 they are known to have made paper from rags. It was in 
 1813 that the shoddy industry was commenced in Batley, 
 and for several years rags from all parts of the world found 
 their way to this Yorkshire town, the "rag metropolis." 
 Since the middle of last century shoddy factories have been 
 established in Belgium, Germany, and France. Rags are 
 divided into two kinds, (i) cotton and linen rags, (2) woollen 
 rags. The cotton and linen rags are made into paper while 
 the woollen rags are converted into cloth. Although rags 
 are gathered from all sources alike by clean and dirty persons, 
 it is astonishing how little sickness there is, comparatively 
 speaking, among the workpeople who have to deal with them 
 ^ Brilish Journal of Dermatology, 1905, December, p. 447. 
 
ORGANIC DUST, ETC. 261 
 
 in the factory. Woollen rags seldom convey infection, but 
 cotton and linen rags have been the means of disseminating 
 small-pox. 
 
 Rag-sorters are generally women. The work is anything 
 but pleasant. This is especially the case with woollen rags, 
 for they so frequently harbour fleas and other pests. All 
 bundles of rags before being opened ought, therefore, to be 
 first disinfected so as to destroy parasites, and since rags from 
 the surgical wards of hospitals and private patients often 
 contain septic material, the importance of making disinfec- 
 tion obligatory is at once apparent. It is when the bundles 
 are first opened that the danger is greatest. The dust given 
 off is irritating to the respiratory passages and causes dryness 
 of the throat. During the grinding of the rags by machinery 
 considerable quantities of dust are thrown off, inhalation of 
 which is extremely trying to new hands but which has little 
 or no immediate effects on the older workpeople. Those 
 persons who are new to the trade develop what is known as 
 "shoddy fever," the symptoms of which are a rise of tempera- 
 ture, severe headache, signs of bronchial catarrh, and running 
 at the nose. The workpeople shiver as if they were going 
 to have a severe fever, and they complain of muscular pains. 
 The symptoms are not unlike those met with in influenza. 
 They rapidly decline on the workpeople absenting themselves 
 from the factory for a few days, but they are apt, in many 
 people, to recur on their return to work. Rags which contain 
 a good deal of cotton have to be carbonised by being plunged 
 into a bath of sulphuric or hydrochloric acid. By this means 
 the cellulose or vegetable part of the fibre is destroyed and 
 the wool can be thus extracted from cotton fabrics. When 
 the rags are subsequently heated to dryness and are beaten, 
 a considerable quantity of fine dust is evolved, some of which 
 is inflammable and may be the cause of an explosion. Dr. 
 John A. E. Stuart, of Batley, says that the older workers 
 suffer from bronchitis and emphysema of the lungs, that the 
 dust in the air combines with the wax in the ears of the 
 workpeople forming plugs and causing temporary deafness, 
 that it induces granular inflammation of the eyelids, and that 
 by plugging the ducts of the sebaceous glands of the skin it 
 
262 DISEASES OF OCCUPATION 
 
 causes acne, a skin eruption characterised by spots often 
 angry looking and with a black head. Dr. Parsons, of the 
 Local Government Board, recommended that all workers in 
 shoddy factories should be revaccinated, also the necessity 
 for good ventilation of the mills and personal cleanliness on 
 the part of the workers themselves. 
 
 Soot. Chimneysweep's Cancer. Gardener^s Cancer 
 
 Coal when burned undergoes some peculiar chemical 
 change, whereby the soot that is formed has conferred upon 
 it properties of a specially irritating character, for only thus 
 can we explain the prevalence of scrotal cancer in chimney- 
 sweeps. Men following this employment exhibit a liability 
 to cancer several times greater than that of the general popu- 
 lation. There is the opinion that the irritant in soot is arsenic, 
 but whether it is this or sulphurous acid or ammonia com- 
 pounds it is difficult to say. In Newcastle-upon-Tyne we 
 seldom see cases of chimney-sweep's cancer, although it was 
 the cause of death of one sweep in 1907. In the London 
 hospitals and on the Continent it is not met with so fre- 
 quently as formerly. According to statistics supplied by Dr. 
 John Tatham, of the General Register Office, the comparative 
 mortality figure for cancer among chimney-sweeps between 
 the ages of 25 and 65 for the three years ending 1902 
 was 133 as compared with 63 among occupied males at 
 the same ages. This is a lower death-rate from cancer in 
 chimney-sweeps than three decades ago, and even later. 
 In his article on dust-producing occupations in " Dangerous 
 Trades," Dr. Tatham gives as the mortality figures from 
 cancer 156 for chimney-sweeps compared with 44 for 
 occupied males. While, therefore, the mortality from cancer 
 has been diminishing in chimney-sweeps, it has been rising 
 in the general population. Although usually met with 
 in the region of the scrotum, the disease may appear on 
 any part of a chimney-sweep's body. It is usually preceded 
 by one or two small warty growths which ulcerate, and 
 these, failing to heal, assume the character of an epithelioma. 
 The glands in the groin subsequently become enlarged, 
 
ORGANIC DUST, ETC. 263 
 
 first from irritation and secondly from malignant infection. 
 The disease makes slow but steady progress. Ultimately 
 secondary deposits occur in such of the internal organs 
 as the liver and lungs and in the peritoneal cavity. 
 
 Gardeners who are in the habit of sprinkling soot upon 
 plants to protect them from slugs occasionally develop 
 cancerous ulceration of the hand. Soot when repeatedly 
 applied to the skin causes it to become thickened, harsh, and 
 dry. Once structural alterations are induced in the skin, 
 repeated irritation may lead to cancer. 
 
 Men who work in tar and paraffin and in anthracene, 
 a product obtained from the distillation of gas-coal tar, 
 are specially prone to suffer from warts and skin eruptions. 
 Distillers of benzine and creasote suffer in a similar manner, 
 although not so frequently. 
 
 Ulcers of the skin in persons who are working among coal- 
 tar and pitch products ought not to be neglected. In 
 the first instance the ulcer may be of a simple character 
 and will heal if properly treated and kept free from irritation. 
 Should it cease to heal, extirpation by the surgeon may be 
 required. 
 
 Tobacco y Cigar y and Snuff Manufacture 
 
 The manufacture of tobacco in Great Britain is in the 
 hands of private owners, but in several of the Continental 
 countries the industry is a State monopoly. In France 
 it gives employment to 16,660 workers, of whom 15,000 
 are females. Within the last few years French tobacco 
 factories, as structural buildings, have considerably improved. 
 In neither the French and Spanish factories nor in those 
 of Great Britain have I witnessed anything to lead me 
 to regard the manufacture of tobacco as an occupation 
 dangerous to health. The women appeared to be quite 
 healthy. In the Newcastle Infirmary I have been occa- 
 sionally consulted by young female tobacco workers suffering 
 from chloro-anaemia, headache, nausea, and distaste for 
 food, but I do not think that these symptoms are met with 
 in tobacco workers in greater proportions than in girls 
 
264 DISEASES OF OCCUPATION 
 
 employed in other indoor occupations. During the mani- 
 pulation of the dried tobacco for making cigars and 
 cigarettes there is a good deal of dust floating about in the 
 workroom, a circumstance which led Proust to include the 
 manufacture of tobacco among the trades which cause 
 diseases of the lungs. Zenker, a German physician, stated 
 at a meeting of German physicians a few years ago that 
 he had found tobacco dust in the lungs of two persons 
 who had worked in a tobacco factory at Erlangen, and 
 although this finding has been supported by Merkel, these 
 discoveries remain isolated, so that we cannot regard pul- 
 monary tobaccosis as a common event. In France, opinions 
 are divided as to whether female tobacco workers are not more 
 prone to miscarry when pregnant than woman employed 
 in other industries, and whether the children who survive 
 birth do not die in greater numbers during the first year 
 of life than children born under other circumstances. It 
 is also stated that nicotine is present in the mammary 
 secretion of nursing women. This statement is entirely 
 devoid of foundation. I have, when visiting one of the large 
 tobacco factories of Madrid, seen the women leave the 
 workrooms at a certain hour to suckle their children, brought 
 to be fed, and a healthier class of women, also stronger 
 and better nourished babies, it would be impossible to find 
 anywhere. The dangers to the health of tobacco and cigar 
 makers from their employment have been exaggerated. On 
 the other hand, it is only proper to state that Galezowski ^ 
 found visual troubles in persons engaged in the manufacture 
 of tobacco. De Schweinitz, an American ophthalmologist, 
 reports the occurrence of amblyopia or loss of vision in 
 persons who work in tobacco, but who do not use it in 
 any form. He relates the case of a young woman whose 
 symptoms disappeared when she left the tobacco factory. 
 Against these statements may be placed the opinion of 
 Dr. Shears, who visited the works of Messrs. Cope Bros., and 
 who on careful inquiry did not learn of one single instance 
 of defective sight among the 1,200 men and women employed 
 in the factory. The works at Pantin-Aubervilliers, near 
 * " Des Amblyop. et Amauroses Toxiques," p. 47, 1897. 
 
ORGANIC DUST, ETC. 265 
 
 Paris, employ 800 persons, of whom 700 are women, but 
 in none of these did I learn of any of the visual defects, 
 to which Galezowski and De Schweinitz have drawn 
 attention. 
 
 France has recently introduced into the State factories a 
 pension fund for all workers. In these factories there is a 
 nine-hours day : the men can make 7 fr. a day and the women 
 5 fr. 25 c. Men and women can work therein until the 
 age of sixty-five. The State puts aside 4 per cent, of the 
 wages of the workers into the Caisse Nationale for pensions 
 from the first day the workers receive wages. After twenty- 
 five years' service in the factory, or if the workers have been 
 invalided, the women receive 400 fr. a year {£16) and the 
 men 600 fr. (;f24); but if both of these work until the age 
 of sixty-five the pension is larger. 
 
 As an illustration of the belief of the French authorities 
 in the harmlessness of tobacco manufacture upon the health 
 of the workers, I cannot do better than mention the following. 
 In order to encourage female workers in the State tobacco 
 factories to suckle their children, and thereby to reduce the 
 high death-rate among infants, the French Government since 
 August 5, 1905, offers certain monetary rewards. The 
 women are allowed thirty days to recover from their confine- 
 ment before returning to work, but on the presentation of a 
 medical certificate that health and fitness have been re- 
 gained, women may return to work twenty days after this 
 event. During the three or four weeks the women are 
 regarded as on the sick-list : they receive a gratuity of 30 to 
 45 fr. if they are working in the Department of the Seine and 
 20 to 30 fr. if working in the provinces. To the mother who 
 will suckle her infant and who has returned to work in the 
 factory, opportunity is afforded of giving the child the breast 
 at the factory, and the State at the same time gives her, in 
 addition to her wages, at the end of every four months, an 
 allowance of 10 fr. per month. At the tobacco works in 
 Pantin-Aubervilliers only one-half of the women suckled their 
 infants, and then only for a few weeks. I saw one healthy 
 mother who had reared her infant on the breast for ten 
 months, and she had received the allowance of 10 fr. per 
 
266 DISEASES OF OCCUPATION 
 
 month. When there are twins the State gives, if both 
 children are nourished at the breast, lo fr. per month for 
 each infant. Certain formalities have to be observed, such 
 as the presentation monthly of the infants to the doctor of 
 the factory, who, after satisfying himself as to the health and 
 progress of the child, certifies accordingly. This action on 
 the part of the French Government towards the female 
 workers in tobacco factories is the strongest proof that the 
 manufacture of tobacco and cigars is not an unhealthy occu- 
 pation. Dr. Courtois-Suffit, who is the medical officer in 
 charge of these factories, informs me that the work does not 
 affect menstruation, pregnancy, nor lactation. When a 
 woman is pregnant she receives for three months before her 
 confinement, if in indifferent health, i fr. 40 c. per day while 
 off work, and after her confinement, if she is prevented work- 
 ing on account of delicate health, she may for a period still 
 receive the same allowance. Notwithstanding these bene- 
 volent offers on the part of the French Government, it is 
 becoming the fashion of female workers who have borne 
 children not to suckle the infants, but to send them out to be 
 nursed. 
 
 In the manufacture of snuff, the tobacco is allowed to 
 ferment. It requires three months for fermentation to take 
 place. Whole stacks of tobacco are thus allowed to stand 
 fermenting. These have to be broken down, shovelled 
 away, and the hard tobacco ground into powder. The men 
 engaged to do this complain that the work gives them a 
 splitting headache and causes them to vomit. They look 
 pale and unhealthy, the work is hot, and there is always 
 a good deal of heavy vapour rising from the tobacco-bed in 
 which the men are employed. When the tobacco is dry, 
 there is a considerable quantity of dust, which the men say 
 catches them in the throat and causes them in the morning 
 to have brownish-black expectoration. 
 
 In the department where the tobacco leaves are primarily 
 steeped in water, the women employed occasionally suffer 
 from painful blisters on the hands. 
 
T 
 
 CHAPTER X 
 
 MINING 
 
 Coal-mining 
 
 HE dangers to life from gas and explosions incurred by 
 the miner in the getting of coal are dealt with else- 
 where in this book. Here we are concerned for the most 
 part with coal-mining as a dusty occupation. Fifty years 
 ago coal-miners' phthisis, or anthracosis, was a well-known 
 disease ; to-day, thanks to the well-ventilated condition of 
 our coal-mines, the malady has remarkably diminished in 
 Great Britain. If proof were required of the good effects of 
 legislation in reducing occupational diseases, we have only 
 to turn to coal-mining and compare its past with f)resent 
 statistics. There are certain occupations in which those who 
 follow them are all more or less picked and healthy men to 
 commence with, but this cannot be said of miners. Of all 
 occupations in this country, none is more hereditary than that 
 of coal mining. A lad goes into the mine because his father 
 is working there and his grandfather did so before him. 
 Miners are therefore not a selected class of men. Although 
 a large part of the working-day is spent underground, the 
 occupation of the miner is not an unhealthy one. Because 
 miners' phthisis is largely a thing of the past, and was 
 dependent upon faulty conditions, there is the opinion that 
 the occupation of the coal-miner rather protects him from, 
 than predisposes him to, pulmonary consumption. When 
 pulmonary tuberculosis is caught by a miner, it is much 
 more likely that the infection has been caught in the home 
 or public-house than in the pit, where the ventilation is 
 remarkably free and the air supplied particularly pure and 
 abundant. In old colliery villages the houses of the miners 
 
 are small, and the ceilings of the sleeping-rooms are low, and 
 
 267 
 
268 
 
 DISEASES OF OCCUPATION 
 
 there is frequently overcrowding; but in the newer mining 
 villages many of these defects have been remedied, gardens 
 are attached to the houses, and in these the men can work 
 when not following their occupation. Better housing, the 
 provision of purer drinking-water, better food, good wages, 
 greater railway facilities, and the establishment of reading- 
 and recreation-rooms have done much to improve the health 
 of the mining classes, and to raise their tone socially and 
 morally. As most of the collieries are in the country, the air 
 is good and the surroundings attractive enough. The daily 
 walk of the miner to and from his work, although in many 
 instances short, is in others sufficiently long to allow him 
 to enjoy the walk, tired though he may be. The com- 
 parative freedom of the coal-miner from tuberculous phthisis 
 is not confined to this country alone. According to a census 
 of the United States, pulmonary consumption caused iO'6 
 per cent, of all deaths among miners and quarrymen, as against 
 1 6*2 per cent, for all occupied males, i.e.y the disease is nearly 
 one-third less frequent among miners than among occupied 
 males. In Great Britain, as Dr. John Tatham has shown, 
 the same thing has taken place. 
 
 There are 882,345 coal-miners in Great Britain : of these 
 709,339 work underground. Dr. John Tatham gives, the 
 following table to show the death-rates from all causes of 
 miners in England and Wales at several ages compared 
 with the corresponding rates of occupied males. 
 
 
 
 
 
 
 
 
 es and 
 
 
 15. 
 
 20. 
 
 25- 
 
 35. 
 
 45- 
 
 55- 
 
 upwards. 
 
 Occupied Males. 
 
 100. 
 
 100. 
 
 100. 
 
 100. 
 
 100. 
 
 100. 
 
 100. 
 
 Mining industry 
 
 148 
 
 112 
 
 87 
 
 78 
 
 95 
 
 121 
 
 147 
 
 Coal-miners 
 
 150 
 
 III 
 
 80 
 
 77 
 
 94 
 
 119 
 
 143 
 
 Durham and Northumberland 
 
 IS4 
 
 III 
 
 75 
 
 66 
 
 79 
 
 97 
 
 152 
 
 Lancashire 
 
 163 
 
 107 
 
 88 
 
 94 
 
 no 
 
 140 
 
 150 
 
 West Riding 
 
 115 
 
 92 
 
 76 
 
 77 
 
 89 
 
 126 
 
 138 
 
 Derby and Notts 
 
 93 
 
 68 
 
 69 
 
 59 
 
 73 
 
 
 
 118 
 
 Staffordshire 
 
 Q5 
 
 109 
 
 82 
 
 70 
 
 95 
 
 135 
 
 180 
 
 Monmouth and Wales 
 
 227 
 
 141 
 
 118 
 
 97 
 
 117 
 
 140 
 
 129 
 
 Ironstone-miner 
 
 134 
 
 90 
 
 82 
 
 66 
 
 83 
 
 91 
 
 144 
 
 Tin-miner 
 
 116 
 
 139 
 
 III 
 
 "5 
 
 161 
 
 180 
 
 178 
 
 Lead-miner 
 
 118 
 
 127 
 
 130 
 
 109 
 
 116 
 
 182 
 
 240 
 
MINING 
 
 269 
 
 At the ages from fifteen to twenty and twenty to twenty- 
 five, as well as above fifty-five, miners die in the aggregate 
 more rapidly than occupied males. In the intervening ages 
 their death-rate is lower. A large proportion of their high 
 mortality is the result of " accident." This factor, as well as 
 the death-rate from phthisis, is brought out in the subjoined 
 table, extracted from one supplied by Dr. Tatham in 
 "Dangerous Trades," p. 157. 
 
 
 Accident. 
 
 Phthisis. 
 
 Respiratory 
 Diseases. 
 
 Mining industry ... 
 
 135 
 
 109 
 
 267 
 
 Coal-miners 
 
 141 
 
 97 
 
 269 
 
 Durham and Northumberland 
 
 96 
 
 94 
 
 156 
 
 Lancashire ... 
 
 15s 
 
 102 
 
 389 
 
 West Riding 
 
 114 
 
 123 
 
 288 
 
 Derby and Notts 
 
 89 
 
 69 
 
 159 
 
 Staffordshire 
 
 135 
 
 83 
 
 319 
 
 Monmouth and Wales 
 
 243 
 
 107 
 
 345 
 
 Ironstone-miners ... 
 
 86 
 
 90 
 
 204 
 
 Tin-miners 
 
 48 
 
 508 
 
 377 
 
 Lead-miners 
 
 43 
 
 380 
 
 325 
 
 In some of the mining centres it will be observed that 
 colliers not only suffer less from phthisis than occupied 
 males, but that they also suffer unequally in different mining 
 centres. Why this should be so, it is difficult to say. This 
 remark applies not only to phthisis, but to the death-rate 
 generally. While the death-rate from phthisis in miners is 
 in many places low, that due to non-tuberculous affections 
 of the lungs is, comparatively speaking, high. The mortality 
 of coal-miners from phthisis is at certain ages a little more 
 than half of that to which other occupied males are subject, 
 whereas their mortality from respiratory diseases exceeds 
 the same standard by 21 per cent. Whilst as a class miners 
 enjoy considerable immunity from pulmonary consumption, 
 yet the disease prevails, and is unequally distributed amongst 
 them, as witness the high mortality from phthisis in the West 
 Riding of Yorkshire — 123 — and in Monmouthshire — 107 — 
 
270 
 
 DISEASES OF OCCUPATION 
 
 compared with 83 and 69 in Staffordshire and Derbyshire 
 respectively. Dr. Tatham states that in the West Riding 
 the mortality of the coal-miner has increased since 1881 
 by one-fifth, but in other counties it has decreased by one- 
 third of its former amount. Non-tuberculous lung diseases, 
 on the other hand, have increased. 
 
 Drs. J. M. Wain Wright and H. J. Nichols,^ in dealing with 
 the subject of anthracosis and tuberculosis, supply some 
 interesting figures drawn from Scranton, a mining centre in 
 the United States, with a general population of 100,000. 
 Taking the percentage of deaths from all lung diseases 
 among miners as 100, they give the following as the rela- 
 tion : — 
 
 I All Lung 
 Diseases. 
 
 Anthracite mine workers 
 All other occupied males 
 
 100 
 114 
 
 Pulmonary 
 Tuberculosis. 
 
 14 
 41 
 
 Asthma. 
 
 29 
 7 
 
 Pneumonia. 
 
 42 
 54 
 
 Tuberculosis at Scranton is about two-thirds less frequent 
 among miners than among occupied males, and if accident 
 is excluded the miners live longer than occupied males. 
 De Crocq speaks of the rarity of phthisis among Belgian 
 coal-miners. Arnold reports that in Germany tuberculous 
 diseases are rare among coal-miners, and that there is a 
 prevailing opinion that anthracosis is antagonistic to tuber- 
 culosis. Seltman not only found tuberculosis rare in coal- 
 miners, but believed coal dust to exercise a favourable 
 influence on tuberculous processes already established. Gold- 
 man attributed the freedom of the coal-miner from pulmonary 
 tuberculosis to an antiseptic action of the coal dust. But 
 is coal dust antiseptic ? It is a fact that when coal-miners 
 have received injuries to their limbs in the pits the wounds, 
 when examined by the surgeon, are frequently found to 
 be black and the tissues powdered with coal dust. So black 
 
 * The American Journal of the Medical Sciences, September, 1905, 
 p. 408. 
 
MINING 271 
 
 and gangrenous looking are the wounds, that at first sight 
 it would appear as if amputation of the affected limb would 
 be necessary, and yet experience shows that, disseminated 
 with coal dust as these wounds are, they heal remarkably well. 
 This would suggest that there was some protective influence 
 exercised by the coal dust. It is interesting to remember 
 that while coal is a vegetable product and largely the 
 result of microbial agency, on bacteriological examination 
 the fresh coal taken from the working face in the mine is 
 found to be sterile and free from micro-organisms. The coal 
 dust seen in a miner's wounds is therefore in all probability 
 sterile, ' and as the particles are non-irritant in character 
 they do no harm. But the question is, Do they do any 
 good? Wainwright and Nichols, having rendered guinea- 
 pigs anthracotic by exposing them to coal dust, found after 
 injecting a suspension of a pure culture of tubercle bacilli 
 into their windpipe that although the glands and abdominal 
 viscera showed signs of tuberculosis, the lungs, which had 
 become black with coal dust, remained free. On the other 
 hand, guinea-pigs not rendered first anthracotic all became 
 the subjects of tuberculosis of the lungs after injection of 
 the culture. A certain protective influence from pulmonary 
 tuberculosis had been extended to the anthracotic guinea- 
 pigs by the coal dust. Experimental results such as these 
 just recorded, also surgical experience of miners' accidents, 
 have suggested that coal dust possesses a distinctly germicidal 
 action, but when this has been tested on various forms of 
 micro-organisms, including tubercle bacilli, no such germicidal 
 action has been found. The subject is one of considerable 
 interest, and it presents many problems that still await solu- 
 tion. Since no germicidal action of coal dust has been 
 proved, the theory has been advanced by Nichols that the 
 protective influence is due to the calcium salts which form 
 such a large proportion of the ash of coal dust. I do not 
 think that either of the above theories explains the com- 
 parative rarity of tuberculosis of the lungs in coal-miners. 
 Fifty to sixty years ago tuberculous disease of the lungs 
 carried off large numbers of coal-miners. The coal dust was 
 just as sterile then as now, and yet there has been a marked 
 
272 DISEASES OF OCCUPATION 
 
 reduction in the death-rate from this disease within recent 
 years. The improved health of the miner and his com- 
 parative freedom from pulmonary tuberculosis are due to the 
 better ventilation of the coal-mines, the air of which, as it 
 passes onwards through the mine, becomes rid of bacteria 
 and reaches the miner at his work in a purer state than the 
 air which we breathe in the streets of a large town. 
 
 Nearly thirty years ago, when I became physician to the 
 Newcastle Infirmary, it was not uncommon to have cases of 
 coal-miners' phthisis in the wards. The patients used to 
 bring up large quantities of " black spit," and after death 
 the lungs were found to be black and solid. When the lungs 
 were cut into and squeezed there came forth a dark fluid 
 as black as ink. The lungs frequently contained cavities 
 of various sizes and forms, and on microscopical examination 
 the fibro-connective tissue of the lung was found to be 
 increased. The bronchial glands, too, on section, were 
 equally black. So great has been the change which has 
 come over the North of England coal-miners that I can 
 safely say there has scarcely been a case of coal-miners' 
 phthisis in the wards of the Newcastle Infirmary during 
 the last ten years. The blackness of the lungs is due to 
 the men inhaling fine coal dust and smoke from the lamps 
 when working in confined spaces. Although a miner's lungs 
 may contain large quantities of carbonaceous material, these 
 organs are still capable of performing their respiratory 
 function remarkably well, and on the whole the men have 
 for a time good health. The pulmonary tissue is wonderfully 
 tolerant of the presence of coal dust and carbon particles, 
 but a time comes when, the infiltration having exceeded 
 the limits consistent with healthy function, aeration becomes 
 imperfect, the pulmonary tissue disintegrates and cavities 
 are formed, or, as is more probable, in consequence of 
 infection by the tubercle bacillus a tuberculous lesion is 
 established in the lungs. The disease is of slow develop- 
 ment. At first the general health is gradually undermined, 
 then follow cough and carbonaceous expectoration, and 
 on examining the chest there may be heard tubular breathing 
 at some parts, deficient respiratory murmur at others, 
 
MINING 273 
 
 muco-crepitant rales here and there, and exaggerated vocal 
 resonance. 
 
 As the opportunity may not recur, I will here briefly 
 refer to some of the other ailments coal-miners suffer from, 
 and which are included among the diseases for which com- 
 pensation is awarded under the Workmen's Compensation 
 Act. I refer, among other things, to what is called miners' 
 "beat hand." As a consequence of using the pick and 
 friction of the handle, the skin of the palm along the bases 
 of the fingers of both hands, also the skin over the fleshy 
 ball of the thumb and that on the outer side of the hand, 
 becomes extremely hard and horny. In addition to the 
 enormous thickening of the epithelial layers of the skin, there 
 is inflammation of the subcutaneous connective tissue. Occa- 
 sionally suppuration takes place in the deeper layers of 
 the hard skin. The suppurating areas are called " keens " by 
 the miners, and for their cure incision by the knife is neces- 
 sary. "Beat hand" is a painful affection and unfits the 
 individual for work for some time. 
 
 A similar condition of things occurs on the knees and 
 elbows, hence the terms " beat knee " and " beat elbow." 
 
 Colliers frequently complain of backache, pain in the lower 
 part of the spine, largely the result of the peculiar mode of 
 sitting adopted by the men when working. " Miners' back" 
 is a troublesome complaint to treat ; the symptoms are 
 entirely subjective and unattended by physical signs. 
 
 Another common complaint of coal-miners is dyspepsia. 
 This is the result of the irregularity with which the men 
 get their meals, owing to working alternately every week 
 on the day and early morning shift. 
 
 Miners' nystagmus, or a peculiar oscillatory condition and 
 unsteadiness of the eyeballs, is less frequently observed than 
 formerly. It is due primarily to fatigue of the elevator 
 muscles of the eyeballs when the men are working in a 
 constrained position in a dim light and are looking upwards 
 in an oblique direction. Occasionally this oscillation of the 
 eyes is attended by headache and giddiness and by the 
 dancing of objects before the eyes, so that the miner is unable 
 to follow his employment. Recovery is slow, and can only 
 
274 DISEASES OF OCCUPATION 
 
 be secured by the men giving up their work for several months. 
 The symptoms are entirely subjective, and there is no 
 necessary relation between the severity of the oscillation and 
 the degree of incapacity for work. Miners' nystagmus has 
 been scheduled for compensation, but the fact just alluded to 
 is sure to raise difficulties in settling disputed cases of com- 
 pensation, since one coal-miner may suffer little, although 
 the subject of marked oscillation of the eyes, while another 
 with less prominent signs may experience so great discomfort 
 as truly to unfit him for work. 
 
 The diseases to which coal-miners are especially liable 
 are few so far as the occupation is concerned. It is otherwise 
 with the risks to life from accident. In another portion of 
 this book a chapter is devoted to the subject of ankylosto- 
 miasis, or miners' worm disease. Before discussing the 
 question of accidents in mines, allusion ought to be made 
 to the prevalence of a very troublesome affection of the eyes 
 among Westphalian coal-miners. In 1904 there were 1,030 
 cases of ophthalmia treated in Westphalia, and in 1905 the 
 malady was still prevalent. This eye affection, called 
 trachoma^ is an inflammation of the eyelids, and is extremely 
 infectious, owing to the purulent nature of the discharge. 
 When miners have become ill they have conveyed the 
 disease to their wives and children. The eyelids, when 
 affected, are not only red, but are swollen, and contain a few 
 hard granules like grains of sago. It is not a painful affec- 
 tion, but there is a good deal of intolerance to light. 
 Trachoma, being an infectious inflammation of the eyelids, is 
 the result of micro-organisms, cocci or bacilli, which are 
 present in the discharge from affected surfaces. Some races 
 are more liable to it than others. The Jews, and the Irish, 
 persons living in certain districts of Germany and Prussia, 
 e.g., Posen, Lower Hesse, and the Lower Rhine districts, also 
 in certain parts of France, are liable to it. The chance of 
 the disease being introduced into the British coal-mines can 
 only arise through alien immigrants bringing it. Cleanliness, 
 frequent ablution, carefulness in regard to the use of towels, 
 and medical treatment are recommended. 
 
 The subjoined table gives the — 
 
MINING 
 
 275 
 
 Comparative Statistics of Fatal Accidents in the 
 Coal-mines of Different Countries: Prussia, 
 Great Britain, Belgium, and France.^ 
 
 I. PER thousand workers. 
 
 Year. 
 
 Prussia. 
 
 Great Britain. 
 
 Belgium. 
 
 France. 
 
 1891 
 
 2-89 
 
 i'55 
 
 1-41 
 
 1-66 
 
 1892 
 
 2*21 
 
 1-48 
 
 2-84 
 
 095 
 
 1893 
 
 2-62 
 
 i'55 
 
 1*12 
 
 093 
 
 1894 
 
 2*21 
 
 r6i 
 
 1-62 
 
 0-85 
 
 1895 
 
 2*54 
 
 1-49 
 
 I '33 
 
 120 
 
 1896 
 
 2-58 
 
 1-48 
 
 I-I4 
 
 1-30 
 
 1897 
 
 2*35 
 
 I '35 
 
 I '05 
 
 107 
 
 1898 
 
 2-86 
 
 1-28 
 
 1-42 
 
 ro7 
 
 1899 
 
 2-31 
 
 1*25 
 
 0-99 
 
 1-35 
 
 1900 
 
 2*25 
 
 1*29 
 
 1*05 
 
 1.42 
 
 1891-1900 
 
 2-47 
 
 1*44 
 
 1-39 
 
 118 
 
 190T 
 
 2'34 
 
 1*37 
 
 ri7 
 
 1-21 
 
 1902 
 
 1*99 
 
 1-25 
 
 1-07 
 
 I -09 
 
 1903 
 
 1-92 
 
 1-28 
 
 ri4 
 
 I 02 
 
 1904 
 
 r8o 
 
 1*25 
 
 o*93 
 
 1-07 
 
 II. per million tons of coal. 
 
 Year. 
 
 Prussia. 
 
 Great Britain. 
 
 Belgium. 
 
 France. 
 
 1891-1900 
 
 9-17 
 
 5*1 
 
 8-02 
 
 57 
 
 1901 
 
 9'43 
 
 4-6 
 
 7-08 
 
 6-1 
 
 1902 
 
 815 
 
 4-5 
 
 6-28 
 
 6-0 
 
 1903 
 
 7-58 
 
 47 
 
 6-69 
 
 4'i 
 
 1904 
 
 7-15 
 
 4-6 
 
 5-65 
 
 5-4 
 
 Gold-mining on the Rand and Elsewhere 
 
 In British mines individual cases of " gassing " occur 
 among the men, due to the use of the higher explosives, but 
 
 ^ From Circular No. 3085 of Le Comite Central des Houilleres de 
 France, 28 Mars, 1Q06. 
 
276 DISEASES OF OCCUPATION 
 
 they are few and far between compared with those in South 
 African mines. During 1904- 1905 there occurred in the Rand 
 mines 30 accidents from this cause. There were 40 deaths, 
 9 of white men and 3 1 of natives ; 24 persons were seriously- 
 injured. Most of the accidents were traceable to the men 
 returning to work in a particular part of the mine too soon 
 after the blasting ; some of them were due to carelessness in 
 the handling of cartridges, while in other instances the fumes 
 given off from the explosives travelled to other parts of the 
 mine, even to different levels, and produced serious symptoms 
 in the men who were working there. Drs. Donald Macaulay 
 and L. G. Irvine state that, of the 40 deaths, 17 were caused 
 by nitrous fumes, and in one-half of these the diagnosis was 
 confirmed by post-mortem examination. It is characteristic 
 of poisoning by nitrous fumes that no symptoms may arise 
 and no pain or discomfort be felt for a time, and yet within 
 12 to 18 hours after exposure to the fumes from the 
 explosives people may die from acute haemorrhagic cedema 
 of the lungs. In mines where dynamite, gelignite, and nitro- 
 explosive compounds are used, and where the cartridge burns 
 rather than explodes, the gas evolved may be both nitrogen 
 oxide (NO) and carbon monoxide (CO), so that some of the 
 symptoms may be due to the person having inhaled both of 
 these gases. In a perfect explosion there should be, theo- 
 retically speaking, nothing but carbon dioxide, but even when 
 the explosion is complete other gases may be liberated. 
 Nitrogen oxide combines readily with oxygen. It is this 
 affinity for oxygen that renders the study of its physiological 
 action difficult. When Sir Humphry Davy tried to breathe 
 the gas he experienced a burning sensation in his throat and a 
 sense of constriction of his glottis. Nysten, after injecting 
 nitrogen oxide into the veins of a dog, found that the animal 
 died with a rapidity proportional to the quantity of gas 
 injected, and that death was preceded by obstinate cough, 
 difficult breathing, small pulse, and signs of chilliness. 
 Nitrogen oxide, by absorbing the oxygen of the blood, causes 
 death by asphyxia. 
 
 Peroxide of nitrogen (NO2) is formed when NO unites with 
 O. In its free state the gas is reddish brown, is an energetic 
 
MINING 277 
 
 oxidising agent, and is disagreeable to breathe. The gas 
 recalls the odour of chlorine, but while the effects of chlorine 
 are instantaneous and painful, and disappear without leaving 
 any trace upon the organism when the inhalation has not 
 been too protracted, it is otherwise with the fumes of nitrogen 
 peroxide. During inspiration of nitrogen peroxide there is 
 a sensation of painful burning in the throat, which ceases 
 when the fits of coughing have rejected the poison from the 
 lungs. A few hours afterwards, when it would seem as if all 
 symptoms had ceased and all fear of possible complications 
 had passed away, the individual who has breathed the gas 
 begins to complain of severe compression of the chest and of 
 respiration being painful ; there is profuse foamy yellow 
 expectoration, the face becomes pale, the temperature elevated, 
 the pulse frequent and small, and the patient succumbs with- 
 out loss of his intellectual functions. After death the lungs 
 are found to be gorged with dark liquid blood and are the 
 seat of patchy haemorrhages, the bronchial tubes contain 
 bloody foam, and the heart is filled with dark liquid blood. 
 In some cases the stomach is distended by gas of an 
 extremely acid nature, the intestines are red and the mucous 
 membrane healthy. 
 
 The inhalation of nitrogen fumes, especially nitrogen per- 
 oxide (NO2), is extremely dangerous. Not only are the 
 lungs congested and the seat of haemorrhages, but the blood 
 itself becomes brown, and gives with the spectroscope the 
 band of acid haematin, situated a little to the right of C, almost 
 in the first third of the portion which separates C from D — 
 which means the breaking up of the colouring matter of the 
 blood into haematin and a proteid. 
 
 I have dwelt at some length upon the effects of nitrogen 
 oxide fumes, for " gassing " of the miners on the Rand has 
 played an important part in the death-rate, owing to the 
 extravagant use of nitro-explosives and the comparative 
 absence of supervision of the men. So silently, too, have been 
 the effects produced, that men have died without ever having 
 been aware that they had been '' gassed," owing to the fumes 
 having travelled some distance in the mine. In the blind 
 ends of drives, in winzes and rises, where there is no aerial 
 
278 DISEASES OF OCCUPATION 
 
 circulation after blasting, the air often contains small 
 quantities of carbon monoxide (CO) as well as of nitrogen 
 oxide (NO), and carbon dioxide (CO2). When the men have 
 been discovered their candle has usually been found burning 
 by their side, but not in every instance. This circumstance 
 shows the desirability of freer ventilation of those parts of 
 the mine where the air tends to become stagnant. In 
 shovelling the broken rock in the mine Kaffir boys have 
 become unconscious, others have died — circumstances which 
 show that the broken rock tends, after blasting, to imprison 
 poisonous gases, the subsequent liberation of which becomes 
 a source of danger when the work is carried on in close and 
 ill-ventilated places. 
 
 Mining engineers are of the opinion that the air of South 
 African mines may be polluted by the air pumped in by com- 
 pressor engines carrying in carbon monoxide and hydro- 
 carbon vapours from the oils used for lubricating the engine. 
 Dr. J. S. Haldane carried out a series of experiments bearing 
 upon this point, so far as the Cornwall tin-mines are 
 concerned, without finding any appreciable quantities of this 
 gas in the compressor air. That the compressor air is not 
 always pure is shown by the fact that in one of the mines in 
 County Durham, a few years ago, an explosion occurred which 
 was traceable to the compressor air, and in South African 
 mines compressor air has also been found capable of explod- 
 ing. In February, 1906, Drs. Macaulay and Irvine reported 
 that a native had been fatally " gassed " in one of the Rand 
 mines through the inhalation of gases due to an explosion 
 in the compressor cylinder. This accident shows the 
 necessity of using as lubricants only oils of a high flash point. 
 The non-removal by ventilation of the gases left by explosives 
 fired on a previous day leaves a vitiated atmosphere for the 
 men to work in. The amount of CO present under these 
 circumstances has been found to be 0*13 to 0*22 per 1,000 
 and CO2 to be 1*39 to 179, and in the worst instances to be 
 0*38 CO per 1,000 and 4 CO2. The inhalation of minute 
 quantities of these gases, continued over a long time when at 
 work, must induce deteriorated health and predispose to 
 illness. 
 
MINING 279 
 
 The effects of nitrous fumes upon the miners are more 
 or less immediate, but the men in the South African gold- 
 mines run other risks to health which in the end are 
 equally destructive to life. I refer to gold-miners' phthisis. 
 In the Lancet of June 14, 1902, I believe I was the first 
 to draw the attention of the Government and mining 
 officials to the high death-rate from pulmonary phthisis in 
 miners working on the Rand. My experience was gained 
 in miners who had returned to Northumberland during 
 and shortly after the close of the Boer War. A few years 
 previously young miners in the bloom of health had left 
 their Northern homes for the South African goldfields, 
 and after working there four to six years returned to North- 
 umberland and elsewhere broken in health, but with their 
 purses lined with gold, often to the extent of ;^8oo or ;f 900. 
 As nearly all of these men died, their wealth had been 
 secured at a tremendous cost — loss of health and life. In 
 my paper in the Lancet I raised the question as to whether 
 something could not be done by improving the working 
 conditions in the mines to put an end to the excessive 
 mortality that was taking place in the Rand miners. Mr. 
 Chamberlain appointed a Commission to inquire into and 
 report upon the subject of phthisis in the miners of the 
 Transvaal. To a mining community like that upon the 
 Rand the prevention of miners' phthisis is one of the most 
 important problems socially and economically. The death- 
 rate from pulmonary diseases in metalliferous miners is un- 
 usually high. This is due to the fact that the men who 
 work therein are exposed to dust, gases, and infection. To 
 these must be added the influences of working in deep mines 
 and close to blasts, also the chilling of the body consequent 
 upon the rapid changes of temperature which the men ex- 
 perience in their transit by the " lift " from deep levels with 
 high temperatures to the surface, where the temperature 
 is low. Exposure to such rapid changes of temperature 
 when the men are overheated and perspiring, and are 
 fatigued at the end of their day's work, is responsible for 
 much of the bronchial catarrh and bronchitis the men^suffer 
 from, and which could be prevented by the establishment 
 
28o DISEASES OF OCCUPATION 
 
 of " change houses " at the mine head where the men could 
 divest themselves of their wet working clothes, have a 
 warm bath, and put on warm dry clothing before going home. 
 
 By "Rand miners' phthisis" is meant a deeply pig- 
 mented and somewhat solid condition of the lungs found 
 in men who during life exhibited signs and symptoms of a 
 progressive pulmonary disease more or less of a chronic 
 character. As far back as 1703 miners' phthisis had been 
 described by an Italian, Rammazini, and in our country 
 Pearson in 181 3 described the disease and attributed it to 
 dust. Doubtless it was coal-miners' phthisis these writers 
 referred to. It was left to Peacock to establish the relation- 
 ship between dust and lung diseases by demonstrating, both 
 chemically and microscopically, the identity of the dust found 
 in the lungs after death with that of the atmosphere in which 
 the patient had worked. In the various pneumokonioses, or 
 lung diseases caused by the inhalation of dust, the lesions 
 in the lungs are, practically speaking, identical, quite irre- 
 spective of the nature of the dust. The lung substance 
 instead of remaining soft and spongy, becomes converted 
 into a hard, unyielding substance, composed for the greater 
 part of fibrous tissue. Thus structurally altered, the lungs 
 are unable to discharge their function as organs of aeration. 
 
 On examining my first patient the subject of gold-miners' 
 phthisis I was struck by the healthy bronzed appearance 
 of his skin. The man looked as if he had been exposed 
 to the sun and the weather. He had the appearance of 
 a man in good health, and yet he could not walk a few 
 paces without panting. In his chest there were all the 
 physical signs of fibrotic lung, with slight displacement 
 of the heart, caused by retraction of the newly-formed tissue 
 in the lung. Within a few months this patient died, the 
 pulmonary symptoms having become progressively worse, 
 and yet there was nothing like the emaciation of the body 
 that is observed in ordinary tuberculous phthisis. What 
 is peculiar to " gold " or " Rand miners' " phthisis is its 
 subtle origin and development. The unobtrusive manner 
 in which the disease invades the lungs without producing 
 symptoms is a noteworthy fact, but once the disease has 
 
MINING 281 
 
 gained a good hold upon the lungs, circumstances at any 
 moment may arise to cause marked ingravescence of the 
 physical signs and symptoms. One of the earliest signs 
 exhibited by a Rand miner who is becoming " lunged " is 
 shortness of breath. The patient who is the subject of 
 miners' phthisis does not feel that he is really ill until 
 he is almost beyond work, whereas in tuberculous phthisis 
 the individual is often very ill long before there is 
 extensive disease of the lungs, owing to the fact that 
 the tubercle bacilli secrete toxins which poison the blood 
 and the nerve centres. In gold-miners' phthisis the loss 
 of flesh and strength is so gradual that the miner con- 
 tinues to follow his calling, for the cough is slight and 
 there is little or no expectoration. By degrees a sense of 
 weakness impresses itself upon the patient, but it is the 
 shortness of breath that obliges him to give up work. When 
 the disease is fully established, it is observed, in addition 
 to the dulness in the chest On percussion, that the breath 
 sounds are coarse and tubular, but in the absence of 
 accompanying bronchial catarrh moist rales are not usually 
 heard. There is often pain in the chest, owing to the 
 presence of a limited pleurisy over the patch of fibrotic 
 lung, which explains the adhesions that are found after 
 death binding the lungs to the chest wall internally. There 
 is, as a rule, neither the rise of temperature nor the evening 
 sweating which are present in tuberculous phthisis, and 
 " blood spitting " is an extremely rare event. So markedly 
 absent is expectoration in uncomplicated cases that it is 
 difficult to obtain sputum for bacteriological examination. 
 In the early part of the illness, and sometimes throughout 
 the whole of it, as in some of my own patients, the ex- 
 pectoration is free from tubercle bacilli. In other instances, 
 towards the end of life tubercle bacilli are found in the 
 sputum. This circumstance, the physical signs and symptoms, 
 as well as the course of the disease, point to Rand miners' 
 phthisis as being in the first instance a purely local affection 
 of the lungs, the result of irritation by dust, and without 
 tubercle. When the disease becomes tuberculous it is in 
 consequence of superadded infection. In the report pre- 
 
282 DISEASES OF OCCUPATION 
 
 sented by the Transvaal Medical Society to the Government 
 Commission on miners' phthisis occur these words : " Out 
 of a series of 30 sputa from cases of disease of the lungs 
 of miners examined by a member of your Committee only 
 two or three were found to contain tubercle bacilli," a cir- 
 cumstance which " leads us to conclude that while in some 
 cases a true tuberculous phthisis may co-exist, or may be super- 
 added, the conjunction is only seen in a minority of cases." 
 
 In mining it is not the coarse particles but the fine, im- 
 palpable dust which is the source of danger, and which, in 
 consequence of the arduous nature of the work in an over- 
 heated atmosphere, is drawn by the miner into the recesses 
 of his lungs owing to the deeper breaths he is obliged to take. 
 On examining, as in one of my own experiments, the 
 lungs of a dog that had breathed for several hours daily 
 an atmosphere rendered dusty by finely-crushed Transvaal 
 rock, the dust on microscopical examination could be 
 seen lying in the finest ramifications of the lungs, and also 
 in the interior of large cells, some of which were lying 
 loose in the alveoli. These large cells are phagocytes, or 
 microbe-eaters, and have the power of moving about in 
 the lungs and of transporting both organic and inorganic 
 particles. They tend to keep the lungs free from dust, 
 and therefore play the part of scavengers, for while they 
 may be expelled with the expectoration they may also pene- 
 trate through the epithelial lining of the alveoli into the lym- 
 phatic vessels, and pass with the lymph stream to the roots 
 of the lungs, where they deposit the dust particles in the 
 bronchial glands. The long black lines of pigment which 
 are observed in the lungs after death mark the course by 
 which dust particles have been carried. The walls of the 
 alveoli become thickened as the result of the irritant action 
 of the dust particles causing overgrowth of fibrous tissue — 
 hence the term fibrosis of the lungs. The rapidity with 
 which the phagocytes remove the dust particles from the 
 lungs is remarkable. After the exposure of an animal 
 for a few hours to a sooty atmosphere the bronchial 
 glands when examined a few days subsequently will be 
 found to contain large quantities of carbon. It is for this as 
 
MINING 283 
 
 well as for other reasons that we cannot accept as the sole 
 explanation the theory of the intestinal origin of pneumo- 
 koniosis mentioned in another chapter. Dust diseases of 
 the lungs are probably more frequently the result of 
 inhalation of dust directly into the lungs, than of the 
 ingestion of it through the alimentary canal, and the 
 proof of this is borne out by a study of Rand miners' 
 phthisis. The disease is principally met with in rock- 
 drillers or in those who work in the dustiest atmosphere. 
 Rock-drills driven by compressed air raise a larger 
 quantity of dust than do hand drills. In all dry mines, 
 such as those of the Witwatersrand, the blasting, drilling, 
 shovelling of the rock and the breaking of it by hand 
 produce great quantities of dust, which under the micro- 
 scope are seen to be sharp particles of a siliceous nature. 
 It is when the miners are " raising," 2>., drilling a hole 
 upwards, that the greatest amount of dust is created, since 
 owing to the upward inclination it is less easy to inject 
 water into the hole when drilling than when boring in a 
 horizontal or downward direction. The amount of dust 
 raised varies from 0'o83 to 0"i85 grain per cubic foot of 
 air, so that a miner breathing his average 21 cubic feet of 
 air per hour would run the risk of inhaling about 2*38 
 grains of fine dust per hour ; hence the large quantity of 
 silica found on chemical analysis in the lungs of gold- 
 miners after death, amounting frequently to 24-4 per cent, 
 of the total weight of the organs. Of 1,377 rock-drill 
 miners employed in the Witwatersrand mines prior to the 
 South African campaign, 225, or i6'34 per cent, died during 
 the two and a half years immediately preceding the war. 
 The average age at death of rock-drill miners, according 
 to the report of a Special Committee of the Transvaal 
 Medical Society, was under 35 years, and the average 
 number of years the men had worked the machines was 
 seven to nine years. Rock-drillers on the Rand are carried 
 off by lung disease long before the prime of life, when 
 they are still young men comparatively speaking. Some 
 of them die very quickly and even unexpectedly. My 
 experience of Rand miners' phthisis, based upon exam- 
 
284 DISEASES OF OCCUPATION 
 
 ination of the men who had returned to Newcastle and the 
 neighbourhood from South Africa, leads me to express the 
 opinion that a shorter period of rock-drilling than seven 
 to nine years kills off most of the men, also that "raising" 
 and " driving " are more dangerous than working in " stopes," 
 and that dry mines are more dangerous than wet mines. 
 There is a case recorded in the Report of the Miners' 
 Phthisis Commission of two brothers, who, after working 
 rock-drills for four years, " raising " all the time, died from 
 lung disease at the ages of 28 and 30 respectively. 
 Further evidence in support of the short life of rock- 
 drillers is supplied by Dr. L. G. Irvine, of Witwatersrand, 
 who says, taking a limited period of years, that "on 
 the Geldenhuis Deep twenty-one men, having worked rock- 
 drills for an average period of five years, died from chest 
 disease at the average age of 35*5 years; on the Geldenhuis 
 Estate thirty-three men who had worked 6*9 years at rock- 
 drills died at an average age of 34-4 ; on the Jumpers Deep 
 thirty-nine men who had worked rock-drills for 6*8 years 
 died at the average age of 37 ; on the Crown Reef we 
 got the names of thirty-two men who had worked rock- 
 drills for 8*8 years, and who died at the average age of 
 32 years. . . . Later on we got from the Crown Deep a 
 list of forty-nine men who had worked rock-drills on an 
 average for six years, and died at the average age of 
 36'6." The shortest time on record of death from miners' 
 phthisis after working rock-drills is three years. What has 
 impressed me particularly in regard to Rand miners' phthisis 
 is that while the men knew what a dangerous occupation 
 gold-mining was, they still went on with the work, uncon- 
 scious that their own lungs were becoming impregnated with 
 dust. 
 
 The miners on the Rand are paid for piece-work ; they are 
 impatient, and as they prefer to run risks, some persons 
 may say that the men are not altogether free from blame. 
 They rush back too soon after blasting to recommence work 
 in the particular part of the mine, the air of which contains a 
 slight excess of CO2 when the explosion has been complete, 
 and always a large quantity of dust. They neither allow 
 
MINING 285 
 
 the gas to clear away nor the dust to settle. The men 
 work in the mine 9 to 9J hours per day. Some patients 
 have told me that they had frequently worked 11 hours 
 per day. The men do not leave the mine for food, except 
 at a few mines north of the Rand, where the men who are 
 working machines, and are not in charge of the "boys," 
 come up for dinner at midday. Many of these men rush to 
 the boarding-house and sit down to meals without washing 
 their hands. They wash afterwards. As they can make £^0 
 to £60 a month, they make haste to be rich, and to accom- 
 plish this they despise all the laws of hygiene. The white 
 men know quite well the danger they are running, but 
 many of them are indifferent to their fate. 
 
 While comparatively easy to obtain statistics relating to 
 Rand miners' phthisis among white men, it has been difficult 
 until lately to know how the disease has affected the 
 Kaffirs, since many of them on becoming ill return to 
 their kraals, where they die often unknown to and unheeded 
 by the employers. There is one circumstance which ought 
 to diminish the liability of the " boys " to the malady, and 
 that is that the Kaffirs do not follow the occupation with 
 the same constancy or as long as the white men. Once 
 they have made a little money they return to their 
 homes, but if perchance they have become the subjects of 
 dust lung disease and have had grafted on to it tubercu- 
 losis, they absent themselves from work and disseminate 
 tuberculous disease among their families in the kraal. 
 
 It was not until October, 1902, that statistics were kept 
 of native labourers. The mortality of natives working in 
 the mines is high. In a return presented by Dr. C. L. 
 Sansom to the House of Commons on native mortality at 
 the Rand mines for six months from October i, 1902, to 
 March 31, 1903, of 70,235 employed 1,476 died, the death- 
 rate being 42*03 per 1,000. The percentage of deaths from 
 pulmonary disease alone equalled 42*8, or almost one-half 
 of the total number. It is stated that " pulmonary diseases 
 amongst natives working in the mines are partly due to 
 carelessness and ignorance of the native, who does not realise 
 that whilst he is living and working in a colder climate and a 
 
286 DISEASES OF OCCUPATION 
 
 higher altitude than he is accustomed to, he should take some 
 ordinary common-sense precaution against getting sudden 
 chills when heated by exertion, partly due also to working 
 in a dust-laden atmosphere and general living conditions 
 in compounds." Two diseases at this date were responsible 
 for the high death-rate, which in the latter half of 1903 rose 
 to 8o'36 per 1,000, viz., pneumonia and phthisis, but enteric 
 fever, dysentery, diarrhoea, and scurvy also contributed. 
 Since 1904, although the mortality has been greatly reduced, it 
 is still too high. The death-rate is not equal in its incidence 
 upon the natives. Those drawn from certain territories suffer 
 more from sickness and have a higher death-rate than others. 
 Of the natives who died, 45*2 per cent, died within one 
 month after allotment to the mines. After this period the 
 mortality shows a steady decline ; the " boys " apparently 
 become acclimatised to the work. The character of the 
 work, too, is of importance. Eighty-five per cent, of the 
 deaths occurred among underground "boys" and 15 per 
 cent, among those working on the surface. It was hoped 
 the provision of "change" and bath houses, drinks of hot 
 coffee on coming out of the mine, and the distribution of warm 
 clothing would do much to diminish this high death-rate. 
 Since, too, the deep-level mines showed a higher mortality 
 than the outcrop mines, much was expected from better 
 ventilation and keeping the temperature of the mines down 
 to 75° and 80° F. The normal temperature of the human 
 body is 98*5° F. The effect of muscular work in a warm 
 medium is to raise the temperature of the body to 101° R, 
 and while this may cause little inconvenience or discomfort, a 
 further rise of i° may not only cause considerable discomfort, 
 but unfit a man for work. The human body has to get 
 rid of the excess of heat principally by radiation and 
 evaporation. In a hot mine, say 80° to 90° F., saturated with 
 moisture, the loss of heat by radiation is very slow. There 
 are several factors contributing to the heat of a mine, 
 e.g.^ the number of men working, use of lights and explosives, 
 the heat given off by the metals in the rock by oxidation, 
 also the temperature of the air driven in by compression, 
 which is 5*50 F. for every 1,000 feet of descent. 
 
MINING 287 
 
 Mr. Hugh F. Marriott ^ gives a series of investigations on 
 the depths and temperatures of South African mines. The 
 mines varied in depth from 497 to 3,916 feet, and the 
 temperatures from 68-5° F. to 83-20 F. In order to measure 
 the temperature and secure as equable results as possible, a 
 five-foot hand-drill hole was made in the rock near the floor 
 and filled with water, the mouth of which, after being plugged 
 with clay, was left untouched for 24 hours or more. 
 Although the proportionate increase of temperature with 
 depth varies considerably in different localities, still the 
 increase is always in direct proportion to the depth. In the 
 Witwatersrand Goldfields the mean rate of increase was 
 found to be a rise of 1° F. for each 208 feet increase in depth, 
 or 0*48° F. increase for 100 feet depth. Starting, therefore, 
 from the mean temperature of 1,000 feet depth as equivalent 
 to 68750 F., Marriott gives the following : — 
 
 Depth, Feet. Degrees Fahr. 
 
 1,000 
 2,000 
 3,000 
 4,000 
 5,000 
 6,000 
 7,000 
 8,000 
 
 6875 
 73-55 
 78-35 
 83-15 
 87-95 
 92-75 
 97-55 
 io2*35 
 
 The natural ventilation of the mines decreases the rock 
 temperatures in the vicinity of the workings from 5° F. to 
 10° F. Work in high-temperature mines is exhausting. A 
 miner can cool himself by removing the greater part of his 
 clothing when the temperature of his own body rises, but 
 when the temperature of his environment rises to 100° F. 
 and the air is saturated with moisture, it is impossible for 
 him to do hard work for any length of time. I have not had 
 any personal experience of the Rand mines, but I have 
 
 ' "A Record of an Investigation of Earth Temperatures on the Wit- 
 watersrand Goldfields and their Relation to Deep Level Mining in 
 the Locality." Institute of Mining and Metallurgy, London, March 15, 
 1906. 
 
288 DISEASES OF OCCUPATION 
 
 incidentally seen the effects of high temperatures upon the 
 men who work in the Hungarian mines at Sopron-Brennberg, 
 whither I went to study the question of ankylostomiasis. 
 Here the temperatures are high. The men work practically 
 without any clothing. The day's work is eight hours, but 
 the men can only work four hours. Owing to the high tem- 
 perature the men are obliged to rest and to come out of the 
 working into the main ways for air. As a consequence of 
 working in high temperatures the Sopron miners seemed to 
 me to be prematurely old, and as a result of their profuse 
 perspiration the men were all thin and of spare body, and a 
 large number of them suffered from functional and organic 
 disease of the heart. The effects of working in high-tem- 
 perature mines are throbbing of the head, increased frequency 
 of the pulse, discomfort in breathing, and physical exhaustion. 
 On the Rand, as already stated, the miners at the end of their 
 shift, when fatigued and perspiring, are rapidly lifted from 
 great depths to the surface, where the temperature is con- 
 siderably lower, a process that cannot but be attended by 
 risks to health from sudden chilling of the body. 
 
 In the Transvaal Native Affairs Department Annual 
 Report for the year ending June 30, 1906, it is stated that 
 the recommendation of " change houses " at the shaft heads 
 and the provision of hot coffee for the native labourers has 
 been largely adopted, also that shelters have been erected to 
 prevent exposure to the low temperatures, which have been 
 regarded as the cause of chills and pneumonia. Much of the 
 high death-rate was no doubt the result of the insufficient 
 care exercised by recruiters in the selection and allotment 
 of natives, many of whom were physically unfit for the mines. 
 From July, 1904, to December, 1905 — 
 
 The total death-rate among natives in mines was 45*5 per 1,000 
 The death-rate among natives from tropical areas 
 
 was ... ... ... ... ... ... i27'2 per 1,000 
 
 The death-rate among natives from British Central 
 
 Africa was j 54-5 per 1,000 
 
 On December 31, 1905, there were employed in mines and 
 in all the labour districts of the Colony — 
 
MINING 
 
 289 
 
 Natives (exclusive of those recruited from tropical areas) ... 84,167 
 
 Natives recruited from tropical areas io>57o 
 
 Chinese 47>2i7 
 
 Since then much has been done to reduce the death-rate 
 among natives by improving the recruiting organisation and 
 by making better arrangements for the transit of the natives 
 to the goldfields, also by improving the conditions of life at 
 the mines. The reduction in the rate of mortality amongst 
 natives employed on mines and works has been steadily 
 maintained. During 1905 the total death-rate 
 
 From disease was 40*3 per 1,000 
 
 Amongst natives recruited from tropical areas was 99*5 per 1,000 
 
 (The term "tropical areas" comprises for the purpose of 
 mortality statistics the following areas of labour supply : 
 British Central Africa, Rhodesia, Quilimane, Mozambique, 
 and Damaraland.) There is the greatest disparity in the 
 relative rates of mortality amongst natives from these areas 
 and those recruited from non-tropical areas, as shown in the 
 following analysis of mortality : — 
 
 Non-Tropical 
 
 Tropical 
 
 
 Death-Rate 
 
 per i,cxx) p.a 
 
 Recruiting Area. 
 
 1905-6. 
 
 ^Orange River Colony ... 
 
 139 
 
 Natal and Zululand 
 
 14-9 
 
 Swaziland 
 
 i6'8 
 
 Cape Colony ... 
 
 198 
 
 East Coast 
 
 35-8 
 
 British Bechuanaland 
 
 35-8 
 
 Transvaal 
 
 36-0 
 
 Basutoland 
 
 45'i 
 
 Mozambique 
 
 658 
 
 Quilimane 
 
 . 71-6 
 
 Rhodesia 
 
 79-8 
 
 Damaraland 
 
 113-8 
 
 British Central Africa 
 
 . 1663 
 
290 
 
 DISEASES OF OCCUPATION 
 
 When these statistics are compared with those of previous 
 years there is observed a marked reduction in the rate of 
 mortality among natives from tropical areas, but there is a 
 marked increase among those from Basutoland. It is note- 
 worthy, too, that the death-rate varies in the different mines ; 
 in the Premier Diamond Mine, in which a large number of 
 Basutos are employed, the death-rate was 103*1 per 1,000, 
 whereas the mortality rate of those employed elsewhere was 
 only 27-5 per 1,000. The death returns were classified under 
 coal, gold, and diamond mines. 
 
 During 1905-6 the mortality on coal-mines was unusually 
 high, viz., 61*24 per 1,000, as against 44*6 during the previous 
 year. On deep level goldmines the death-rate was 59*24 per 
 1,000; the death-rate on diamond mines was 56*63, and on 
 outcrop mines and surface works 39*42 and 27*69 respectively 
 per 1,000. In analysing the mortality rate it is noticed that 
 respiratory diseases, of which pneumonia and phthisis have 
 been respectively responsible for 31*6 and 14*4 per cent, have 
 accounted for 51*2 per cent, of the total deaths — the mor- 
 tality rate from pneumonia showing a slight decrease and the 
 death-rate from phthisis an increase by 3*2 per cent. The 
 death-rate from accidents was 5*64 per 1,000 per annum, 
 or 12*8 per cent, of the total mortality. Through the kind- 
 ness and courtesy of the Earl of Elgin I am able to supply 
 recent statistics bearing upon this subject from a comparative 
 point of view : — 
 
 Comparative Statement of Mortality amongst Natives Employed on Mines and 
 Works in Labour Districts, including Natives Employed by Contractors, 
 January, 1906 and 1907. 
 
 Month. 
 
 No. of Natives 
 Employed. 
 
 No. of 
 
 Deaths 
 
 from 
 
 Disease. 
 
 Death-rate 
 per 1,000 
 
 p.a. from 
 Disease. 
 
 No. of 
 
 Deaths 
 
 from 
 
 Accident. 
 
 Death-rate 
 per 1,000 
 p.a. from 
 Accident. 
 
 Total No. 
 
 of 
 Deaths. 
 
 Total 
 
 Death-rate 
 
 per 1,000 
 
 p.a. 
 
 January 
 
 1906. 
 101,230 
 
 1907. 
 111,389 
 
 1906, 
 357 
 
 1907. 
 
 1906. 1907. 
 42-32 2919 
 
 1906. 
 41 
 
 1907. 
 46 
 
 1906. 
 4-86 
 
 1907. 
 496 
 
 1906. 1907. 
 398 317 
 
 1906. 
 4718 
 
 1907. 
 3415 
 
MINING 
 
 291 
 
 Analysis of Mortality amongst Chinese Mine 
 August, 1905, to February, 
 
 Employes 
 1906. 
 
 in Transvaal, 
 
 Month 
 
 August, 
 1905. 
 
 September, 
 1905- 
 
 October, 
 1905. 
 
 November, 
 1905. 
 
 December, 
 1905. 
 
 January, 
 1906. 
 
 February, 
 1906. 
 
 Population... 
 
 44.559 
 
 44,487 
 
 45.900 
 
 45,804 
 
 47,217 
 
 47,117 
 
 49-955 
 
 Cause of 
 Death. 
 
 No. 
 
 Rate 
 per 
 1,000 
 p.a. 
 
 No. 
 
 Rate 
 per 
 1,000 
 p.a. 
 
 No. 
 
 Rate 
 per 
 1,000 
 p.a. 
 
 No. 
 
 Rate 
 per 
 1,000 
 p.a. 
 
 No. 
 
 Rate 
 per 
 i,oco 
 p.a. 
 
 No. 
 
 Rate 
 per 
 1,000 
 p.a. 
 
 No. 
 
 Rate 
 per 
 1,000 
 p.a. 
 
 Phthisis ... 
 Pneumonia 
 Tuberculosis 
 Accidents ... 
 
 5 
 2 
 
 19 
 
 1-34 
 0-54 
 
 5-II 
 
 5 
 3 
 
 I 
 2, 
 
 1-35 
 o-8i 
 027 
 647 
 
 8 
 3 
 
 29 
 
 2-09 
 
 079 
 7-58 
 
 7 
 3 
 
 20 
 
 183 
 078 
 
 5-24 
 
 2 
 
 4 
 
 I 
 
 15 
 
 0-51 
 1-02 
 0-25 
 381 
 
 6 
 6 
 
 35 
 
 .■53 
 
 1-53 
 
 8-92 
 
 8 
 
 2 
 
 5 
 
 25 
 
 1-92 
 0-48 
 1-20 
 6-00 
 
 All Causes ... 
 
 62 
 
 1669 
 
 67 
 
 18-07 
 
 72 
 
 18-82 
 
 76 
 
 19-91 
 
 73 
 
 1855 
 
 97 
 
 24-70 
 
 79 
 
 1897 
 
 At the time of writing further statistical tables have not 
 been published, but through the courtesy of the Colonial 
 Office I am able to supply figures for comparison of the two 
 last months of the year 1906 with the two first months 
 of 1907 : — 
 
 Chinese Mortality Rate, November and December, 1906, 
 January and February, 1907. 
 
 
 1906. 
 
 1907. 
 
 
 November. 
 
 December. 
 
 January. 
 
 February. 
 
 Number Employed 
 
 53.004 
 
 52,889 
 
 53.828 
 
 53.736 
 
 
 No. of 
 Deaths. 
 
 Rate 
 per 
 
 1,000 
 p.a. 
 
 No. of 
 Deaths. 
 
 Rate 
 per 
 
 1,000 
 p.a. 
 
 No. of 
 Deaths. 
 
 Rate 
 per 
 1,000 
 p.a. 
 
 No. of 
 Deaths. 
 
 Rate 
 
 per 
 1,000 
 p.a. 
 
 Phthisis 
 
 4 
 
 0-91 
 
 4 
 
 0-90 
 
 6 
 
 1-34 
 
 3 
 
 0-67 
 
 Pneumonia 
 
 2 
 
 0-45 
 
 I 
 
 0-23 
 
 4 
 
 0-89 
 
 4 
 
 0-89 
 
 Tuberculosis 
 
 4 
 
 0*91 
 
 5 
 
 I-I4 
 
 3 
 
 0-67 
 
 I 
 
 0'22 
 
 Accident 
 
 30 
 
 679 
 
 21 
 
 476 
 
 29 
 
 6-46 
 
 19 
 
 4'24 
 
 Total Deaths from all 
 Causes 
 
 82 
 
 18-56 
 
 58 
 
 13-15 
 
 82 
 
 18-28 
 
 60 
 
 13-39 
 
292 DISEASES OF OCCUPATION 
 
 I have not included in the Chinese mortality tables the 
 number of deaths from homicide, suicide, and the opium 
 habit. In comparing the mortality returns of native labourers 
 and Chinese one is struck by the fewer deaths from phthisis 
 and accident among the Chinese. At the time of writing no 
 case of miners' phthisis has been recorded among the Chinese, 
 but this is only to be expected, for the work in mines has 
 to be carried on a few years before the disease develops. 
 There is not the least doubt that within the next five or six 
 years many Chinese, after their return home, will die of 
 pulmonary disease, the result of the inhalation of the rock- 
 dust of the Transvaal mines. 
 
 When the history of the development of the South African 
 goldfields comes to be written, posterity is sure to pass severe 
 strictures, not altogether unmerited from a medical point of 
 view, upon the labour conditions that prevailed, and were 
 allowed to continue so long unheeded. The race for wealth 
 has alike blinded employers and employed to the lives that 
 were at stake. There has been a disregard for human life 
 not creditable to those in charge. Employers can take 
 care of themselves, and the employed white men ought to 
 have taken greater care of themselves, for most of them knew 
 the risks to health they were running ; but as regards the 
 native labourers, who were ignorant of the dangers, it cannot 
 be said there was the thoughtful and sympathetic care 
 extended to them there might have been. The large 
 number of deaths from accidents in the Transvaal gold- 
 mines has been appalling. Since such a condition of things 
 would not have been allowed to go on at home, it is more 
 than probable that many of the accidents could have been 
 prevented by spending more money on plant and by bring- 
 ing to bear upon the mining authorities the expression of a 
 healthy local public opinion through an unbiassed press and 
 through greater publicity of Coroners' courts. The high 
 wages paid to miners on the Rand is of itself proof of the 
 dangerous nature of the employment, and yet, high as the 
 wages have been, they never seemed to attract for any length 
 of time the natives to the mines. 
 
 The one disease to which in these pages attention has been 
 
MINING 293 
 
 specially directed is miners' phthisis. Attempts have been 
 made to minimise the relation of the lung disease to the dusty 
 nature of the occupation by assigning to the dust-storms that 
 sweep over Johannesburg some part in the production of the 
 malady. March to November are dry months in the Trans- 
 vaal. In July there are frequently great dust-storms, which 
 are attended by variations of temperature on the surface, and 
 yet the people of Johannesburg do not suffer from lung 
 disease due to dust. 
 
 Although no importance can be attached to this theory of 
 " dust-storms " at Johannesburg, it is another question as to 
 whether there may not be something specific in the dust of 
 the Transvaal rock to explain the prevalence of Rand miners 
 phthisis. On this point the experience of Dr. R. H. Brem- 
 ridge, who is on the medical staff of the Kolar gold field in 
 India, is extremely valuable. In the Kolar goldmines there 
 are 40,000 coolies employed ; the rock is hard. Dr. Brem 
 ridge went to India expecting to meet with cases of miners' 
 phthisis, but he failed to find evidence of the disease except 
 in men who had come from the Transvaal. Although no pre- 
 cautions are taken in the Kolar mines to throw water on the 
 surface to diminish the dust after the use of explosives, and 
 the men work hard, yet Dr. Bremridge finds that the miners, 
 native and white men, keep good health. He attributes the 
 freedom from miners' phthisis partly to the fact that in India 
 the men work eight-hour shifts, take more leisure, and are not 
 so eager to make a fortune as the miners in the Transvaal. 
 There is plenty of dust in the Kolar mines ; it is a hard quartz 
 rock that is blasted, and without such precautions as the 
 spraying of water. It would seem, therefore, as if there might 
 be something in the character of the dust itself to explain, 
 on the one hand, the prevalence of miners' phthisis in the 
 Transvaal and, on the other, its marked absence in India, 
 where no special precautions are taken to allay dust. Hard 
 and angular as are the particles of all forms of quartz rock- 
 dust, it would appear as if in the development of the malady 
 there is something over and above mere mechanical irrita- 
 tion of the lung tissue to explain why chronic inflammatory 
 changes once induced run in some instances a more rapid 
 
294 DISEASES OF OCCUPATION 
 
 course than in others and pave the way more readily for 
 tuberculous infection. Although miners' phthisis on the 
 Kolar goldfield is remarkable rather for its absence than its 
 presence, it is not so with other forms of lung disease. 
 Dr. Bremridge finds that a large percentage of the miners 
 die from pneumonia, due not so much to dust as to the fact 
 that the men, after having worked hard for eight hours, are 
 obliged to climb ladders to the height of 2,000 feet in a state 
 of fatigue and when perspiring, and thus become chilled. 
 The proof that this has had much to do with the prevalence 
 of pneumonia has been demonstrated by the fact that since 
 a skip, whereby coolies can ride to the surface, has been 
 introduced into one of the mines from which the largest 
 number of cases of pneumonia came, the number of cases 
 of acute lung disease has considerably diminished. 
 
 Further support to the theory that certain forms of rock- 
 dust are more liable than others to cause, if not miners' 
 phthisis, certainly symptoms of ill-health, is given by Mr. 
 R. J. Watkin,! who had been for several years foreman of a 
 sampling mill in Queensland, Australia. The work in the 
 mine was dry and dusty. He found that he almost invariably 
 lost the services for several days of the four men who were 
 working on the bottom floor. The ores that proved to be 
 most dangerous were the sulphide ores ; these contained, 
 roughly speaking, 35 to 40 per cent, of silica, 20 per cent, of 
 pyrites, 1 5 per cent, of zinc-blende, 3 to 4 per cent, of copper 
 and lead. The miners attributed the illness to the presence 
 of lead, but the quantity of this metal was small and it was in 
 an unoxidised form, so that he could not accept this theory. 
 Yet whenever this particular kind of ore was sampled the 
 men became ill, and remained thus often for many days. It 
 is more than probable that in these cases gases played an im- 
 portant part in the development of symptoms. Shortly after 
 the South African War miners on the Rand were encouraged 
 to wear " respirators," but they could not work in them. So 
 great is the dust in the mines that, as regards the Kaffirs, 
 their upper lip and parts immediately adjacent to the nostrils 
 
 * " Discussion on Prevention of Miners' Phthisis." Mining Institute, 
 London, May 19, 1904. 
 
MINING 295 
 
 often appear greyish-white, as if powdered. This rime-like 
 appearance stands out in contrast with their dark skin. 
 
 In the mines the temperatures are high, and as the Kaffirs 
 work practically naked, they simply throw a blanket round 
 themselves on going from the mines to the compounds. The 
 natives are careless in regard to falls of temperature, and are, 
 therefore, much to blame for the chills that follow exposure 
 to cold. The compounds are good ; the natives are better 
 fed and better lodged in them than in their straw-thatched 
 kraals, with small doorway closed at night, and in which 
 a fire is lit without any provision made for the smoke to 
 escape. The native labourer is a poor specimen of mankind. 
 His physique is bad, and he does not stand illness well. 
 Within recent years employers have introduced many im- 
 provements. If mine-owners would give further consideration 
 to the hygienic conditions of labour in the mines, bestow a 
 little more personal attention upon both the white and black 
 men employed, see that water-spraying is used with every 
 rock-drill, spend more money on machinery, and keep it in 
 proper condition, and would take such steps as to maintain 
 the safe working of their cages, many lives would be saved 
 that are otherwise imperilled, the risk of miners' phthisis 
 would be reduced, and employers would earn — although not 
 always expressed — the gratitude of countless workers. 
 
 Australian Mines: Bendigo 
 
 A carefully prepared report upon the health of the miners 
 employed in the quartz mines of Bendigo, by Dr. Walter 
 Summons, has been issued by the Trustees of the Edward 
 Wilson Estate, Melbourne, 1906. In determining the extent 
 to which phthisis and respiratory diseases are present amongst 
 the Bendigo miners the death registers have been perused for 
 the last thirty years, as prior to 1875 machine rock-drills 
 were hardly in use. Since 1875 the number of deaths from 
 pulmonary disease has much increased. At present there are 
 3,650 quartz miners employed at Bendigo, but in the year 
 1 899 there were 3,990. The following table supplies statistical 
 information as to the deaths of miners at Bendigo : — 
 
296 
 
 DISEASES OF OCCUPATION 
 
 Annual Deaths amongst Bendigo Miners, Determined in Five-year 
 Periods, and Estimated as per Ten Thousand Living at All Ages. 
 
 Year. 
 
 Miners- 
 Phthisis 
 (Tuber- 
 culous), 
 
 Chronic 
 Bron- 
 chitis. 
 
 Acute 
 Pneu- 
 monia. 
 
 Total 
 
 Lung 
 
 Diseases. 
 
 Fatal 
 
 Mining 
 
 Accidents. 
 
 All other 
 Causes. 
 
 Total 
 Deaths. 
 
 ^oP'V^ 
 
 48-5 
 
 8-0 
 
 20-5 
 
 77-0 
 
 28-5 
 
 74-3 
 
 179-8 
 
 1880-84 
 
 569 
 
 I3'I 
 
 17-0 
 
 87-0 
 
 32-8 
 
 70-6 
 
 190-4 
 
 1885-89 
 
 800 
 
 39-3 
 
 20-6 
 
 139-9 
 
 31-3 
 
 111-3 
 
 282-5 
 
 1890-94 
 
 84-6 
 
 34-4 
 
 16-9 
 
 135-9 
 
 28-4 
 
 120-2 
 
 284-5 
 
 1895-99 
 
 102-4 
 
 35-6 
 
 27-4 
 
 1^5-4 
 
 21-9 
 
 130-4 
 
 317-7 
 
 1900-04 
 
 100-8 
 
 230 
 
 213 
 
 145-2 
 
 14-7 
 
 96-5 
 
 256-3 
 
 i905-o6(J) 
 
 129-6 
 
 34"6 
 
 274 
 
 191-6 
 
 92 
 
 692 
 
 270-0 
 
 Since 1880 there has been a marked increase in the number 
 of deaths from respiratory diseases, especially from miners' 
 phthisis. The total deaths from lung diseases have risen from 
 77 'O to 191 '6 per 10,000, and this is largely accounted for by 
 the increase in those from tuberculous diseases, w^hich were 
 48*5 in the first period and 129-6 in 1905 — an increase 
 out of all proportion to the annual mortality rate from 
 consumption amongst other occupied males. 
 
 Fatal mining accidents, on the other hand, have been 
 becoming fewer and fewer, owing to the greater precautions 
 taken to safeguard the life of the miner. The number of 
 deaths of miners from tuberculosis is six times greater than 
 that of adult males in Victoria generally. While the disease 
 has been diminishing among the general population, it has 
 been increasing among the miners, which is pretty strong 
 proof of the unhealthy conditions under which the work in 
 the Bendigo mines has been carried on. A large number of 
 the men have died before reaching the prime of life. The 
 average age at death is under fifty — slightly higher than that 
 observed on the Rand, 
 
 The lung disease of the quartz miners at Bendigo develops 
 insidiously, without there being at first any symptoms to 
 attract attention, unless it be slight cough. Occasionally 
 there are recurrent attacks of mild bronchitis, which by 
 denuding the mucous membrane of the respiratory passages 
 of its protective ciliated epithelium more readily allows of 
 the entrance and absorption of particles of dust. As the 
 
MINING 297 
 
 general health remains for a time good the men continue 
 to follow their employment. With recurrent attacks of 
 bronchitis there occurs "black spit," or the expectoration 
 becomes muco-purulent, which on bacteriological examination, 
 although found to be teeming with staphylococci and putre- 
 factive organisms, is yet free from tubercle bacilli. Shortness 
 of breath sooner or later shows itself and is a distressing 
 symptom, for it is often severe, and is out of all proportion to 
 the amount of bronchitis that is present. There may be 
 complaint of stitch-like pains in the chest, due to limited 
 pleurisies. On examining the chest by percussion, dulness is 
 frequently detected at the base of the lungs. Along with 
 Dr. Jackson of Bendigo, Dr. Summons examined with the 
 fluorescent screen three patients who were the subjects of 
 advanced fibrosis of the lungs. The lungs in each instance 
 showed abnormal shadows that were extremely irregular in 
 distribution, dark lines being particularly noticeable in the 
 situation of the interlobar septa. 
 
 Men can work longer in the Bendigo mines than on the 
 Rand without becoming affected. The average number of 
 years worked is 22. Most of the miners presented the deep 
 sunburnt appearance of men in health, and yet the slightest 
 exertion would be attended by great difficulty of breathing. 
 Summons classifies miners' phthisis at Bendigo under two 
 heads : (a) pure fibrosis of the lungs, non-tubercular in origin, 
 a true silicosis ; (^) a mixed type, in which there has occurred 
 a tuberculous infection of a fibrotic lung. Bendigo miners 
 suffering from dust disease of the lungs were found to have a 
 normal resisting power to tuberculous infection, but when 
 infection took place their opsonic index became subnormal. 
 Forty-seven per cent, of the men suffering from miners' phthisis 
 became tuberculous. The high death-rate from respiratory 
 diseases of 204 per 10,000 miners calls for some improvement 
 in the conditions of labour and attention to hygienic details 
 in the home. Owing to the frequency with which tuberculosis 
 becomes grafted upon a diseased lung which at first was non- 
 tuberculous, also to the risk of a careless consumptive patient 
 spreading infection in the home, the greatest care should be 
 taken to disinfect the expectoration, for at Bendigo miners' 
 
298 DISEASES OF OCCUPATION 
 
 wives have died from pulmonary tuberculosis in larger 
 numbers than other married females in Bendigo and Victoria. 
 Once symptoms of pulmonary fibrosis have shown them- 
 selves, the men ought to give up work in the mines, and by 
 engaging in some agricultural occupation thus try to prolong 
 life. It remains to be seen how far such a change of occupa- 
 tion will be followed by permanent good results. The mines 
 should be well ventilated, so as to keep down dust and reduce 
 temperatures, but as dust is the enemy most to be feared, no 
 rock-drill should be used without a jet or spray of water kept 
 playing in and around the hole when the drill is in operation. 
 
 Canister Mining 
 
 Ganister or calliard, a hard, close-grained siliceous stone 
 obtained from under the coal seam, is found in Yorkshire, 
 Durham, and Denbighshire. When crushed and ground into 
 dust it is made into bricks, which, owing to their great 
 resistance to heat, are used for lining Bessemer and steel 
 converters in ironworks. The mortality rate of the men 
 who are employed in ganister mining is high. The miners 
 suffer from lung disease in larger proportion than the men on 
 the surface, but the grinders even still more, and for this the 
 inhalation of dust is responsible. Attention has been drawn 
 to the high death-rate of ganister miners living in the valley 
 of the Don by Dr. C. L. Birmingham,^ and subsequently by 
 Dr. Robertshaw in his reports as Medical Officer of Health, 
 Stockbridge. Ganister is so hard that, as it cannot be 
 obtained in quantity by the ordinary methods of mining, 
 recourse has to be had to blasting it by means of dynamite. 
 When brought to the surface of the mine it is taken to 
 powerful grinding mills, where it is pulverised and made into 
 bricks. The men who are liable to ganister disease are the 
 miners, grinders, and brickmakers. In this form of pneumo- 
 koniosis the lungs become converted into hard, almost solid 
 material, composed for the most part of dense fibrous tissue, 
 which unfits them for performing their function of aeration. 
 As it is stone dust or particles of silex that are inhaled, the 
 ' Journal of the Sanitary Institute, April, 1900, p. 67. 
 
MINING 299 
 
 disease is known as silicosis. Both in the preparatory drilling 
 of the rock for blasting and after the use of explosives the 
 atmosphere becomes charged with very fine dust. It is into 
 such an atmosphere that the miner enters after firing ex- 
 plosives. He cannot prevent himself inhaling particles of dust. 
 These, becoming caught in his bronchial tubes and lungs, 
 induce a reactive inflammation which ends in fibrosis. When 
 the disease has gained a firm hold the miner becomes anaemic 
 and enfeebled in health. Gradually developing a cough and 
 becoming the subject of difficulty of breathing, he is unable 
 to undergo the physical exertion required of him in his work, 
 and is therefore at a comparatively early age obliged to 
 relinquish his occupation. Dr. Birmingham supplies the 
 following data : — 
 
 During 1894 there were 22*86 deaths from ganister disease 
 
 per 1,000 workers 
 „ 1895 „ 28-59 
 
 „ 1896 „ 1714 „ „ 
 
 » 1897 „ 28-59 „ „ 
 
 „ 1898 „ 1429 „ „ 
 
 or an average annual death-rate of 22*29 P^r 1,000 workers. 
 The mortality rates differ as between ganister miners, 
 grinders, and brickmakers. For every 1,000 men employed 
 in each group there die annually : 
 
 Ganister miners 42-3 
 
 „ grinders i79'8 
 
 „ brickmakers ... ... ... 22*2 
 
 The mortality of ganister grinders is eight times as great 
 as among brickmakers and four times as great as among 
 miners. Readers may well wonder how it is possible to find 
 men willing to follow such an occupation as ganister grind- 
 ing, with a death-rate of 179*8 per 1,000 employed. Owing 
 to the arduous nature of the work it is difficult for the men 
 to wear respirators, and although steam jets and sprinkling 
 with water have been introduced to allay dust, the mortality 
 from ganister disease still remains far too high. 
 
300 DISEASES OF OCCUPATION 
 
 Tin-mining 
 
 The health of the Cornish tin-miners is dealt with in a 
 Blue Book published four years ago.^ Tin-mining has for 
 long been regarded as a dangerous occupation. Within the 
 last sixteen years the mortality from lung diseases has con- 
 siderably increased in miners living in Cornwall, so that the 
 death-rate of men aged from 25 to 45 is eight to ten times 
 that of colliers or ironstone miners of the same age. The 
 high death-rate of recent years has been contributed to by 
 miners who have returned home from the Transvaal and by 
 the increasing employment of rock-drills. Out of 320 deaths 
 of miners in the Redruth district, Haldane found that 141 
 were of men who had worked rock-drills, and of these 141 
 men 133, or 94 per cent, died of lung disease, the average 
 age at death being 37*2 years. Of the 179 men who had not 
 worked rock-drills 120, or 6^ per cent., died of lung disease, 
 the average age at death being 53 years. The quantity of 
 dust raised in rock-drilling is very great if water spraying is 
 not made use of at the same time, and as rock-drillers have 
 a higher mortality from lung diseases than men engaged in 
 other processes of mining, inhalation of the dust cannot but 
 be regarded as the principal cause of the disease. Com- 
 mencing as a purely dust disease, the lungs subsequently 
 become infected by the tubercle bacillus, and this hurries 
 on the malady to a fatal termination. As the infection 
 usually occurs a few years after the men have been exposed 
 to the dust-laden air, frequently after they have given up 
 underground work, it would appear as if the tubercle bacilli 
 had been inhaled not in the mine, but elsewhere. Other 
 causes of the malady than dust have been suspected, such 
 as absence of sunlight, exposure to high temperatures, and 
 sudden variation of temperatures, climbing of ladders, and 
 gaseous impurities underground ; but while all or some of 
 these may reduce the vital resistance of the miner and 
 predispose him to the more acute forms of inflammation 
 of the lungs, they are not responsible for the chronic 
 
 * " Report to the Secretary of State for the Home Department on the 
 Health of Cornish Miners," 1904. 
 
MINING 301 
 
 structural changes which end in fibrosis. Taking this view 
 of the malady, tin-miners' phthisis can be to a large extent 
 prevented by the laying of dust during rock-drilling by 
 water spraying, by the men not returning too soon to the 
 particular part of the mine after the use of explosives, and 
 by care taken, in moving the ore and conveying it to the 
 shafts, to keep it damp as far as possible. 
 
 Slate Quarrying 
 
 The quarrying of slate by the underground method is 
 a comparatively modern industry in Wales. Sixty years 
 ago the slate in the Festiniog district of Merionethshire was 
 worked in open quarries, but as the depth increased and the 
 expenses connected with the worthless "cover" or "top" 
 became great, underground mining was resorted to. The 
 health of the slate-miners of Merionethshire and the conditions 
 of labour in the mines formed the subject of an inquiry by 
 a Departmental Committee, which reported upon the matter 
 in 1 895.1 In this report is fully described the method of 
 working the slate. After having made an inclined passage 
 along the dip of the bed and vertical tunnels having been 
 driven along the strike, the men excavate downwards and 
 upwards, making underground chambers. The rock is 
 removed in slices, so that an underground slate quarry 
 is a series of working chambers and pillars, the pillars, 
 roofs, and floors being formed of slate. The only light 
 used in the mines is a tallow candle. Blasting is done by 
 means of gunpowder, as this severs the slate without 
 smashing it, but for such preliminary work as driving levels, 
 making roofs, and cutting "free side," gun-cotton and the 
 various nitro-glycerine explosives are used. The blocks of 
 slate are taken to the " mill," where they are cut into various 
 lengths and thickness, according to whether the slate is to 
 be used for roofing purposes, for making cisterns, or billiard 
 tables. 
 
 * " Report of the Departmental Committee upon Merionethshire 
 Slate Mines," 1895. Published by Messrs. Eyre & Spottiswoode, 
 London. 
 
302 DISEASES OF OCCUPATION 
 
 Slate-mining is not free from the risk of accidents. During 
 the nineteen years ending 1895 there were in the Merioneth- 
 shire slate-mines 147 fatal accidents, in which 163 lives were 
 lost, due mostly to falls of roof and side during the process 
 of getting the slate. Roofs and sides of a slate-mine that 
 are perfectly safe when left by the miners and rockmen 
 become less and less safe as time goes on. Air and moisture 
 penetrate into the joints of the rock and loosen it, while the 
 natural earth tremors and the quivering caused by blasting 
 are not without their influence in weakening the supports. 
 Only a small number of the accidents was traceable to the 
 use of explosives. The average annual death-rate from 
 accidents during the nineteen years mentioned above was 
 as follows : 
 
 Per 1,000 persons employed underground ... ... 3*23 
 
 ,, „ above ground ... ... 070 
 
 „ „ above and below ground... i"94 
 
 "The occupation of the Merionethshire slate-miner is more 
 risky than that of the average miner of the United Kingdom, 
 but less hazardous than that of the South Wales and of the 
 Cleveland miner." In the open slate quarries of Carnarvon- 
 shire, e.g., those of Penrhyn and Dinorwic, there are com- 
 paratively few accidents: 076 and 071 per i,0CX) persons 
 employed respectively. Dr. Richard Jones, of Blaenau 
 Festiniog, who has had large experience of slate-miners 
 and their maladies, says that the Festiniog quarrymen are 
 less liable to phthisis than the non-quarrymen in the district, 
 but that the death-rate from phthisis is higher among those 
 engaged in the slate mills than among the underground 
 workers, the rockmen and miners. This, as might be 
 expected, is partly the result of the dust created during the 
 dressing of the slates. Festiniog quarrymen are especially 
 prone to pneumonia and to diseases of the alimentary canal. 
 There is a general agreement of medical opinion that the 
 diseases from which slate-miners particularly suffer are : 
 (i) diseases of the respiratory organs, especially pneumonia; 
 (2) rheumatism and its complications; and (3) indigestion. 
 
MINING 303 
 
 The cold, damp climate of the district, imperfect housing of 
 the workers, and the undrained character of the land con- 
 tribute to the causation of rheumatism and diseases of the 
 respiratory organs. Owing to the scarcity of houses several 
 of the men live in " barracks." These are frequently badly 
 kept, are far from being sanitary, and are always over- 
 crowded. The food of the Welsh slate-miner is poor — too 
 little nitrogenous food is taken and too much stewed tea 
 is drunk. It is interesting to note that the death-rate from 
 phthisis is higher among the females in the district than in 
 the miners, and that they die from pulmonary consumption 
 at an earlier age than the miners — strong proof of the 
 imperfect house accommodation. The mean age of females 
 dying from phthisis is 31*4 years, of quarrymen 39*08, 
 and non-quarrymen 35*6. In 1890 Dr. Richard Jones found 
 that 55 per cent, of the deaths from respiratory diseases were 
 due to pneumonia, but the usual average is 36*4. The men 
 who dress the slates in the mills are more liable to fibroid 
 phthisis than the men who work underground : the latter, 
 on the other hand, are more liable to pneumonia, probably 
 the result of chill and exposure on leaving the mines. Were 
 it not for the fact that 5,000 cubic feet of air-space per man 
 is the average in the mills, as against the 250 cubic feet 
 required by the Factory Law, fibroid phthisis would be 
 probably more prevalent than it is. 
 
 Dr. Lachlan Grant, of the Ballachulish Quarries, Glencoe, 
 informs me that fibroid phthisis and pneumonia are seldom 
 met with among the quarrymen there, also that pulmonary 
 tuberculosis is more frequent among the women employed 
 at home than among the men. All the slates are hand-cut. 
 No machinery is used, not even hand-drills. The immunity 
 enjoyed by the Ballachulish quarriers may be partly due to 
 the fact that as all the work is done by hand less dust is 
 raised. 
 
 The subject of the maladies of slate-miners in France has 
 been carefully studied by Dr. Sejournet,' of Revin, at the 
 St. Joseph slate-mines near Fumay, a small town with 5,280 
 
 * " La Maladie des Ardoisiers : la Schistose," Reims, 1900. Im- 
 primerie Matot-Braine, 
 
304 DISEASES OF OCCUPATION 
 
 inhabitants, in the valley of the Meuse. The five slate works 
 of the district give employment to 600 men — one half of 
 whom work underground, while the remainder are employed 
 on the surface dressing the slates. Dynamite is made use of 
 to dissever the rock. The miners inhale the dust and the 
 fumes caused by the blasting. In some of the slate works 
 the only mode of exit from the deep mines is by long 
 ladders and steps ; in one mine, after a hard day's work 
 of twelve hours, the men have to lift themselves up ladders 
 and stairs with 1,500 steps before they can emerge — a 
 process attended by a considerable amount of fatigue as 
 well as consumption of time. The rough cutting of slates 
 is mostly done by hand. A cutter can make from 1,000 
 to 1,200 slates per day. These are passed on to other 
 men who by means of machinery give the required shape 
 to the slate. Machine cutters can turn out 600 to 700 slates 
 per hour. The work is dusty, and during the whole of the 
 working day the men are more or less inhaling dust. The 
 French slate-miner has been represented as a man of short 
 stature and bent, round-shouldered and almost hunchbacked 
 in appearance, but at Fumay many of the slate-miners are 
 men of good physique and they carry themselves straight. 
 Notwithstanding this, several of the slate workers are 
 observed to walk slowly, their chest is frequently barrel- 
 shaped and emphysematous, and although young and 
 apparently in good health they are short-winded com- 
 pared with the men in the district who are following 
 other occupations. Like the Welsh slate-miners, the diet 
 of the French workmen is poor. Their food is mostly 
 potatoes and cafe au lait^ or soup and bread. Dr. Hamaide, 
 of Fumay, who knows the slate-miners well, says that they 
 begin to suffer from bronchitis between the ages of 35 and 
 40 years, and that once this becomes fixed and is followed 
 by structural alterations in the lungs and bronchi, the 
 malady proves fatal in 5 to 10 years. The mean dura- 
 tion of the life of the Fumay slate-miner is 48 years. 
 Most of the miners die from pulmonary fibrosis, the result 
 of the inhalation of dust. Dr. Hamaide has seen men 
 who are the subjects of slate-miners' phthisis expectorate 
 
MINING 305 
 
 fragments of hard, stony material like schist, accompanied 
 by profuse bleeding from the lungs. Dr. Arlidge found a 
 similar thing happen in the lung-affected potters of Staf- 
 fordshire. M. Ripert reproduced experimentally pneumo- 
 koniosis in the lungs of rats and guinea-pigs by slate dust. 
 French writers divide the lung disease of the slate-miners 
 into three stages : (i) the period of commencement, in which 
 there are symptoms and signs of pulmonary emphysema 
 with difficulty of breathing and dry cough ; (2) an indefinite 
 period in which the emphysematous type of the disease may 
 be attended by accessions of asthma, and which may allow 
 the miner to live to the age of 60, or the disease becomes 
 associated with congestive attacks that are followed by 
 pleurisy or pneumonia ; and (3) the terminal stage, in which 
 the lung becomes hard and fibrotic, owing to the large 
 amount of slate dust it contains. In 65 per cent, of the 
 cases no tubercle bacilli are found in the sputum — a cir- 
 cumstance which points to the dust origin of the malady. 
 
 Stonemasons' Phthisis 
 
 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 observed in other 
 forms of pneumokoniosis, 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 argu- 
 ment in favour of the dust origin of pneumokonioses 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 
 
3o6 DISEASES OF OCCUPATION 
 
 from pulmonary phthisis is observed in other outdoor occupa- 
 tions than stone-cutting. 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 
 create a favourable soil for the implantation of the tubercle 
 bacillus, while in the slowly developed forms of pneumo- 
 koniosis the hard and unyielding fibrous tissue does not offer 
 the same attractions to the micro-organism, and as a conse- 
 quence it is in those parts of the lung where the structure is 
 least fibrous that the tubercle bacilli exert their greatest 
 power for harm. 
 
 Millstone Building 
 
 This trade is extremely limited ; it is, practically speaking, 
 confined to the banks of the Thames and the Mersey. The 
 stone used for making millstones is extremely hard ; it is 
 imported from Fiertd-sous-Jouarre, in France, and is known 
 as buhr stone. It is a variety of quartz, and is so hard that 
 when being dressed by a workman, the points of as many as 
 ten steel tools will be knocked off in a quarter of an hour. 
 A considerable quantity of steel and stone dust is given off. 
 which the men cannot but inhale. Notwithstanding the fact 
 that the work is carried on in the open air, these men suffer 
 in their lungs. When, as one of the members of the Dangerous 
 Trades Committee of the Home Office, I visited several of 
 the yards on the banks of the Thames, I was particularly 
 struck by the absence of old men in the trade. Buhr stone 
 builders make good wages — fifty to sixty shillings a week — 
 all by piece-work. Few men survive ten to fifteen years' work 
 in the trade. They are carried off — very rapidly sometimes — 
 by disease of the lungs. One of the earliest symptoms is 
 blood-spitting. If the men continue to follow their employ- 
 ment after haemoptysis has set in, the pulmonary disease tends 
 to run a rapid course. Buhr-stone workers are frequently 
 intemperate. Indulgence in alcohol reduces the vital re- 
 sistance of the men and precipitates the fatal termination. 
 
MINING 307 
 
 In order to study millstone builders' phthisis I went to 
 Fiert^-sous-Jouarre, in France, where the buhr-stone is 
 quarried. In France the millstone building is carried on 
 exactly in the same manner as in England. Similar condi- 
 tions prevail among the men, there is the same tendency for 
 lung disease to develop, and, if anything, the intemperate 
 habits of the British millstone builders are surpassed by those 
 of the Frenchmen. There were no old men working in the 
 yards. Most of the men in the Fierte yards die before 
 reaching the age of forty-five ; the men, too, look old for 
 their age. The Government inspector who accompanied me 
 stated that the men worked on Wednesday, Thursday, 
 Friday, and Saturday, and drank on Sunday, Monday, and 
 Tuesday at least. This may have been an exaggerated 
 expose of the failings of the men, who pleaded to me, as an 
 excuse for their excessive indulgence in alcohol that they 
 suffered from an intolerable dryness in the throat created by 
 inhalation of the dust. As a similar complaint is made by 
 all persons engaged in dusty occupations, it is not without 
 some basis of foundation. In discussing with the doctor at 
 Fierte-sous-Jouarre the subject of diseases incidental to mill- 
 stone builders, he alluded to the high mortality rate of the 
 men from pulmonary phthisis at an early age, and confirmed 
 all that has been said of the intemperate habits of the work- 
 men. The wearing of respirators has been tried by the men, 
 but they tend to restrict the freedom of breathing. A few of 
 the more careful men make use of water-spraying while 
 chiselling the stone, with the result that not only is the dust 
 allayed but their health is better. 
 
 Manufacture of Pottery 
 
 The manufacture of pottery has for long been regarded as 
 an unhealthy occupation. As far back as the days of Ramaz- 
 zini (1670), the lung troubles of the potter had been recognised 
 and described. With the terms " potters' rot " and "potters' 
 asthma" the public are quite familiar. It is this liability to 
 lung disease on the one hand and to lead poisoning on the 
 other that has placed pottery manufacture high up on the list 
 
3o8 DISEASES OF OCCUPATION 
 
 of dangerous trades. The late Dr. Arlidge, of Stoke-upon- 
 Trent, has left behind him excellent descriptions of the lung 
 diseases of potters. Thanks to improved methods of working 
 and the introduction of fans and strong draughts to carry 
 away the dust from the face of the workers, the malady is 
 becoming less frequent than formerly. Cheap pottery is 
 made from ordinary clay, but in the manufacture of the finer 
 ware Cornish clay and stone are used. In firing china the 
 cups, saucers, plates, &c., are placed in " saggers," or burnt 
 clay boxes. The contents of the saggers are kept individually 
 apart from each other by means of ground flint, which can be 
 used over and over again. The particles of flint are extremely 
 sharp and angular. When drawn into the respiratory passages 
 they set up a considerable amount of irritation and cough. 
 This is particularly apt to occur during the " scouring " or 
 brushing of the ware on its removal from the saggers after 
 having been in the oven. There is also a good deal of dust 
 thrown off during the " towing " or smoothing of the dried 
 ware before it is fired. Under all circumstances this must 
 be very much less than after the ware has been fired or 
 biscuited. Although "scouring" of the biscuited ware has 
 been rendered a less dusty, and therefore a less harmful, opera- 
 tion since strong down-draughts have been provided, it is 
 still dusty, and if the aspiration goes wrong the atmosphere 
 of the workroom at once becomes thick and unpleasant. 
 The dust difficulty can to a large extent be got over by 
 finishing the ware in the " green " condition. At the large 
 pottery works of Messrs. Boulenger et Cie. at Choisy-le-Roi, 
 near Paris, I found that the slightly moist ware was smoothed 
 with paper before being heated. No dust at all, practically 
 speaking, was given off by the ware when thus treated on the 
 revolving wheels. In Messrs. Boulenger's factory the results 
 were quite satisfactory. The workmen at first objected to the 
 finishing of the ware when " green," but now that they have had 
 experience of it they would not revert to the former method, 
 with its attendant clouds of dust. In the porcelain works at 
 Limoges I saw and learned something of the baneful effects 
 of dust upon the men and women employed in the scouring 
 of china. No provision was made in some of the works for 
 
MINING 309 
 
 the artificial removal of the dust. Among the brushers-off 
 in Limoges there is a high death-rate from respiratory diseases 
 and pulmonary consumption. Of 75 deaths registered as 
 occurring in china-makers, 36 were due to phthisis, and of 
 30 potters whom Dr. Raymondaud examined, 20 were suffer- 
 ing from phthisis. Pulmonary phthisis is regarded as the 
 principal disease affecting the workers in the Limoges 
 potteries. Dr. Lemaistre, with whom I had the opportunity 
 of discussing this subject, had analysed the air of the potteries, 
 and he found that the dust in some of the workshops is com- 
 posed of earthy particles, fragments of granite, flint, particles 
 of dried glaze from the ware, soot, and wood charcoal. The 
 atmosphere in which the brushers-off, the finishers, and the 
 porcelain makers generally work contained 640 million 
 particles of dust per cubic metre of air, while several of the 
 finishers, i.e., the persons whose work consists in removing 
 the excess of the dried glaze on the ware, are often breathing 
 an atmosphere containing 680 million particles of dust to the 
 cubic metre. This large number of dust particles in the air 
 of the workrooms is one explanation of the frequency of 
 bronchitis and pulmonary disease in pottery workers, and 
 while these dust particles act mechanically they may, by 
 making a breach in the epithelial • lining of the smaller 
 bronchial tubes and pulmonary alveoli, reduce local resistance 
 to microorganisms, and therefore pave the way for the 
 entrance of the tubercle bacillus. The average age at death 
 of men from fibroid phthisis in the potteries of Limoges 
 is 43, and of the female workers 38 years. In the 
 Staffordshire potters Dr. Arlidge found that the mean 
 age at death of male potters aged twenty years and upwards 
 was 46*5, and that of non-potters 54. Bronchitis is met with 
 among the male pressers, who are exposed to the dust of the 
 clay, but in china scourers the severer types of pulmonary 
 disease prevail. 
 
 Much can be done by means of improved ventilation to 
 diminish the evil. Open windows are not enough : fans and 
 strong aspirating draughts must be provided. Scouring of 
 china by hand over a grated trough into which the ground 
 flint falls should be discontinued and done in semi- closed 
 
310 DISEASES OF OCCUPATION 
 
 boxes, with a strong downdraught on the offside of the 
 workers, or by revolving brushes driven by machinery in 
 semi-closed spaces similarly aspirated. As dust diseases 
 of lungs develop insidiously and progress slowly, it would be 
 to the advantage of the workers themselves if their chest 
 was examined every few months by a doctor, for signs of 
 commencing lung disease should be regarded as disqualify- 
 ing for further employment in china scouring. 
 
 Mixed Forms of Pneumokonioses. Slag Work 
 
 Since men who are following a dusty occupation are 
 frequently exposed to more than one particular kind of dust, 
 so in their lungs after death there is found corroboration of 
 the fact. In colliers who work in hard coal there is occa- 
 sionally found a mixture of coal-miners' phthisis and stone- 
 miners' phthisis, anthracosis and silicosis, in needle-grinders 
 siderosis and silicosis, and in pottery workers silicosis and 
 aluminosis. In the lungs of an emery grinder who died 
 from chronic pneumonia Professor Letulle found hard masses 
 which, on chemical analysis, were composed of silica, alum, 
 and peroxide of iron. The slag which is left in the manu- 
 facture of steel by the Gilchrist-Thomas method contains 
 phosphate of lime, magnesia, iron, and silica, and when 
 ground to a fine powder is sold for the purposes of manure. 
 In my visits to the slag-crushing works in Middlesbrough and 
 elsewhere, I have been struck by the large amount of dust 
 that is given off during the crushing of this refuse from the 
 blast furnaces. If not wearing respirators the men cannot 
 avoid inhaling the dust, and as a consequence several of 
 them suffer from bronchitis and asthma, chronic cough, and 
 difficulty of breathing. The men, too, are liable to pneumonia. 
 A few years ago there occurred an epidemic of pneumonia 
 in Middlesbrough, the nature and origin of which, for a 
 time, remained obscure. As its ravages were particu- 
 larly severe among men labouring at the blast furnaces 
 and in the slag works, the inflammation of the lungs was 
 at first believed to be in some way or other connected 
 with the dusty occupations these men were following. Dr. 
 
MINING 311 
 
 Ballard, of the Local Government Board, subsequently 
 demonstrated that the pneumonia was of a specific type, and 
 was due to the consumption of tainted meat. Although in 
 this particular outbreak of pneumonia slag crushing was 
 proved to be in no way responsible for the malady, in 
 Germany slag crushers have been found to be the subjects 
 of respiratory diseases in larger proportions than men 
 following other occupations in ironworks. 
 
 Metallic Dust and Siderosis 
 
 Only a few cases of siderosis have been reported. For 
 what we know of the malady we are indebted mostly to 
 Zenker. The disease is met with in persons who work among 
 the red oxide of iron, e,g.^ looking-glass makers, gold beaters, 
 glass polishers, and in men who clean the surface of rolled 
 iron plates by means of sand. In the men employed in this 
 last occupation, the greyish black dust which is found in 
 the lungs and bronchial glands is the oxide of iron in the 
 form of the magnetic oxide. Persons who are suffering from 
 siderosis have the usual signs and symptoms of a pulmonary 
 dust disease, with, in addition, the expectoration of reddish 
 material due to the presence of iron. Zenker found on post- 
 mortem examination that the pleural surface of the lung was 
 studded with red patches, and that on section the lung 
 substance exhibited a bright brick-red appearance. Although 
 there were cavities in the lungs there were no traces of 
 tuberculosis. The brick-red appearance of the lung was 
 chemically proved to be due to the red oxide of iron. 
 
CHAPTER XI 
 
 DISEASES DUE TO PARASITES AND MICRO-ORGANISMS 
 
 Ankylostomiasis ^ Miners' Worm Disease, Miners' Ancsmia, 
 Hook-worm Disease or Uncinariasis 
 
 IT was during the tunnelling of the St. Gothard in 1892 
 for railway purposes that European nations first came 
 to realise what a power for harm ankylostomiasis can be. 
 During one year when engineering operations were in 
 progress at the St. Gothard, there were registered between 
 October i, 1880, and September 30 following, 186 cases 
 of anaemia in miners. The making of the tunnel was 
 attended by a loss of life, human and equine, which was 
 appalling. Many of the miners were seen to become pale, 
 to suffer from shortness of breath on exertion, their feet 
 to swell so that the men became unable to walk, and as the 
 illness assumed endemic proportions and had not been 
 observed previously to any extent in Europe, the malady, 
 since it was thought to be the consequence of men working 
 in tunnels, came to be called " maladie des tonnelles." As 
 pallor of the body was one of its most striking features, it 
 was also known as " miners' anaemia." At first it was 
 currently believed that owing to the great length of the 
 railway tunnel, upwards of nine miles, the conditions under 
 which the work was carried on in the interior of the Alpine 
 mountains were extremely unhealthy, and that the men 
 succumbed to the combined influences of excessive heat, 
 laborious work, bad food and ventilation, also to the effect 
 of the sudden chilling of the surface of the body when 
 the men, fatigued and perspiring at the end of their shift, 
 emerged from the warm tunnel into the biting cold air. The 
 
 312 
 
PARASITES AND MICRO-ORGANISMS 313 
 
 ventilation of the St. Gothard tunnel is admitted to have 
 been defective, so that work under the conditions that then 
 existed could not have been other than prejudicial to the 
 health of the miners. It was reserved to Dr. Perroncito, of 
 Turin, to discover and point out the real cause of the malady. 
 On making a post-mortem examination of the body of 
 deceased miners, he found numerous small white threadlike 
 worms in the upper part of the small intestine and adherent 
 to its lining membrane. When the parasite was examined 
 microscopically, it was recognised as the worm described by 
 Dubini, of Milan, in 1838, and further as the same parasite 
 which affects the fellaheen of Egypt, causing Egyptian 
 chlorosis, and the field labourers of India, Ceylon, Assam, 
 South America, Australia, &c. The malady was not there- 
 fore, as was at first thought, a new disease. As far back as 
 3,450 years ago there appears in a medical papyrus an accu- 
 rate description of the symptoms exhibited by a person who 
 is suffering from ankylostomiasis. In the United States of 
 America the disease has been regarded as the result of mud 
 or earth eating, especially among the poor white people and 
 the negroes who live along the banks of the Roanoke River 
 in North Carolina. It was also found years ago among the 
 slaves of Louisiana, and attributed t the same cause. The 
 Zoology Director of the United States Government, Dr. 
 C. W. Stiles, describes two species of the ankylostoma, the 
 New World parasite and the Old World parasite — the latter 
 so called because of its having been introduced into America 
 by immigrants from Europe. The disease is spoken of by 
 Stiles as "uncinariasis." He regards residence on a sandy 
 soil as one of the conditions favourable to the development 
 of the disease. Many of the cases occur in agricultural 
 labourers and in women and children. The women and 
 children suffer more severely than the men. A large number 
 of infected young persons become pot-bellied, like the Indian 
 children who have been fed upon rice. 
 
 Since ankylostomiasis affects field labourers who are 
 working in the glare of a warm sun equally as well as the 
 Italian miners in the gloom of the St. Gothard, it is 
 apparent that the disease must be due to other than 
 
314 DISEASES OF OCCUPATION 
 
 subterranean causes. Perroncito settled the point so far as 
 mining is concerned. It was by utilising the knowledge 
 supplied by him and others, also owing to special care taken 
 of the miners by the medical men, that the engineers were 
 able to make and complete the Simplon Tunnel, which 
 is three miles longer than the St. Gothard, without any 
 cases of ankylostomiasis appearing amongst the miners. 
 
 On the completion of the St. Gothard tunnel there were 
 set free large numbers of Italian miners, who, in order to 
 obtain employment elsewhere, travelled far and wide to the 
 various mining districts of Central Europe. A few years 
 afterwards ankylostomiasis broke out unexpectedly in the 
 coal-bearing districts of Hungary, Germany, and Belgium, 
 and as the disease assumed alarming proportions it called 
 forth the united efforts of the mining authorities and the 
 medical profession to cope with the ravages of the endemic. 
 While this was occurring on the Continent, considerable 
 uneasiness was created in our own country by the discovery 
 of the disease among the tin-miners of Cornwall. The 
 manager of the Dolcoath mine had observed that several of 
 the miners were suffering from debility, anaemia, and oedema 
 of the feet, and were unable to follow their occupation. He 
 attributed the ill-health of the miners to imperfect ventilation 
 of the mine, but on microscopical examination of the faeces, the 
 ova of the ankylostoma were found therein. The malady 
 had, therefore, silently gained an entree into the tin-mines of 
 Cornwall : it was the same disease as that which proved 
 so destructive to the miners in Westphalia and Hungary. 
 
 In order to study the subject of ankylostomiasis practically, 
 I visited the Dolcoath mine, where, through the kindness of 
 the manager, Mr. Thomas, I had not only the opportunity 
 of descending into the mine, but of examining infected 
 workmen. Subsequently, in company with Mr. Belger, of 
 Armstrong College, Newcastle, I proceeded to the infected 
 coal-fields in the valley of the Ruhr in Westphalia, and to 
 those of Sopron-Brennberg, in Hungary. We entered the 
 Westphalian coal-fields by Bochum, for it is here that Dr. 
 Tenholt lives, who is in Germany the greatest authority on 
 the miners' worm disease. Here, too, is established the 
 
PARASITES AND MICRO-ORGANISMS 315 
 
 excellently equipped Knaffschaftsverein, or Miners' Institute, 
 which, while it is the official centre of the colliery proprietors 
 and of the workmen, is also the seat of the medical adminis- 
 tration and of mining education. 
 
 It was in 1760 that men began to win the coal in this 
 particular district of Germany, but it was not until 1840 that 
 the impetus was given to the coal industry which has made 
 Westphalia the prosperous Duchy it is to-day. So great was 
 the demand for coal a few years ago, that in one year there 
 entered Westphalia twenty thousand miners. These men 
 came from Posen in Prussia, from Poland, Hungary, and Italy. 
 It is not known how ankylostomiasis was introduced into 
 the valley of the Ruhr. Some authorities maintain that the 
 disease was brought thither by infected Italian miners who 
 had just quitted the St. Gothard ; by others it is contended 
 that the malady came from Hungary ; while others again 
 blamed the men who had worked in the brickfields near 
 Cologne in the summer and in the mines in winter. Owing 
 to the large number of miners who entered Westphalia in 
 one year, as already mentioned, and who were of various 
 nationalities, it is impossible to say how ankylostomiasis 
 originated in the German coal-fields ; but while the origin of 
 the disease is unknown, there is not the least doubt that the 
 use of water sprays in the mines, compulsorily ordered by the 
 Government owing to the fiery character of the coal-dust and 
 the numerous explosions that had taken place attended with 
 loss of life, materially contributed to the spread of the 
 disease. Water-spraying became general in 1900. In the 
 Ruhr Valley, where most of the coal-mines are situated, the 
 number of cases of ankylostomiasis has been as follows : — 
 
 
 Cases. 
 
 
 Cases. 
 
 1896 ... 
 
 ... 107 
 
 1900 ... 
 
 ... 275 
 
 1897 ... 
 
 ... 113 
 
 1901 ... 
 
 ... 1,030 
 
 1898 ... 
 
 ... 99 
 
 1902 ... 
 
 ... 1,355 
 
 The increase in the number of cases of ankylostomiasis in 
 the German mines after water spraying is more than a coin- 
 cidence. It became a serious matter in Westphalia from a 
 
3i6 DISEASES OF OCCUPATION 
 
 health and money point of view, to say nothing of the social 
 and economic questions which it raised. During the three 
 years previous to my visit it cost the Miners' Union in its 
 efforts to grapple with the disease upwards of ;^ioo,ocxD. 
 Nothing could exceed the excellent organisation and the 
 hygienic methods adopted by Germany to get rid of the 
 scourge. They are object lessons which this country, in the 
 event of the disease becoming endemic, might follow. 
 
 In July, 1903, the Royal Department of Mines ordered a 
 microscopical examination to be made of the excreta of 
 not less than 20 per cent, of the underground miners living in 
 the province of Dortmund. It was found that of 188,730 
 workmen employed, 17,161, or 9-1 per cent, were suffering 
 from ankylostomiasis. When compared with previous 
 figures, these show that the disease was declining. Investi- 
 gations were also made among the families and relatives of 
 worm-sick miners. At Arnsberg, 386 wives and 964 children 
 of the miners known to be the subjects of ankylostomiasis 
 were examined, but in only one case was the disease detected. 
 As this and another case previously reported are the only 
 cases where until that date the presence of worms has been 
 established among the female relatives and the children, it is 
 clear that the infection did not reside in or at the homes, 
 but was confined to the mines. Ten to 15 per cent, of the 
 miners had to undergo a second course of treatment. 
 
 At five of the collieries water sprinkling was, with the 
 consent of the Royal Department of Mines, discontinued in 
 whole or in part, so as to ascertain what would be the effect 
 of the diminution of moisture in the pits. No particular 
 result was noticeable at the time of the publication of the 
 article in Gluckauf, 1903, vol. xxxix. p. 11 38, from which I 
 have quoted, but it is believed that the mines chosen were 
 naturally damp, and in those that were dry sufficient time 
 had not been allowed for the results of the experiment to have 
 been achieved. 
 
 At the Lothringen mine, which I visited with Dr. 
 Tenholt, and where ankylostomiasis broke out in 1885, the 
 number of infected underground workers had fallen from 72 
 to 8 per cent. The larvse were still to be found in the muddy 
 
PARASITES AND MICRO-ORGANISMS 317 
 
 water along the sides of the roadways in the mine and in the 
 wooden props which supported the roofs. How long the 
 larvae are capable of living in the pit it is impossible to say, 
 but in the Erin mine, a few miles away from the Lothringen, 
 I was informed by Dr. Perner, the medical officer in charge, 
 that he had found in one of the disused parts of the pit the 
 larvae alive and very active eight months after the gallery 
 had been shut off from the other parts of the pit. At the 
 date of my visit experiments were being conducted at the 
 Lothringen mine by Dr. Tenholt in regard to the disinfection 
 of the infected galleries by lime, but the difficulty of carrying 
 this to a successful issue is apparent from the enormous 
 extent of surface and the possibility of fresh infection by 
 careless miners. 
 
 In Germany the ravages of the ankylostoma are not 
 confined to the mining population : many of the brick- 
 makers in the fields around Cologne are not free from the 
 parasite. Surgeon-Major Talayrach (" Annal. d' Hygiene," 
 Aout, 1904, p. 182), quoting from the medical statistics 
 of the German Army, shows the prevalence of ankylosto- 
 miasis among soldiers. This is hardly to be wondered 
 at in a country where all the young men have to do com- 
 pulsory military service. Talayrach is of the opinion that 
 the German pits became infected by Hungarian miners 
 who had returned from Brazil, whither the parasite had been 
 introduced by Italian mining immigrants. In Germany there 
 were in 1902 17,161 cases of ankylostomiasis out of 188,730 
 miners examined, i.e., about 9 per cent. The disease is 
 not confined to Westphalia and the Rhine provinces ; it is 
 also met with in Luxembourg and the frontiers of Alsace- 
 Lorraine. 
 
 The German Government now requires military surgeons 
 to notify all cases of ankylostomiasis coming under their 
 cognisance. As a consequence of circularising the military 
 doctors, there were reported in October, 1903, 40 cases of 
 ankylostomiasis in the army, of which 33 were in the i6th 
 Army Corps. Of the infected soldiers, 39 belonged to the 
 mining districts of Westphalia and the Rhine provinces. A 
 subsequent inquiry elicited the presence of the parasite in 
 
3i8 DISEASES OF OCCUPATION 
 
 28 men who had just finished their military service and who 
 had all the appearance of good health. 
 
 An infected miner will pass in his stools myriads of ova 
 of the ankylostoma, which in a few days, if the temperature 
 is favourable, will develop into living, active, and voracious 
 larvae. Opinions are still divided as to whether these larvae 
 can, in the sludge of a warm mine, develop into the 
 fully-developed worm. Giles affirms the fact, and his 
 observations are confirmed by Sandwith, but in none of 
 the experiments I carried out with the larvae of the anky- 
 lostoma of the dog was such maturity ever reached. 
 While not denying the possibility, the usual course is for 
 the larvae to be transferred to a host, in the upper 
 reaches of whose intestinal canal transformation of the 
 larvae into the sexually mature worms takes place. There 
 are several forms of ankylostoma, e.g.y that of man — in whom 
 two kinds are met: (i) Ankylostoma duodenale and (2) An- 
 kylostoma Americanum — also the parasite which infects the 
 dog, fox, sheep, &c., but by most writers the organisms are 
 not considered to be interchangeable. The larvae of the 
 ankylostoma of the dog cannot develop into the adult worm 
 in any other body than that of the dog. 
 
 P. D. Siccardi {Atti d.Reale ist Veneto d. Set, Vet. &c., vol. 65, 
 ii., 1905-6), in his review of the subject of ankylostomiasis, 
 maintains that the larvae of the American form of anky- 
 lostoma are incapable of infecting the dog, but that those of 
 Ankylostoma duodenale can. The ova of the Ankylostoma 
 Americanum^ or Uncinaria Americana^ are larger than those 
 of the Old World parasite. They resemble the ova of 
 Ascaris lumbricoides that have lost their external capsule. 
 
 At Sopron-Brennberg, Hungary, where I was the guest of 
 Dr. Goldman, the medical officer to the colliery, there were 
 ten years ago 70 per cent, of the miners infected, but at the 
 date of my visit 30 per cent. The miners had suffered very 
 severely in their general health. Several of the miners whom 
 I saw at the works' hospital were anaemic and short of 
 breath, their feet were swollen, and they were suffering from 
 dyspeptic troubles, and yet the virulence of the endemic was 
 on the wane. The conditions of work in the Sopron mine 
 
PARASITES AND MICRO-ORGANISMS 319 
 
 are peculiar. The coal is of a pitch variety. In the mine 
 fires keep breaking out several times a day. The temperature 
 is frequently as high as 104° F., and even higher where the 
 ventilation is imperfect and water spraying not attended to. 
 Owing to working in this high temperature the men are all 
 thin and spare of body. Half of the time they are in the 
 mine they have to leave off working and go into the main 
 galleries to get cooled. As they perspire freely, boys, 
 carrying water barrels on their back, keep walking up and 
 down the underground roadways in order to supply pure 
 drinking-water to the miners. 
 
 It is not known how ankylostomiasis reached the Hun- 
 garian coal-fields. Miners from the St. Gothard tunnel are 
 blamed, but the manager of the Sopron-Brennberg Colliery, 
 Mr. Rudolf, informed me that as far back as 1864 he knew 
 of the existence of the miners' worm disease in Hungary. 
 Evidently what takes place in the infection of coal-mines is 
 something like this. Probably one diseased and thoughtless 
 miner is capable of infecting a mine owing to the myriads of 
 ova passed in his stools. Grassi and Parona state that one 
 centigramme of faeces from a miner harbouring 1,000 worms 
 in his intestinal canal will contain 150 to 180 ova. These, 
 as we have seen, under favourable conditions develop into 
 larvae, some of which sooner or later may gain an entrance 
 into the body of healthy miners. For a period everything 
 goes on at the pit as previously, when all at once several of 
 the miners become ill and unfit for work. When the disease 
 breaks out suddenly and in many of the workmen, it is 
 usually extremely virulent. This is a feature of the malady 
 which is lost as time goes on. 
 
 Ankylostomiasis has shown itself in the coal-bearing 
 districts of other countries. It was prevalent in the mines 
 of Bohemia in 1903. Belgian miners have suffered severely 
 from the disease. As far back as 1884 the malady, according 
 to Firket, existed in the collieries around Liege. Between 
 1884 and 1895 there were 92 cases of ankylostomiasis treated 
 in the hospital at Liege, but shortly after this the number of 
 cases became so large that a Commission was appointed to 
 inquire into the subject. Although certain sanitary recom- 
 
320 DISEASES OF OCCUPATION 
 
 mendations were made by this body, the miners themselves 
 refused to allow them to be put in force, and as a con- 
 sequence the disease spread, so that in November, 1903, it 
 was known that around Li^ge 7,000 miners were suffering 
 from ankylostomiasis. A well - equipped bacteriological 
 laboratory and dispensary were established at Liege and 
 placed under the direction of Dr. Lambinet. Since then, 
 owing to the preventive and curative measures employed, the 
 disease has almost disappeared. 
 
 In France miners' anaemia has long been known. At the 
 commencement of last century it was prevalent at Anzin, 
 but here, as in Cornwall, the malady was wrongly attributed 
 to the defective ventilation of the mines, the breathing of 
 harmful gases, and the laborious nature of the miner's 
 occupation. The occurrence of an endemic among the 
 colliers at St. Etienne was proved by Perroncito, of Turin, to 
 have been due to ankylostomiasis. To-day the disease is 
 not unknown in the mining district of the Pas de Calais, in 
 the North of France, also at Lens, Escarpelles, and Bruay, 
 and so far as the valley of the Loire is concerned, the mines 
 of Rive-de-Gier and of La Perroniere have been considered 
 the worst. On more than one occasion the malady has been 
 made the subject of special inquiry by the French Govern- 
 ment. It is a notable fact that in France, Germany, and 
 elsewhere improved ventilation of the coal-mines has always 
 been followed by a marked reduction in the number of cases 
 of ankylostomiasis. 
 
 The malady is also met with among the sulphur miners 
 of Sicily. The Italian climate is favourable to the free 
 development of the ankylostoma both above-ground and 
 underground. Giardini {Rassegna Mineraria, 1903, vol. xix. 
 p. 115), says it occurs among the agricultural labourers, e.g.y 
 rice cultivators, and the brick and tile makers. The disease 
 is also met with in the mines of Venetia, the Romagna, and 
 Sardinia. At the sulphur mines of Lercara, in Sicily, a 
 Commission appointed to inquire into the subject found that 
 of 20,000 workers examined 30 per cent, of the sol/atari were 
 suffering from ankylostomiasis. The nomadic life of the 
 Sicilian miners is largely responsible for the spread of the 
 
PARASITES AND MICRO-ORGANISMS 321 
 
 disease. As these men are extremely poor and miserably fed, 
 the ravages of the disease are especially severe upon them. 
 Dispensaries have been established, but the greatest diffi- 
 culties are being experienced owing to the uncleanly habits 
 and the ignorance of the miners. 
 
 The prosperity and opening up of South Africa have drawn 
 thither miners from all the world over, to say nothing of the 
 importation of Chinese labour. For many years past the 
 native African population has been known to be suffering 
 from ankylostomiasis. While the disease so far has not 
 assumed an endemic character, still groups of cases have 
 occurred here and there in the mines, a circumstance which 
 calls for vigilance and medical examination of sus- 
 pected new hands applying for work. Especially is this 
 a necessity, since W. G. T. Posnett, who is pathologist to the 
 Johannesburg Hospital, has {Lancet^ September 15, 1906) 
 drawn attention to the fact that in 70 per cent, of the stools 
 of the natives from Rhodesia and Portuguese East Africa he 
 has found the ova of ankylostoma. None of the patients 
 exhibited symptoms of the disease. The "boys" from 
 Portuguese East Africa and the Shangaans from the low 
 Veldt were more frequently affected than the members of 
 other tribes. Posnett is of the opinion that the parasite is 
 widely distributed throughout the natives employed in the 
 Witwatersrand mines, and that, while not a direct cause of 
 death, its debilitating influence must be counted as a serious 
 factor in the high death-rate prevailing among the natives. 
 
 Since Dubini's discovery of the worm the Ankylostoma 
 duodenale has been found widely distributed all over the 
 globe, wherever there exists a favourable temperature and 
 uncleanly habits of the people. It is found in 20 to 30 per 
 cent, of the fellaheen in Egypt, and is even more prevalent in 
 the natives of certain parts of India, Assam, Ceylon, Japan, 
 West Indies, &c. The ova are occasionally found in the 
 stools of natives of warm countries who are visiting England, 
 also in the faeces of miners and others who have returned 
 from foreign parts. Thus are to be explained the few cases 
 of ankylostomiasis that have been reported in Scotland. One 
 patient was a miner, who had been previously a soldier in 
 
 Y 
 
322 DISEASES OF OCCUPATION 
 
 India. Although the parasite is called Ankylostoma duo- 
 denale it is not confined in its habitat to the duodenal portion 
 of the alimentary canal. In the dog I have found the worm 
 in large numbers in the jejunum or upper portion of the small 
 intestine. The worms, which are small threadlike bodies, 
 vary in size from 8 to lo mm. in length, by 0*4 to 0'5 in 
 breadth. The female is the larger of the two. By means of 
 four claw-like hooks, two on each side of the ventral line, and 
 two conical teeth, one on each side of the dorsal line, the 
 worm attaches itself to the mucous membrane of the 
 intestine, and thereby secures its nutriment. The worms 
 when passed per anum are white or grey in colour — white 
 when alive, grey when dead. Others are reddish, owing to 
 containing blood abstracted from their host. While the tail 
 end of the female parasite is pointed, that of the male is 
 spread out like an umbrella and contains eleven ribs. In the 
 female the anus is subterminal ; the vagina is ventral, close to 
 the commencement of the lowest third of the body. In the 
 male the cloaca opens into the umbrella-like bursa. When 
 in conjugation the worms resemble the Greek letter " -y." 
 
 The numbers of ova produced and shed by the female 
 ankylostoma are enormous. The eggs are oval in shape, 
 and have a delicate transparent membrane, through which the 
 yolk can be seen in the stage of segmentation. The ova vary 
 in length from 0*056 to 0'o6i mm. and are always twice 
 as long as they are broad. Within three days after being 
 passed by a patient the ova, under favourable circumstances, 
 develop into actively moving filiform larvae 0'2 mm. in 
 length, and 0'Oi4 in breadth. So voracious is their appetite 
 that within a week they have grown thrice their original 
 length. They twice undergo a process of moulting, after 
 which they cease to be so vigorous. One reason asserted for 
 the ova being unable to be transformed into larvae in the 
 intestinal canal of the host is the absence of oxygen therein. 
 The larvae gain admission into the human body through 
 water or through food, owing to workmen eating with un- 
 washed hands. Until recently this was the usually accepted 
 theory as to the mode of entrance into the human body, but 
 it was reserved to Looss, of Cairo, who had accidentally 
 
^ 
 
Fig. I. ANKYLOSTOMA DUODEN'AL/^ (HUMAN) 
 
 NATURAL SIZE. THE SMALLER WORM IS THE MALE 
 
 Fig. 2. ANKYLOSTOMA DUODENALE (HUMAN) 
 
 X 12 DIAMETERS 
 
Fig. 3, ANKVLOSTOMUM DUODENALE (HUMANJ 
 
 CONJUGATION OF MALE AND FEMALE WORMS 
 X 7 DIAMETERS. 
 
 F IG. 4. A NK YL OS TO MA CA NIN UM 
 OVA OF 
 
 IN VARIOUS STAGES OF DEVELOPMENT 
 X 2CO DIAMETERS. 
 
 FiG. 5. LARVA OF ANKVLOSTOMUM 
 CA NINUM 
 
 ■J'Z HOURS AFTER INOCULATION ON AGAR 
 AT 20° C. X 300 DIAMETERS 
 
PARASITES AND MICRO-ORGANISMS 323 
 
 infected his skin by a living culture, to demonstrate that 
 the larvae penetrate the skin, enter a small vein, are carried 
 to the right side of the heart, and thence by the pulmonary 
 artery into the lungs. Through the walls of the pulmonary 
 capillaries they escape into the alveoli of the lungs, from 
 which they migrate by their own gliding and lashing move- 
 ment up the bronchi to the glottis, and then pass down 
 the oesophagus and stomach into the duodenum and jejunum. 
 Having reached this portion of the intestinal canal, the 
 larvae, having in their course become more and more matured, 
 attach themselves to the lining membrane of the bowel. 
 It takes at least three days for the larvae to pass through 
 the skin and by the blood stream, respiratory passages 
 and oesophagus to reach the intestine. In passing through 
 the skin they set up considerable irritation both in man 
 and in the dog. It is thus that are to be explained the 
 peculiar eruption of small boils on the arms of the Cornwall 
 tin-miners known as " bunches," and the sores and boils on the 
 feet and legs of coolies working with their bare feet in the tea 
 plantations in India and Ceylon, and in the fields in tropical 
 countries. It is difficult to say why the larvae of the ankylo- 
 stoma pass so frequently by the skin. They may possibly 
 find in the intercellular fluids and in the liquor sanguinis 
 something that aids their transformation into the mature 
 worm, but, so far as we know, there is no difference between 
 the fully developed worms whatever their mode of entrance. 
 
 Symptomatology. — Men who are the subjects of ankylosto- 
 miasis usually complain of extreme weakness, difficulty of 
 breathing on slight exertion, fluttering of the heart, uneasy 
 sensations at the stomach, and swelling of the feet which pre- 
 vents them walking. They are worse in the summer than in 
 the winter. This periodic character of the complaint is ex- 
 tremely interesting. On the approach of winter I noticed in 
 my experiments upon canine ankylostomiasis that not only did 
 the number of ova in the stools become diminished, but the 
 ova themselves were if anything smaller and did not so readily 
 develop into larvae. The larvae, too, were feebler. The dog 
 which passed the ova improved in condition on the advent 
 of the colder weather. On the approach of summer the ova 
 
324 DISEASES OF OCCUPATION 
 
 became more numerous and the larvae more active. This 
 cyclical condition of things is not peculiar to ankylostoma. 
 I have observed the same in an infant who was passing live 
 maggots by the bowel. When the larvae of ankylostoma, 
 having penetrated the skin through a hair follicle, have 
 reached the upper part of the small intestine, it is not until 
 the ninth day that their hooks are developed, and not until 
 four to six weeks (Stiles), 71 days (Looss), after their entrance 
 into the body that they become fully matured worms capable 
 of throwing off ova in the faeces. Although immature, they 
 are yet capable of inflicting great damage. The administra- 
 tion to a dog of milk containing ankylostoma larvae caused 
 the animal to retch and to vomit, followed in a day or two 
 afterwards by signs of gastro-intestinal irritation, diarrhoea, 
 and a disinclination for food. In man the early symptoms 
 are also gastro-intestinal, but owing to the mode of infection 
 being in all probability more through the skin, or if by the 
 mouth, then owing to the fact that very few larvae have been 
 swallowed, it is seldom that the symptoms are those of an 
 acute gastro-enteritis. The intestinal symptoms largely 
 depend upon the number of larvae entering the alimentary 
 canal, the idiosyncrasy and the health of the patient at the 
 time. As repeated infections probably occur, the symptoms 
 are slowly developed. Gradually digestion becomes impaired 
 and there is induced anaemia. The pallor, which is at first 
 slight, slowly increases, the pulse becomes feebler, the dys- 
 pnoea greater, and the feet more swollen. If in this condition 
 the patient continues to remain in the infected area and 
 incurs the risk of fresh invasion of his alimentary canal by 
 larvae, the symptoms will become progressively worse and 
 death may take place. Where the possibility of re-infection 
 is excluded and the malady is slight, the illness tends to wear 
 itself out, for the individual cannot re-infect himself by the 
 parasites in his intestine, except by ova passed in his stools 
 developing externally into larvae and some of these embryos 
 accidentally gaining admission into his alimentary canal 
 through food or drink. While anaemia and pallor of the body 
 are the physical signs of the disease in miners, the coolies who 
 work in the fields in the tropics suffer from an eruption on 
 
PARASITES AND MICRO-ORGANISMS 325 
 
 their skin called "ground itch" or "water itch," a similar 
 eruption to that on the arms of the Cornwall miners known 
 as " bunches." In persons thus afflicted it is observed that 
 when the skin becomes broken or is ulcerated it does not 
 heal rapidly. Stiles found "pot belly" a frequent physical 
 sign of the malady in young persons. The peculiar shape of 
 the abdomen is due to an extremely distended state of the 
 bowel from gas and the presence of free fluid in the peritoneal 
 cavity. The feet swell and in advanced cases the urine may 
 contain albumen. According to Zimm and Jacoby (" Report 
 on Prevalence and Geographic Distribution of Hook-worm 
 Disease," Washington, U.S.A., 1903, p. 68) the urine contains 
 a poison or ptomaine, so that when the urine is injected into 
 the vein of a healthy animal it causes destruction of the red 
 blood corpuscles. The faeces may be neutral, alkaline, or 
 acid. I have found that the transformation of ova into larvae 
 takes place quite irrespective of the chemical reaction of the 
 stools. This transformation may occur in 24 to 36 hours. 
 Fully developed larvae of the Ankylostoma duodenale are not 
 found in the recently passed stools of patients. When larvae 
 are thus found they are the immature forms of another para- 
 site, usually the Strongy hides stercoralis^ which is the cause 
 of Cochin-China diarrhoea, and the fully matured worms of 
 which often co-exist in the human intestine along with the 
 ankylostoma. In fact, there are frequently present in infected 
 miners more than one form of parasite in the alimentary 
 canal, the differentiation of which rests upon microscopical 
 examination of the various kinds of ova present in the faeces. 
 In some patients the bloodlessness or anaemia is very 
 pronounced. The degree of anaemia is generally, but not 
 always, proportional to the number of worms in the intestine. 
 The red blood corpuscles are reduced in number, and there is 
 a marked fall in the amount of haemoglobin or red colouring 
 matter. The eosinophile corpuscles, a variety of the white, 
 are usually increased in number. Instead of there being 
 5,000,000 red blood corpuscles in I cmm. of blood, there may 
 be only 3,000,000 to 1,500,000 ; and the eosinophile corpuscles, 
 which are normally present to the extent of 2 to 4 per cent, 
 of the white corpuscles, may rise to 18 per cent. Any diffi- 
 
326 DISEASES OF OCCUPATION 
 
 culty of breathing experienced by the patient is largely the 
 result of the diminution of the red blood corpuscles, which 
 are the oxygen carriers to the system. Emaciation is in 
 some instances very pronounced, and, while in some persons 
 in the early stages of the malady there may have been a 
 slight rise of temperature owing to a mild gastro-enteritis, 
 the skin is usually cool. Infected subjects resist cold badly. 
 The digestion is often impaired. There may be constipation, 
 or alternating attacks of diarrhoea and constipation. In con- 
 nection with disordered digestion it is frequently observed, 
 especially in hot countries, that the appetite is perverted and 
 there is developed a strong craving for indigestible substances, 
 such as clay and mud. Opinions are divided as to the injurious 
 effects of earth-eating. It is stated that the Javanese women 
 eat it to improve their appearance. In Oronoco the natives 
 eat earth brought down by the overflow of the river. Dirt- 
 eating is not unknown in Africa. Stiles states that Alaskan 
 seals, when infected with round worms, eat pebbles, and that 
 elephants suffering from fluke-worm eat a particular kind of 
 clay until diarrhoea is produced. Dogs infected with intestinal 
 worms eat grass, and in hot countries children infected with 
 thread- worm, Ascaris lumbricoides^ eat dirt, a practice they 
 desist from as soon as the worms are expelled. While earth- 
 eating cannot be regarded as an absolute indication of the 
 presence of worms in the intestinal canal, it appears to be a 
 common practice both in man and animals, and is suggestive 
 of some peculiar irritation being the stimulus to it. The 
 practice should be discouraged, for there is little or no nutri- 
 ment in the dirt, but possibly the ova of all kinds of parasites, 
 whereby risks of fresh infection are incurred. Miners who 
 are the subjects of ankylostomiasis do not exhibit to my 
 knowledge this peculiar craving or geophagy. 
 
 Causes of Ancemia. — Since the fully developed ankylostoma 
 attaches itself by its hooks to the mucous membrane of the 
 intestinal canal, and when expelled is often observed to be 
 gorged with blood, some writers have maintained that the 
 anaemia is the result of the repeated abstractions of blood by 
 the numerous parasites present in the alimentary tube. That 
 this is a possible cause cannot be doubted, for when worms 
 
PARASITES AND MICRO-ORGANISMS 327 
 
 are passed by the bowel after treatment it is not uncommon 
 to find several of them choke full of blood, and at the post- 
 mortem examination of one of my dogs who died from the 
 disease I found several small bleeding and ulcerating points 
 in the mucous membrane of the jejunum which marked the 
 spots to which the parasites had been adherent. The worms 
 apparently change their hold from time to time, and just as a 
 leech-bite often bleeds after the animal has fallen off the skin, 
 so the ankylostoma in detaching itself leaves a bleeding point 
 behind, through which wound micro-organisms from the 
 intestine may enter. Against the abstraction of blood theory 
 it is stated by some writers that the amount of anaemia is not 
 always proportional to the number of parasites present in the 
 intestinal canal, but it is not always easy to determine before- 
 hand the number of parasites even when vermifuges have 
 been given. The severity of the symptoms must depend 
 upon the number of worms present, the vital resistance, and 
 the idiosyncrasy of the patient. The fact that in the liver 
 and spleen of five persons who had died of ankylostomiasis in 
 Fiji and Ceylon, Professor Stockman, of Glasgow {Brit, Med, 
 Journ., 1896, vol. ii. p. 189), found an extremely low per- 
 centage of iron rather suggests that a loss of blood had 
 taken place and that this was the cause of the anaemia. 
 Looss, of Cairo, on the other hand, maintains that the 
 ankylostoma does not necessarily live upon the blood of its 
 host, but upon the superficial cells of the mucous membrane 
 and their secretions, and that the presence of blood in the 
 worm is entirely accidental. In the act of sucking into its 
 oesophagus the materials formed by the cells of the intestinal 
 mucous membrane there is secreted by the small glands in 
 the head of the ankylostoma a toxin or poisonous material 
 which is absorbed by the host through the pricked mucous 
 membrane. It is this toxin circulating in the blood of the 
 host and causing destruction of the red blood corpuscles that 
 by Looss and others is regarded as the cause of the anaemia. 
 All the parasites that are found in the alimentary canal of 
 man secrete substances that are more or less toxic. In 
 addition the worms are frequently covered with the microbes 
 that inhabit the intestine, some of which must gain an entrance 
 
328 DISEASES OF OCCUPATION 
 
 into the patient's body through the punctured wounds in the 
 mucous membrane caused by the booklets of the parasite. 
 The presence of ankylostomes in the intestine, therefore, 
 opens the door to secondary infection by micro-organisms 
 from the alimentary canal, which induces such a serious state 
 of body as to cause death. 
 
 The extension of the disease from an infected miner to his 
 children is in Europe, as already stated, an uncommon occur- 
 rence. Cases, however, have been reported. M. O. Cozzolino 
 {Pediatria, F^vrier, 1907) found the disease in two twin sisters 
 two and a half years of age, the children of an Italian miner in 
 Genoa, who had recently arrived from Brazil, both of whom 
 died. In the upper part of the small intestine in one there were 
 found, at the autopsy, upwards of two hundred ankylostomes, 
 and numerous small haemorrhages in the mucous membrane. 
 These children had all the appearance of pernicious anaemia : 
 the red blood corpuscles numbered 2,600,000 per c.mm. of 
 blood without any notable eosinophilia. During life the ova 
 of the parasite had been found in the stools. As the parents 
 with their family had only recently returned from South 
 America, it is hardly right to regard the presence of the disease 
 in the children as having been necessarily associated with the 
 work of the father. It is more than likely that the ankylo- 
 stomiasis was endemic in the place where they had lived. 
 
 Treatment of Ankylostomiasis. — The treatment of this 
 disease is preventive and curative. As the presence of 
 one infected careless workman in a mine may be fol- 
 lowed by infection of that mine, experience has shown 
 the desirability of mine-owners getting made for them a 
 microscopical examination of the faeces of suspected miners 
 and of men who have come from an infected district, since 
 in our own country, apart from Cornwall, three or four cases 
 of ankylostomiasis have been found among miners who have 
 returned from India and elsewhere. The necessity of watch- 
 fulness is at once apparent. The ova of Ankylostoma 
 duodenale do not hatch readily at low temperatures, but 
 because the temperature of British coal-mines is usually 
 lower than that of many of the pits on the Continent, and 
 the ventilation of our collieries is considered to be better, 
 
PARASITES AND MICRO-ORGANISMS 329 
 
 there is an idea that our coal-pits do not offer the con- 
 ditions favourable to the development of the parasite. As a 
 mining country we have no right to hug this belief, and 
 close our eyes to the necessity of instituting watchful and 
 preventive measures. 
 
 Dr. Lambinet, who is in charge of the Miners' Dispensary 
 at Li^ge, found that the ova of ankylostoma could be 
 hatched at temperatures lower than 60° F., and Haldane 
 even as low as 48° F. I have kept ova in a cold cellar at 
 a temperature of 50° F. for six weeks to two months, and 
 yet at the end of that time found that the larvae which 
 developed were extremely strong and vigorous-^in fact, it 
 seemed as if the exposure to a low temperature had rather 
 improved than diminished their vitality. This was not 
 always the case, however, for after exposures to low tem- 
 peratures the ova required fifteen days to change into larvae. 
 I have placed ova in freezing mixtures of ice, and kept them 
 at 1° C. for more than an hour, and yet forty-eight hours 
 afterwards the ova became transformed into larvae. There 
 is, therefore, no real security from ankylostomiasis because 
 of the lower temperatures in British coal-mines compared 
 with those of the Continent. The ova require a certain 
 amount of water and oxygen. It is partly owing to the 
 absence of oxygen and to the rather high temperature of 
 the human body that the ova do not become transformed 
 into larvae in the alimentary canal, and yet on one occasion 
 I exposed larvae to a temperature of 99° F. — practically 
 speaking, the temperature of the human body — for twenty- 
 four hours, and on the following day they were still alive. 
 In addition larvae which I had put into an artificial gastric 
 juice were, at the end of five days, still living and 
 mobile. 
 
 Water-closets should be provided for the men at the pit 
 mouth, and their use encouraged. In infected mines portable 
 dry closets or covered iron pails should be provided for the use 
 of the men working underground. The deposition of faeces by 
 the men elsewhere than in the receptacles provided for this pur- 
 pose should be made penal. The pails or receptacles should 
 be taken out of the mine daily, rinsed with boiling water 
 
330 DISEASES OF OCCUPATION 
 
 and thoroughly disinfected. The miners should wash their 
 hands well before eating. Instruction should be given to 
 the workmen upon the life-history of the parasite, so as to 
 secure their intelligent co-operation. Fresh miners, who have 
 worked in tropical or mid-European countries, on applying 
 for employment in British mines should have their faeces 
 microscopically examined before being accepted. Free 
 ventilation of the pits and a cool temperature therein are 
 aids to prevention. At my visit to the Westphalian coal- 
 mines I found Dr. Tenholt carrying out a series of experi- 
 ments with antiseptics as to the possible destruction of ova 
 and larvae in one of the galleries of the Lothringen mine. 
 The temperature was rather high. The sides of the gallery 
 to the extent of 3 feet upwards, and the wooden props in 
 a similar way, were being sprinkled with a strong solution of 
 lime, but the results were not so satisfactory as had been 
 anticipated. The resistance of the ankylostoma larvae to dis- 
 infectants of all kinds is remarkable, unless the solutions used 
 are of such strength as to become dangerous in their general 
 application. It has been known for some time that mines 
 into which salt or sea water has trickled exhibit a remarkable 
 freedom from ankylostomiasis, while contiguous mines not so 
 circumstanced are infected. Manouvriez, of Valenciennes, 
 was one of the first to demonstrate this fact, which finds 
 corroboration in the tin-mines of Cornwall. The Levant 
 mine contains water in which sea salt to the extent of 
 272 per cent, has been found. This mine is free from the 
 ankylostoma. Lambinet, of Liege, has carried out a series 
 of experiments with salt water. If the larvae are simply 
 deprived of water alone — that is to say, undergo gradual 
 desiccation — they shrink inside their capsule ; and if the 
 process of drying has been carried too far, it is impossible 
 to reanimate the shrivelled-up larvae. If, under the influence 
 of exposure to a 15 per cent, solution of sodium chloride, the 
 abstraction of water from the larvae has not been carried too 
 far, there is simply arrest of movement after twenty-four 
 hours' exposure ; but if the salt water is replaced by pure 
 water, the movements gradually return and the larvae are 
 soon brisk again. A 30 per cent, solution of common salt 
 
PARASITES AND MICRO-ORGANISMS 331 
 
 or strong glycerine causes such a retraction and withering 
 of the larvae that even when re-hydrated it is impossible 
 to restore movement, for the larvae have been killed owing 
 to breaking up of their substance by plasmolysis. Lambinet 
 submitted larvae for twenty-four hours to solutions of chloride 
 of sodium varying from 2 to 15 per cent It was only at the 
 higher percentage that the movements of the larvae became 
 impaired or ceased, and not until a 30 per cent, solution was 
 employed that death of the larvae was fully assured. The ova 
 of the ankylostoma were destroyed by a feebler saline solution 
 than the larvae. A 4 per cent, solution of salt absolutely 
 prevented the ova becoming transformed into larvae : smaller 
 percentages only retarded the transformation. In an infected 
 mine the repeated spraying of the walls with concentrated 
 solutions of common salt would be worth trying. This 
 would be in pits an inexpensive method of getting rid of 
 the pest, but to be successful strong solutions would have to 
 be used. 
 
 Since the publication of Lambinet's experiments fresh 
 support to the theory of the protective influence of sea salt 
 solution in mines has been announced by M. L. Tirelli,i 
 who is officially attached to the sulphur mines of Trezza 
 Albini, Romagna. Tirelli noticed that some mines were free 
 from the ankylostoma, while others, despite all precautions, 
 regularly furnished a large number of cases. The geological 
 structure of all the mines is the same. The mines that are 
 free are the driest, but immunity from the parasite does not 
 depend upon this circumstance, for there is plenty of mois- 
 ture for the larvae to live and thrive in. On examining the 
 water Tirelli found that it contained different quantities of 
 godium chloride, varying in some mines from 0*009 P^^* cent, 
 to 19 per cent, in others, also that the mines in which the 
 water contained i per cent, were infected, while those in 
 which the water contained 2 per cent, and upwards were 
 free. The fact that the ova of the ankylostoma cannot live 
 in water containing 2 per cent, and upwards of common salt 
 points the way along which infected mines may be cleared 
 of the larvae. The galleries must be sprayed with strong 
 " Riv. d'Igiene e Sanita," published 19 Mars, 1907. 
 
332 DISEASES OF OCCUPATION 
 
 solutions of chloride of sodium, as recommended in the 
 preceding paragraph. 
 
 In the treatment of patients by medicine reliance must 
 be placed upon the internal administration of aperients and 
 vermifuges. Of purgatives allusion need only be made to 
 a few, such as castor oil, jalap, and calomel. Before giving 
 intestinal antiseptics it is always well to clear out the bowels 
 first and to put the patient on liquid diet for at least one 
 day. In Westphalia I found extract of male fern was given 
 by Tenholt ; but in large doses, frequently repeated, he had 
 noticed that it caused neuro-retinitis, and that in at least 
 one case its administration had been followed by permanent 
 blindness. The introduction of thymol by Bozzolo, in 1880, 
 has placed in the hands of the medical profession a more 
 reliable drug than male fern, and one, on the whole, safer if 
 certain precautions are attended to. The efficacy of the drug 
 depends largely upon the fact that it is insoluble in the 
 alimentary canal, and is, therefore, capable of acting upon 
 a considerable length of the intestine. Collapse and alarm- 
 ing symptoms have occasionally shown themselves after its 
 use. Thymol, to be of any good, must be given in doses from 
 1 5 to 30 grains every two hours until four or six doses of the 
 drug have been taken, when the bowels should be relieved 
 by means of a purgative, unless previously opened sponta- 
 neously. The drug is best given in cachets, or in tablet 
 form. It is extremely soluble in alcohol, ether, turpentine, 
 chloroform, oil, glycerine, and some alkaline solutions, so 
 that during a course of thymol treatment these agents should 
 be avoided. When, in a patient who is taking thymol, the 
 urine becomes dark brown in colour, and there develop such 
 symptoms as delirium and vertigo, it is time to discontinue 
 the drug. 
 
 Goldman, of Sopron-Brennberg, uses a compound which is 
 efficacious, and which he calls ankyl.^ In one of his patients, 
 whom I saw with him, there were, as the result of a single 
 
 * Goldman also named the preparation taeniol. It is obtained from 
 the rind of Mussenna Abyssinica, a Myrsinacea found in Persia. The 
 active principle of the drug is not well known chemically : it is best 
 given with thymol. 
 
PARASITES AND MICRO-ORGANISMS 333 
 
 administration of the medicine given four hours previous to 
 my visit, fully one hundred mature worms passed in the 
 dejection. Beta-naphthol, eucalyptus oil, and areca nut, with 
 a host of other drugs, have been tried. The proof that the 
 treatment is doing good is the presence of the worms, dead 
 or alive, in the stools. After discontinuing the antiseptic 
 treatment for a week, the faeces should be again micro- 
 scopically examined for ova, and, if present, the treatment 
 must be renewed. 
 
 Since the presence of salt in the water trickling down the 
 galleries of a mine is a preventive of ankylostomiasis, it has 
 been recommended to replace the antiseptic treatment in the 
 case of infected miners by common salt in large doses. 
 Chloride of sodium in days gone by was regarded as a 
 safe and reliable anthelmintic. It has to be given in large 
 doses, say, half an ounce to three-quarters. Administered in 
 the form of a concentrated solution, it loses to a great extent 
 its power of being absorbed ; it passes on into the intestine, 
 where it acts as an aperient, causes detachment of the worm 
 from the mucous membrane, and aids in its expulsion from 
 the body. To prevent the absorption of the sodium chloride 
 it is well to saturate the solution of common salt with bicar- 
 bonate of soda, e.g,^ 6 drams of chloride of sodium, 2 drams of 
 bicarbonate of soda in 5 to 6 ounces of water. Experi- 
 ments upon animals that harboured intestinal worms gave 
 good results with sodium chloride. 
 
 Notwithstanding all that is done in the way of medicinal 
 treatment, a few ankylostomata often remain adherent to the 
 intestinal mucous membrane and seem to be uninfluenced 
 by drugs. It is thus that we seek to explain the fact that 
 in a mine that has been infected, despite all the prophylactic 
 and curative measures that have been taken, there still remain 
 5 to 9 per cent, of the men in whose faeces the ova can be 
 found. The points that have struck me in regard to ankylo- 
 stomiasis are the silent march of the disease from mine to 
 mine and from one mining centre to another, the long latent 
 period of its incubation, the suddenness of its outbursts, and 
 the extreme virulence of the endemic when it first appears 
 compared with what it is later on. 
 
334 DISEASES OF OCCUPATION 
 
 Anthrax^ or Woolsorters' Disease 
 Anthrax, or woolsorters' disease, is an infectious malady- 
 due to the entrance into the body of a minute organism, 
 the Bacillus anthracis. Discovered by Pollender in 1849, 
 its life history was subsequently detailed by Pasteur, Davaine, 
 and Koch. The organism clings to the hides of animals 
 that have died from the disease or been slaughtered on 
 account of it. The bacillus also attaches itself to wool 
 and horsehair, and to pigs' bristles used in brush-making. 
 The slightest scratch of the skin or the presence of a minute 
 wound is sufficient when contact occurs for inoculation to take 
 place, or the organism may gain entrance into the body 
 by the inhalation of spore-laden dust or by food. Animals 
 become infected mostly through food, man by other 
 channels, such as the respiratory organs and the skin. As in 
 infected animals the spleen becomes enlarged, the disease 
 in them is often called " splenic fever." Although the cases 
 recorded in history of the concurrence of murrain in animals 
 and of disease in man may have been illustrations of 
 anthrax, it was not until the latter half of the eighteenth 
 century that anthrax in the human subject came to be 
 associated with the manipulation of hides and fleeces 
 used for industrial purposes. In 1769 Fournier, of Dijon, 
 drew attention to the occurrence of the disease in men 
 who were engaged in the handling of raw animal products, 
 but it was not until a century afterwards that the malady 
 received serious study. Lawrence, in 1847, described the 
 disease as observed in a hair factory in England. Subse- 
 quently, owing to the large number of deaths among 
 woolsorters in this country, men began to suspect that the 
 deaths might in some way or other be associated with the 
 nature of their employment. In 1879 Dr. John Henry 
 Bell, of Bradford, when visiting a patient who had died twelve 
 hours after the commencement of his illness, took blood from 
 the man's arm, and after injecting some of it into a guinea- 
 pig and mouse, found that the blood of these animals was 
 swarming with anthrax bacilli. The association of wool- 
 sorters' disease with anthrax was thus definitely established 
 {Lancety 1879, vol. ii. p. 920). 
 
PARASITES AND MICRO-ORGANISMS 335 
 
 For several years past anthrax has been at times a 
 veritable scourge in Bradford and in the woollen districts 
 of the West Riding of Yorkshire, where about three-fourths 
 of all the foreign wool imported into this country is manipu- 
 lated. The disease is met with, too, in Worcestershire. 
 In the woollen districts of the South of England and of 
 Scotland anthrax has been conspicuously absent, owing 
 to the fact that only colonial and home-grown wool is 
 manipulated in these places. In London and Liverpool 
 anthrax is well known. Dr. T. M. Legge in his Milroy 
 Lectures {Lancety March 18, 1905) has gathered together 
 nearly all that is known of woolsorters' disease. He states 
 that during the six years 1899 to 1904 there were reported 
 to the Home Office 261 cases of anthrax contracted in 
 factories and workshops. Of these 88 occurred in worsted and 
 wool factories, 70 in horsehair and bristle works, Z(> in hides 
 and skins, and 17 in other industries ; 224 of the sufferers 
 were males and 37 were females ; 6j of the cases proved 
 fatal. The disease has appeared mostly in the wool-sorting, 
 wool-combing and spinning industries, in the manipulation 
 of horsehair for stuffing chairs and mattresses, and in the 
 preparation of bristles for brush-making. Anthrax has 
 also been met with in persons employed in tanyards and 
 in warehouses connected with docks. An idea may 
 be formed of the importance of these trades by a reference 
 to the number of persons employed in them. The wool, 
 worsted, and shoddy industries of the United Kingdom 
 gave employment in 1901 to 259,909 persons (106,598 males 
 and 153,311 females), but of this number only 1,171 (1,164 
 males and 7 females) were engaged in sorting, and 3,093 
 (1,882 males and 1,211 females) in combing the dangerous 
 wools. In horsehair factories according to a recent Home 
 Office Report the total number of persons employed is 
 2,535 and in brush-making factories and workshops 611 
 and 11,753 respectively. Of the two industries wool and 
 horsehair it is found that persons employed in horsehair 
 are the more liable to the disease. The percentage of 
 cases of anthrax in bristle works is small. The danger 
 resides in the handling of the hides and fleeces of infected 
 
336 DISEASES OF OCCUPATION 
 
 animals ; hence the occurrence of the disease in farmers and 
 farm labourers, butchers, and meat inspectors. Dusty wools 
 and " fallen fleeces " — i.e., fleeces of animals that have died 
 from anthrax — are the most dangerous. According to the 
 method of infection in man, so is the type of the disease. 
 The mode of infection is largely determined by the nature of 
 the employment. Anthrax is a general disease when the 
 bacillus or its spores have gained access to the blood-stream, 
 or it may give rise to a local red and painful swelling 
 called " malignant pustule." Of these the former is the more 
 dangerous since it implies a widespread infection of the 
 system. In Newcastle-upon-Tyne anthrax in any other form 
 than malignant pustule is hardly known. My own experi- 
 ence of the disease is drawn from its limited manifestations 
 in the form of pustule on the cheek and neck of butchers 
 and cattle salesmen. These are the parts of the body most 
 liable to be affected, but the arms and fingers are by no 
 means exempted. In addition to the pustular form there 
 occurs an erysipelatous type which is known as malignant 
 oedema. 
 
 It is estimated that there are about i,ooo cases of anthrax 
 in animals annually in Great Britain ; but this is only one- 
 fourth of what occurs in Germany and Italy, while in 
 European Russia and the Caucasus the number of cases is 
 probably 40,000 a year. 
 
 In this country anthrax is more frequently due to the 
 entrance into the body of the spores of the Bacillus anthracis 
 than the fully developed organism, which usually infects man 
 direct by handling the carcass of a dead animal. The disease 
 comes into Britain with the wool from Persia, hair and van 
 mohair from Asiatic Turkey, with horsehair from China, 
 bristles from Siberia, and dry hides from India and China. 
 It is from Asia that most of the infected material comes. 
 There, many of the people still lead a wandering pastoral life, 
 and are indifferent to all the requirements of hygiene as 
 affecting either themselves or their cattle. Stagnant water 
 in which soiled fodder has been allowed to decay forms, when 
 it becomes alkaline, a suitable medium for the growth and 
 reproduction of the anthrax bacillus. The micro-organism 
 
PARASITES AND MICRO-ORGANISMS 337 
 
 flourishes in low, marshy lands, where organic matter is 
 undergoing putrefaction in brackish water, in river valleys, 
 in the salt grass Steppes of Siberia, and also on lands that are 
 flooded in winter and are dry in summer. The bacillus 
 grows best between a temperature of I2°C. (53° F.) and 
 40° C. (1040 F.). In countries where the winter is severe and 
 the summer heat is excessive, as in the central plateau of 
 Asia Minor, with its numerous salt and fresh water lakes, 
 where roams the Angora goat on the plains and are herded 
 innumerable flocks of sheep, there anthrax flourishes, and 
 there, too, occurs the contamination of the hides and wool 
 owing to the dirt and sand, which contain the spores of 
 anthrax, becoming adherent to the fleeces and the long hair 
 as these are trailed along the ground. That the soil and 
 pasture become contaminated, can harbour the spores, and 
 cause infection has been shown by placing the manes of 
 animals that died from anthrax upon the fields and allowing 
 healthy animals to graze thereon, or, as occurred in the case 
 of two horses that consumed the grass in a field close to a 
 woollen factory in Yorkshire, in 1901, and upon which had 
 been blown dust from Persian wool that was being cleaned 
 in the factory. Silberschmidt mentions outbreaks of the 
 disease near Zurich, in which eight out of twenty-two animals 
 became infected by dust blown from the chimney of a horse- 
 hair factory {Zeitsch. f. Bj/gzen.y vol xx. p. 4SS)' ^^S^^> i" 
 his Milroy Lectures, alludes to other instances, and draws 
 attention to the relationship of outbreaks of anthrax and the 
 factory conditions prevailing at the time. Ravenhal, of Penn- 
 sylvania, instituted an inquiry a few years ago into the part 
 played by tanneries in spreading the disease among cattle fed 
 upon pastures that were watered by streams contaminated 
 by tannery refuse, and he found that there had died of anthrax 
 sixty cattle which had been grazing near the tanneries. In 
 factories a considerable quantity of dust is given off during 
 the opening of the packages of wool, also during the sorting, 
 blending, and cleansing of wool that has been neither washed 
 nor disinfected. The long hair used for weaving purposes 
 may have been previously soaked in warm soda solution ; but 
 China mane hair and bristles are only subjected to a process 
 
338 DISEASES OF OCCUPATION 
 
 of dry heckling through steel pins before being used in 
 manufacture. In the woollen factories of Bradford I have 
 been struck by the good effects that have followed the intro- 
 duction of exhaust ventilation at the sorting tables, whereby 
 the dust is at once removed downwards and away from the 
 face of the worker when the bales are opened ; and yet this 
 and the running of fans have not always prevented the occur- 
 rence of the disease. When, perchance, something has gone 
 wrong with the machinery and methods of ventilation, cases 
 of anthrax occur unexpectedly. 
 
 New Zealand and Australian wool does not cause anthrax, 
 as a rule, owing to the disease being less prevalent in the 
 Colonies and the exercise of greater caution in the disposal 
 of the carcases of infected animals. Dr. Bell, of Bradford, 
 was of the opinion that the worst wools are those which are 
 dusty and contain little " yolk," i.e., the unctuous substance, 
 a " kind of potash soap which pervades the wool and protects 
 the animal from the effects of rain and cold ; it also nourishes 
 the wool, rendering it soft, oily, and pliable." The yolk is equal 
 in weight to 7 or 8 per cent, of the " raw " fleece. When the 
 yolk is abundant Bell considered that it fixes the anthrax 
 spores, and renders the wool not so harmful to the sorters 
 through being less dusty. There is not the least doubt that 
 in woolsorting dust is the principal danger. W. H. Hamer 
 has pointed out that although infection from wet hides is 
 infrequent (article " Anthrax " in " Dangerous Trades "), the 
 presence of moisture in hides favours the development of 
 anthrax spores into bacilli. In this fully developed form the 
 micro-organism does not live so long as the spores. The 
 substitution of wet for dry hides would tend to lessen the 
 risk of anthrax in persons handling the hides. The manipu- 
 lation of dry horsehair has on several occasions been followed 
 by an outbreak of the disease. In 1879 there occurred nine 
 cases of anthrax in persons who had manipulated infected 
 Russian horsehair, and of these seven died. Experience has 
 shown that anthrax can be averted by disinfecting horsehair 
 with steam under pressure. In Germany industrial problems 
 such as the one we are discussing are dealt with in a manner 
 which we cannot but admire. Not only have public disin- 
 
PARASITES AND MICRO-ORGANISMS 339 
 
 fecting stations been erected, where wool and hair can thus 
 be dealt with, but there is a Government regulation to the 
 effect that " all foreign horsehair, cowhair, or goathair, pigs* 
 bristles, and wool, before they are manipulated in the factory- 
 shall be disinfected at the choice of the occupier in one of the 
 following prescribed ways : — 
 
 " I. By the action, for at least half an hour, of current steam 
 at 0*15 atmosphere above atmospheric pressure (about 17 lbs., 
 ^nd equivalent to a temperature of 220° F.). 
 
 " 2. By boiling for at least a quarter of an hour in a 2 per 
 cent, solution of potassium permanganate, and subsequent 
 bleaching in a 3 to 4 per cent, solution of sulphurous acid. 
 
 " 3. By boiling in water for at least two hours." 
 
 In his Report on Anthrax (1906) Dr. T. M. Legge states 
 that experiments carried out at the Imperial Office, Berlin, 
 have shown that so long as the pressure does not exceed 
 2^ lbs. above atmospheric pressure, equivalent to a tempera- 
 ture of 220° R, long hair will suffer no damage. Curled hair 
 can be submitted to higher temperatures. The adoption of 
 these and other means of disinfection would materially reduce 
 the risk from anthrax, if it did not abolish the risk entirely. 
 
 Symptomatology. — The effects of the entrance of anthrax 
 bacilli or spores into the human body may be local or 
 general. When local the disease causes a hard, red swelling, 
 known as " malignant pustule," usually situated on the face or 
 neck, and which, if seen early by the surgeon, can be excised 
 with success, for at this stage of the malady the bacilli 
 multiply slowly at the point of inoculation, and the organisms 
 are not found in the blood. Around the margin of the 
 pustule there are signs of inflammatory oedema, of a reac- 
 tionary nature, which is a protective barrier to the system. 
 If the organism effects an entrance it can only be by rather a 
 roundabout path, for the lymphatic glands are likely to offer 
 obstruction. General infection of the system can only occur 
 after the cells of the tissues at the local point of infection 
 have become weakened in their struggle with the bacilli or 
 when their protoplasm has become poisoned by the toxins 
 formed by the micro-organism. The patients with malignant 
 pustule operated upon in the Newcastle Infirmary made, with 
 
340 DISEASES OF OCCUPATION 
 
 one or two exceptions, a satisfactory recovery, showing that 
 up to a certain point the disease is local. Excision of the 
 pustule is almost sure to be followed by disfigurement, but 
 this possible result must not be allowed to weigh against the 
 risk to life by leaving the pustule alone. In the erysipelatous 
 form of anthrax, or malignant oedema, as it is sometimes 
 called, the appearance presented by the patient so closely 
 resembles that observed in ordinary erysipelas with oedema 
 that the one disease might be readily mistaken for the other, 
 were it not for the fact that there is less constitutional dis- 
 turbance in malignant oedema. The detectionof the Bacillus 
 anthracis in the culture made from serum withdrawn from 
 the affected part would settle the diagnosis. The erysipela- 
 tous form of the malady is more fatal than malignant pustule. 
 When the tissues over a considerable area around an 
 anthrax pustule on the face or neck become inflamed and 
 oedematous, the half of the face or neck affected assumes 
 enormous proportions, and the patients complain when the 
 neck is swollen, as if they were being choked. One patient 
 whom I saw in this condition, and who was perfectly rational 
 at the time of my visit, whose pulse-rate was 122 per minute, 
 temperature 103°, and whose lungs and heart were healthy, 
 suddenly became delirious a few hours afterwards, ran up 
 and down the Infirmary ward, and ultimately shut himself 
 up in a room in a state of frenzy. This outburst of acute 
 toxic delirium was followed by extreme exhaustion, and 
 shortly afterwards by death. This patient had received 
 serum treatment, but it was of no benefit to him. 
 
 Woolsorters' disease is the pulmonary form of anthrax. 
 It was observed in sorters of alpaca and mohair in Bradford 
 as far back as 1 846. Since then it has been met with in per- 
 sons who manipulate camels'-hair, Persian hair, and dusty 
 foreign wools, owing to inhalation of the anthrax spores in 
 the dust given off by these animal products. Although 
 anthrax is extremely fatal when the micro-organism has 
 invaded the system through the lungs, the absence of acute, 
 severe, and painful symptoms from the commencement of the 
 illness until death is noteworthy. There is none of the severe 
 rigor nor of the shivering which so frequently ushers in 
 
PARASITES AND MICRO-ORGANISMS 341 
 
 acute infectious diseases. If there is shivering, it is slight ; 
 it is more a sensation of chilliness that is complained of than 
 anything else. Pain, cough, vomiting, and diarrhoea are not 
 prominent features. An uncomfortable sensation at the pit 
 of the stomach is often complained of Although there may 
 be little cough, the breathing is embarrassed, and there is 
 a sense of tightness and oppression about the chest. Expec- 
 toration is not abundant, and only occasionally is it rusty- 
 coloured, as in pneumonia. On percussing the chest-wall 
 slight dulness may be detected over the base of one lung, 
 usually the right, and on auscultation the respiratory murmur 
 is feeble, or it is attended by moist bronchial rales and crepi- 
 tations. Subsequently the physical signs suggest the presence 
 of fluid in the chest. The pulse is feeble and the heart's 
 sounds are weak. The skin presents a dusky appearance, and 
 is cold to the touch ; the patient exhibits signs of collapse. 
 With all this the mind remains clear to the last, or the patient 
 dies in a state of coma, with or without convulsions. The 
 urine is scanty, and often contains albumen. Pyrexia is not 
 a prominent feature. Should a rise of temperature to 103° F. 
 occur, it generally betokens widespread infection or a septic 
 pneumonia. In the pulmonary form of anthrax death gene- 
 rally comes any time from the second to the fourth day. 
 The characteristic feature of this form of the malady is the 
 rapidity with which collapse sets in. After death the body 
 decomposes very rapidly. There is extensive livid dis- 
 colouration of the skin of the face and neck, of the skin 
 of the trunk and posterior parts of the body, and on incising 
 the skin of the chest-wall bubbles of air escape, owing to the 
 existence of subcutaneous emphysema and commencing 
 gangrene. In the pleural cavity there is usually some straw- 
 coloured fluid. A thick layer of gelatinous material covers the 
 lungs, which on section are found to be gorged with black fluid 
 blood, with here and there small patches of red consolidation 
 or haemorrhages. The bronchial glands are enlarged. On 
 the surface of the heart and in its substance are numerous 
 petechial haemorrhages. In the abdominal cavity there is 
 gelatinous-looking fluid. The spleen may or may not be 
 enlarged. On examining the brain haemorrhages may be 
 
342 DISEASES OF OCCUPATION 
 
 found underneath the membranes. The post-mortem ap- 
 pearances are consistent with the fact of some profound 
 impression having been made upon the blood whereby the 
 nutrition of the small blood-vessels is destroyed and there 
 occur as a consequence numerous minute haemorrhages. In 
 the brain of a woolwasher (Russian camel-hair, Persian 
 wool, &c.), aged forty-eight, kindly sent to me by Dr. F. W. 
 Eurich, of Bradford, there are numerous haemorrhages under 
 the pia-arachnoid membranes. The illness began with a 
 small pimple on the man's wrist on February 25, 1907, but 
 it was considered so trifling that medical advice was not 
 sought until February 27th. The bacilli of anthrax were 
 then found in the serum of the pustule. An hour or two 
 afterwards the pustule was excised, and 80 cc. of Sclavo's 
 serum injected during the course of the next forty-eight 
 hours. The patient never responded to the treatment, but 
 became delirious and violent, and died on March ist in a 
 state of coma. At the autopsy numerous haemorrhages were 
 found in the lungs and extensive haemorrhages on the brain. 
 The case is a good illustration of an infection extremely 
 limited in the earliest instance being rapidly followed by a 
 general infection and death. 
 
 Treatment. — The treatment of anthrax is preventive and 
 curative. So far as curative measures are concerned, extirpa- 
 tion of the malignant pustule when the disease is entirely 
 local gives good results. The hypodermic injection of a small 
 quantity of a 2 per cent, solution of carbolic acid into the 
 tissues immediately surrounding the pustule has sometimes 
 proved satisfactory, but removal of the pustule is preferable. 
 It is when we have to deal with the pulmonary form of the 
 malady that we find we are face to face with a disease that 
 resists ordinary medicinal treatment. The recent advances 
 of serumtherapy have placed in our hands a powerful and 
 fairly reliable remedy. Sclavo, of Milan, has introduced an 
 anti-anthrax serum which, when early adopted, has been fol- 
 lowed by marked success. Sclavo published all the cases 
 of anthrax treated by serum up till 1903. Of 164 thus 
 treated 10 died, equivalent to 6*09 per cent., compared 
 with 24*1 per cent, for the whole of Italy. Since July, 
 
PARASITES AND MICRO-ORGANISMS 343 
 
 1904, the serum treatment has been tried in England 
 either alone or in connection with excision, in 12 cases of 
 external anthrax. In 4 of these 12 cases serum alone was 
 used — one of these, which was far advanced before the serum 
 was adopted, died. Strong testimony to the efficacy of the 
 serum treatment comes from Santa Croce, a small town on 
 the Arno. Here 36 tanneries give employment to 350 
 persons. Among the workers who manipulate China hides 
 anthrax has been frequent and fatal. So convinced are the 
 workmen of the beneficial effects of the serum treatment that 
 they insist on having it to the exclusion of all other means. 
 The peasantry of the district around Siena when ill often 
 make their way into that town voluntarily to receive treat- 
 ment. The immunity conferred upon sheep and cattle by 
 injecting into them anti-anthrax serum is now a recognised 
 fact. The result of a series of experiments carried out by 
 Sobernheim confirms the opinion expressed by Sclavo that 
 the use of anti-anthrax serum is free from danger and is very 
 effective, that it protects the animal from all forms of anthrax, 
 including the intestinal, and that it can be used for curative 
 purposes in man with safety. The inoculation treatment of 
 infected persons by serum, specially prepared on the lines 
 recommended by Sclavo, gives promise of great success, and 
 ought to be tried early in every case of the pulmonary form 
 of anthrax — which has hitherto been defiant of all medicinal 
 treatment. 
 
 While the disease is to some extent prevented by the bales 
 of wool and hair being opened in wool and hair sorting 
 factories in closed spaces with strong draught removing the 
 dust away from the workers, not less than 75 cubic feet 
 of air per minute being thus drawn away by the fan, it is 
 advisable to disinfect the material first. Dusty and dangerous 
 wools, such as van mohair and Persian, require to be 
 thoroughly steeped in water in the bale before being opened, 
 and the bales are only allowed to be opened by experienced 
 workmen who have some skill in discerning flaws in the 
 material. In steam we have a means of disinfecting hair 
 which deserves to be given a trial. To be effective, as Dr. 
 Legge, in his " Report on the Incidence of Anthrax," 1906, 
 
344 DISEASES ;OF OCCUPATION 
 
 says, " The steam must be in contact with the material in a 
 loosened condition for a sufficiently long time and at a suffi- 
 ciently high temperature, but in order that the material may 
 not be injured this temperature must not exceed certain 
 limits." Further, the conditions in which the steam is used, 
 whether saturated or superheated, as current or confined 
 steam, largely determine its efficiency. "To obtain the best 
 results formation of moisture in the steam in contact with 
 the material to be disinfected is necessary, the steam should 
 be subjected to a slight degree of pressure, and the steam be 
 allowed to stream through the apparatus until the air has been 
 wholly expelled from the chamber. . . . Disinfection is 
 brought about by the steam coming into contact with a 
 colder surface, on which it condenses, and in so doing it 
 gives up its latent heat (sufficient to raise from fifteen to 
 sixteen times its own weight of wool from o° F. to 212° F.)." 
 Anthrax spores are not so readily destroyed by heat as are 
 the fully developed bacilli. In the experiments carried out 
 in Berlin it was found that even long hair exposed to steam 
 under a pressure of 28 lbs. above atmospheric pressure, 
 equivalent to a temperature of 220° F., suffered no damage 
 for manufacturing purposes and sale. Since the enforcement 
 in Germany of the regulation introduced in 1899 requiring 
 that hair shall be boiled for at least two hours in water 
 or for a quarter of an hour in a 2 per cent, solution of 
 potassium permanganate, with subsequent bleaching in a 3 to 
 4 per cent, of sulphurous acid, the number of cases of anthrax 
 in that country has markedly diminished. In England 
 higher steam pressures have been used than in Germany, 
 and with success. Boiling or disinfecting by steam the 
 suspected material can, on the whole, be relied upon as likely 
 to confer security upon the workmen, but for success to be 
 attained attention to minute details is necessary. 
 
 In the Draft Regulations recently issued by the Home 
 Secretary (May, 1907) re anthrax in the use of horsehair, it 
 is stated that arrangements will be made whereby a large 
 proportion of the horsehair can be disinfected by or for the 
 importers before distribution to the manufacturers. This 
 disinfection of the material on its entrance into the country 
 
PARASITES AND MICRO-ORGANISMS 345 
 
 ought to be followed by good results. All horsehair should 
 be disinfected except the white and light grey hair, which 
 might suffer damage in the process. The Home Secretary 
 has excluded bristles from the order, but although excluded 
 from the Regulations the hope is expressed that when the 
 disinfecting apparatus is installed manufacturers will adopt 
 the practice of having undressed bristles also disinfected. 
 Between January i, 1906, and March 31, 1907, there were 
 seventeen cases of anthrax, including six deaths, in con- 
 nection with horsehair and bristles. 
 
 Hospital Nursing 
 
 The hospital, private, and district nurse has come to stay. 
 As to the utility and helpfulness of the trained nurse there 
 can be no question. But for her assistance medical and 
 surgical skill would be robbed of much of its power for good. 
 Attractive to women as hospital and private nursing is, the 
 work is at times anxious and frequently fatiguing. The 
 hours are often long. Many nurses after being on duty in 
 the wards of a hospital all day are thoroughly tired at night, 
 and their feet are tender and swollen. If the hospital is so 
 placed that the nurses can sleep in good air a short distance 
 from the hospital and in quiet surroundings, the gain to health 
 and fitness for work are noticeable. Only strong, healthy, 
 and well-developed women, with a distinct love for the work 
 and sympathy with suffering, should undertake the duties of 
 a hospital nurse, for there is much to try their patience and 
 temper. Their feet should be good. As a consequence of 
 spending the greater part of each day in infirmary wards which 
 are not always too well ventilated, many nurses suffer from 
 what is known as " hospital throat." Occasionally the sore 
 throat becomes septic. Nurses who are in attendance upon 
 patients with infectious diseases, such as scarlet fever, may 
 become the victims of infection ; others who are looking after 
 septic cases may through a small wound on their finger 
 become infected and suffer from blood-poisoning. There is 
 the risk, too, of tuberculosis. The records of hospitals for 
 the treatment of consumption, also of sanatoria, do not show 
 
346 DISEASES OF OCCUPATION 
 
 that the nurses employed therein suffer from tuberculous 
 phthisis in larger proportion than those engaged in general 
 hospitals, a circumstance to be explained by the extremely 
 well ventilated condition of these buildings, and the care that 
 is taken in collecting the sputum and rendering it antiseptic 
 before disposing of it. 
 
 What has been said of hospital nurses applies almost 
 equally to house physicians and house surgeons in infirmaries, 
 with this exception, that since these officers are not spending 
 the greater part of the day in the wards they are less likely 
 to incur many of the commoner risks which the nurses run, 
 but are more exposed to the accidental dangers of blood 
 poisoning in the treatment of abscesses and foul wounds 
 in operations. 
 
CHAPTER XII 
 
 DANGERS ATTENDANT UPON THE GENERATION AND USES 
 OF ELECTRICITY AND ELECTRIC WELDING 
 
 Electricity 
 
 THE generation of electricity for lighting and for motor 
 purposes is not an unhealthy occupation, but it is 
 an extremely dangerous one, since the slightest contact with 
 a live wire highly charged or a live part of the machinery 
 is frequently followed by immediate death. In 1906 there 
 were reported 199 electrical accidents in factories alone, and 
 of these eight proved fatal. In generating stations there is 
 elaborate machinery for the conversion of mechanical into 
 electrical energy. The current formed may be immediately 
 distributed or stored, or it may be transformed in the 
 appliances of a transformer station, whereby small currents 
 at high pressure are converted into large currents at low 
 pressure, or vice versa, and where direct and alternating 
 currents can be also dealt with. " The currents produced by 
 dynamos are classed as low pressure, high pressure, and 
 extra high pressure. Currents at low pressure distributed 
 from generating stations are invariably direct. High- 
 pressure currents are distributed either as direct or alternat- 
 ing" (" Dangerous Trades," p. 252, Sir Hamilton Freer-Smith). 
 Electrical experts differ as to what are the limits of safety 
 for pressures. It was the opinion of the Dangerous Trades 
 Committee of the Home Office, which investigated this 
 subject, that currents at 700 volts direct and 350 alternating 
 should be regarded as dangerous. American experts regard 
 only such high voltages as 1,500 as dangerous. This was 
 the amount they recommended to be used in the execution 
 
 347 
 
348 DISEASES OF OCCUPATION 
 
 of criminals, but even with this voltage it has occasionally 
 happened that the heart of the electrocuted criminal began 
 to beat again and respiration to be restarted, so that a 
 fresh electrical contact had to be made. The result in every 
 instance depends upon the manner in which contact with 
 the live metal is made. If the skin is moist and unprotected, 
 if the person is wearing damp boots and standing upon an 
 earthed metal plate, these conditions tend to magnify the 
 effects produced by contact, so that a direct current of 250 
 volts, and even less, may prove fatal. In Great Britain 
 there have been several deaths from electric shock, but 
 considering the extent to which electricity is used, and its 
 increasing employment, it is astonishing that there have not 
 been more fatalities. At the electrical stations of electricity 
 supply companies throughout the country there were in 
 1906 39 accidents, 2 of which were fatal : in private 
 electrical generating stations, 14 accidents, none of which 
 proved fatal. In factories and engineering works, &c., there 
 were in 1906 199 accidents, 8 of which were fatal. This 
 is a considerable increase in the number of accidents in 
 factories and engineering works over those of the previous 
 year, viz., 199 as against 122, or an increase of 60 per cent, 
 with 8 fatalities as against 4 in 1905. It is not always 
 easy to get workmen to appreciate the dangers incidental to 
 their calling. Since, for example, the cleaning or repairing 
 of " live " switchboards is a cause of fatal accidents, this 
 ought to be done when the pressure is off. There is no occu- 
 pation, unless it be that of the manufacture of explosives, in 
 which it is more desirable to employ healthy, well educated, 
 careful and capable men, to whom the dangers of the 
 occupation should be pointed out, than in the generation and 
 distribution of electricity. There is no proof that one person 
 is more susceptible to electricity than another. It is 
 entirely a question of mode of contact and how the current 
 enters the body. Accidental contact may occur with any 
 person, but even fatalities from accidental contact can be 
 diminished by the exercise of care based upon knowledge ot 
 the danger. Faulty construction of switches and installation 
 of cheap machinery are often causes of burns. Opinions are 
 
ELECTRICITY AND ELECTRIC WELDING 349 
 
 divided as to whether high-pressure alternating currents are 
 more deadly than direct or continuous. It has been stated 
 that alternating currents are twice as dangerous as the 
 continuous, but this requires confirmation. The continuous 
 current at high tension causes burns and considerable de- 
 struction of the tissues, but if the shock has been severe it 
 causes death. With alternating currents burns also occur, 
 but they are usually less severe, and the destruction of the 
 tissues is less. D'Arsonval maintains that the continuous 
 current is only risky to life when the circuit is broken, but 
 other experts state that while the shock may be greater 
 when the circuit is broken, closure of the circuit is not free 
 from danger. One consequence of contact with high elec- 
 trical currents is burning. The wounds inflicted are deep, 
 irregular, and are apt to slough, and while the burned part 
 is insensitive to pain, the surrounding parts, owing to their 
 being in a state of inflammation, are extremely sensitive. 
 
 To the dangers attendant upon using electricity for 
 lighting and heating purposes must be added those of the 
 live rail. As a means of locomotion electricity is destined 
 to play an important part in the future of railway travelling. 
 It is freely used by the North-Eastern Railway Company 
 on some of the local lines in and around Newcastle-upon- 
 Tyne, and for a considerable time after its introduction it 
 was a cause of death to men and children, as well as to 
 animals that had strayed upon the line and had accidentally 
 touched the live rail. Dogs are still slaughtered by it, and 
 occasionally a fox gets killed. I saw on two or three occa- 
 sions, with Dr. Alfred Wilson, of Wallsend, a man who had 
 accidentally touched with one foot the elevated rail, which 
 was charged with electricity. He immediately fell. For- 
 tunately the accident was witnessed by a signalman, who 
 left his box and rendered assistance. The injured man 
 was removed from the rails in a state of coma attended 
 by convulsions. For a few hours after reaching home he 
 remained unconscious. When I saw him two days after the 
 accident there were extensive burns on his head and a 
 wound with blisters on the sole of the right foot. Within 
 a few days the wound on the foot had sloughed so that 
 
350 DISEASES OF OCCUPATION 
 
 the bone of the big toe was exposed. The bone ulti- 
 mately became necrosed and had to be removed. What 
 struck me about the wounds inflicted by the live rail were 
 their severity and the red, angry look they assumed. A 
 month after the injury the wounds were irritable, painful, 
 and not disposed to heal. An interesting point, too, in this 
 case was that the man's foot had been literally split without 
 the boot he was wearing showing the slightest injury.^ 
 
 Dangers to life incidental to the use of electricity was 
 one of the subjects referred to the Dangerous Trades Com- 
 mittee of the Home Office. As a member of that committee 
 I felt that before expressing my personal opinion upon the 
 matter it was desirable to know how death was brought 
 about in electric shock. I submitted dogs to the influence 
 of electric shock {Brit. Med. Journ., January 15, 1898), 
 and I concluded that death was due to sudden arrest of 
 the heart's action. The immediate effect of passing high 
 electrical currents through an animal is to throw the whole 
 body into a state of extreme muscular rigidity, as in opis- 
 thotonos. On breaking the current the respiration becomes 
 quicker and deeper than before the contact and the beat of 
 the heart gradually returns to the normal. It occasionally 
 happened that in a dog apparently killed by electricity the 
 heart's action would entirely cease, no beat could be heard 
 nor pulse felt, and yet, although to all appearances dead, the 
 animal would bark loudly for a minute or two, the heart 
 never again beating. Theoretically it is usually thought that 
 it is the respiration that is first affected and that death in 
 electric shock comes from the respiratory centre. Such was 
 not my experience, and in this I am supported by Professor 
 Prevost, of Geneva University, and by his assistant. Dr. Bat- 
 telli, whose experience is that no matter whether the direct or 
 alternating current is used, death is the result of the heart be- 
 coming paralysed. With high voltages, e.g.^ 550 volts, the beat 
 
 ^ In a " Return " presented to the House of Lords, August, 1907, of 
 the number of persons injured by" live rails" on 11 electrified railways, 
 there occur the following figures. In 1904 there were 8 persons killed 
 and 20 injured ; 1905, 2 killed and 18 injured ; 1906, 4 killed and 21 
 injured ; and for 8 months, 1907, 2 killed and 12 injured. Total, 1904 
 to August, 1907 : 16 killed and 71 injured. Of the 16 killed, 12 were 
 trespassers and 4 were railway servants. 
 
ELECTRICITY AND ELECTRIC WELDING 351 
 
 of the heart of an animal might become suddenly arrested by 
 one shock, and after suspension of the respiration for a few 
 seconds the breathing might again return for a short time, 
 then gradually become feebler and feebler until life came to 
 an end. When a man receives an electric shock and is not 
 rendered unconscious by it, terror may cause him to faint. 
 
 Opinions as to the cause of death in electric shock other 
 than those just mentioned have been published. Grange 
 {Lancet^ August 20, 1904) attributed death to haemorrhage 
 into the medulla oblongata, which by pressing upon the 
 pneumogastric nerve induced respiratory failure and arrest 
 of the heart's action. D'Arsonval believes that in the 
 strong local effects which are produced, not only are the 
 physiological properties of the tissues destroyed, but the 
 local conditions reflexly and indirectly cause inhibition of the 
 respiratory and cardiac centres. Of the two main views as 
 to the cause of death that are generally advanced, respiratory 
 arrest or cardiac failure, I lean to sudden stoppage of the beat 
 of the heart. From what has just been said it is clear that 
 the mechanism of death in electrocution is still a matter 
 of dispute. It is possible that electrocution only causes 
 apparent death, and that the real cessation of life is brought 
 about by want of proper care and effort to set going again 
 the beat of the heart and the play of the lungs. In death 
 after electric shock Jellinek, of Vienna, found on lumbar 
 puncture evidence of extremely high cerebro-spinal fluid 
 pressure. 
 
 As already stated, electrical currents produce varying effects 
 upon the human body, according to the manner in which 
 they enter. A dry skin is a bad conductor. With a low 
 voltage and good contact the muscles are thrown into a 
 state of extreme rigidity. It is this muscular spasm which 
 renders it impossible for a man to relax his grip of a piece 
 of metal charged with electricity. The effects of electrical 
 currents are only experienced when the currents enter and 
 leave the body, and not when the circuit has been closed. 
 The making and breaking of the contact are the periods 
 when there is danger. The pain felt by men in non-fatal 
 electrical accidents is due to the violent muscular contrac- 
 
352 DISEASES OF OCCUPATION 
 
 tions compressing sensory nerves or to the action upon the 
 nerve endings of the products of electrolytic decomposition. 
 
 When an animal is mortally struck by electricity a cry is 
 frequently uttered. The same occurs when a workman becomes 
 the subject of a severe electrical accident. It is the cry that 
 draws the attention of fellow-workmen to the spot where lies 
 the apparently lifeless body of a comrade. The face is pale or 
 it is cyanosed, the heart can no longer be felt beating or the 
 pulse, the pupils are dilated, and mucus keeps oozing from 
 the mouth and nose. Considerable care has to be exercised 
 in removing the body from its contact with the live metal. 
 
 One of the important facts revealed by my own and 
 others' experiments is that while death in electric shock, in 
 all or nearly all cases, comes from sudden arrest of the 
 heart's action, yet immediate resort to artificial respiration 
 will in many instances restore an apparently dead body to 
 life again. This I have succeeded in doing on several 
 occasions, and it has been shown by practice, in the case of 
 workmen apparently killed by electricity, that once contact 
 with the live metal has been broken nothing succeeds better 
 in restoring men to life again than artificial respiration 
 immediately begun, and continued until breathing is estab- 
 lished, or for such a length of time as to leave no doubt 
 that life is quite extinct. One of the dangers and difficulties 
 to workmen attempting to rescue an injured comrade is that 
 the live wire or cable may still be grasped by the hand of the 
 victim, so that it is dangerous to seize any part of the body, 
 even the clothes, if they are damp. An attempt to remove 
 the body of a workman suspended from the wires of an electric 
 street lamp in Boston, U.S.A., was the cause of the death of 
 the rescuer. If the clothes upon the body are damp there 
 is always danger. Whenever any rescue work is being 
 attempted indiarubber gloves should be worn, and if these 
 are not available the hands of the rescuer should be wrapped 
 in thick dry rags before trying to pull the victim away from 
 the cable or machinery. When removed the body should be 
 placed upon its back, and while medical assistance is being 
 sent for no time should be lost in putting artificial respira- 
 tion into practice. Kneeling behind the head of the injured 
 
ELECTRICITY AND ELECTRIC WELDING 353 
 
 person, the operator should grasp the elbows and draw them 
 well over the head, so as almost to bring them together above 
 it, and hold them there for a few seconds; then, carrying 
 the arms down and on to the chest, firm compression of the 
 thoracic wall should be made, so as to displace the air in the 
 lungs. The movements should not succeed each other too 
 rapidly, but ought to imitate nature as far as possible, i.e.^ 
 about sixteen times per minute. Stimulants should on no 
 account be poured down the throat of the victim nor even 
 placed in his mouth. If life is to be restored at all, it will 
 only be by artificial respiration carefully and methodically 
 carried out, not too hurriedly, as already advised, and per- 
 sisted in for a considerable time — half an hour or even longer. 
 
 After death in electric shock the blood is generally found 
 dark and fluid, but occasionally I found it clotted in the 
 right side of the heart. On spectroscopic examination the 
 blood may be found to contain oxyhaemoglobin and reduced 
 haemoglobin. The lungs present nothing abnormal, unless a 
 few ecchymoses if artificial respiration has been rather vigor- 
 ously attempted. The pupils are usually dilated. The brain 
 and spinal cord may be congested. There may or may not 
 be marks of burns upon the body. 
 
 The voltage used on railways varies from 300 to 600 
 volts. This is allowed by the Board of Trade, the 
 opinion being that it is not dangerous, but contact with 
 lower voltages than these has caused death on several 
 occasions. In all cases the circumstances in operation at the 
 time have to be considered. It is known that the risk to 
 railway men is increased in wet weather. The danger con- 
 sists in one part of the body, e.g., the foot, touching the live 
 rail while the other is on the wet earth. The elevated rail 
 ought therefore to be protected as far as possible to prevent 
 accidents taking place. 
 
 Electric Welding 
 
 In the electric welding of metal, a method that is becom- 
 ing extensively used in ironworks, the light produced is so 
 intense that it cannot be looked at by the naked eye even 
 
 AA 
 
354 DISEASES OF OCCUPATION 
 
 for a second, yet it is necessary for the workmen to follow 
 the process closely and to direct the current sometimes at 
 one point, sometimes at another, as the work proceeds. For 
 this purpose the workmen wear spectacles of smoked glass 
 or, as in Sheffield, shields composed of alternating layers 
 of blue and red glass. The heat evolved in electric welding 
 is so intense that the metal submitted to the process is 
 almost immediately liquefied. In addition to the risk to 
 the eyesight, the skin is apt to become red and hot, as 
 if acutely sunburnt. The reddening of the skin does not 
 appear to be due to the high temperature, for the heat 
 generated does not radiate very far, but is more probably 
 the result of a combined electrical and chemical action of 
 the light rays, such as occurs with the Rontgen rays. In 
 some of the Sheffield steel works, Mr. Simeon Snell says, the 
 men, in order to protect the head and face, wear a helmet in 
 front of which is a glass window made up of red and blue 
 glass. Exposed parts of the body get immediately burned, 
 and should perchance the eyes " catch " the light the effects 
 may not be felt immediately, but some hours afterwards. 
 The eyelids swell and the men complain of their eyes feeling 
 sore. Fortunately the symptoms, which are attended by an 
 excessive secretion of tears, only last in most instances for 
 24 to 36 hours. Snell is of the opinion that the effects of 
 the light are confined to the conjunctival and corneal surface 
 of the eye, but in some instances I have been informed of 
 temporary blindness associated with vascular changes in the 
 optic disc and retina. Electric welding is work which no 
 man with weak eyes ought to undertake without first being 
 warned of the dangers and without having his eyes examined 
 by an oculist. It has not been exactly determined whether 
 it is the heat or the chemical rays of light that are hurtful 
 to the eyes. The heat is excessive and is with difficulty 
 measured, but it may rise to 7,000° F., while the luminosity, 
 according to Mr. Simeon Snell, may be equal to 8,000 candle 
 power. 
 
 M. Crzellitzer {La Presse Medicate^ December 8, 1906) 
 reports the occurrence of several cases of "electrical oph- 
 thalmia " simultaneously in a group of workers employed in 
 
ELECTRICITY AND ELECTRIC WELDING 355 
 
 a factory in Berlin where steel rails were fused by means of 
 electrical currents. The work was being carried on in the 
 angle of a small court through which, on one particular day, 
 thirty-two workmen had to pass. All the men felt more or 
 less the influence of the electrical currents. On the following 
 morning twelve of these men presented themselves for 
 medical advice, as they were all suffering from " electrical 
 ophthalmia." They had been awakened during the night 
 by severe pains in the eyes, when they found their eyelids 
 so swollen that they could hardly open them. There were 
 photophobia and running at the eyes. On examination the 
 conjunctiva was found to be red and swollen. In eleven of 
 these men the cornea was intact, but in the twelfth it was 
 slightly affected. The pupil of the eye was in each instance 
 normal and reacted normally. The fundus oculi presented 
 nothing abnormal, except that in two or three of the men 
 the veins were slightly turgid and the papillae congested. 
 The acuteness of vision and colour perception were in no 
 way affected. 
 
 In a large works at Lamotte Breuil, on the River Oise, in 
 which chloride of calcium is manufactured by the electrolysis 
 of chloride of sodium and potassium, several of the work- 
 men have suffered from an irritating form of skin eruption, 
 characterised by a succession of crops of acne pustules and 
 inflammatory nodules on the face, chest, and back of the 
 trunk. The acne spots present a dark appearance, as if they 
 contained grains of gunpowder. The colour persists long 
 after the spots have disappeared. Dr. Fumouze, who has 
 described the malady, calls it " Dermatose chlorique electro- 
 lytique," and states that this form of dermatitis has been 
 met with in Germany in men similarly employed. The 
 explanation of the cause of the malady which has been 
 advanced by M. Jarackzewski ^ is the presence of certain 
 substances deposited on the electrodes, among which are 
 found one possessing strong oxidising energy, viz., chloranile 
 or the tetrachloride of quinone, the vapours emitted from 
 which are extremely irritating. The chlorine vapour that 
 is given off produces irritation of the skin, but there is 
 * Revue Scieniifique, quoted September 29, 1906. 
 
356 DISEASES OF OCCUPATION 
 
 apparently some other cause in operation, since it is the men 
 who are engaged in the removal of the products of decom- 
 position that suffer most. The means recommended to 
 overcome the dangers are the immediate removal of the 
 decomposition products from the electrolytic chambers after 
 breaking up of the same in order to set free certain parts of 
 the machinery once it has become cooled ; wearing of gloves 
 during handling of the products, frequent washing of the 
 hands, a bath and douching before leaving work at the end 
 of the day. Since putting into force these recommendations 
 the malady has ceased to exist. 
 
 Dr. Alfred C. Jordan,^ medical radiographer of Guy's 
 Hospital, has drawn attention to sterility among X-ray 
 workers. It is now admitted that azoospermia is produced 
 by exposure to X-rays. If a worker has not taken every 
 reasonable care to avoid exposing himself unduly to their 
 action, he becomes sterile after working daily for a year or 
 so. The wearing of specially prepared protective aprons 
 is recommended. The back of the hands of an X-ray 
 worker whom I have examined are swollen, tender, and 
 cracked. So, too, are the finger-nails. He gets relief by 
 rubbing them with vaseline. Other serious effects have 
 followed exposure to X-rays. One of Edison's experi- 
 menters,2 named Dally, after suffering for six months from 
 scattered patches of a painless erythematous redness of 
 the skin like scalds, noticed that his hands were swollen. 
 Although thus affected he continued to set X-ray machines 
 in hospitals and colleges for two years, when the burns 
 began to smart and to tingle and to be extremely painful. 
 His sufferings were so intense at night that he was obliged 
 to lie with his arms in iced water in order to get sleep. 
 Later on the left wrist became cancerous, and as the disease 
 made rapid progress the left arm was amputated below the 
 shoulder. Three months afterwards the little finger of the 
 right hand became cancerous and had to be removed. 
 Subsequently the right wrist was similarly attacked, and 
 the arm had to be amputated below the elbow. The respite 
 
 » British Medical Journal, July 6, 1907, p. 15. 
 « " Thomas Alva Edison," by F. A. Jones, p. 248. 
 
ELECTRICITY AND ELECTRIC WELDING 357 
 
 was of brief duration, for within a very few months Dally 
 succumbed to the disease, which had become general. 
 Although a martyr to a malady for which no cure was 
 found. Daily's mysterious disease and regrettable death drew 
 attention to the dangers of X-rays and to the absolute 
 necessity of having the skin adequately protected. 
 
 According to Dr. Alfred Haas, of Munich, a similar danger 
 is said to exist among the Rontgen tube makers in Germany. 
 In testing the tubes upon themselves the men have suffered 
 from a severe form of dermatitis of the hands — the usual 
 effects being an acute inflammation of the skin followed by 
 an eruption, at first vesicular and subsequently pustular, 
 which frequently ended in ulceration not amenable to treat- 
 ment, or in gangrene. The Rontgen tube makers no longer 
 test the instruments upon themselves, but use the hand of 
 a human skeleton which is encompassed with gelatinous 
 material to resemble the hand of a living person. As in 
 England, atrophy of the testicles has also been found to be 
 one of the results of exposure to the electric rays. Of sixteen 
 workmen who were the victims of azoospermia (Brown and 
 Osgood : Archives of Rontgen Rays^ 1905), all had been the 
 fathers of families until they worked in Rontgen rays, after 
 which the wives of all the men became sterile. The sterility 
 continued for two years after the men gave up the work. In 
 Germany the workmen protect their hands, face, and front of 
 the body by large sheets of metallic lead. For the dermatitis 
 alkaline lotions, oxide of zinc, and salicylic ointments have 
 been found useful. 
 
CHAPTER XIII 
 
 DISEASES THE CONSEQUENCE OF FATIGUE; OCCUPATION 
 
 NEUROSES 
 
 THE stress and hurry of modern life are developing 
 effects peculiar to the age in which we live. While 
 labour-saving machinery continues to increase there is yet a 
 degree of physical strain and nerve- tension being experienced 
 by the workers the influence of which cannot be ignored. 
 The lightening of the burden of the textile worker by im- 
 proved machinery has not altogether made mill-work easier, 
 for by raising the speed and increasing the output a larger 
 amount of machinery has to be tended, and this constant 
 vigilance imposes a considerable strain upon the worker. If 
 this is true of simple muscular movements necessitating only 
 mechanical supervision, how much greater must be the strain 
 and exhaustion upon persons who in their employment are 
 obliged to execute a series of educated and rapid muscular 
 movements in which volition is sustained throughout. 
 
 Engine-drivers and Signalmen 
 
 are, as a class, healthy men. They are all medically examined 
 before given work under a railway company. The occupation 
 of engine-driving is consistent with long life. Engine- 
 drivers who have fixed passenger trains to look after have 
 regular hours. It is the men who are called upon at all 
 hours to perform irregular work that suffer from the demands 
 made upon their sleep and the opportunities of getting food 
 and of eating it. Among this class dyspepsia is frequent ; 
 for the food that is carried away from home ceases to be 
 
 358 
 
FATIGUE AND OCCUPATION NEUROSES 359 
 
 attractive, and as it is occasionally far into the night before 
 the men return it is often impossible for them to get a 
 good meal. Diabetes prevails among engine-drivers to a 
 considerable extent. It is double that of the standard. 
 Many of them die from this disease between 50 and 55 
 years of age. The malady is largely the result of the long- 
 continued nerve-tension to which the drivers are exposed 
 Acute pulmonary complaints, too, are not uncommon. 
 Pneumonia is more frequently met with than phthisis. The 
 mortality from accidents is lower than in any employes in 
 the running department. An engine-driver who has once 
 been in a collision, and whether the accident was his fault 
 or not, is subsequently transferred to the mineral traffic 
 department of the railway company, a change of work which, 
 while it may be meant as a solace to public opinion, is 
 acutely felt as a degradation by the person concerned. 
 Whether it is as the result of the shock, or in con- 
 sequence of their altered position in the railway service, 
 engine-men under these circumstances become nervous and 
 never quite regain the self-confidence they possessed before 
 the accident. 
 
 What is true of engine-drivers is, in the main, true of 
 signalmen. Many railway accidents are the result of the 
 too long hours and the continued strain upon the nervous 
 system of the men. They are overtaken by a kind of fear 
 which paralyses them, or there is temporarily produced a 
 degree of mental aberration. The chief causes of death 
 among signalmen are diseases of the circulatory system and 
 phthisis. 
 
 In a Parliamentary paper, " Instances in which Eight-hour 
 and Ten-hour Signalmen were on Duty on the Railways of the 
 United Kingdom for more than their Booked Hours during 
 the Month of February, 1906," it is stated that the total 
 number of instances shown in the return of one railway com- 
 pany alone was 617. In 430 of these instances the late 
 working was due to the absence, through illness or other 
 causes, of the men by whom the work should have been taken 
 over at the end of ten hours, and the impossibility of obtain- 
 ing relief owing to the short notice. In 162 instances the 
 
36o DISEASES OF OCCUPATION 
 
 overtime was worked, chiefly on Saturday night, to pass a 
 late train. The total number of instances in the United 
 Kingdom of eight-hour signalmen being on duty for more 
 than their booked hours was 2,226, and of ten-hour signalmen 
 being on duty for more than their booked hours the total 
 was 9,512. These returns refer to the 9,164 signalmen who 
 are eight-hour men, and 9,721 ten-hour signalmen in the 
 United Kingdom. 
 
 It is unnecessary to dwell upon the strain necessarily felt 
 by an engine-driver who is driving an express passenger 
 train on a long journey. No sooner has he passed one 
 signal than he is on the outlook for another, and as a con- 
 sequence the nerve-tension is kept up all the time. It is not 
 alone a question of observing signals, but also of attending 
 to the rate of the running and its bearing upon the manage- 
 ment of his engine. Furnished with a time-sheet on which is 
 stated the second at which he ought to pass every station and 
 every important signal-box, he is obliged to record on this 
 sheet the actual time of passing. As a counter record is kept 
 by the guard of the train and the signalmen, the work imposed 
 upon the engine-driver is greater than most people imagine. 
 There is nothing to indicate that the speed at which these 
 men run their trains makes them careless of the dangers they 
 have to avoid or heedless of the freight entrusted to them. 
 On long-distance fast trains the fireman is also extremely hard 
 worked. He is stoking nearly the whole way. Coal has to 
 be shovelled into the firebox at the rate of two tons per 
 hour. Seeing that there is imposed a severe strain upon the 
 engine-driver and that the stoker is also fully employed, the 
 question has frequently been asked, in view of the possible 
 sudden illness of one or other of the two men, as to the 
 advisability of having a third man on the engine. This is 
 a question which railway experts alone can answer, but 
 which in fairness to the public ought to be seriously con- 
 sidered. 
 
 Writers' Palsy : Scriveners' Spasm 
 
 One of the consequences of the oft-repeated use of the pen 
 carried on for months and years is the development of a 
 
FATIGUE AND OCCUPATION NEUROSES 361 
 
 peculiar spasm of the fingers, whereby, when a person is 
 writing, the hand becomes unable to execute the commands 
 of the will. Writing is an act learned by education : it never 
 becomes automatic. Attention must be concentrated to a 
 greater or less extent when writing. In scriveners' spasm 
 the fingers during the act of writing become the seat of 
 painful cramp, which makes it impossible for them to complete 
 the word begun. Although in one sense the result of some 
 defect in the function of the muscles and nerves concerned, 
 it is more than probable that a central cause is in operation 
 as well, and that there is fatigue of the brain as well as of the 
 small muscles of the wrists and fingers. A long rest and 
 abstinence from work may restore healthy function to the 
 muscles of the hand, but even after a lengthened rest it is 
 not uncommon for spasm unexpectedly to occur. This is a 
 serious trouble to persons, such as clerks, who have to earn 
 their living by copying, &c. There is not the least doubt 
 that it is this circumstance and the long required rest, with 
 the sense of impending poverty, that makes recovery so slow 
 in the majority of these cases. When the spasm and the loss 
 of power are well marked it is advisable to train the muscles 
 of the other hand to execute the necessary movements, or 
 for the individual to take up some other work, such as typing 
 instead of writing. The possibility of writers' palsy occur- 
 ring in those who have to use the pen for several hours every 
 day raises the question incidentally as to whether it would 
 not be well to encourage the study and practice of ambi- 
 dexterity in our schools. By ambidexterity we might be 
 able to obviate some such troubles as these just mentioned. 
 Writers' palsy is certainly best got rid of by inducing other 
 sets of fresh muscular movements. The intemperate use of 
 alcohol and the excessive use of tobacco favour the develop- 
 ment of fatigue neuroses and retard recovery. 
 
 Typists and Telegraph Clerks 
 
 are liable to similar troubles to those just described ; so, too, 
 are pianoforte players. Mai telegraphique, or telegraphists' 
 spasm, was first described by Onimus, a Frenchman, in 1875. 
 
362 DISEASES OF OCCUPATION 
 
 Thirty years ago the malady was rare, but in the succeeding 
 ten years many cases were recorded. It is met with mostly 
 in those who use the Morse instrument. The Morse alphabet 
 is composed of a series of dots and dashes, and the messages 
 have to be quickly transmitted. Females do not appear to 
 be more predisposed to the muscular spasms than males. 
 Telegraphists who have suffered are prone to become 
 depressed mentally. A long holiday should be insisted 
 upon and ambidexterity encouraged. 
 
 Trap-Drummers^ Neurosis 
 
 In the Medical News, February 7, 1903, Dr. Charles 
 Aldrich, neurologist to the Cleveland General Hospital, 
 Ohio, draws attention to a hitherto undescribed series of 
 symptoms occurring in a man who had followed for twenty 
 years the occupation of a trap-drummer. Besides being 
 obliged to practise, he had to play twice a day in a theatre. 
 The work was heavy and required great rapidity and 
 strength. The drum had to be beaten by the operation 
 of a pedal manipulated by the right foot. This gave him 
 the use of both hands to play the other drums, triangle, and 
 the various traps, hence the name of trap-drummer. His 
 illness began with cramp-like pains and a feeling of exhaus- 
 tion in the muscles of the right leg below the knee, and was 
 accompanied by a sense of constriction of the leg as if the 
 circulation had ceased. This was followed by burning pains 
 in the knees when he began to walk or use the leg in beating. 
 It required a pressure of 5 to 25 lbs. for each stroke to play 
 the drum and a rapidity of movement equal to 150 to 180 
 strokes per minute. This always brought on a severe pain 
 in the knee, and at the end of the performance the leg felt 
 numb, heavy, and useless. On examining the right leg and 
 foot which did the work, they were found to be better 
 developed than the left leg and foot, but the muscles were 
 thrown into a state of painful cramp when the movements 
 required in beating the drum were made. It may be said of 
 all occupation neuroses that the muscles which are liable to 
 become affected by paralysis and painful cramps are those 
 
FATIGUE AND OCCUPATION NEUROSES 363 
 
 which are called upon to perform almost continually move- 
 ments that are the result of volition and sustained mental 
 attention — movements, in a word, that cannot be relegated 
 to automatic or excito-motor centres in the lower brain and 
 spinal cord. Hence motion and sensation both become 
 affected. It was only when Aldrich got the patient to 
 educate himself to use the left instead of the right foot that 
 progress towards recovery was effected. 
 
 It is astonishing how the exercise of certain muscles 
 leads to hypertrophy of these muscles. In a Punch and 
 Judy man who was an in-patient of the Royal Infirmary 
 I found the muscles of the forearms and hands, but espe- 
 cially those of the thumbs, enormously developed and 
 extremely strong compared with those of the other parts 
 of the body. He told me that on several occasions on a 
 Saturday evening, when some man in the crowd had inter- 
 posed his arm between the dolls, he would bring down the 
 wooden baton in Punch's hands with such force as almost 
 to break the arm of the intruder. The muscles of the thumbs 
 and forearm had become overgrown through use. It is well 
 to remember that over-employment can even affect hyper- 
 trophied muscles, as illustrated by the painful affection known 
 as " hammermen's spasm." 
 
 It is unnecessary to multiply examples of fatigue neuroses. 
 Violinists suffer equally with pianoforte players. Seam- 
 stresses are similarly affected in their hands, so too are 
 type-setters. The cowherds in the Tyrol are said to suffer 
 from milkers' spasm. All persons following occupations in 
 which quickly repeated muscular movements with con- 
 centrated mental attention are required are liable to the 
 painful cramps mentioned above. 
 
 School Teaching 
 
 The demand for education has created opportunities for 
 an increasing number of young girls to take up teaching as 
 a profession. To many girls the strain of preparation for 
 becoming pupil teachers is too great ; they break down 
 entirely in their nervous system, while in the case of others 
 
364 DISEASES OF OCCUPATION 
 
 the confinement in school is a cause of anaemia, and the 
 inability to sit and obtain rest during the menstrual 
 periods is productive of pain and uterine displacements. 
 Apart from these, the vocation of the female teacher is 
 not unhealthy, so long as the schools are well ventilated 
 and are not overcrowded. When the air is close and the 
 classrooms too full, headache is experienced by many of 
 the teachers. As pulmonary phthisis occurs in school 
 teachers with greater frequency than in members of the 
 other learned professions there is not the least doubt that 
 the malady is caught in the school or the conditions of 
 school life are such as to reduce the vital resistance of 
 the individual and render him more liable to disease. 
 As tuberculosis is an infective disease, and frequently the 
 result of inhaling dust to which the specific bacilli are 
 adherent, this raises the question as to the best means of 
 ventilating schools and of laying the dust of schoolroom 
 floors. The sweeping of floors should never be done in 
 the morning before school hours — always after, and before 
 being swept they ought to be sprinkled with some such 
 antiseptic liquid as a solution of carbolic acid. Children who 
 are known to be the subjects of tuberculous lung disease 
 ought not to be allowed to attend the ordinary schools, nor 
 should the attendance of children with open tuberculous 
 sores be encouraged unless the wounds have been dressed 
 antiseptically. 
 
 As a consequence of giving lessons in singing over a long 
 period young school teachers occasionally become hoarse. 
 On examining the larynx minute nodules, smaller than grains 
 of semolina, may be observed on the vocal cords. Under 
 complete rest to the voice, speaking only when necessary 
 and then not louder than a whisper, recovery usually takes 
 place. School teachers would act wisely if they did not use 
 dry cloths to remove the chalk markings on the black- 
 board, since inhalation of the fine dust in many instances 
 is followed by irritation of the lining membrane of the throat. 
 
 Young school teachers who have not had the ordinary 
 infectious ailments of childhood run the risk of catching 
 these during epidemics in schools. 
 
FATIGUE AND OCCUPATION NEUROSES 365 
 
 Domestic Servants 
 
 Domestic servants as a class supply a large contingent of 
 patients to infirmaries. The " general " servant has often 
 a hard life of it, owing to long hours, insufficient and 
 improper food, and the want of proper sleeping accommoda- 
 tion. A large number of domestic servants become anaemic. 
 Many of them suffer from dyspepsia and ulceration of the 
 stomach. In a few the ulceration is followed by vomiting 
 of blood and sudden perforation of the wall of the stomach. 
 As a consequence of being too many hours on their feet 
 some of the older servants suffer from varicose veins of 
 the legs, while owing to confinement indoors headache and 
 constipation are frequent complaints among all who are pre- 
 disposed to anaemia. 
 
CHAPTER XIV 
 DISEASES IN MISCELLANEOUS TRADES AND OCCUPATIONS 
 
 Tea Tasting 
 
 MEN employed as buyers and sellers in the wholesale 
 tea trade, and who are therefore required to taste 
 several samples of infused tea daily, frequently suffer from 
 dyspepsia and insomnia. The infused beverage is seldom 
 swallowed, the mouth is simply rinsed with the liquid ; but 
 as this is repeated several times in one day tea tasters 
 frequently suffer in consequence from uneasy sensations 
 in the stomach after food, flatulence, loss of appetite, and 
 constipation. Their nervous system, too, becomes unstrung. 
 Tea samplers suffer from nervousness and irritability, also 
 from loss of sleep. In some instances there is emaciation 
 and discoloration of the nails. The effects of tea tasting 
 and immoderate tea drinking differ from those of alcohol in 
 so far as the symptoms are mostly functional. If the 
 intemperate use of alcohol is carried on for a long time, 
 structural changes are set up in the liver, kidneys, and 
 nervous system, which may lead to death even after 
 indulgence in alcohol has ceased, but there are no similar 
 organic changes induced in the internal organs as the result 
 of the excessive use of tea. A patient has only to give up 
 taking tea, when he begins to improve and his symptoms 
 to disappear. When therefore tea tasters begin to suffer 
 in the manner already mentioned, they ought at once 
 to renounce the practice for a few months. There is an 
 idiosyncrasy to tea. Some persons can follow the occupa- 
 tion of tea tasting without experiencing any ill effects. 
 Those who cannot do so ought to renounce this particular 
 
 part of their duty. 
 
 366 
 
MISCELLANEOUS TRADES 367 
 
 Fish Curing: Herring Salting 
 
 Allusion is made elsewhere in these pages to the risks to 
 life and the dangers incurred by fishermen when plying their 
 calling. Out in all sorts of weather and exposed to sudden 
 squalls, their occupation is attended by considerable risk. 
 It is of the curing of fish that I would speak, and especially 
 of herring. This is an important industry. According to 
 the Report of the Scotch Fishery Board, 90,000 Scots are 
 employed in the various branches of sea fishing, of whom 
 one-fourth are women, and these follow the occupation of fish 
 curing. The perishable nature of the product and the 
 unexpected appearance of shoals of herring at certain places 
 render the trade peculiarly uncertain, and oblige employers 
 to proceed at once with the cleaning and curing of large 
 hauls of herring. As the herring migrate round the coast of 
 Scotland and down the East Coast of England, the fish are 
 followed by a fleet of boats and an army of male coopers and 
 female curers, and as the migration occurs during the summer 
 months, when in Scotland the days are long, the work is 
 frequently carried on well into midnight. In the months of 
 May and June the herrings are found at Stornoway and 
 Thurso, but by July the fish have moved onwards to the 
 Shetlands, Wick, Fraserburgh, and Peterhead, and for a time 
 these are the centres of the herring industry. Later on in 
 the autumn the move is southwards, to the Yorkshire and 
 Lincolnshire coasts, so that by October, Lowestoft and 
 Yarmouth are the principal seats of the industry. During 
 the summer months, when the weather is dry and fine, little 
 can be said against the surroundings of certain places where 
 the work is carried on. The hours are long and the work 
 is necessarily attended by a considerable amount of physical 
 fatigue. For the best accounts of the herring industry we 
 must turn to the Reports of the Lady Inspectors of Factories 
 which are published in the Annual Reports of the Chief 
 Inspectors of Factories and Workshops. The importance of 
 the herring harvest is not realised until a visit is made into 
 the far north of Scotland, when it becomes at once apparent 
 how the industry affects the wellbeing of thousands of 
 
368 DISEASES OF OCCUPATION 
 
 people. The uncertainty of the supply of herring and the 
 absence of local labour create special difficulties. Employers 
 are obliged to import large numbers of workers, since it is 
 impossible " to foretell with any degree of accuracy the 
 places where or the exact times at which herring are most 
 likely to be taken in great numbers ; consequently the curer 
 has to be prepared for dealing with a rich harvest, while fully 
 aware that it may not await him." Although the commercial 
 risks are considerable, they are on the whole favourable to 
 the employer. It pays him to engage and pay retaining fees 
 to a large number of women ready to deal immediately with 
 heavy catches of herring, for when the boats come into 
 harbour they are at once emptied of the fish, and the process 
 of curing is begun and continued to the finish without any 
 break in the work. The women who cure the herring are 
 strong and healthy : they are drawn from the Shetlands 
 and the Western Isles of Scotland, from the Highlands and 
 Aberdeenshire, and while there is a considerable amount of 
 friendliness among them, there is little intermingling of the 
 workers. Each set adheres to itself, and particularly is this 
 the case in regard to the hut accommodation provided. 
 
 After having wrapped bandages round the fingers that are 
 most likely to be injured by the knives, the female gutters, 
 having donned high boots, waterproof skirts, and a thick 
 coat, proceed to the work of cleaning and salting. Two 
 gutters and one packer constitute a "crew." Among the 
 crews there is a considerable amount of rivalry, and as the 
 gutting and packing of fresh herring come under the excep- 
 tion of unlimited hours permitted by the Factory Act, the 
 physical powers of the crews who are competing with each 
 other may become exhausted. The boats, too, come in at 
 irregular hours ; consequently just as much of the work may 
 have to be done between night and morning as during the 
 day. By working late on Saturday evening and commencing 
 again at midnight on Sunday the workers usually succeed in 
 getting the Sunday's rest. It is the irregular nature of the 
 work and the long hours that try the health of the gutters. 
 Occasionally they have nothing to do for days ; at other times 
 there is no possibility of getting leisure. Add to the long 
 
MISCELLANEOUS TRADES 369 
 
 hours the insanitary conditions of the surroundings, the wet 
 ground on which the women are standing exposed to 
 inclement weather, shortage of sleeping accommodation, 
 difficulty of obtaining proper food and time to eat it, and 
 it is small wonder that, strong and healthy as the women 
 are at the commencement of the fishing season, they are 
 towards the end of it frequently crippled in health. Some 
 idea of the imperfect housing accommodation may be learned 
 from the fact that in some places the sheds used in winter as 
 stores are utilised as sleeping-rooms in summer, one bed 
 being provided for each crew. As a consequence of the 
 arduous work, long hours, exposure to weather, and the lack 
 of healthy sleeping accommodation the vital resistance of the 
 women is reduced, so that many of them on reaching home 
 are found to be suffering from pulmonary disease or become 
 subsequently the subjects of chronic rheumatism. 
 
 There are risks incurred from the use of the knife in 
 gutting the herring, also from the stings inflicted by the 
 jelly-fish which often adhere by their tentacles to the fish. 
 Although the fingers which are liable to be injured are 
 usually protected by bandages, yet wounds are often acci- 
 dentally self-inflicted. Owing to the nature of the work and 
 the difficulty of keeping the wounds clean the broken skin is 
 apt to fester and the cuts to heal slowly, conditions which 
 expose the women to the possibility of blood-poisoning. 
 These are risks to which the gutters as a body are exposed, 
 yet fortunately few of the women become ill from this cause. 
 In addition to the overcrowding and insufficient hut accom- 
 modation the women complain of the deficiency of sanitary 
 conveniences. There is not the privacy for the women that 
 there ought to be, either at the curing stations or near their 
 huts, nor is there always an adequate supply of pure water 
 for drinking purposes and washing. As the industry is a 
 profitable one, employers should be obliged to pay more 
 attention to the requirements of female workers and should 
 be compelled to provide proper sleeping accommodation 
 and easily accessible sanitary conveniences, and, whenever 
 possible, not to extend the hours of work beyond the limits 
 of a reasonable working day. The evil effects of the work 
 
 BB 
 
370 DISEASES OF OCCUPATION 
 
 are not always in evidence during the busy season ; it is 
 later on when the women, having returned to their homes, 
 exhibit the signs of physical fatigue and of disease which 
 may be permanent. Were it not for the fact that the 
 women are strong and healthy at the commencement of 
 the season and are generally above 20 years of age, there 
 would be a greater amount of ill-health to record. 
 
 Younger girls, e.g., under 1 8 years of age, are employed in 
 the curing and smoking of haddocks, also in the preserving 
 and tinning of fish, but these girls live at home owing to the 
 industry being purely local. The surroundings in which the 
 work is carried on are not always good. The hours, too, are 
 long and are particularly trying to growing girls. If the 
 hours of work were better regulated, the curing and smoking 
 of fish would become a healthier occupation. 
 
 Fruit Preserving 
 
 The cheapness of sugar and the increasing inexperience 
 and helplessness of many of the wives of the working classes 
 as regards cooking in all its branches, are creating a growing 
 demand for factory-made jams. The art of preserving fruits, 
 of making sweet cakes, and of baking is declining as a 
 domestic pursuit in most parts of the country. To meet 
 this attempts are being made by municipal and other 
 authorities to instruct the rising generation in cookery. 
 Ignorance of cooking on the part of the wives and daughters 
 of the artisan and poorer working classes is responsible for 
 much of the domestic discomfort, also for the poor physique 
 of some of the children of to-day, and the wasteful extrava- 
 gance in many a home. 
 
 Many of the places in which jam is made in this country 
 ought not to be allowed to exist. Some manufacturers are 
 of the opinion that any building is good enough for their 
 trade. Consequently we find jam factories in courtyards 
 contiguous to stables and even more objectionable buildings 
 and with no attempt made to provide good flooring or 
 satisfactory ventilation. On the other hand, several of the 
 jam, chocolate, and confectionery factories which I have 
 
MISCELLANEOUS TRADES 371 
 
 visited at home and abroad are models of cleanliness. There 
 is no reason why all jam factories should not be such, for if 
 the British public only saw some of the places and knew how 
 preserves were made it is questionable whether the taste for 
 bought jams would be as widespread as it is. Fortunately 
 the old type of factory is disappearing. 
 
 There is neither any difficulty to be overcome nor any 
 intricacy of process to be observed in the making of pre- 
 serves. Much of the work can be done by unskilled labour. 
 Machinery is in use for the removal of the stones from 
 stone fruit. What are essential in a jam factory are cleanli- 
 ness and attention to minute details. The work is not light, 
 and yet many employers hesitate to introduce labour-saving 
 machinery. By young persons weights have to be carried 
 that are beyond their strength, and owing to the slippery 
 state of the floors falls are frequent. Burns and scalds from 
 the boiling mixtures are not unknown. There is a relaxation 
 of the Factory Act which allows of overtime being worked 
 during some of the summer months, and in consequence of 
 this there is a tendency for employers to overwork the 
 younger hands especially. To some extent this might be 
 prevented by the fruit being cleaned before it is sent to the 
 factories, and with the ready means of conveying information 
 by telegram between the growers of fruit and the pre- 
 serve manufacturers, there need not be the sudden and 
 unexpected arrival of large quantities of perishable fruit 
 towards the close of a working day, which, if it is to 
 be boiled at once, will necessitate overtime. 
 
 With judicious supervision the excessive moisture in the 
 boiling-rooms can be restrained, and considerable discomfort 
 and injury to health thereby prevented. The removal of ex- 
 cessive steam is desirable owing to its chilling effects upon the 
 workers, many of whom are thinly clad, are anaemic, and of 
 poor physique. In the large towns the girls are not always 
 drawn from the best classes of workwomen. They are ill-shod 
 as well as badly clad, and as they have to stand for hours 
 on wet floors, chilling of the extremities and the long shifts 
 lead to functional and structural derangement of the pelvic 
 organs, and lay the basis of female disorders and displace- 
 
372 DISEASES OF OCCUPATION 
 
 ments. During the spurt in the trade in the summer months 
 the work is fatiguing ; it is practically continuous, there being 
 little time for rest and meals. These conditions Home Office 
 Regulations have already materially improved. The evil 
 effects of working long hours in jam factories may not show 
 themselves in female workers until after long service therein, 
 or after the women have given up the factory altogether. 
 
 Label Licking 
 
 Formerly much in vogue in thread mills and in industries 
 connected with the sale of small packets, label licking fortu- 
 nately is falling into disrepute. On the occasion of my visit 
 to several factories wherein the practice was carried on it was 
 not uncommon to see young girls sticking labels on bobbins 
 after having licked them. In many instances the effect of 
 this practice was the development of enlarged glands in the 
 neck and small sores on the tongue. The coloured labels 
 often contain copper and lead, and had it not been for the 
 varnish on- the labels being of some resistance, there might 
 have occurred metallic poisoning as well. Apart from this 
 risk, the adhesive agent on the labels is occasionally obtained 
 from unhealthy sources. While the gum may be normal, the 
 water made use of to dissolve it may not be pure. Besides 
 it is not gum but a substance of an animal nature, a 
 serum, that is sometimes employed. To the use of this serum 
 and gum must be attributed the malady known as " stamp- 
 licker's tongue," in which small ulcers are found on the tongue 
 and inside of mouth. From these ulcers septic material may 
 be conveyed to the submaxillary glands in the neck, and 
 induce in these and adjacent glands an acutely painful 
 inflammation. Although the ulcers in the mouth are readily 
 cured by antiseptic washes and constitutional treatment, 
 label licking is a nasty practice which ought to be prohibited, 
 not simply on account of the risk of septic affection, but of 
 the great sacrifice of saliva it entails upon young girls at an 
 age when they require the secretion for digestive purposes. 
 The quantity of saliva lost to the system may be gauged by 
 the fact that half-timers will lick as many as forty to fifty 
 
MISCELLANEOUS TRADES 373 
 
 gross of labels in one day, and an adult woman ninety gross. 
 Mechanical contrivances exist for putting on labels. 
 
 In the thread mills of Scotland special power-driven 
 machines are in use for labelling reels of thread. It is a 
 matter of regret that in several of the large mills in England 
 manufacturers seem unwilling to put an end to the insanitary 
 method of effecting the labelling by means of the tongue and 
 saliva of girls. MiSs Squire, H.M. Inspector of Factories, 
 recently found in one factory forty little girls, twenty-one 
 of whom were half-timers, employed in labelling reels of 
 sewing silk and skeins and balls of embroidery silks. All of 
 them were moistening the adhesive labels by the mouth, 
 sometimes to the number of thirty gross a day or more. The 
 tongue of each girl had the polished tip characteristic of 
 label licking, while the remainder of the tongue was brown 
 from the gum. Some of the girls complained of the gum 
 tasting nasty and of making them feel sick at times, others 
 complained of feeling thirsty. One woman had sores on her 
 lips, which, while possibly a consequence of the work, presented 
 a breach of surface through which infection might enter. 
 Employers occasionally complain that where dampers have 
 been provided the employees refuse to make use of them. 
 In Leek, Staffordshire, a centre of the silk thread industry, 
 there are 250 women and girls who earn their living by 
 licking labels. The girls, who are paid on piece, can get 
 through 30 to 40 per cent, more labels than those who use 
 the dampers. This circumstance explains why dampers are 
 not used. The work is badly paid. Few girls make more 
 than 2s. to 2s. 6d. a week. 
 
 Sugar Refining 
 
 The manufacture of beetroot sugar is less a British than a 
 continental industry. In sugar factories the men who are 
 employed to stir the molasses, also those who work at the 
 refining processes, occasionally suffer from skin eruptions 
 which prevent them following their occupation. There is an 
 affection known as the " lymphangitis of sugar makers," but 
 this inflammation of the lymphatic vessels is not a serious 
 
374 DISEASES OF OCCUPATION 
 
 matter. At the outset the lymphangitis is attended by slight 
 fever and loss of appetite. If the workman continues to follow 
 his employment, there may occur a crop of boils, the skin 
 around which is hard and indurated. Occasionally the boils 
 suppurate. Within a fortnight the workman is able to return 
 to the factory. It is interesting in connection with this to 
 remember that patients who are the subjects of diabetes and 
 who are passing sugar in their urine also suffer from boils. In 
 the case of sugar makers it is more than probable that the 
 micro-organisms of the air and water settle down upon the fine 
 hairs of the skin, and through the follicles gain an entrance 
 into the skin itself The sugar itself seems to exercise some 
 local influence, for it may act upon the blood, and thus, as in 
 diabetes, predispose to the formation of boils, eczema, and 
 ulceration of the skin. A series of experiments carried out 
 by M. Gaillot ^ at Aisne has shown that the lymphangitis of 
 sugar makers is caused by an organism, the Staphylococcus 
 pyogenes aureus^ and that this micro-organism is not found 
 in freshly-made molasses, but is met with in the residue, and 
 that the temperature of the factory and the condition of the 
 skin of the workpeople are both favourable to the develop- 
 ment of the microbe. During the multiplication and growth 
 of the Staphylococcus pyogenes aureus the micro-organisms 
 produce fatty acids by transforming saccharine material into 
 lactic, acetic, and butyric acids, while virulent toxins are 
 formed as well. These soluble poisons along with the micro- 
 organisms may penetrate the skin by the hair-follicles. 
 
 The treatment of the skin affection consists in bathing the 
 skin with such antiseptic and germicidal solutions as mercury 
 perchloride or carbolic acid. In the newer processes of sugar 
 manufacture in which mechanical methods have supplanted 
 hand labour boils are not so frequently met with among the 
 workmen. 
 
 Manufacture of Aerated Waters 
 
 The manufacture of aerated waters is a dangerous industry, 
 for owing to the pressure under which the bottles are filled 
 accidents arise through breakage. The bottles when they fly 
 ' Bulletin de t Inspection du Travail, 1903, Nos. 3 and 4, p. 197. 
 
MISCELLANEOUS TRADES 375 
 
 produce serious wounds, for these are usually deep and 
 blood-vessels are frequently severed. Until recently the loss 
 of an eye was not an uncommon occurrence in aerated mineral 
 water works. Since the introduction of face-guards and 
 gauntlets the number of accidents has been materially 
 reduced. Bottlers, wirers, sighters, and labellers are all 
 alike liable to be injured unless protectors are worn. The 
 bottlers are most exposed to danger. The bottles often 
 burst in the machine with considerable force and fly great dis- 
 tances, occasionally inflicting serious injury upon workpeople 
 several feet away. Bottling is done both by men and young 
 women. Wiring has gone out greatly since the introduction 
 of patent stoppers. Sighters examine the filled bottles by 
 holding them up to the light to see if any specks are present. 
 Sighters and labellers often discard the protective wire 
 gauze face-guards and gauntlets. The sighters say the face- 
 guard interferes with their proper observation of the bottles, 
 and the labellers dislike the gauntlets, or woollen mittens, 
 because they interfere with the rapid handling of the bottles. 
 If the face-guards are made of light wire and do not press 
 too closely upon the face, but fit comfortably, there is less 
 objection raised to them, but if they are at all heavy or of a 
 clumsy make the workpeople refuse to wear them. All 
 persons employed in an aerated water works are exposed to 
 the risk of bottles bursting and flying through the workroom. 
 The other dangers incidental to the trade are standing in the 
 wet and working in wet clothes. In addition to wearing the 
 protectors above mentioned, splashboards should be provided, 
 also waterproof clothing and clogs for the feet. 
 
 Glass Making 
 
 Glass is made from fine sand that has been carefully dried, 
 and is known to be free from iron. The sand supplies the 
 necessary silicic acid. To it soda, salt, lime, felspar or 
 quartz, and according to the colour wanted, red lead, black 
 oxide of manganese, nickel, arsenic, or copper are added. 
 Boric acid may be substituted for silicic acid. The sub- 
 stances when mixed are melted in a circular furnace at an 
 
376 DISEASES OF OCCUPATION 
 
 extremely high temperature. Through small openings in 
 the wall of the furnace workmen wearing blue-tinted spec- 
 tacles can watch the molten mass. At a high temperature 
 the vitreous material is in a fluid state, and can be poured, 
 moulded, or blown. Blowing is usually adopted for hollow 
 glassware. The principal instrument of the glass-blower is a 
 hollow iron tube, one end of which is dipped into the lake of 
 molten material in the furnace. On removing the iron tube 
 there is a blob at the end of it. In blowing down the tube 
 the glowing mass at the distal end assumes a globular shape. 
 This can be blown into the particular form required. 
 
 Glass-blowing is, comparatively speaking, an unskilled 
 trade, and one of rather low standing. It throws a good 
 deal of strain upon the muscles of the trunk, also upon the 
 lungs, which in course of time may become emphysematous 
 and the seat of bronchitis. This, however, as we shall see 
 later on, has been doubted. The excessive heat and perspira- 
 tion create a sense of thirst not always easily appeased. 
 
 Sheet and plate glass are obtained by pouring on to an 
 flat iron table the molten mass from the furnace or crucible 
 and rolling it to the required thickness. Beyond burns and 
 the effects of exposure to the great heat the work is not 
 dangerous, nor is there anything unhealthy in the polishing 
 of glass on the oscillating tables so long as simple polishing 
 powders are used for the purpose. Glass polishing has been 
 a source of ill-health to persons employed, but that has 
 always been when the polishing powder has contained lead. 
 
 Engraving on glass is generally performed by exposing 
 glass to small wheels covered with leather and revolving 
 rapidly or by the application of hydrofluoric acid. This 
 acid has the power of eating out, as it were, the glass 
 wherever applied. The portions of glass not to be acted 
 upon are protected by a coating of wax. The whole of the 
 glass is in the first instance covered with wax, and by means 
 of a hard pencil the emblems are delineated upon it. Hydro- 
 fluoric acid is a poison, and when applied to the skin it may 
 cause ulceration which is both painful and slow to heal. 
 The vapour given off by the acid causes running at the eyes 
 and nose. 
 
MISCELLANEOUS TRADES 377 
 
 Glass makers suffer at times from the effects of the great 
 heat and exposure to rapid variations of temperature. Bron- 
 chitis and pulmonary diseases are common among them. 
 In the Munch. Med. Wochensch., 1904, Prettin and Liebkind 
 discuss the subject of the pulmonary emphysema of glass- 
 blowers. Physicians who attribute emphysema of the lungs 
 to mechanical causes generally allude to instances of the dis- 
 ease in men whose occupations require powerful respiratory 
 efforts frequently repeated, e.g.^ players on wind instruments, 
 glass-blowers, &c., but Fischer did not find one single case 
 of pulmonary emphysema in five hundred army musicians 
 whom he examined. My friend and teacher the late Sir Wm. 
 Tennant Gairdner, in his lectures on the causation of pul- 
 monary emphysema, used to tell his class of the absence of 
 emphysema of the lungs in well-known bagpipe players. 
 Prettin and Liebkind examined 230 glass-blowers, of whom 
 218 were from 25 to 50 years of age, also 12 glass-blowers 
 aged from 50 to 62. All had worked at the trade for more 
 than twenty years. The numbers were 10 1 for more than 
 thirty-one years, and 24 for ten years. Of these 230 work- 
 men there were only 5 who were suffering from pulmonary 
 emphysema. One hundred and sixty-four of the men aged less 
 than 40 years did not furnish one single case : of 54 men 
 from 40 to 50 years of age only 2 were attacked, and of 12 
 more than 50 years of age 3 presented physical signs and 
 symptoms of emphysema. Using pneumatomatic methods, 
 these observers found that the intra-thoracic pressure in all 
 glass-blowers is greatly increased. Notwithstanding this 
 fact they maintain that glass-blowing does not produce 
 pulmonary emphysema, and that when it does occur dis- 
 crimination should be made between the distension of the 
 alveoli of the lungs caused by repeated respiratory efforts 
 and the same condition induced by inhalation of dust and 
 the frequent colds and bronchitis to which glass-blowers are 
 subject. Cough alone, according to Prettin and Liebkind, is 
 not of itself causative of emphysema of the lungs. Although 
 according to their statistics emphysema in glass-blowers is 
 uncommon, their inquiry showed on the other hand that pul- 
 monary tuberculosis is met with in glass-blowers to the extent 
 
378 DISEASES OF OCCUPATION 
 
 of 20 per cent., part of which they attribute to the unhealthy 
 condition of the trade and to direct contagion by the blow- 
 pipe which is in use being passed on from one workman to 
 another. 
 
 As there is usually a great amount of dust being blown 
 about in the neighbourhood of the furnaces the eyes of the 
 workmen occasionally become inflamed. Glass-blowers should 
 have and should use their own blow-pipes and not take them 
 up indiscriminately, owing to the possibility of tubercular and 
 syphilitic infection. The men who use the blow-pipes are 
 liable to "glass-blowers' mouth," a condition to which Dr. 
 Schule, of Berlin, drew attention, and in which large swellings 
 like air-cushions appear on the cheeks, extending from the 
 angle of the mouth to below the ears. The swellings look 
 like mumps, and involve the parotid gland. They crepitate 
 under the finger, and by pressure can be made to disappear. 
 This relaxation of the cheeks is by some writers attributed 
 to faulty blowing. I have met with this facial deformity in 
 glass-blowers in Newcastle, but it is not of common occur- 
 rence in the North of England. Dr. Schule found it present 
 in 25 per cent, of the men employed. The deformity is due 
 to air under high pressure entering the duct of the parotid 
 gland, where it opens into the mouth inside the cheek, and 
 where thick pale patches of hardened mucous membrane 
 can be seen — plaques opalines — which Guinard regards 
 as the result of the great straining and pressure the buccal 
 mucous membrane is exposed to during the act of blowing. 
 In the course of one day a good workman will blow as many 
 as six or seven hundred bottles. This is an indication of 
 the strain the men are exposed to, and from which, in 
 addition to the deformity just mentioned, the men suffer 
 from deafness consequent upon the increased internal pressure 
 in the middle ear. Many of the men, owing to the peculiar 
 manner in which they grasp the iron blow-pipe, suffer from 
 a deformity of the fingers known as main en crochet. In the 
 new methods of glass-blowing the blowing is not done by men 
 but by machinery. Compressed air is driven into the glass 
 by machinery, so that instead of a man being able to throw 
 off only 40 glass tumblers in an hour, i machine worked 
 
MISCELLANEOUS TRADES 379 
 
 by 4 men and 7 boys can by the new method throw oflf 
 500 in an hour or 5,000 in a working day. The substitution 
 of compressed air will do much to remove many of the minor 
 ailments glass-blowers have suffered from. It is also more 
 cleanly and hygienic. 
 
 There is one other malady glass workers are subject to 
 and to which attention must be drawn, and that is the risk 
 to the men of losing their eyesight from cataract. The 
 statistics of ophthalmic surgeons in regard to the frequency 
 of cataract in glass workers are somewhat at variance, but 
 from figures supplied by the Yorkshire Bottle Trades' Union 
 it appears that out of 1 14 cases of men on their superannua- 
 tion fund 37 went on the fund on account of cataract.^ It is 
 believed that the crystalline lens of the eye in glass workers 
 becomes more frequently opaque than in men following other 
 occupations. Dr. Probsting, an oculist in Cologne, found 
 cataract present in 12 per cent, of the factory operatives in 
 Ehrenfeld above 40 years of age, and Meyhofer in 11 '6 per 
 cent, of 506 glass workers. In Sunderland there are 400 men 
 employed in glass factories. Dr. Wm. Robinson, of that 
 town, informs me that 48 of these men have been operated 
 upon for cataract. It is the furnacemen, or those who are 
 exposed to the great heat and light, who suffer most. 
 Bottle-makers have to look into large tanks filled with 
 molten material, the temperature of which is often 2,500° F. 
 Robinson finds that the cataract commences in the posterior 
 pole of the lens, and Hirsch is also of the opinion that it 
 begins in the cortical layer on the posterior wall of the 
 crystalline lens. According to Cramer 2 it is the left eye 
 that is the more frequently affected. The workman usually 
 stands with his left side to the furnace, the left hand sup- 
 porting the blow-tube, which is held and directed by the 
 right. The change in the lens proceeds so slowly that it is 
 not until months or years have elapsed that the men consult 
 
 ^ Through the kindness of Mr. Alfred Greenwood, Secretary of the 
 Glass Bottle Makers of Yorkshire United Trade Protection Society, 
 I am able to state that since these figures were published other 85 cases 
 have been added to the superannuation fund, making a total of 199, 
 and of these 85 cases 15 were placed on the fund on account of cataract. 
 
 =* Klin. MonatsbldtUr f. Augenheilk., January, 1907. 
 
38o DISEASES OF OCCUPATION 
 
 a doctor. Meyhofer attributes the physical and structural 
 changes in the lens to excessive perspiration, or, in other 
 words, to great loss of liquid from the system, as in the 
 cataract of diabetic patients ; but it is much more likely 
 that it is the result of the extreme heat and the brilliant 
 white light, which has a dazzling effect, and which by 
 fatiguing the retina of the eye reflexly influences the 
 nutrition of the lens. Cramer attributes the cataract to 
 the chemical rays emitted by the glowing glass and due 
 to the calcium present in the sand. The wearing of blue- 
 tinted spectacles by the men when at work would go far 
 to prevent this tendency to cataract in glass workers. The 
 interposition of a flat glass dish between the chink in the 
 furnace and the workman, and filled with a red solution of 
 such concentration as not to impede the view, would cut off 
 the chemical rays from the calcium salts just mentioned and 
 would act as a preventive to cataract. Fortunately, when the 
 worst comes to the worst nearly all the cases do well after 
 operation for the removal of the opaque lens. Mr. Simeon 
 Snell of Sheffield is of the opinion that the frequency of 
 cataract in glass-blowers is overrated. 
 
 Bnck Making 
 
 In an appeal almost as plaintive as that of Mrs. Barrett 
 Browning in the "Cry of the Children," George Smith, of 
 Coalville, laid bare the iniquities that existed and the hard- 
 ships that were endured by children in the brickyards of 
 England only a few years ago. " The matter of fact that 
 I should wish to bulk out in all its largeness and shame 
 before the philanthropy and Christianity of England is that 
 in our brickfields and brick works there are from 20,000 to 
 30,000 children, from as low as 3 and 4 up to 16 and 17, 
 undergoing a ' bondage ' of toil and a horror of evil training 
 that carries peril in it. ... I claim the protection of the 
 law for these children specially, and all children universally, 
 by placing them within the inspection and regulation of an 
 Act kindred with the Workshop or Factory Acts.''^ The 
 » " The Cry of the Children from the Brickyards of England," 1879. 
 
MISCELLANEOUS TRADES 3^1 
 
 condition of the children employed in the Midlands in brick 
 and tile making in the seventies was deplorable. George 
 Smith himself began life by assisting to make bricks at the 
 age of seven, and he incidentally alludes to the harsh and 
 unkind treatment often meted out to him. At the age of 
 nine his occupation consisted in carrying upon his head 
 loads of clay weighing 40 lbs. in weight from the clay heap 
 to the table upon which the bricks were made. This went 
 on, practically speaking, without intermission for thirteen 
 hours a day. On one occasion after a customary day's 
 work he was obliged to carry 1,200 nine-inch bricks from 
 the maker to the floors upon which they were to harden. 
 For all this labour he received sixpence. The fatigue 
 induced brought on a serious illness. Smith's experience 
 was only that of hundreds of other children. Boys and 
 girls from nine to twelve years of age worked together in 
 the brickyards in a state bordering upon nudity. Their 
 employment consisted in carrying damp clay upon their 
 head to the brick makers, or in carrying away the made 
 bricks to the drying floors ; and as the work went on for 
 thirteen hours a day the children often travelled a distance 
 of 20 miles, and yet the Government officials could not 
 interfere, since the Acts of 1867 did not apply to establish- 
 ments in which less than fifty persons were employed. It 
 was impossible for such young children, many of them im- 
 properly fed and all of them poorly clad, to keep up 
 with the requirements of the men at work, and so between 
 curses and blows this iniquitous slavery went on for years. 
 As a proof of the heavy weights carried by the children, 
 Smith removed a piece of clay which a child of nine years 
 of age was carrying and found that it weighed 43 lbs. This 
 child covered daily a distance of 12J miles, in one-half of 
 which the weight had to be borne. In those days a work- 
 man made on an average 3,000 bricks a day, equal to 
 12 tons in weight, and these had to be carried by two 
 children. Under these degrading conditions there is small 
 wonder at the ignorance and immorality that prevailed and 
 at the physical degeneration of the children. As the boys 
 grew to manhood they rose to higher positions in the brick- 
 
382 DISEASES OF OCCUPATION 
 
 yard, but without any true knowledge of their duties, 
 religious or social. Thriftless and ignorant, the years went 
 by, and when these men became prematurely old the 
 workhouse was their goal. Eighty per cent, of the males 
 who applied to one of the large unions for relief were 
 brick makers. 
 
 A Brickyard Act was passed in 1871 which did much 
 to change the character, habits, and customs of those in the 
 trade. Since then the children have been spared the long 
 hours, and all of them can receive the benefits of a school 
 education. They are no longer permitted to commence 
 work in the summer months at 5 a.m. and go on until 
 8 and 9 p.m. Notwithstanding all that has been done in 
 the way of factory legislation, cases still are brought into 
 court of young persons being worked overtime and of being 
 obliged to carry weights upon their heads far beyond their 
 strength. 
 
 Brick making cannot be said to be an unhealthy occu- 
 pation, except as regards exposure to the weather, the 
 temperature, and fatigue. The bulk of the work is carried 
 on in the open air. Ulcers and varicose veins in the legs 
 are frequently found in the workers who knead the clay. 
 The moulders suffer from painful and inflammatory swellings 
 of the hands and wrists, and the palm of the hands may 
 be the seat of a dermatitis.^ 
 
 As a consequence of the hard work men become 
 prematurely old. In the brickyards around Cologne the 
 workpeople suffer from anaemia, due to the presence of a 
 parasite in their intestinal canal (see " Ankylostomiasis "). 
 In England brick makers live at home, but in certain parts 
 
 ^ The introduction of machinery is altering the manufacture of bricks. 
 While these pages are passing through the press I have a young woman 
 twenty years of age in my ward, in the Royal Victoria Infirmary, who 
 is a brickmaker, and who, although a strong, healthy girl and free from 
 organic disease, was admitted on account of sheer exhaustion. She 
 was simply worn out. She informs me that she can make 20,000 bricks 
 in one day, and that she is paid at the rate of twopence-halfpenny 
 per 1,000 bricks. The lifting off of the bricks is tiring work. By 
 working from 6 a.m. to 7 p.m. she has sometimes made as much as 
 from 4s. to 4s. 6d. a day. 
 
MISCELLANEOUS TRADES 383 
 
 of the Continent the workpeople are housed in wooden 
 barracks, most of the dormitories of which have no windows, 
 the bedding swarms with vermin, and overcrowding prevails. 
 Rather than occupy such places the Factory Inspector of 
 Augsberg states that the workpeople sleep out of doors. 
 
 Coal-tar^ Pitchy and Allied Products 
 
 Technical chemistry has demonstrated what a world of 
 wealth and variety of colours are concealed in tar. In the 
 distillation of tar certain oily liquids are obtained. From 
 the lighter oils benzine is obtained and from the heavier 
 daraffin. Carbolic acid is also a tar product. During the 
 distillation of tar, such gases and products as ammonia, 
 carbonic acid, sulphuric acid, sulphurous acid, and creasote are 
 given off. Persons brought into contact with these products 
 occasionally suffer from inflammation of the eyes, running 
 at the nose, bronchial catarrh, dyspepsia, headache and 
 vertigo. Frequently the skin becomes dirty looking and 
 cyanosed. Men employed in pitch works suffer in a similar 
 way from the vapours given off during the pouring and 
 settling of the molten material. During the pounding 
 or grinding of dry pitch large quantities of dust are given 
 off. Many of the men who follow the employment not only 
 become bronzed and sallow, but their skin becomes the 
 seat of a peculiar cancroid eruption such as is occasionally 
 met with on the scrotum of chimney-sweeps. In other 
 persons there may be bronchitis, digestive disorders with 
 dark stools, also ulceration of the nose. 
 
 The question as to whether manipulation of tar products 
 or exposure to the fumes given off by coal-oil and tar is 
 capable of giving rise to cancer has come before me in the 
 case of three men employed in grease works. These men 
 in following their employment all worked with their sleeves 
 rolled up to above the elbow. It has been observed in the 
 trade that when men have warts on their hands these 
 frequently disappear when they first undertake the work, 
 and, on the other hand, that in men whose skin has been 
 quite healthy, wart-like growths are apt to develop when 
 
384 DISEASES OF OCCUPATION 
 
 they have followed their employment for some time. In 
 addition to the warts, of which there may be as many as from 
 thirty to forty on the hands and forearms, there develop 
 hard nodules in the skin which ulcerate and often exhibit 
 very little tendency to heal. The edges become hard, and 
 the ulceration, extending to the deeper tissues, may ulti- 
 mately involve the bone and necessitate, as in one of the 
 men I have alluded to, amputation of the arm. The appear- 
 ances presented by the ulcer are those of the type of cancer 
 known as epithelioma. The presence of these warty growths 
 on the forearms and hands, and of ulcers that tend to take on 
 malignant characters, in tar and pitch workers is so frequent 
 that they must be in some way or other associated with the 
 employment. The morbid processes advance very slowly, 
 and therefore do not readily unfit the individual for work. 
 In many instances removal of the ulcer is not followed by 
 any recurrence of the growth, but a return to the work lays 
 the person open to fresh developments. On the forearms of 
 one of the grease workers above-mentioned there are numerous 
 small patches of induration, some of which have ulcerated 
 and exhibit no tendency to heal. The edges of the ulcers 
 are hard and brawny. There are, in addition, scattered all 
 over the forearm numerous black warts of various sizes, 
 also several scars of a pale colour compared with the 
 bronzed skin that surrounds them. One of these men, 
 aged fifty-eight, has worked among coal-oil and tar pro- 
 ducts for thirty years. The scars referred to are the remains 
 of ulcers that have healed. In the case of his son, aged 
 twenty-seven years, the ulceration took on the characters 
 of malignant disease, and on that account the arm had 
 to be amputated above the elbow. Although it is usual 
 when the disease is treated by surgical operation for no 
 recurrence of the growth to take place, in this particular 
 instance the glands in the armpit and neck became subse- 
 quently enlarged owing to infective particles having reached 
 these glands by the lymphatics, and the patient became the 
 subject of secondary cancer. Microscopical examination of , 
 the ulcer leaves no doubt as to the cancerous nature of the 
 lesion. Knowing that in the case of chimney-sweeps' cancer 
 
 J 
 
MISCELLANEOUS TRADES 385 
 
 arsenic is present in soot, and may possibly be a cause of 
 epithelioma, I analysed the coal-oil these men had been 
 manipulating, but failed to find any traces of the metal. The 
 Departmental Committee on Compensation for Industrial 
 Diseases has recommended that the malady should be made 
 the subject of compensation. 
 
 Motor-car Driving: Motor Garage 
 In the Lancet, July 7, 1906, Mr. W. J. Burroughs reports the 
 case of injury to the spine of a motor-bus driver who, on a 
 particular day, had considerable difficulty in starting his engine. 
 In turning the starting-handle and giving it a jerk consider- 
 able force was required. Owing to the muscular strain 
 involved in this act he lost the power in his legs, and was 
 for a time incapacitated for work. Motor-car drivers are 
 exposed to all sorts of accidents, some of which are due to 
 starting the cars, others to excessive speed, collisions, &c. 
 I have recently had under my care a young chauffeur who, 
 when trying to set his engine in motion, had one of his 
 hands forcibly driven against the dial marker by the wheel 
 revolving suddenly. His median nerve was ruptured, and 
 in consequence of a bad union having taken place there 
 was loss of sensation and loss of power in the hand, which 
 were restored by surgical operation. In what is known as 
 "chauffeurs' fracture" it is the radius that is broken. The 
 injury is consequent upon the sudden backward jerk of the 
 starting handle. Pain in the wrist is at once experienced, 
 and crepitation can shortly afterwards be felt. In some of the 
 cases there is no deformity — the physical signs are simply those 
 of separation of the styloid process — but in others the deformity 
 is considerable. The right hand, the one usually affected, 
 is displaced in a dorsal and ulnar direction. The lower end 
 of the radius may be found projecting immediately under 
 the skin on the flexor surface of the wrist. Lucas-Cham- 
 pionniere distinguishes two forms of chauffeurs' fracture : " one 
 direct, and caused by the lower end of the forearm being 
 struck by the reversed handle ; the other indirect, and caused 
 by a violent jerk while the wrist is hyper-extended (^fracture 
 par arrachement) . . . . Occasionally the fracture seems to be 
 cc 
 
386 DISEASES OF OCCUPATION 
 
 caused by the palm of the hand being violently struck {com- 
 pression fracture)" ^ Madelung attributes the fracture to the 
 fact that the hand is so forcibly bent backwards by the 
 handle that the styloid process of the radius is torn off. The 
 kind of fracture that ensues depends upon whether the 
 chauffeur retains his grip on the handle or not. 
 
 Chauffeurs have consulted me for headache, loss of appetite, 
 and giddiness on account of inhalation of the petrol vapour 
 when cleaning the cars ; others, in consequence of the 
 strain upon their nervous system in frequently repeated long 
 drives, have sought my advice owing to tremors and loss of 
 confidence in themselves without any such concurrent cause 
 as indiscretion in the use of alcoholic stimulants. Rest from 
 driving for a few days, along with tonic medicines to which 
 bromide of ammonia or potassium is added, gives satisfactory 
 results and a speedy cure. 
 
 It is unnecessary to emphasise the necessity for wearing 
 goggles, on account of insects in the air and the irritation 
 to the eyes caused by dust. 
 
 Persons driving in a motor-car have been accidentally 
 poisoned by carbon monoxide gas. In an ordinary way the 
 carbon monoxide which is produced in the explosions escapes 
 by a tube which discharges behind the car, and cannot there- 
 fore injure the occupants. A lady and her two daughters 
 who had been driving in a closed motor-car became at the 
 end of half an hour the subjects of tingling noises in the ears, 
 vomiting, and unconsciousness. The car had recently been 
 mended, and owing to loosening of the partitions of the floor 
 the burnt gases had found their way into the interior of the 
 car and had poisoned the inmates. 
 
 Laundries 
 The hardships experienced by laundresses who work at 
 home, and who in a large city like London have to compete 
 with the laundries owned by companies and run by machinery, 
 are graphically told by Miss L. A. E. Deane, H.M. Inspector 
 of Factories in " Dangerous Trades," to whom I am indebted 
 for much that follows in the text. The social changes of our 
 * Medical Review, November, 1906, p. 591. 
 
 J 
 
MISCELLANEOUS TRADES 387 
 
 times, the increase of town populations, and a diminishing 
 aptitude on the part of the rising generation for laundry 
 work, are tending to the development of company laundries 
 and public washhouses, and so far as towns are concerned 
 there is not the least doubt that these laundries will increase. 
 To have the washing done away from home is in some 
 instances a necessity, in others it is a luxury. A new 
 industry has thus sprung up in our midst. As time goes on 
 it will give employment to an increasing number of hands 
 drilled and organised so as to look after particular kinds of 
 work. At present 100,000 persons are employed in laundries. 
 In towns where the atmosphere is smoky bleaching can only 
 be carried on by artificial means. Some of the bleaching 
 powders used are injurious to the hands of the workers. 
 They are a frequent cause of painful cracking of the skin 
 and of eczema. Owing to the variety of the machinery in 
 use accidents are not unknown. In certain processes the 
 women are exposed to high temperatures, especially in the 
 ironing department of large laundries where the washed linen 
 is drawn under hot revolving rollers, and where a temperature 
 of 90° F. even in winter has to be borne by the girls that feed 
 the machinery. It is the use of machinery that has brought 
 laundries within the sphere of the Factory Acts and enabled 
 owners to employ comparatively unskilled labour such as can 
 be obtained from girls of fourteen and sixteen years of age. 
 As the public requirements increase there will be a greater 
 demand for girls as machine tenders, for laundries run by 
 machinery are fast displacing the hand laundries in which 
 five or six women only are employed and the work in which 
 is frequently carried on in, or close to, dwelling-houses. It is 
 unnecessary to descant upon the inconvenience and discom- 
 forts of the washing day at home in small houses, or upon 
 the unhealthy atmosphere created by the steam and heat 
 and by the disagreeable odours that are raised in the processes. 
 The number of accidents in laundries is unusually large. 
 In 1906 there were 301 accidents reported to the Chief 
 Inspector of Factories — 46 males and 255 females. The 
 increased number of accidents affecting women and girls is 
 probably the result of the growing use of ironing machinery 
 
388 DISEASES OF OCCUPATION 
 
 and of the employment of young, unskilled girls in operating 
 and cleaning it. Miss Sadler, H.M. Inspector of Factories,^ 
 draws attention to the rapid increase in the number of 
 mechanical calenders, ironers, wringers, and hydro-extractors 
 used in laundries. A most unusual cause of death in laundry 
 workers has been reported by Miss Tracey. Two persons 
 are reported to have died of tetanus ; one, a girl aged fifteen, 
 got a splinter under her finger when washing the messroom 
 floor of the laundry and died two days afterwards ; the other 
 was a man who received injuries while trying to start his 
 engine. How the tetanus bacillus got into the laundry it 
 is impossible to say. In each instance the fatal illness had 
 nothing to do directly with the employment. Probably the 
 flooring of the messroom had become infected by the soiled 
 boots of the workers. 
 
 Apart from the unhealthy influence of the high temperature 
 and steam, there has hitherto been the tendency for the 
 employees to be worked too long and for the hours to be 
 irregular. Long before the establishment of large laundries 
 we as medical men were familiar with the varicose veins and 
 ulcers on the legs of women who went from house to house 
 doing a day's washing ; and although in the modern laundry 
 machinery has replaced hand labour, women are still obliged 
 to be on their feet for many hours during the day and are 
 thus still predisposed to these minor but troublesome ailments. 
 Many of these women are so poor that when they become 
 unfit for work they gravitate towards the Union Infirmaries. 
 Among the patients in the Wandsworth Union Infirmary the 
 proportion of laundresses suffering from ulcers of the legs is 
 I in 6, whereas in non-laundresses it is i in 23 ; and in the 
 Isleworth Infirmary i in 6 laundresses suffers from ulcers on 
 the legs, while in non-laundresses the proportion is i in 25 
 to 31. There is a considerable amount of ill-health among 
 laundresses, especially the younger women, since the work 
 has to be done by them standing and in a high temperature, 
 which cannot be other than exhausting. The hours per 
 week of workers in laundries are longer than those of persons 
 
 ^ " Annual Report of the Chief Inspector of Factories and Workshops," 
 1906, p. 203. 
 
MISCELLANEOUS TRADES 389 
 
 employed in textile factories ; j6 hours a week may be spent 
 in laundries, not including meal hours. 
 
 In visiting large laundries I have been struck by the pale 
 and anaemic look of many of the women employed in the 
 department where ironing by hand is carried on. Many of 
 the women suffer from headache and tender eyes consequent 
 upon bending over the table and inhaling some of the coal- 
 gas which escapes from the tube or jets and which is kept 
 lit to maintain the temperature of the irons. Some of the 
 symptoms are the result of high temperature and mild carbon 
 monoxide poisoning. 
 
 There is a current opinion that women employed in 
 laundries are intemperate, and that the conditions of the 
 work are such as to lead them to drink. The close atmo- 
 sphere, the wet floors, and the disagreeable odours in some 
 of the departments are extremely trying ; the hours are long 
 and the work is exhausting ; the chemicals used, such as soda 
 and ammonia, by causing dryness of the throat create a thirst 
 which the workers feel a draught of beer will allay. I was 
 certainly astonished in visiting laundries in London to find 
 that at certain hours of the day a stop was called and that 
 cans of beer were brought into the laundry and sold to the 
 workers. Is there any other industry in which twice a day 
 the work of the factory ceases for ten minutes to allow of 
 beer being drunk by the workers ? When we remember that 
 it is to women the beer is being distributed and that the 
 female sex is more prone than the male to some of the more 
 serious nervous affections caused by alcohol, e.g.^ peripheral 
 neuritis followed by paralysis, to say nothing of the particular 
 relations of woman to offspring, no words can be used suffi- 
 ciently strong to condemn a practice which, while it may 
 allay immediate sensations, is in the long run productive of 
 the most serious consequences not confined to the workers 
 themselves. In many of the large ironworks in the North of 
 England and in many of the factories wherein high tempera- 
 tures are experienced the men drink water in which oatmeal 
 has been soaked. There is no reason why some such diluent 
 as this or something equally simple should not be tried by 
 women employed in laundries. 
 
390 DISEASES OF OCCUPATION 
 
 There is another side of laundry life to which attention 
 must be drawn. Laundry workers exhibit a greater liability 
 to pulmonary consumption than women following other 
 employments. In the Clapham Infirmary of the Wandsworth 
 Union while i of every ii laundresses was found to be 
 suffering from pulmonary phthisis, among female patients 
 who were not laundresses the proportion was i in 19 ; in the 
 Isleworth Infirmary the numbers were i in 10 and i in 20 
 respectively. If anything were required to demonstrate the 
 unhealthiness of laundry work and the liability to tuberculous 
 disease created by it, reference need only be made to the 
 writings of a French physician. Professor Landouzy, of 
 the H6pital Laennec, Paris, has in La Presse Medicate^ 
 October 6, 1905, described what is the experience of his 
 own hospital in regard to this subject. In Parisian laundries 
 both men and women are employed in washing and ironing. 
 The laundresses seek hospital treatment on account of vari- 
 cose veins, ulcers on the legs, and for such pelvic troubles as 
 uterine displacements, while the men apply for relief mostly 
 on account of hernia. Injuries and burns are frequently met 
 with. What struck Professor Landouzy in laundry workers 
 as compared with the other patients in the hospital was the 
 high death-rate from tuberculosis as affecting mainly the 
 respiratory organs. Tuberculosis was present in fully one- 
 third of the 1,200 laundresses and female ironers, and in less 
 than one-half of the male laundry workers. The women 
 were affected at an earlier age than the men. The men 
 seldom suffered before the ages of 40 and 45 ; the women 
 usually at 30. In both sexes the mortality was extremely 
 high. Out of 238 laundry workers, male and female, who 
 died in five years in the Laennec hospital, 143 died from 
 phthisis. More males died than females. The mortality of 
 male laundry workers from pulmonary consumption was 75 
 per cent, while it was 56 per cent, among the laundresses. 
 This is an interesting fact, seeing that the women are affected 
 at an earlier age than the men. 
 
 To what is this high death-rate of laundry workers 
 from tuberculosis to be attributed? We must regard as 
 contributing causes the hard nature of the work, repeated 
 
MISCELLANEOUS TRADES 391 
 
 pregnancies, bad hygienic condition of the laundries, poor 
 feeding, and the intemperate use of wine and stimulants, but 
 the main cause is undoubtedly infection, to which the workers 
 succumb often after eight or ten years of service. The strange 
 point, too, is that it is in many instances the healthy-looking 
 and the strong men who become affected ; those who have 
 gone about with the vans collecting the material to be 
 washed, and who have therefore been much in the open air 
 and lifting heavy packages, while of the women many 
 have been robust and energetic. Such facts rather suggest 
 that in many of the patients there had been no special 
 predisposition to the disease, and that the contagion was 
 caught by handling and sorting handkerchiefs which gave 
 off, in a finely divided form, dust from dried expectoration 
 laden with tubercle bacilli, also dust from the clothes 
 and soiled linen of persons suffering from tuberculous 
 phthisis. It is by the inhalation of such dried bacilliferous 
 dust that the high mortality of laundry workers from 
 tuberculous phthisis is to be explained. Much of this could 
 be avoided by patients using spittoons for collecting the 
 expectoration. No doubt in the terminal stages of pulmonary 
 consumption the patient is so weak that he cannot ex- 
 pectorate into a dish, and he is therefore obliged to use 
 something to wipe and dry his lips. Pieces of old linen that 
 can be burned immediately after being used for this purpose 
 are not only more cleanly, but are better and freer from risk 
 than handkerchiefs. In addition to the danger from tubercle, 
 laundry workers are exposed to the risk of catching other 
 infectious diseases. Many of us have known instances of 
 women dying of small-pox, contracted by washing the 
 clothes of relatives who had been suffering from this disease. 
 A few words in regard to laundries of large Infirmaries, or 
 in reference to laundries to which the soiled linen of large 
 Infirmaries is sent. It has frequently happened that the 
 sorters suffer from blood-poisoning. All infected clothing 
 should be at once placed in a tank containing water and 
 some such antiseptic as cyllin. Cyllin is twenty times 
 stronger as a disinfectant than carbolic acid and it does not 
 rot the linen like formalin, whose antiseptic powers are only 
 
392 DISEASES OF OCCUPATION 
 
 0*30 of carbolic acid. Cyllin has antiseptic properties equal 
 to perchloride of mercury. In the " calendering " department 
 of a laundry, i.e., where the clothes are passed underneath 
 large rollers, there is a considerable amount of steam and 
 the work is extremely hot. Phthisis is said to be occasionally 
 met with in the girls who follow this particular work. There 
 is a tendency in many modern laundries to substitute for the 
 old drying horse large drying chambers. The objection to 
 the drying chambers is that the women have to go into the 
 chambers, and when there are exposed to extremely high 
 temperatures. In few occupations are the good effects of 
 free ventilation better seen than in laundries. 
 
 Within recent years laundries have considerably improved. 
 In May, 1907, I visited Messrs. Charvet's laundries in Paris. 
 These are quite up-to-date, and are worked by electricity. 
 The soiled clothes, especially shirts that contain starch, are 
 placed in a revolving drum in which there is water containing 
 a diastatic ferment which has the power of transforming 
 starch into soluble sugar. It is maintained that by removing 
 the starch the linen is made much whiter. The clothes are 
 subsequently washed in soap and water, and afterwards in a 
 solution of ammonia to remove the soap. The ironing of 
 the larger and flat clothes is done by passing them under a 
 revolving metal roller in the interior of which are gas jets 
 kept burning, with an adequate amount of ordinary air. So 
 complete is the combustion that, although it was towards the 
 close of the working day that my visit was made, there was 
 not the slightest odour of gas detected. To this circumstance 
 and the good ventilation of the rooms I attributed the 
 healthy look of the women in this room, as also the fact that 
 for ironing the front of the shirts only the old-fashioned 
 hand-iron is employed, and not the hollow hand-iron with 
 gas jet internally. Even in such a well-conducted laundry 
 the sorting-room is the place where there is risk to health 
 through handling the soiled clothes from tuberculous persons. 
 Primary disinfection of the clothes by means of formalin 
 and steam has been tried, but the formalin was found to 
 destroy the linen, and as a consequence the method was 
 abandoned. 
 
CHAPTER XV 
 
 SOLDIERS, SAILORS, AND FISHERMEN 
 
 ALTHOUGH picked men and living when on home 
 service under favourable hygienic surroundings, soldiers 
 have a rate of mortality different but little from that of 
 civilians of their own age. There are few middle-aged men 
 in the rank and file of the British Army, and while this is 
 largely the result of the system that at present prevails, it is 
 admitted that a soldier forty years of age is in most instances 
 an older man than a civilian of the same age. There is 
 an opinion that the abolition of the " sentry go " as carried 
 out by soldiers in former years and the assumption of this 
 duty by a special class of men known as military police will 
 do much to lighten the burden of the young soldier and 
 relieve him of work which was monotonous to and always 
 disliked by him. Once a recruit has overcome the difficulties 
 and hardships of his training, he has often, if in the infantry, 
 more time on his hands than he can usefully employ. 
 He has therefore often periods of enforced idleness which do 
 not always help him physically or morally. His opportunities 
 of smoking and of drinking are too many, and in other ways 
 he is apt to go astray from paths that make for health. 
 What is said of a soldier on home service applies with 
 greater force to the soldier sent abroad. Foreign stations 
 are not all equally healthy. The fault is not always in the 
 barracks, but in the country itself and in the carelessness 
 of the men in regard to drinking water outside the barrack 
 area. Again enforced idleness, ennui, Venus, and Bacchus 
 tell their tale, and as a consequence the death- and sick-rate 
 of the British Army on foreign service is much higher than a 
 
 393 
 
394 DISEASES OF OCCUPATION 
 
 simple review of the circumstances would at first lead us to 
 expect. 
 
 There will always be dangers to health incidental to 
 herding together large numbers of men in barrack-rooms ; 
 but the attention that is given by military authorities to the 
 subject of overcrowding and the fact that in almost all 
 barracks each soldier is allowed 600 cubic feet of space have 
 done much to diminish the mortality from pulmonary phthisis 
 in the British Army. During the first years of the late Queen's 
 reign the death-rate from lung diseases in the Army per 1,000 
 of strength was 7*82 ; in 1898 there were only 2*5 cases per 
 1,000 admitted into the hospital for pulmonary disease, and 
 of these only a small proportion died. It is in barrack life 
 that the good effects of ventilation have been most marked. 
 
 It is impossible in this chapter to deal at length with the 
 diseases incidental to soldiering at home or abroad. Enteric 
 and other fevers claim annually large numbers of our soldiers. 
 As many of our soldiers are lost in the process of making, 
 what I must do is to draw attention to the serious conse- 
 quences that in manyj instances follow the hard training 
 the young recruit has to undergo. Whether physical 
 deterioration of the race is taking place or no we need not 
 for the moment stop to inquire. All we know is that about 
 half of the youths who present themselves for examination 
 are refused on account of deficient height and weight, 
 deficient chest measurement, and defective teeth. Of those 
 who are accepted a certain percentage go wrong in the 
 training. The difference effected in the raw recruit by the 
 exercises, drill, discipline, regular and substantial meals 
 is quickly apparent. He becomes in a few months a smart 
 soldier, with little resemblance when in uniform to his 
 former self. It costs the country ;^I50 for every soldier 
 before he can be placed in the field as efficient. 
 
 Considerable discussion has taken place as to whether 
 the physical training of the recruit is not too hard and the 
 system faulty. Many of the recruits are young men who 
 are out of work, whose homes are poor, and who for 
 months or years previously have not been able to obtain 
 always an adequate supply of food. The training therefore 
 
SOLDIERS, SAILORS, AND FISHERMEN 395 
 
 should be gradual and the effects of "setting-up drill" 
 carefully watched. The object sought to be attained in 
 training is the improvement of the physique of the recruit, 
 but if the following is one of the modes by which an attempt 
 is made to attain this, opinions will be widely divergent as to 
 its utility. Surgeon A. F. Davy, speaking of the recruit, 
 says : " He is made to stand bolt upright, his head well 
 back, and his chest, being dilated to the fullest inspiration, is 
 kept as much as possible so dilated, an attitude useful for 
 no kind or description of work." It is now several years ago 
 since Surgeon Myers drew attention to the interference 
 of the movements of the chest by tight clothing and accoutre- 
 ments. Any attempt to change the shape of the chest 
 and skeleton should be gradual. Davy says that the 
 " setting up " or rather " breaking down " drill of the recruit 
 starts at his first appearance on the parade-ground, with the 
 "position of the soldier." In an interesting paper by Lieut- 
 Colonel H. M. Deane,! M.D., R.A.M.C., the whole question 
 of the maintenance of the erect position of the soldier and 
 his drill is fully discussed and the various drawbacks to the 
 present methods pointed out. Attention is being directed, 
 and not a day too soon, to the affection known as " soldier's 
 irritable heart." For this malady the " chest advanced " 
 posture exhibited by soldiers standing to " attention " with 
 their chest walls fixed and the abdomen retracted so that 
 respiration becomes extremely shallow, is to some extent 
 responsible. Unless a man can take deep inspirations 
 and thus send on the blood from the large veins through 
 the right side of the heart and lungs and by full expiration 
 assist the heart in propelling the blood into the arteries, 
 the circulation cannot be effectively carried on. One 
 of the results of standing to " attention " with the chest 
 fixed in the manner just described, whereby inspiration and 
 expiration are both impeded, is a tendency for the blood 
 to accumulate in the right side of the heart and venous 
 system and for less blood to pass out of the left ventricle. 
 The pulse rate rises : it will rise from 80 to icx) per minute. 
 In some instances after exercise in the gymnasium and when 
 ' Journal of Preventive Medicine, May, 1906. 
 
396 DISEASES OF OCCUPATION 
 
 the position of" attention " is maintained the pulse has risen to 
 1 20 and 132. With the rapid pulse there is also epigastric 
 pulsation, and in many of the men a diffused cardiac impulse, 
 with absence of apical definition. Deane submits the 
 exercise taken by young soldiers in the gymnasium to 
 stringent criticism. He considers it to be altogether wrong. 
 Muscular exercise tends to increase the pulse rate, but if 
 carefully conducted there need not be signs of disordered 
 action of the heart as a consequence. The foundation 
 of the heart trouble of young soldiers is laid on the parade- 
 ground, and is intensified by the exercises in the gymnasium 
 not being conducted on physiological lines. " The mischief 
 done to the recruit on the parade-ground can be stopped by 
 abolishing the present position of * attention ' and giving short, 
 plain instructions as to how to stand erect — in reality with- 
 out constraint." The gymnastic staff ought itself to be 
 properly instructed in physical training. There must be 
 something wrong with a method of physical training which, 
 as in the British Army, is responsible for the invaliding of 
 such a large number of otherwise strong and healthy young 
 men through disease of the heart and circulatory system. 
 Since much of this arises before the soldier is sent on foreign 
 service it is clearly traceable to conditions at home, and 
 which experience has demonstrated to be the result of faulty 
 physical training on the parade-ground and in the gym- 
 nasium. That the disability can be prevented is shown by 
 the fact that when soldiers are freed from the harmful physical 
 conditions in the Army they usually make a good recovery. 
 We must plead for the physical training of the soldier being 
 conducted on physiological lines. What is required of the 
 soldier is not well developed muscle at the expense of his 
 heart and lungs, but a healthy and well toned heart and good 
 lungs. It is these which will help him on parade and in 
 military marching will enable him to cover distance with 
 little fatigue. 
 
 Tke Marine Service 
 
 The lot of the sailor is a hard one, and yet as a class 
 sailors are jovial and happy men. It is only within recent 
 
SOLDIERS, SAILORS, AND FISHERMEN 397 
 
 years that attention has been directed to the hygienic 
 conditions that prevail on board ship. Too often even now 
 the sleeping accommodation provided for seamen is not good. 
 There is a danger, too, in damp weather of too many men 
 congregating together in an overheated and badly ventilated 
 forecastle and of further polluting the atmosphere by 
 tobacco smoke. Much has been done by legislation to 
 improve the sanitary surroundings of sailors on board ship, 
 but there is still much to be accomplished. The good effects 
 of the sea air obtained on deck are to a large extent 
 counterbalanced by the overcrowding that prevails below. 
 According to the Merchant Shipping Act, 72 cubic feet 
 is the minimum space allowed per head, and in this space 
 the sailor has to sleep, eat, and live when off duty. The 
 ventilation of the sleeping cabins, like that of the forecastle, 
 is bad, and owing to the construction of modern ships the iron 
 and steel sweat from condensation of moisture, so that the 
 bed-clothes in the bunks are often wet and uncomfortable. 
 Notwithstanding these inconveniences, there are no diseases 
 that the sailor is liable to specially attributable to his 
 occupation. Persons become accustomed to almost any- 
 thing. The sailor becomes accustomed to his frequent 
 shifts, the intermittent character of his work, and the broken 
 sleep. The habits thus formed in the early part of a man's 
 life remain with him in his later years, long after he has 
 retired from the sea. His hours of sleep are shorter than 
 those of most people. As a reaction against the confine- 
 ment on board ship, the quietude of a long voyage, and the 
 absence of amusements except those provided by their fellow- 
 seamen, sailors on arriving in port are apt to give way to 
 indulgence in pleasures that often leave a sting behind. 
 Many of their illnesses are therefore traceable to their habits 
 when in port. Their work at times is hard, and during storms 
 they are exposed to risks to life and to accidents of all kinds. 
 A good many of the sailors who come to the Royal Victoria 
 Infirmary are the subjects of thoracic aneurism, the result 
 of hard work, sudden strain, and syphilis, also of the violent 
 knocks and bruises to their chest received during gales. 
 In the case of sailors who have been all the world over, and 
 
398 DISEASES OF OCCUPATION 
 
 therefore been exposed to the influence of tropical climates and 
 to drinking contaminated water there is frequently a history 
 of malarial, blackwater, and yellow fever, of dysentery and 
 cholera. As a consequence, their health for long afterwards 
 is undermined. Many of these men develop peculiar forms of 
 bloodlessness, some of which pass into progressive or perni- 
 cious anaemia with a fatal termination. As a result of malarial 
 fever the spleen remains enlarged for years, and long after 
 the primary attack has passed away and the seaman lives on 
 land he has recurrences of ague fever. Improved methods 
 of feeding have, practically speaking, abolished scurvy, which 
 used to be the scourge of the sea. The common diseases 
 of sailors, such as those of the respiratory organs and heart, 
 including rheumatism and phthisis, are partly the result of 
 their immediate environment and insanitary surroundings, 
 also of exposure and getting wet. The lot of the stoker on 
 our large ships is particularly a hard one. The temperature 
 in which the work is carried on is extremely high, so that 
 when the ship is passing, for example, through the Red Sea 
 and the temperature of the outside air is high and there is no 
 aerial circulation, the men often suffer from heat apoplexy. At 
 other times stokers run the risk of being chilled. Working 
 with little clothing upon them, they often come out of the hold 
 in a state of extreme perspiration to get a breath of cooler 
 air, but the practice is not free from danger. That much can 
 still be done to improve the health of the ordinary sailor 
 and diminish risk to life and limb through accident, is shown 
 by the difference in men following the same vocation but 
 under different conditions. In the merchant service the 
 mortality rate from all causes for 1898-99 was 9*60 per 1,000, 
 while for 1899 the corresponding rate in the Royal Navy 
 was 4*91 per 1,000, or about one-half. The mortality figures 
 of 9*6o per 1,000 in the mercantile marine were made up as 
 follows : 7*4 from injury and 2*2 from disease. The 4*91 
 per 1,000 of the Royal Navy were compounded of 3*56 from 
 disease and i'35 from injury. These figures speak for them- 
 selves. Probably some lives would be saved in the 
 mercantile marine service were medical and surgical aid 
 more readily available. The officers of steam and sailing 
 
SOLDIERS, SAILORS, AND FISHERMEN 399 
 
 ships ought to have some practical knowledge of ambulance 
 work. 
 
 Of the vocation of the fisherman little need be said. Like 
 that of the sailor, the occupation is one attended by great 
 risk to life from sudden squalls, dangers to health from 
 exposure to inclement weather, occasionally long hours and 
 irregular meals. Fishermen are liable to many minor 
 accidents, neglect of which is often followed by blood- 
 poisoning. 
 
CHAPTER XVI 
 
 RESCUE WORK IN MINES 
 
 EXPERIENCE and statistics show that while the occupa- 
 tion of the coal-miner is not per se an unhealthy one, 
 the risks attendant upon his calling are such as to render coal 
 getting one of the most hazardous occupations man can follow. 
 It is only when some great calamity occurs that the public 
 realises this fact. The appalling catastrophe at Courrieres, 
 in France, on March lo, 1906, whereby the lives of 1,100 
 men and boys were lost, created widespread interest in 
 and sympathy for a class of men who in the hour of danger 
 are known to be capable of performing deeds heroic and 
 altruistic. No sooner had the sad news passed from one 
 country to another than Germany, in her desire to show 
 practical sympathy with the French people and her eagerness 
 to have rescue apparatus practically tested, volunteered 
 to send trained men to assist in rescuing the entombed 
 miners, an offer which was as gratefully accepted as it 
 was generously made. It was an example of a great nation 
 offering to another in its hour of distress the application of 
 science to the saving of human life. The loss of such 
 a large number of human lives has again revived in our 
 own as in every coal-producing country the question as 
 to the best means to be adopted for the rescue of miners 
 imprisoned in a coal-mine after an explosion. In this 
 matter Great Britain ought to lead the way. As to the 
 causes of colliery explosions little need here be said beyond 
 the fact that colliery owners and officials are gradually 
 coming round to an acceptance of the opinion that explosions 
 
 are in many instances due to the ignition of fine coal dust in 
 
 400 
 
RESCUE WORK IN MINES 401 
 
 a dry part of a mine. Gas is the enemy of the coal-miner ; 
 
 so, too, is dust. When mention is made of " mine gas " or 
 
 " gas " in a mine it is methane, marsh gas, or what is popularly 
 
 known as " fire-damp," that is meant. Although the gas does 
 
 not support combustion, it is itself combustible and burns 
 
 with a blue flame. It is a product of the decomposition 
 
 of organic substances, especially of vegetable fibre, in 
 
 the absence of air but in presence of water. The gas is 
 
 pent up in the coal frequently under such high pressure 
 
 that it issues from the pores of the coal with a crackling 
 
 noise well known to the miner. Mixed with oxygen, 
 
 methane forms an explosive mixture, to which the term 
 
 " fire-damp " ought only to be applied, and not to methane 
 
 itself The other dangerous gases are carbon monoxide, 
 
 generated in an explosion, and the less poisonous carbon 
 
 dioxide. In a colliery explosion miners may be killed either by 
 
 the severe shock or by the flame, as the extensive burning of 
 
 the body shows, but the largest number fall victims to the 
 
 carbon monoxide gas which accompanies the hot column 
 
 of air that has been generated. When an explosion occurs 
 
 there is at first an enormous expansion of the air in the 
 
 particular gallery of the mine, consequent upon the 
 
 production of hot gases. This is followed by a rapid 
 
 shrinking. The hot gases pass along the path of least 
 
 resistance, and having undergone combustion their volume 
 
 is less than previously. Marsh gas when exploded is found 
 
 to have undergone a diminution of two-thirds of its volume 
 
 after condensation of the moisture produced. An explosion 
 
 in a coal-mine is followed by an enormous rise of temperature, 
 
 to 300° F. and higher. Upon the bodies of the miners who 
 
 have been killed in a colliery explosion the effects of two 
 
 different causes are observed. There are wounds that have 
 
 evidently been produced from without inwards and are due 
 
 to the enormous pressure of the gases at the time of their 
 
 combustion, and there are wounds produced from within 
 
 outwards during the cooling of the gases. These latter 
 
 wounds are only met with upon the bodies of men who had 
 
 been working a short distance from the seat of the explosion 
 
 in a gallery that was a cul-de-sac or where falls had occurred. 
 
 DD 
 
402 DISEASES OF OCCUPATION 
 
 Thus are explained the ecchymoses and multiple injuries 
 or wounds from without inwards, and the shattering and 
 disruption of the body when the wounds have been produced 
 by causes operating from within outwards. In the blood 
 of miners killed in this manner there is no trace of carbon 
 monoxide on spectroscopic examination. Many of the miners 
 are killed by the column of gas suddenly striking them 
 with all the force of a projectile. It is this shock or sudden 
 impact that kills, frequently tearing asunder the limbs from 
 the body and hurling them yards away. That men thus 
 killed had died suddenly is proved by the absence of the 
 spectrum of carbon monoxide in their blood. Where 
 the corpses exhibit marks of burning it might, under certain 
 circumstances, be desirable to know whether the burns 
 occurred before or after death. Miners who perish in an 
 explosion from an expansion of the flame are not really 
 burned in the ordinary meaning of the word*; it is more 
 a singeing than a burning. Brouardel, in speaking of such 
 cases, says the burns are not all serious, but as the air 
 contains a large quantity of coal dust which becomes 
 encrusted upon the skin of the body, the corpses are black 
 and appear as if badly burned. Most of the burns on the 
 body are the result of the hot air. In the Courrieres mine ^ 
 there was little flame — any that there had been was of short 
 duration ; for while the clothes of the miners were not burned 
 the underlying skin of the body was singed. It was therefore 
 difficult to make a distinction between the bodies of miners 
 who had died from burns and dead bodies which had been 
 subjected to the action of fire. The burnt corpses were those 
 of men who had either been burned by the hot gases or had 
 been killed by carbon monoxide before the arrival of the 
 flame. It is very improbable that any absorption of carbon 
 monoxide gas occurred after death. In another part of this 
 book I deal with this subject. Here I need only say that in 
 none of the bodies of dead animals exposed even for a 
 week to carbon monoxide gas did I find that absorption of 
 the gas had taken place. 
 
 ^ Annales d' Hygiene, publique et de Medecine Legale, Novembre and 
 Decembre, 1906, Etude Medico- Legale de la Catastrophe de Courrieres. 
 Dr. Firmin Dervieux, Paris. 
 
RESCUE WORK IN MINES 403 
 
 The largest numbers of deaths in the Courrieres mine 
 were due to carbon monoxide poisoning. Several of the 
 bodies of the dead miners were found in the position in 
 which the men had been working when death suddenly 
 overtook them. The force of the explosion had driven 
 before it a column of gas containing carbon monoxide, and 
 as this gas became cooled on its course along the galleries 
 it immediately poisoned the workers who inhaled it. When 
 death takes place through inhalation of air containing a high 
 percentage of carbon monoxide gas convulsions do not 
 occur. The features are perfectly placid. It is in slowly 
 induced intoxication by carbon monoxide that the locomotive 
 powers become enfeebled. Of the occurrence of this there 
 was evidence in some of the miners at Courrieres ; for the 
 men, feeling that there was something wrong with the air 
 they were breathing and probably experiencing headache 
 and vertigo, had tried to save themselves, but as the gas 
 travelled more quickly than they were able to walk it over- 
 took and poisoned them. 
 
 I have taken as the basis of my remarks for this chapter 
 the mine catastrophe at Courrieres because it is the greatest 
 mining disaster of recent years. It is said that one of the 
 most painful circumstances to the relatives of the deceased 
 miners was the difficulty of recognising the bodies owing to 
 the injuries and putrefaction. In the mine itself one of the 
 most trying circumstances the rescue men had to deal with 
 was the rapidity with which putrefaction of the dead bodies 
 had occurred, the unpleasant and repellent odour that pre- 
 vailed, and which made rescue work a peril to the health of all 
 who attempted it. Some of the wounded miners who were 
 brought to bank only lived a few days. Most of them died 
 from pneumonia, either due to having respired the hot air 
 in the mine — which is scarcely likely, for death would prob- 
 ably have come more quickly — or as the sequel of carbon 
 monoxide poisoning. Dr. Lourties states that several of the 
 miners died from pneumonia 50 to 60 hours after being 
 rescued. The inflammation of the lungs in each instance 
 developed with great rapidity, and was accompanied by 
 a high temperature. The pulmonary lesions, which were 
 
404 DISEASES OF OCCUPATION 
 
 extensive, were lobar and not lobular. There was a greater 
 tendency for the right than the left lung to be involved, 
 probably owing to the fact that the right bronchus is larger 
 than the left. That several of the rescued miners who suffered 
 from pneumonia had breathed carbon monoxide gas in the 
 pit their own statements amply confirmed. The invalids 
 stated that they had felt headachy and dizzy, and had been 
 overcome by a drowsy, sleepy feeling. A few of the men, 
 too, became paralysed in their limbs. 
 
 To enable firemen to enter premises filled with smoke and 
 irrespirable gases, also rescue parties to descend into a mine 
 after an explosion, several forms of respiratory apparatus 
 have been recommended. When an accident has occurred 
 in the down-cast shaft of a pit, as happened a short while 
 ago at Boldon Colliery, near Newcastle-upon-Tyne, whereby, 
 owing to a break in the rope, the cage suddenly dashed to 
 the bottom of the shaft, killing its three occupants, the only 
 entrance into the mine is by the up-cast shaft, or that up 
 which the foul air of the mine is passing along with smoke 
 from the furnace at the foot of the shaft. This shaft, required 
 by law in all pits, is nothing else than a wide smoking 
 chimney. In descending the up-cast shaft it is almost im- 
 possible to breathe owing to the thick and poisoned air, and 
 as the lower part of the shaft is reached the heat becomes 
 intolerable owing to the proximity of the furnace. It was 
 a Sunday morning when the accident occurred at Boldon 
 Colliery, and there were therefore no men in the pit, except 
 those who had gone down in the cage that morning. Dr. 
 O'Kelly, of Boldon Colliery, with two mining officials 
 entered the mine by the up-cast shaft. The air was stifling 
 and hot. The descent was of such a nature as ought only 
 to have been made by men wearing each a safety respira- 
 tory apparatus. In the absence of such, Dr. O'Kelly and 
 his comrades applied a wet handkerchief over their mouth 
 and nostrils, and by this means they withstood the choking 
 influence of the sulphurous vapours given off by the burning 
 coal at the bottom of the shaft. Many forms of respiratory 
 apparatus have been recommended. Rescue work in mines 
 is work upon which physicians, chemists, mining engineers. 
 
RESCUE WORK IN MINES 405 
 
 and colliery officials can bring to bear the united influence 
 of the allied sciences. One of the greatest difficulties 
 rescue parties have to encounter is the extremely high 
 temperature in a mine after an explosion. This, while a 
 serious difficulty, ought not to be insurmountable. Science 
 has already accomplished much in the saving of human life ; 
 it will yet do more. 
 
 In 1846 Sir Henry T. de la Beche and Dr. Lyon Playfair 
 reported that after a colliery explosion there was, but for 
 carbonic acid, a sufficient quantity of oxygen present in the 
 mine to support life where men had survived the imme- 
 diate effects of the explosion. Three years afterwards 
 Dr. John Hutchinson proposed that an exploring party 
 should carry bags containing air into the mine, so that 
 they might exist for half an hour. In 1880 Henry Fleuss 
 invented an apparatus which was used with some success 
 at Seaham Colliery in the following year. Twelve months 
 afterwards David Rhys Jones showed that oxygen could 
 be used for rescue work in mines. In the early experi- 
 ments men were provided with a tube which they placed 
 in their mouth, or it was fixed to the helmet, and through 
 this tube atmospheric air was pumped from without, 
 as in the case of divers, but the disadvantages of such a 
 method are that the tube might become kinked, and owing 
 to the distance the men might have to travel the tube 
 would become extremely heavy. It is, therefore, necessary 
 to have an autonomous respiratory apparatus which will 
 enable a man to carry with him a sufficient quantity of air 
 to render him independent of the atmosphere immediately 
 surrounding him, and which at the same time shall cut him 
 off from the possibility of inhaling dangerous gases. When 
 compressed air was first tried it was found that men could 
 support themselves in a poisonous atmosphere for twenty 
 minutes. Since then many improvements have been made 
 in the forms of respiratory apparatus. On the Continent, 
 one of the pioneers of the movement is Dr. Guglielminetti, 
 whose experience as an aeronaut and an Alpine climber 
 enables him to speak with some authority as to the value 
 of compressed oxygen, and whose invention has been adopted 
 
4o6 DISEASES OF OCCUPATION 
 
 by the Draegerwerk at Lubeck. Atmospheric air contains 
 in volumes 79*04 nitrogen, 20'93 oxygen, and carbonic acid 
 0*03, while expired air contains 79-6 volumes of nitrogen, 
 i6'04 oxygen, and 4 of carbonic acid. About the same 
 quantity of carbonic acid is given off as there is of oxygen 
 absorbed. There is a mutual interchange between the two 
 gases. A man requires not less than 500,000 cubic inches 
 of air per 24 hours. In other words, he gives off per hour 
 half a cubic foot, or 864 cubic inches, of carbonic acid and 
 the same quantity of oxygen is absorbed. Any person 
 attempting to do rescue work should therefore be provided 
 with not less than i cubic foot of oxygen per hour. Mr. 
 W. E. Garforth,! Altofts Colliery, Normanton, who has given 
 considerable attention to the practical study of this question, 
 says that " if a workman had given to him a cylinder con- 
 taining 3 cubic feet of oxygen at atmospheric pressure for 
 the outward journey, and a cylinder containing 3 cubic feet 
 at atmospheric pressure for the return journey, he would 
 under any circumstances, unless there was great waste, have 
 sufficient oxygen to last for 2 hours, even if during that time 
 he underwent considerable exertion." In the respiratory 
 interchange of gases in the human body nitrogen plays no 
 part. The gas is quite inert, and this is one of the reasons 
 advanced for not using compressed atmospheric air in rescue 
 work, since, nitrogen being lighter than oxygen, would be the 
 first gas to be given off; also, in order to carry a sufficient 
 quantity of respirable gas, the weight of the apparatus would 
 be considerably added to by the nitrogen, which, after all, is 
 of no special use, since it plays a purely passive part in 
 respiration. By eliminating nitrogen the apparatus can be 
 reduced to one-seventh of its original weight. In a demon- 
 stration given at the Institution of Mining Engineers, 
 Newcastle-upon-Tyne, Mr. Ctto Simonis^ showed how the 
 " aerolith," a liquid-air rescue apparatus, could be employed 
 in mines after an explosion. The entire apparatus weighs 
 
 * "A New Apparatus for Rescue Work in Mines," Transactions of the 
 Institution of Mining Engineers, June 14, 1906. 
 
 » Transactions Mining Engineers, 1906, " Liquid Air and its Use in 
 Rescue Apparatus." 
 
RESCUE WORK IN MINES 407 
 
 14 lbs., " is easily carried on the back without any encum- 
 brance, and it gives an absolutely pure and deliciously cool 
 air-supply for up to three hours' working. It does not 
 contain any chemicals ; it is without any complications 
 whatsoever ; there is not a single valve in the whole 
 apparatus, and its use does not require any special training. 
 Atmospheric air liquefies at a temperature of — 191° C. and is 
 compressed to about the seven-hundredth to eight-hundredth 
 part of its original volume. Consequently i gallon of liquid 
 air will evaporate into 7CX) to 800 gallons (no to 130 cubic 
 feet) of atmospheric air." When fully charged the entire 
 apparatus weighs 24 lbs. Liquid air contains 2 parts of 
 oxygen to i part of nitrogen. Simonis claims for his 
 apparatus, that the fresh air-supply is always ample, that it 
 is absolutely pure, and that it can be stored in the vacuum 
 vessels designed by Sir James Dewar, but losing from 5 to 10 
 per cent, by evaporation per day. Liquid air can be pro- 
 duced at the rate of threepence per gallon and upwards, 
 according to the size of the plant. 
 
 In respiration only 4 per cent, of the oxygen inhaled is 
 taken up by the blood passing through the lungs ; the 
 remainder is exhaled without being utilised. To replace this 
 loss of oxygen there is added to the exhaled air 4 per cent, 
 of carbon dioxide. With physical exertion the amount of 
 CO2 is increased. It is this gas which, when it accumulates 
 in too large a quantity, becomes a source of trouble, and has 
 therefore to be removed. When present beyond i per cent, 
 it causes headache and a sense of distress. In all forms of 
 rescue apparatus, therefore, provision is made for the absorp- 
 tion of the carbon dioxide by passing it through a series of 
 tubes containing a solution of caustic potass. The air thus 
 purified passes further on through the apparatus, where at a 
 particular part it meets and mixes with the oxygen coming 
 from one of the cylinders. In all forms of rescue apparatus 
 the oxygen should escape from the cylinder automatically 
 into a tube going to the motith-part of the helmet worn by 
 the miner. The air that has been breathed becomes hotter : 
 at the increased temperature it becomes a source of incon- 
 venience and uneasiness to the wearer of the apparatus. 
 
4o8 DISEASES OF OCCUPATION 
 
 Means are therefore provided in the apparatus for cooling 
 the air by passing it through a refrigerator. That the CO2 
 of the exhaled air is really absorbed in the potass tubes is 
 confirmed by the analyses made by Grehant, who found no 
 trace of the gas in the apparatus used by the German miners 
 at Courrieres. 
 
 On November 29, 1905, at the School of Mines, Bochum, 
 Westphalia, an examination of the various forms of apparatus 
 was made by a commission appointed by the Board of 
 Administration of the Mines at Dortmund. Of the various 
 forms of apparatus tried the Giersberg, Meyer, and Gugliel- 
 minetti-Draeger, it was found that the men who used the 
 Draeger were not at all fatigued when they came out of 
 the artificial mine. If a rescue apparatus is to be of any 
 help to men exposed to a poisonous atmosphere it ought to 
 be easy of application and adapted to meet the requirements 
 of the body ; it should not be too heavy, nor so cumbersome 
 as to prevent a miner passing over rough ground or crawling 
 on his hands and knees through narrow spaces, nor should 
 the apparatus in any way compress the chest-wall of the 
 wearer and impede his respiration. The wearing of it should 
 neither cause distress nor be attended by difficulty or rapidity 
 of breathing. The eyes of the miner must be protected from 
 irritating smoke and gases, but they must not be so dimmed 
 by the protecting surface that the individual cannot see suffi- 
 ciently. It is an advantage to have the ears clear and open, 
 so that sounds and cries of distress or for help can be heard. 
 Opinions are divided as to the desirability of wearing a 
 helmet. It is safer. The apparatus should be provided with 
 two cylinders of oxygen, so that the rescuer might be 
 capable of staying in the mine at least two hours, and it 
 should be of such a design as not to restrict the movements of 
 the limbs. The expired air must be passed through caustic 
 potass to have the carbonic acid removed, and also through 
 refrigerators to be cooled. Above all the apparatus must be 
 trustworthy and be in perfect order, so as not to play false in 
 the moment of danger. To be on the safe side, and in order to 
 allow of heavy work being done, a man about to undertake 
 rescue work should be given a continuous supply of two litres 
 
RESCUE WORK IN MINES 409 
 
 (122 cubic inches) of oxygen per minute. Too much oxygen 
 must not be supplied, as it causes dryness of the throat. 
 Nearly all the forms of rescue apparatus are designed on the 
 same plan. It is desirable that the apparatus should be capable 
 of being put on and taken off by the wearers themselves, also 
 that men should be practically trained as to its use, so as to 
 overcome the nervousness which is invariably observed in 
 those wearing the apparatus for the first time. Mine managers 
 and mining officials are of the opinion that there is as yet no 
 ideal rescue apparatus in the market, but the vast strides that 
 have been made in this direction within recent years show 
 that many difficulties have already been surmounted, that 
 there is every prospect of a more perfect apparatus being 
 reached, and to accomplish this British inventors are doing 
 their part. A few years ago it was proposed by the Midland 
 Institute of Mining, Civil, and Mechanical Engineers to 
 establish rescue stations, at which men might be trained 
 in the use of life-saving apparatus in colliery explosions. 
 In 1899 Mr. W. E. Garforth, of Altofts Colliery, Normanton, 
 arranged for the construction of an artificial gallery in which 
 experiments might be carried on. I have had, through the 
 kindness and courtesy of Mr. Garforth, the opportunity of 
 witnessing some of these experiments. At Messrs. Pope, 
 Pearson & Co.'s collieries four men have been undergoing 
 training in the gallery. The gallery is 150 feet long and 
 forms three sides of a square ; it is 6J to 7 feet high and 
 is air-tight. It is provided with windows, through which 
 the experiments can be watched. A successful effort has 
 been made to make the interior of the gallery resemble as 
 far as possible the galleries of a coal-mine that have been 
 wrecked after an explosion, where the floors are covered 
 with debris, timber has been broken and blown out of its 
 place, the roof fallen in here and there, so as to make 
 walking impossible. Into this gallery, which is filled with 
 smoke and noxious fumes from burning sulphur, timber, 
 leather, &c., the men, wearing an apparatus of Mr. Garforth's 
 own device, enter. Each man is provided with a double 
 cylinder of oxygen and an electric lamp. The men work in 
 couples, and they have to encounter the physical difficulties 
 
4IO DISEASES OF OCCUPATION 
 
 that are likely to be met with in a coal-mine after an 
 explosion, including the presence of poisonous gases. They 
 have also to extinguish a fire and to bring out of the gallery 
 a dummy, a supposed injured or dead miner, weighing 
 i6o lbs. I saw these men, wearing the apparatus on their 
 back, crawl on their knees over as rough surfaces as any 
 likely to be met with in a wrecked mine, extinguish a fire and 
 bring out a dummy miner which they had themselves brought 
 through a broken iron pipe i8 inches in diameter, also pulled 
 and pushed it over rough falls of stone. In the three hours 
 during which the men were in the artificial gallery they 
 walked and crawled a distance equivalent to two and three- 
 quarter miles ; they also performed all kinds of hard work.^ 
 
 In the earlier experiments carried out by Mr. Garforth, Drs. 
 T. Marshall Nicholson and A. Mackenzie, of Leeds, recorded 
 the pulse rate and temperature of the men before entering 
 and again on coming out of the gallery. With the physical 
 work it was found that the rate of the pulse increased and 
 there was a rise of the body temperature from 1° to 2° F. 
 The men complained of headache, which in half an hour 
 disappeared, also of nausea and giddiness, and it was observed 
 that they were cyanosed in the face owing to the congestion 
 of the blood-vessels. Since that date Mr. Garforth has 
 considerably improved his apparatus, known in the trade as 
 the " Weg," and with it even after prolonged tests there are 
 no longer complaints by the men of headache, nausea, or 
 feeling of sickness. The men come out of the gallery after 
 three hours' hard exercise fresh and fit for other work. The 
 total weight of the " Weg" apparatus is 21 lbs. 5 oz. 
 
 A series of experiments carried out by men wearing the 
 Draeger apparatus has been equally successful. The men 
 emerged from the gallery after having performed arduous 
 work for two and a quarter hours without signs of fatigue. It 
 was shown too that the men wearing the Draeger were 
 capable of lifting a greater number of pounds weight in a 
 given time than with some of the other forms of apparatus. 
 For a full description of this apparatus and its power of 
 
 * Transactions of the Institution of Mining Engineers, vol. xxii. 
 1901-1902. 
 
RESCUE WORK IN MINES 411 
 
 removing CO2 from the exhaled air see pamphlet " Tests of 
 Life-saving Apparatus," by H. and B. Draeger, Lubeck.^ 
 
 The Director-General of the Society of Mines at Lens, 
 France, informs me (August 7, 1907) that several experiments 
 have just been made in the mines at Lens with the safety 
 apparatus invented by Dr. Tissot, which he regards as 
 superior to the other forms of apparatus that have hitherto 
 been tried. Two coal-miners wearing the " Tissot " safety 
 appliance were able without any previous training or 
 experience of the apparatus to penetrate into the various 
 parts of the mine for three hours, and when there to undergo 
 work of such an extremely fatiguing nature as had been found 
 to be impossible in experiments with other forms of apparatus. 
 The apparatus is of the same type as the " Weg." 
 
 Through the kindness of Major Cardier I have had the 
 opportunity of seeing the firemen at one of the barracks of the 
 Sapeurs-Pompiers, Paris, demonstrate the applicability of 
 the rescue apparatus invented by one of their officers, 
 Lieutenant Vauginot. One of the peculiar features of the 
 apparatus is the warning given by a shrill whistle when 
 the compressed air is almost played out. Two cylinders of 
 compressed air are carried ; these together last forty minutes. 
 The expired air escapes by a valve below the helmet. The 
 apparatus weighs 32 lbs. The Vauginot appeared to me to 
 be useful for firemen going into a building filled with smoke 
 or poisonous vapour for a short period. 
 
 If rescue work in mines after explosions is to be carried 
 out on sound practical lines and on scientific principles, there 
 ought to be training stations in different parts of the country. 
 The subject is one to which medical men engaged in colliery 
 practice, also casualty surgeons to police authorities, should 
 give attention. Training in rescue work ought to form part 
 of the ambulance instruction given in mining centres. If 
 young men who are being educated for the higher appoint- 
 ments in mining were also trained in rescue work, the 
 instruction would be invaluable to them, since they will be 
 the mine managers of the future. 
 
 * Obtainable from R. Jacobson, 11, Water Lane, Great Tower Street, 
 London, E.G. 
 
412 DISEASES OF OCCUPATION 
 
 To get to the entombed miners is one of the difficulties 
 in rescue work, owing to the high temperature, and another 
 difficulty is the removal to a place of safety of miners found 
 alive. By a rescue party an extra number of masks would 
 have to be carried, which could be placed on the face of the 
 men who when found show signs of life, oxygen supplied, and 
 its entrance into the lungs secured by artificial respiration ; 
 in addition efforts would have to be made to bring the 
 miners to the surface as soon as possible. Much yet remains 
 to be done before rescue work by men wearing special 
 respiratory apparatus can be regarded as perfectly safe. In 
 Austria fatalities have occurred to men wearing these, but 
 only when the appliance has been of the type in which 
 reliance is placed upon chemical decompositions being 
 effected and oxygen liberated, and not when the men have 
 been carrying small cylinders of oxygen in the manner 
 detailed above. 
 
 Any doubts held by colliery managers as to the practica- 
 bility of the use of rescue apparatus in mines after explosions, 
 if not removed by the Garforth and other experiments 
 alluded to in the text, ought to be by the results obtained 
 under the following circumstances : — On Sept. 14, 1907, an 
 explosion occurred in the " Saar " and " Mosel " Colliery at 
 Merlbach in the Prussian Saar district. A rescue party of 
 twelve men, equipped with the Draeger apparatus, descended, 
 and, after working for an hour, brought to the surface the 
 eight survivors and the bodies of four men who had been 
 killed by the explosion. Vide Iron and Coal Trades Review^ 
 Sept. 27, 1907. 
 
INDEX 
 
 Accidents in coal mines, 275 ; in 
 laundries, 387 
 
 Accidents in the manufacture and 
 use of explosives, 134-36 ; in 
 coal mines, 275; in laundries, 
 378 
 
 Achard, his experiments on ani- 
 mals with tubercle bacilli, 17 
 
 Aerated waters, manufacture of, 
 
 374 
 Air-lock, described, 89 ; effect on 
 
 entering, 89, 90; condition of 
 
 workers when leaving, 91 
 Alcohol, detrimental effect on 
 
 workers, 2, 10, 24, 121 ; predis- 
 posing cause of plumbism, 147, 
 
 148, 186 
 Aldrich, Dr. Charles, neurologist 
 
 to the Cleveland Hospital, Ohio, 
 
 362 
 Almaden, mercury mines at, 224 
 Alps, effects of climbing the, 115, 
 
 116 
 Altitude, its effect on the body, 
 
 I 15-19 
 America, speed of machinery in, 
 
 3 ; industrial pressure, 5 
 Amsterdam, tunnelling operations 
 
 in, 105, 106 ; diamond cutting 
 
 industry at, 170, 171 
 Anaemia, from excessive heat, 229 ; 
 
 from ankylostomiasis, 311, 320, 
 
 32S> 326 
 Anaemia, miners, 311, 320, 325; 
 
 from ankylostomiasis, 326 
 Angus, Mr. H. B., 229 
 Aniline poisoning, 125-28 
 Ankylostomiasis, considered, 312- 
 
 23 ; symptomatology, 323 ; an- 
 
 aemia and, 326; treatment of, 
 328-33 
 
 Anthracosis, 247 
 
 Anthrax, considered, 334 ; symp- 
 tomatology, 339 ; treatment of, 
 
 342-45 
 
 Antwerp, diamond-cutting indus- 
 try in, 170 
 
 Arens, on dust, 245 
 
 Arlidge, Dr., on potters' lung 
 diseases, 305, 308, 309 
 
 Armit, H. W., his opinion on poi- 
 sonous effect of nickel carbonyl, 
 
 74 
 
 Arnaud, Dr., on the effect of the 
 fumes of phosphorus, 44 
 
 Arsenic poisoning considered, 
 216-18 
 
 Asquith, Mr., Committee ap- 
 pointed by, to inquire into the 
 industry of blanket-stoving, 86 
 
 Assyrian pottery, 168 
 
 Asthma, chemical workers subject 
 to, 120 
 
 Atmospheric pressure, com- 
 pressed, considered, 88-108 ; 
 diminished, considered, 115-19 
 
 Australia, mines in, 295 ; purity of 
 wool from, 338 
 
 Austria, compensation of workers 
 in, 27 ; match-making industry 
 in, 39-;-4i ; regulations for lead 
 factories in, 144 
 
 B 
 
 Babylon, enamelled bricks of, 168 
 Baccarat, glass works at, 182 
 Baker Street and Waterloo Rail- 
 way tunnel works, 94, 97 
 
 413 
 
414 
 
 DISEASES OF OCCUPATION 
 
 Ballachulish quarries, 303 
 
 Balland, on the offspring of lead 
 workers, 199; experiments by, 
 201 
 
 Ballard, Dr., on the cause of the 
 epidemic of pneumonia in Mid- 
 dlesbrough, 310 
 
 Basutoland, death-rate of miners, 
 289, 290 
 
 Batelli, Dr., his opinion on the 
 cause of death in electric shock, 
 351 
 
 Batley, shoddy industry at, 260, 
 261 
 
 " Beat hand," 273 
 
 Beche, Sir Henry T. de la, 405 
 
 Bechuanaland, 289 
 
 Bedson, Professor, on lead poison- 
 ing, 140, 148, 201, 204, 211 
 
 Belfast, linen industry in, 253 
 
 Bell, Dr. John Henry, of Bradford, 
 334 ; on impure wools, 338 
 
 Belgium, statistics of accidents in 
 coal-mines in, 275, 314 ; anky- 
 lostomiasis among the miners 
 in, 319 
 
 Bendigo, quartz mines, health of 
 workers in the, 295-98 
 
 Benzine, dry cleaning by means 
 of, 82 ; inflammability of, 83 ; 
 poisonous vapours of, 83 ; ex- 
 periments upon animals with, 
 84, 85 ; nitro-, 128, 129 
 
 Berlin, match factories in, 40 
 
 Bernard, H. M., 9 
 
 Berne Congress, use of white phos- 
 phorus discussed at the, 53 
 
 Bert, Paul, on carbonic acid poi- 
 soning, 55 ; on high pressures 
 of oxygen, 98 ; on caisson 
 disease, 102 
 
 Besangon et Cie, Messrs., white 
 lead works of, 145, 189 
 
 Binet, G., on the effects of intel- 
 lectual work, 9 
 
 Birmingham, Dr. C. L., on the 
 death-rate of ganister miners, 
 298, 299 
 
 Birmingham, enamelling industry 
 at, 172 ; brass industry at, 220 
 
 Bisulphide of carbon, its use in 
 the manufacture of indiarubber 
 goods, 77 ; poisonous vapour 
 given off by, 77-79 
 
 Blacksmiths, health of, 229 
 
 Blackwall Tunnel, Dr. Snell on 
 the condition of workers during 
 the making of the, 91, 92, 94, 
 108 
 
 Blanket- stoving, health of the oc- 
 cupation of, discussed, 86-7 
 
 Blast furnaces, poisonous gas 
 from, 60; hard life of workers 
 in, 227, 228 
 
 Bleaching powder, I2i 
 
 Bleiberg, lead smelting works at, 
 139 ; zinc smelting works at, 
 222 
 
 Bochum, School of Mines at, 
 408 
 
 Bohemia, match industry in, 40, 
 
 Boldon Colliery, accident at, 404 
 Bolivia, mining in, 118 
 Boulenger, Messrs., pottery works 
 
 of, 308 
 Bourneville, on the mental health 
 
 of children of house-painters, 
 
 202 
 Boxwood, maladies among 
 
 workers of, 259 
 Bradford, scourge of anthrax in, 
 
 335, 339, 340 
 Brandt, of Hamburg, white phos- 
 phorus discovered by, 35 
 Brass works, health of workers in, 
 
 220 
 Bremridge, Dr. R. H., his report 
 
 on the health of the Kolar miners, 
 
 293, 294 
 Brick making, employment of 
 
 children in, 380 ; health of 
 
 workers, 382 
 British Central Africa, 289 
 Brittany, intemperate habits of 
 
 working classes in, 147 
 Brociner, on acetylene gas, 79 
 Brocoorens, Dr., on diseases of 
 
 match makers, 46, 47 
 Brogniart, on the enamelled bricks 
 
 of Babylon, 168 
 Broken Hill lead mines in Aus- 
 tralia, 138 
 Bronchitis, chronic chemical 
 
 workers subject to, 120 ; death 
 
 rate of lead miners from, 141 ; 
 
 glass blowers subject to, 376 
 Bronzing industry considered, 234 
 
INDEX 
 
 415 
 
 l^rooklyn Bridge, condition of 
 
 workers on the, 94, 97 
 Brouardel, Professor, on tubercu- 
 losis, 13 
 Brown, Dr. Sanger, his report of 
 a case of coal-gas poisoning, 71 
 Brown- Sequard, his experiments 
 upon animals with expired air, 
 56 
 B runel, caissons used by, 94 
 Bryant and May's Match Works, 
 
 health of workers in, 51 
 Buhr stone, workers in, 306 
 Burroughs, Mr. W. J., 384 
 Burslem, pottery works at, 158 
 Byesson, on the effects ef mus- 
 cular work, 9 
 Byssinosis, 247 
 
 Caermarthen, tin-plate mills at, 
 
 239 
 
 Cahen, M., use of sesquisulphide 
 of phosphorus for matches dis- 
 covered by, 49 
 
 Caissons, described, 88 ; effect on 
 workers when entering the air- 
 lock, 89 ; condition of work in, 
 90 ; the hghting of, 90 ; condi- 
 tion of workers on leaving 
 the air-lock, 91, 92 ; those used 
 by the Cleveland Bridge Co. 
 described, 92, 93 ; "compressed- 
 air illness" from working in, 
 93-5 ; causes of illness con- 
 sidered, 96-108 
 
 Calcutta, jute industry in, 255 
 
 Calmette, on pneumokoniosis, 245 
 
 Cancer, its relation to injury, 24 ; 
 death-rate from, in chimney- 
 sweeps, 262 ; workers in coal- 
 oil and tar subject to, 383 
 
 Carbon monoxide, poisonous ef- 
 fects of, 58, 59 ; given off by 
 blast furnaces, 60-62 ; symp- 
 toms and pathology of poison- 
 ing by, 63 ; penetration of, into 
 dead bodies considered, 64-6 ; 
 acclimatisation of living bodies 
 to, 66-8 
 
 Carbonic acid gas, considered, 
 54-8, 97 
 
 Cardier, Major, 411 
 
 Carpathian Mountains, petrol 
 springs in the, 85 
 
 Cartell, on carbonic acid poison- 
 ing, 55 
 
 Caspari, on mountain climbing, 116 
 
 Cataract, glass-blowers subject to, 
 
 379 
 
 Cerro de Pasca, copper-mines at, 
 118 
 
 Chalicosis, 247 
 
 Chamberlain, Mr., Miners' Phthisis 
 Commission appointed by, 279 
 
 Charcot, his opinion on lead palsy, 
 209 
 
 Charvet's, Messrs., laundries in 
 Paris, 392 
 
 Chassevant, A., on the effect of 
 carbon bisulphide on the blood, 
 78 ; his experiments upon ani- 
 mals with benzine, 84 
 
 Chavigny, P., " Diagnostic des 
 Maladies Simulees," by, 31 
 
 Chemical trades, illness among 
 workers of, 120-29 
 
 Chimney sweep's cancer, 262 
 
 Chinese labourers in South Africa, 
 death-rate among, 289, 291, 292 
 
 Chloride of lime, manufacture of, 
 120 
 
 Chloride of sodium, skin eruption 
 caused by, 123 
 
 Clay, Dr. John, 26 
 
 Cleveland Bridge Company, their 
 work on the Tyne, 92, 93 
 
 Coach-painters, health of, 187 
 
 Coal-gas, asphyxiation by, 71 
 
 Coal-mines, improved ventilation 
 of, 267 ; phthisis among workers 
 considered, 268-72 ; ailments of 
 workers, 273, 274; explosions 
 in, 400-403 ; rescue apparatus 
 considered, 404-408 ; rescue 
 training, 409 
 Coal-tar, health of workers in, 
 
 382-84 
 Compressed air in caissons de- 
 scribed, 88 ; proper supply of, 
 considered, 91-3 ; illness aris- 
 ing from working in, 93-6; 
 causes of illness from, con- 
 sidered, 96-108 
 Cope Bros., Messrs., tobacco 
 works of, 264 
 
4i6 
 
 DISEASES OF OCCUPATION 
 
 Copper, harmful effects of, con- 
 sidered, 219-20 
 
 Corning, Dr., on caisson disease, 
 104 
 
 Cornwall, tin -mining in, 300; 
 ankylostomiasis in the miners 
 of, 314, 320, 323 
 
 Cotton Cloth Factories Act, 251 
 
 Cotton mills, health of workers in, 
 considered, 248-53 
 
 Courrieres, explosion in coal-mine 
 at, 400-403 
 
 Courtois-Suffit, Dr., quoted on 
 health of match workers in 
 France, 50 ; on condition of 
 women workers in tobacco 
 factories, 266 
 
 Cozzolino, M. O., 328 
 
 Cronquist, Professor, on the poi- 
 sonous gases given off by ferro- 
 silicon, 69 
 
 Crown Reef, death-rate of rock 
 drillers on the, 284 
 
 Crzellitzer, M., his report on " elec- 
 trical ophthalmia," 354 
 
 Cunningham, Dr. Geo., member 
 of Phosphorus Committee, 36 
 
 Cutlery, manufacture of , described, 
 230 ; high death-rate from tuber- 
 culosis among workers of, 231, 
 232 ; works at Solingen and 
 Sheffield compared, 233, 234 
 
 Cyanides, use of, in extraction of 
 gold, 225 
 
 Damaraland, death - rate among 
 
 native miners from, 289 
 Dangerous Trades Committee, 77, 
 
 181, 306, 350 
 D'Arsonval, his experiments upon 
 
 animals with expired air, 56 ; on 
 
 electric currents, 349, 351 
 Daudin, M. Pierre, attitude of, on 
 
 the use of white lead, 189 
 Davis, Mr. Frank, 93 
 Davy, Sir Humphry, 276 
 Davy, Surgeon A. F., on physical 
 
 training of soldiers, 395 
 Deane, Lieut.-Colonel H. M., on 
 
 the physical training of soldiers, 
 
 395 
 
 Deane, Miss L. A. E., Inspector 
 
 of Factories, 386 
 Dearden, Dr., quoted, 46 
 Demme,on chest- wounds followed 
 
 by tuberculosis, 14 
 Denayrouse, diving dress invented 
 
 by, no 
 Denbighshire, ganister mining in, 
 
 298 
 Denmark, use of white phosphorus 
 
 interdicted in, 48 
 Dewar, Sir James, 407 
 Diabetes, caused by accident, 25, 
 
 Diamond cutting described, 170, 
 171 
 
 Di-nitro-benzene poisoning, 128, 
 129 
 
 Disease simulated, 26 
 
 Dixon, Professor, his investigation 
 of African boxwood, 259 
 
 Dinorwic slate quarries, 302 
 
 Divers, dangerous occupation of, 
 109 ; disease owing to occupa- 
 tion, no. III ; costume of, 112 ; 
 in the Navy, 1 12-14 
 
 Dobson, Mr., Inspector of Fac- 
 tories, Sheffield, 192 
 
 Dolcoath tin-mines, 314 
 
 Dole, College of Arc, at, 39 ; birth- 
 place of Pasteur, 40 
 
 Domestic servants, health of, con- 
 sidered, 365 
 
 Draeger, rescue apparatus invented 
 by, 408, 410, 41 1 
 
 Dry cleaning by means of benzine 
 discussed, 82-5 
 
 Dundee, jute industry at, 255-57 
 
 Dupre, Dr., on lead poisoning, 157 
 
 Durham, ganister mining in, 298 
 
 Dust, injurious effects of, 242-48 ; 
 as a predisposing cause of 
 miners' phthisis, 279-85, 295- 
 300, 302, 305-307 
 
 Dye works, use of anihne in, 125, 
 126 ; use of lead in, 182 
 
 Earthenware, see Pottery 
 Egypt, ancient pottery of, 168 
 Electric accumulator works, lead 
 poisoning in, 175-78 
 
INDEX 
 
 417 
 
 Electric welding, dangerous to the 
 
 ^ eyes, 353, 355 
 
 Electricity, dangers of, considered, 
 347-49 ; cause of death by, con- 
 sidered, 350-53 
 
 Elgin, Earl of, 290 
 
 Embden, on poisoning in man- 
 ganese workers, 227 
 
 Emery-wheels, 237, 238 
 
 Emphysema, pulmonary, in glass 
 blowers, 376, 377 
 
 EnamelHng of iron plates de- 
 scribed, 172-75 
 
 Encephalopathy, " caused " by 
 "lead poisoning," 205, 211, 215 
 
 Engine-drivers, health of, con- 
 sidered, 358 
 
 Epilepsy simulated, 27 
 
 Eurick, Dr. F. W., of Bradford, 
 
 343 
 Evans, Willmott, 260 
 Explosives, considered, 130-36 
 Eyesight, loss of, in lead poison- 
 ing, 204, 206, 207, and elec- 
 tricity, 353, 354; frequency of 
 cataract in glass-blowers, 379, 
 383 
 
 Factories, control of match, con- 
 sidered, II ; ventilation of, 56 
 
 Fatigue, important factor contri- 
 buting to industrial diseases and 
 accidents, 1,4; definition of, 6 : 
 toxins of, considered, 6-8 ; 
 effects of, 8 ; intellectual and 
 muscular, considered, 9 ; pre- 
 vention of, II 
 
 Fenton, pottery works at, 158 
 
 Ferri carbonyl, 74 
 
 Ferro-silicon, poisonous gas given 
 off by, 69 
 
 Festiniog, health of quarrymen in 
 the mines of, 301-303 
 
 Fierte - sous - Jouarre, millstone 
 building at, 306-307 
 
 File-cutting described, 168-70 
 
 Fi«h-curing, considered, 367-70 
 
 Flax workers, 253 
 
 Fleuss, Henry, respiratory appar- 
 atus invented by, 405 
 
 Forgemen, health of, 229 
 
 Forth Bridge, the building of, 
 94 
 
 EE 
 
 Fournier, of Dijon, 334 
 
 France, compensation of workers, 
 in, 26 ; health of match workers 
 in, 47, 49 ; use of sesquisulphide 
 for making matches in, 49-51 ; 
 legislation on the use of white 
 lead, 188-90 ; condition of 
 workers in State tobacco fac- 
 tories, 263-66 ; statistics of acci- 
 dents in coal-mines, 275 ; slate- 
 mines in, 303, 320 
 
 Freer-Smith, Sir Hamilton, 347 
 
 Fruit preserving, considered, 370 
 
 Fulminate of mercury, manufac- 
 ture of, 136 
 
 Fumay, slate-mines at, 303 
 
 Fumouze, Dr., 355 
 
 Furnival, W. I., quoted on leadless 
 glaze, 168 
 
 Gaillot, M., 374 
 
 Gairdner, Sir Wm. Tennant, on 
 
 pulmonary emphysema, 377 
 Galezowski, on the eyesight of 
 
 workers in tobacco factories, 
 
 264, 265 
 Galicia, match industry in, 40 
 Galvanised iron, manufacture of, 
 
 239 
 Ganister mining considered, 298, 
 
 299 
 Gardener's cancer, 262 
 Garforth, Mr. W. E., on rescue 
 
 work in mines, 406 ; and rescue 
 
 training, 409 
 Garman, Dr., medical officer to 
 
 Messrs. Bryant & May's Works, 
 
 46,47 
 
 Garnier, M. Marcel, experiments 
 upon animals with benzine, 84 
 
 Gases, poisonous, carbonic acid 
 considered, 54-8 ; carbon mon- 
 oxide, considered, 58-68 ; ferro- 
 silicon, 69 ; illuminating gas, 69 ; 
 water gas, 70-2 ; poisonous gas 
 given off by nickel carbonyl, 73 ; 
 ferri carbonyl, 74 ; sulphuretted 
 hydrogen gas, 74-7 ; acetylene 
 gas, considered, 79, 80 
 
 " Gassing " considered, 275 
 
 Geldenhuis Deep, death-rate of 
 rock-drillers on the, 281 
 
4i8 
 
 DISEASES OF OCCUPATION 
 
 Germany, compensation of work- 
 men in, 15, 21 ; simulation of 
 disease in view of compensation, 
 26 ; regulations in lead manu- 
 factories, 144, 177 ; statistics of 
 iron workers in, 228 ; hygienic 
 methods of, with regard to 
 ankylostomiasis, 316-17 ; regu- 
 lations with regard to anthrax, 
 338 ; rescue party sent to en- 
 tombed miners at Courrieres, 
 400 
 Giardini, on ankylostomiasis, 319 
 Gibson, Professor Harvey, his in- 
 vestigation of African boxwood, 
 
 259 
 Giles, on ankylostomiasis, 318 
 Glamorgan, tin-plate industry in, 
 
 239 
 
 " Glass-blowers' mouth," 378 
 
 Glass making, described, 375 ; 
 health of workers, 377 ; preva- 
 lence of cataract in workers, 379 
 
 Glass polishing, health of workers 
 considered, 181 
 
 Glazes, leadless, see Lead 
 
 Glazing of earthenware, 158-60 ; 
 without lead, 166-68 
 
 Gilbert, Dr., on the diseases of 
 flax workers, 254 
 
 Gold, methods of extracting, 225, 
 236 
 
 Goldman, Dr., his opinion on the 
 antiseptic action of coal dust, 
 270, 318, 332 
 
 Gold-mining in South Africa, 275 ; 
 deaths from "gassing" dis- 
 cussed, 276-78 ; phthisis in 
 miners considered, 279-86 ; 
 temperatures of mines con- 
 sidered, 287 ; statistical tables 
 showing death - rate among 
 native miners, 283-91 ; health 
 of Kolar miners, 293 
 
 Gombault, his opinion on lead 
 palsy, 209 
 
 Gould, Mr. Edward, his report on 
 health of workers at Tavistock 
 arsenic mines, 217 
 
 Graham, his experiments upon 
 animals with carbon monoxide, 
 66,67 
 
 Grammont, match works at, 46 
 
 Grant, Dr. Lachlan, 303 
 
 Grassi, on ankylostomiasis, 319 
 
 Great Britain, compensation of 
 workers in, 27 ; match industry 
 in, 37, 42 ; statistics of phos- 
 phorus necrosis in, 47 ; attitude 
 towards the prohibition of white 
 phosphorus, 52, 53 ; statistics of 
 accidents in coal-mines in, 275 
 
 Greenhow, Dr., 221 
 
 Greenwood, Dr. Alfred, quoted on 
 death-rate of cotton-weavers, 
 250 
 
 Greenwood, M., on air pressures, 
 
 105 
 Greidenberg, cases of coal-gas 
 
 poisoning reported by, 72 
 Grevy, M. Jules, 39 
 Grinding of cutlery, 230 
 Guglielminetti, Dr., 406 
 Gun-cotton described, 132 
 Gunpowder, 130, 131 
 
 H 
 
 Haemoptysis, simulated, 31, 32 
 
 Haldane, Dr. J. S., his experiments 
 upon animals with expired air, 
 56 ; " Investigation of Mine Air " 
 by, 68, 278 ; on health of 
 Cornish tin-miners, 300, 329 
 
 Hall, Dr. T. C, statistics of steel- 
 grinders by, 231 
 
 Hamaide, Dr., on the slate miners 
 of Fumay, 304 
 
 Hamer, W. H., on anthrax, 338 
 
 Hanley, pottery works at, 158 
 
 Hauft, G., his experiments with 
 carbon bisulphide, 78 
 
 Hawthorne, C. O., " Functional 
 Hemiplegia" by, 29 
 
 Heart disease and injury, 32, 33 ; 
 in iron workers, 228, 229 
 
 Hebert, M., experiments by, 184 
 
 Heim, M., experiments by, 184 
 
 Hemiplegia, 29 
 
 Herring salting, considered, 367- 
 
 370 
 Hesse, on dust, 245 
 Hill, Leonard, quoted, 100 ; on 
 
 compressed air, 105, 107 
 Hirt, on prevalence of tuberculosis 
 
 among lead workers, 178 
 Hodge, American physiologist, 8 
 Hogben, Dr., 221 
 
INDEX 
 
 419 
 
 Hogg, T. W., " Immunity of some 
 Low Forms of Life from Lead 
 Poisoning " by, 139, 140 
 
 Holden, Sir Isaac, inventor of the 
 lucifer match, 38 
 
 Holland, use of white phosphorus 
 interdicted in, 48 
 
 Honsell, his investigations on trau- 
 matism, 15 
 
 Hooper, diving feats done by, 109 
 
 Hopital St. Antoine, Paris, 13, 18, 
 206, 215 
 
 Hospital nursing, considered, 345 
 
 Hudson River Tunnel,compressed- 
 air illness among the workers of 
 the, 98, 106 
 
 Hughes, Dr. Hugh, his report on 
 lead poisoning in electric ac- 
 cumulator works, 176 
 
 Hughes, caissons first used by, 
 in making bridge over Medway, 
 
 94 
 Hungary, ankylostomiasis in the 
 
 miners in, 314-19 
 Hunter, Dr., 96 
 Hutchinson, Dr. John, on rescue 
 
 work in mines, 405 
 Hydrochloric acid, manufacture 
 
 of, 120 
 Hysteria, 28, 30, 32, 34 
 
 Illuminating gas, 69 ; acetylene 
 gas considered, 79, 80 
 
 "Immunity of some Low Forms 
 of Life from Lead Poisoning," 
 by T. W. Hogg, 139, 140. 
 
 India, jute exportation from, 255 ; 
 ankylostomiasis among the na- 
 tives of, 321, 323 
 
 Indiarubber goods, health of the 
 workers in the making of, 77-9 
 
 Inglis, Dr., 211 
 
 " Industrial Efficiency," by Arthur 
 Shadwell, 232 
 
 Insanity, caused by lead poison- 
 ing, 210 
 
 Intellectual work, its effect on 
 health, 8 
 
 "Investigation of Mine Air" by 
 Haldane, 68 
 
 Irinyi, Bartholomaus, 38 
 
 Iron foundries, hard life of workers 
 in, 227, 228 
 
 Irvine, Dr. L. G., 276 ; on death- 
 rate of rock-drillers, 284 
 
 J 
 
 Jacoud, Professor, quoted on injury 
 followed by tuberculosis, 22 
 
 Jaksch, Dr. von, on poisoning in 
 manganese workers, 227 
 
 James, Lord, of Hereford, arbitrator 
 on findings of White Lead Com- 
 mission, 161-63 
 
 Japan, match industry in, 41, 42 ; 
 condition of match making in, 
 42 ; attitude of, towards the 
 abolition of white phosphorus 
 at the Berne Congress, 52 ; anky- 
 lostomiasis among the natives 
 of, 321 
 
 Jarackzewski, M., 355 
 
 Jellinek, of Vienna, his opinion as 
 to cause of death in electric 
 shock, 351 
 
 Johannesburg, dust storms at, 293 
 
 Johnston, Mr. C, report on condi- 
 tion of cutlery works at Solingen 
 and Sheffield, 233 
 
 Jones, David Rhys, on rescue work 
 in mines, 405 
 
 Jones, Dr. H. Lewis, of St. Bar- 
 tholomew's Hospital, 214 
 
 Jones, Dr. Richard, on the maladies 
 of slate-mines, 302, 303 
 
 Jordan, Dr. Alfred C, 356 
 
 Josserand, quoted, 31 
 
 Jumpers Deep, death-rate of rock- 
 drillers on the, 284 
 
 Jute, manufacture of, 255 ; health 
 of workers considered, 256, 257 
 
 K 
 
 Kaffirs, death-rate of, working in 
 mines, 285, 294 
 
 Kammerer, Johann Friedrich, 
 match works estabhshed in Ger- 
 many by, 39 
 
 Kellet, Mr., on lead poisoning in 
 electric accumulator works, 175 
 
 Key, Major Cooper, Inspector of 
 Explosives, 134, 135 
 
420 
 
 DISEASES OF OCCUPATION 
 
 Kidneys, effect of lead on, 203, 
 211, 213 ; disease of, 229 
 
 King Edward Bridge at New- 
 castle, condition of workers 
 when making, 91, 94, 107 
 
 Klagenfiirt White Lead Works in 
 Austria, 144 
 
 Knysna wood, 259 
 
 Koch, Professor, tubercle bacillus 
 discovered by, 15, i6; on an- 
 thrax, 334 
 
 Kocher, Dr., 47 
 
 Kolar gold-mines, freedom from 
 phthisis among workers in the, 
 
 293 
 Kopperberg, Sweden, copper 
 mines at, 219 
 
 Lambinet, Dr., miners' dispensary 
 at Liege under, 320, 329, 330, 
 331 
 
 Lacrosse, zinc white used instead 
 of white lead by order of, 189 
 
 Label licking, injuriousness of, 
 
 372 
 Landouzy, Professor, of Hopital 
 
 Laennec, 390 
 Langlois, Professor, on nickel car- 
 
 bonyl, 74 ; on compressed-air 
 
 illness, 105 
 Lannelongue, his experiments on 
 
 animals with tubercle bacilli, 17 
 Laslett, Dr., his opinion on lead 
 
 palsy, 209 
 Laundries, considered, 386 ; acci- 
 dents in, 387 ; long hours in, 
 
 388 ; intemperance of workers, 
 
 389 ; prevalence of tuberculosis 
 in workers, 390-92 
 
 Lead, poisonous character of, con- 
 sidered, 137-41 ; mining, 141 ; 
 smelting and desilvering, 143 ; 
 manufacture of red lead de- 
 scribed,i43; regulations in manu- 
 factories of, 144-46 ; alcohol a 
 predisposing cause of lead 
 poisoning, 147, 148 ; suscepti- 
 bility of females to plumbism, 
 149, 150 ; manufacture of white 
 lead described, 151-57 ; glaze 
 used in the manufacture of 
 pottery, 157, 158 ; findings of 
 
 Commission on, 159,160 ; arbitra- 
 tion on, 161-63 ; statistics of 
 poisoning by, 164-66 ; glaze 
 without, considered, 16^8 ; 
 file-cutting described, 168-70 ; 
 use of, in diamond-cutting 
 industry, 171 ; use of, in 
 polishing and setting of pre- 
 cious stones, 172 ; use of, in the 
 enamelling of iron plates and 
 hollow ware, 172-75 ; use of, in 
 electric accumulator works, 
 175-78 ; use of, in printing 
 works, 178-81 ; use of, in glass 
 polishing, 181 ; poisoning by, 
 among painters considered, 182- 
 88 ; substitutes for, considered, 
 188-91 ; symptomatology of 
 poisoning by, 192-98 ; effect of 
 poisoning in pregnancy, 198-202; 
 its effects on kidneys, liver, and 
 nervous systems, 202-08 ; path- 
 ology of poisoning by, 211 ; 
 treatment of poisoning, 212-15 
 
 Le Blanc, process of manufacture, 
 120, 122 
 
 Leclaire, on the substitution of 
 zinc white for white lead, 189 
 
 Legge, Dr. T. Morrison, on lead 
 poisoning, 154 ; his report on 
 lead poisoning, 179 ; on wool- 
 sorters' disease, 335 ; his report 
 on anthrax, 339, 343 
 
 Lemaistre, Dr., on the air in 
 potteries, 309 
 
 Lenberger, his experiments with 
 carbon monoxide, 64 
 
 Lenormant, M., 168 
 
 Letulle, Professor, on tuberculosis, 
 
 i3> 310 
 Leudet, Dr., on prevalence of 
 
 tuberculosis among lead workers, 
 
 179 
 Lewin, Professor, on the offspring 
 
 of lead workers, 199, 200 
 Liebeg, on carbonic acid poison- 
 
 ing,55; on sulphuretted hydrogen 
 
 gas poisoning, 76 
 Liebkind, on pulmonary emphy- 
 sema in glass blowers, 377 
 Liege, ankylostomiasis among the 
 
 miners of, 319, 320, 329 
 Lille, report on the health of the 
 
 house-painters at, 186 
 
INDEX 
 
 421 
 
 Limoges, porcelain works at, 159 ; 
 health of workers, 308, 309 
 
 Linares, lead mines at, 138 
 
 Linen workers, diseases of, con- 
 sidered, 253-55 
 
 Linotyping, 178-80 
 
 Lisburn, linen industry at, 253 
 
 Litharge, 143 
 
 Livache, M., experiments with 
 zinc white and white lead by, 
 190 
 
 Liverpool, Diamond Match Works 
 of, 48 
 
 Locomotor ataxia simulated, 208 
 
 Longton, pottery works at, 158 
 
 Looss, of Cairo, 324, 327 
 
 Lorinser, Dr., of Vienna, phos- 
 phorus necrosis first diagnosed 
 
 by, 39 
 
 Lothringen mine, 316, 317 
 
 Lourties, Dr., 403 
 
 Lowy, on respiration, 1 16 
 
 Lucas-Championniere, on chauf- 
 feurs' fracture, 385 
 
 Lucifer match, inventors of, 37-9 ; 
 industry of the making of, 40-2 ; 
 description of manufacture of, 
 43 ; poisonous effect of the use 
 of phosphorus, discussed, 43-8 ; 
 ill-health of the workers at the 
 works at Panton-Aubervilliers, 
 49 ; use of sesquisulphide of 
 phosphorus, 49-52 
 
 Lurgan, linen industry at, 253 
 
 Lyddite, described, 133, 134 
 
 M 
 
 Macaulay, Dr. Donald, 276, 278 
 Macdiarmid, Dr., quoted, 138 
 Mackenzie, Dr. A., of Leeds, 410 
 Macleod, on decompression, 107 
 Macnaughton, Dr. George W. F., 
 
 on caisson disease, 103 
 Malassez, Dr., on lead poisoning, 
 
 198 
 Maiden, Dr. Walter, on aniline 
 
 poisoning, 127 ; on di-nitro- 
 
 benzene poisoning, 128 
 Manganese, poisonous effects of, 
 
 227 
 Mann, Dr. Dixon,on lead poisoning, 
 
 205 
 Manouvriez, of Valenciennes, 330 
 
 Marine service, considered, 396 
 Marix, Dr., quoted on statistics of 
 soldiers wounded in the chest, 
 
 19 
 
 Marriott, Mr. Hugh F., on tem- 
 peratures of South African mines, 
 287 
 
 Martin, Mr. Joseph S., his report 
 on health of workers at Tavistock 
 arsenic mines, 217 
 
 McKinlay, Fleet-Surgeon Archi- 
 bald, case of diving fatality re- 
 counted by, 113 
 
 Medway, caissons first used in 
 making bridge over, 94 
 
 Meningitis, septic, caused by lead 
 poisoning, 52 
 
 Mercury, poisonous effects of, con- 
 sidered, 223-26 
 
 Mericourt, Leroy de, on dangers 
 incurred by sponge-divers, 1 10 
 
 Merionethshire, slate mines in, 301, 
 302 
 
 Metallic dust, 311 
 
 Meyhofer, on cataract in glass- 
 blowers, 379 
 
 Middleton St. George, blast fur- 
 naces at, 60 
 
 Mies, lead smelting works at, 142 
 
 Millstone building, 306 
 
 Miners' anaemia, see Anaemia 
 
 Miners' nystagmus, 273 
 
 Miners' phthisis among coal- 
 miners considered, 267-73 ; 
 among South African gold- 
 miners, 279-86, 290-93 ; among 
 the quartz miners of Bendigo, 
 295-98 
 
 Miners' Phthisis Commission, 284 
 
 Mining, see Coal Mines, also Gold- 
 mining 
 
 Mirror gilding, 225 
 
 Mirto, on the penetration of car- 
 bon monoxide into dead bodies, 
 
 65 
 
 Miscarriage, lead poisoning, 186, 
 198 
 
 Monmouth, tin-plate mills at, 239 
 
 Monmouthshire, high death-rate 
 from phthisis in miners in, 
 269 
 
 Morveau, Guyton de, on the sub- 
 stitution of zinc white for white 
 lead, 189 
 
422 
 
 DISEASES OF OCCUPATION 
 
 Mosny, Dr., quoted on traumatism 
 and tuberculosis, i8 ; his opinion 
 on lead encephalopathy, 206, 
 
 215 
 Mossaglia, A., on fatigue, 7 
 Mosso, Professor, of Turin, his 
 experiments upon animals with 
 acetylene, 79 ; on " mountain- 
 sickness," 117 
 Motor-car driving, dangers of, 
 
 384 
 Mott, Dr. F. W., 73, see note, 74 
 Mountain-sickness, 1 15-19 
 Miiller, on respiration, 116 
 Munich, Dr. L. V. Stubenrauch of, 
 
 45 
 Muscular strain, effects of, 9, 10, 
 
 II 
 Myers, Surgeon, on the uniform of 
 
 soldiers, 395 
 Myrbane, 129 
 
 N 
 
 Naphtha, its use in dry-cleaning, 
 82-4 
 
 Nasmith, experiments upon ani- 
 mals with carbon monoxide, 66, 
 67 
 
 Newcastle-upon-Tyne, Royal Vic- 
 toria Infirmary at, 10, 12 ; deaths 
 from phosphorus poisoning in, 
 50; 53 ; construction of King 
 Edward Bridge at, 91 ; lead 
 works at, 150, 157 ; plumbism 
 among printers in, 180 ; Arm- 
 strong College at, 314 ; electric 
 railways in, 349 
 
 New York, underground railways 
 of, 242 
 
 Nichols, Dr. H. J., quoted on 
 anthracosis and tuberculosis, 
 270, 271 
 
 Nicholson, Dr. T. Marshall, 410 
 
 Nickel carbonyl, poisonous gas 
 given off in the manufacture of, 
 
 73,74 
 Nicolai, quoted, 32 
 Nicolet, Professor, 39 
 Nitric acid poisoning, 124 
 Nitro-benzene, 128, 129 
 Nitrogen oxide, deaths from the 
 
 fumes of, 276-78 
 Nitro-glycerine described, 133 
 
 Nobel, Alfred, nitro-glycerine 
 
 manufactured by, 133 
 Normandy, intemperate habits of 
 
 working classes in, 147, 148 
 Norway, export of matches from, 42 
 Nuremberg, match factories at, 40 
 Nystagmus in miners, 273 
 
 Oakworth House, 38 
 
 O' Kelly, Dr., rescue work by, 404 
 
 Oldbury, manufacture of white 
 
 phosphorus at, 36 
 Oldendorf, his report on the steel 
 
 grinders of Solingen, 232 
 Ophthalmia, electrical, 354 
 Orange River Colony, death-rate 
 
 among native miners, 289 
 Ottolenghi, his experiments upon 
 
 animals with acetylene, 79 
 
 Paardeberg, lyddite used at, 134 
 
 Pain as sign of disease, 34 
 
 Painters, prevalence of lead 
 poisoning among, 182-88 
 
 Paints, dangers of quickly-drying, 
 80-2 
 
 Pantin-Aubervilliers, match works 
 at, health of the workers at, 49- 
 51 ; tobacco works at, 264, 265 
 
 Para red dying, 126 
 
 Paralysis from lead poisoning, 
 207, 208, 214 
 
 Paralysis, simulated, 28, 29 
 
 Paris, match factories in, 40 
 
 Parkin, Dr. Alfred, experiments 
 upon animals with high pres- 
 sures of oxygen, 98, 99 ; " Thesis 
 on Caisson Disease," by, 109 
 
 Parona on ankylostomiasis, 319 
 
 Parsons, Dr., his recommendations 
 for workers in shoddy factories, 
 262 
 
 Pasteur, Dole birthplace of, 40 ; 
 on anthrax, 334 
 
 Pasteur Institute, 190 
 
 Paterson, Miss, report on female 
 workers in lead factories by, 
 149 
 
 Paul, Constantin, on the offspring 
 of lead-workers, 199 
 
INDEX 
 
 423 
 
 Peacock on miners' phthisis, 280 
 
 Pearson on miners' phthisis, 280 
 
 Pelton Fell, incident at, recounted, 
 61 
 
 Penrhyn slate quarries, 302 
 
 Perroncito, Dr., on ankylostomiasis 
 in miners of the St. Gothard 
 Tunnel, 313, 314, 320 
 
 Persigny, M., attitude of, on the 
 use of white lead, 189 
 
 Perroud, his investigations on 
 phthisis among the sailors on 
 the Rhone, 15 
 
 Persia, impure wool from, 336 
 
 Persian pottery, 168 
 
 Peru, mining in, 118 
 
 Petrol, poisonous vapours given 
 off by, 85, 86 
 
 Phosphorus described, 35 ; manu- 
 facture of white, 36 ; used in 
 the manufacture of matches, 36 ; 
 poisonous qualities of, 36 ; com- 
 mittee to inquire into poisonous 
 effects of, 36 ; effects of its 
 fumes on the teeth, 43, 44 ; ex- 
 periments upon animals with, 
 45 ; affections arising from, 46 ; 
 statistics of poisoning from, 
 47, 48 ; use of sesquisulphide 
 of, 49-51 ; prohibition of, 52, 
 
 53 
 
 Phosphorus necrosis, or " phossy 
 jaw," 37, 44 ; described, 44, 45 ; 
 immunity of animals from, 45 ; 
 statistics of, 47, 50 ; treatment 
 of, 52 
 
 Petrow, his experiments on ani- 
 mals with tubercle bacilli, 17 
 
 Phthisis, see Tuberculosis 
 
 Pidoux, Dr., 178 
 
 Pitch, 332 
 
 Playfair, Dr. Lyon, 405 
 
 Plumbism, see Lead Poisoning 
 
 Pneumokonioses, 247-310 
 
 Pneumonia, injury as a deter- 
 mining cause of, considered, 
 21-23 ; dust as a predisposing 
 cause of, 244; among miners, 
 290-94, 302, 303, 310 
 
 " Poisons Industriels " quoted, 84 
 
 Pol and Watelle on compressed- 
 air illness, 93 
 
 Polishing of precious stones, 172 ; 
 of metals, 230 
 
 Pollender, bacillus anthracis dis- 
 covered by, 334 
 
 Pope, Pearson & Co., Messrs., 
 collieries, 409 
 
 Posnett, W. G. T., pathologist to 
 the Johannesburg Hospital, 
 321 
 
 Pottery manufacture, 157 ; health 
 of workers considered, 307-10 
 
 Pott's disease, 30 
 
 Preshel, his large match factory 
 in Vienna, 40 
 
 Prettin on pulmonary emphysema 
 in glass-blowers, 377 
 
 Prevost, Professor, of Geneva Uni- 
 versity, 350 
 
 Printing works, health of workers 
 in, 178-81 
 
 Probsting, Dr., oculist, 379 
 
 Proust, his opinion on the manu- 
 facture of tobacco causing dis- 
 eases of the lungs, 264 
 
 Prussia, statistics of accidents in 
 coal-mines in, 275 
 
 Prussian blue, manufacture of, 77 
 
 Purdon, Dr. H. S., on the maladies 
 of linen workers, 254 
 
 Putty powder, 181 
 
 Quilimane, death-rate among 
 native miners from, 289 
 
 Racing of grindstones, 230 
 
 Rag sorting, 260 
 
 Rammazini, miners' phthisis de- 
 scribed by, 280, 307 
 
 Rand miners' phthisis, 276-85 
 
 Ransome, Dr., on the Committee 
 appointed to inquire into the 
 ventilation of factories, 251 
 
 Ravenhal of Pennsylvania, 337 
 
 Raymondaud, Dr., 309 
 
 Red lead, see Lead 
 
 Redruth tin-mines, 300 
 
 Reichenberg, pohshing industry 
 at, 172 
 
 Relm, German surgeon, on aniline 
 poisoning, 127, 128 
 
 Rescue work in mines, 304-12 
 
424 
 
 DISEASES OF OCCUPATION 
 
 Ridley, Sir Matthew White, Com- 
 mittee appointed by, to inquire 
 into the dangers attending the 
 use of phosphorus, 36 ; quoted 
 on lead poisoning, 153, 162 
 
 Rigolot, M., 190 
 
 Ripert, M., his experiments upon 
 animals, 305 
 
 Roberts, Sir William, on the Com- 
 mittee to inquire into the venti- 
 lation of factories, 251 
 
 Robertshaw, Dr., on death-rate of 
 ganister miners, 298 
 
 Robinson, Dr. Wm., 379 
 
 Rochester, caissons first used at, 
 94 
 
 Rock-drillers, health of, 283, 284, 
 
 293 
 Rhodesia, 289 
 Rogers, Mr., on lead poisoning, 
 
 Romer, Stephen, inventor and 
 manufacturer of lucifer matches 
 in Vienna, 38, 40 
 
 Roques, M., 202 
 
 Roscoe, Sir Henry, Committee on 
 the condition of ventilation of 
 factories, 56, 251 
 
 Rostock on traumatism, 15 
 
 Royal Victoria Infirmary at New- 
 castle, 10, 12 ; deaths from 
 phosphorus poisoning in, 50, 
 53 ; cases of plumbism in, 150, 
 
 195 
 Rudolf, Mr., manager of the 
 
 Sopron-Brennberg Colliery, 319 
 Ruhr Valley, coal-mines in the, 
 
 314, 315 
 
 Sadler, Miss, Inspector of Fac- 
 tories, 387 
 
 Sailors, conditions of life and 
 health of, 396-98 
 
 Saltash, caissons used at, 94 
 
 Salt cake, manufacture of, de- 
 scribed, 120-23 
 
 Salvetat, M., 168 
 
 Sansom, Dr. C. L., on death-rate 
 of native miners, 285 
 
 Santesson of Stockholm, case of 
 benzene poisoning reported by, 
 84 
 
 Sauria, Charles, student at Dole, 
 inventor of a lucifer match, 39 
 
 Scheele's green, arsenic used in 
 manufacture of, 216 
 
 Schlockow on diseases of zinc 
 workers, 222 
 
 Schonbein, gun-cotton discovered 
 by, 132 
 
 School teachers, health of, con- 
 sidered, 363 
 
 Schroter, of Vienna, red phos- 
 phorus discovered by, 35 
 
 Schrotter, H. von, on caisson 
 workers, 109 
 
 Schule, Dr., of Berlin, 378 
 
 Schultz on the penetration of car- 
 bon monoxide into dead bodies, 
 64-6 
 
 Schweinitz, Dr., on the eyesight 
 of workers in tobacco factories, 
 264 
 
 Sclavo, of Milan, anti-anthrax 
 serum invented by, 342, 343 
 
 Scott, F. H., on fatigue, 8 
 
 Scranton, health of miners at, 270 
 
 Sejournet, Dr., on the maladies of 
 slate-miners, 303 
 
 Seltman on tuberculosis in coal- 
 miners, 270 
 
 Sesquisulphide of phosphorus used 
 instead of white phosphorus for 
 matches, 49-52 
 
 Sevene, M., use of sesquisulphide 
 of phosphorus for matches dis- 
 covered by, 49 
 
 Sevres china, 159 
 
 Shadwell, Dr. Arthur, " Industrial 
 Efficiency " by, 232 
 
 Shears, Dr., on the eyesight of 
 workers in tobacco factories, 
 264 
 
 Sheffield, file-cutting industry at, 
 170 ; cutlery manufacture at 
 considered, 230, 231 ; Solingen 
 compared with, 233, 234 ; elec- 
 tric welding at, 354 
 
 Shidlowski, M., diving apparatus 
 invented by, 112 
 
 Shoddy industry considered, 260- 
 
 61 
 Shuttle making, 258 
 Siberia, 336, 337 
 Sicily, sulphur mines in, 320 
 Siderosis, 247, 311 
 
INDEX 
 
 425 
 
 Siegl, large match factory of, in 
 
 Vienna, 40 
 Signalmen, health of, considered, 
 
 358 
 Silicosis, 247 
 Simonis, Mr. Otto, on liquid-air 
 
 rescue apparatus, 406 
 Simplon Tunnel, making of the, 
 
 314 
 
 Slag crushing, 310 
 
 Slate quarrying in mines, 301 ; 
 ailments of workers, 302 ; mala- 
 dies of French miners, 303-305 
 
 Smith, Dr., on compressed-air ill- 
 ness, 97, 104 
 
 Smith, George, on the employment 
 of children in brickyards, 380 
 
 Smith, Lorrain, Professor, his ex- 
 periments upon animals with 
 expired air, 56 ; effect of high 
 pressure on the blood, 99 
 
 Snell, Dr. E. Hugh, on com- 
 pressed-air illness, 91, 92, 97, 108 
 
 Snell, Mr. Simeon, 354 
 
 Sobrero, A., nitro-glycerine dis- 
 covered by, 133 
 
 Soda, manufacture of, described, 
 120-23 
 
 Soldiers, life of, considered, 393 ; 
 health of, 394 ; physical training 
 
 of, 395-96 
 
 Solingen, cutlery manufacture at, 
 231 ; compared with Sheffield, 
 233, 234 
 
 Sommerfield, statistics quoted from 
 his book on diseases of occupa- 
 tion, 247 
 
 Soot, injurious effect of, 262 
 
 Soot, irritation caused by, 262 
 
 Soper, Dr. G. A., his report upon 
 the air and dust of the New 
 York Underground Railway, 
 242-45 
 
 Sopron-Brennberg, health of 
 miners at, 288 ; ankylosto- 
 miasis in the miners at, 314-19 
 
 South African gold-mines, health 
 of workers in, considered, 276 ; 
 ankylostomiasis among the 
 miners of, 321 
 
 Sponge seekers, no 
 
 Squire, Miss Rose, her report on 
 tin-plate workers, 240, 373 
 
 Staffordshire, potteries of, 158, 159, 
 
 161, 164; death-rate of potters, 
 
 309 
 
 Steavenson, Dr. C. Stanley, 60 
 
 Steel grinding, 230 
 
 Stephenson, Dr., his report on the 
 ventilation of cotton mills, 251 
 
 St. Gothard Tunnel, ankylosto- 
 miasis in the miners of the, 312- 
 
 14 
 
 Stewart, Sir Thomas Grainger, on 
 fatigue, 8 
 
 Stiles, Dr. C. W., on ankylosto- 
 miasis, 313 
 
 St. Joseph slate mines, 303 
 
 St. Louis Bridge, Mississippi, con- 
 dition of workers at, 94 
 
 Stoke-on-Trent, pottery works at, 
 158; Court of Arbitration at, 
 161-63 
 
 Stockman, Professor, 327 
 
 Stockton-on-Tees, first lucifer 
 match made at, 37, 38 
 
 Stonemasons' phthisis, 305 
 
 Strasburg, match factories in, 40 
 
 Strassman and Schultz, on the 
 penetration of carbon monoxide 
 into dead bodies, 64-6 
 
 Stuart, Dr. I. A. E., on the health 
 of blanket-stovers, 86; on the 
 maladies of workers in shoddy 
 factories, 261 
 
 Stubenrauch, Dr. L. v., his experi- 
 ments upon animals with phos- 
 phorus, 45 
 
 Stuttgart, match factories in, 40 
 
 Styria, match industry of, 40 
 
 Sugar refining, 373 
 
 Sulphuretted hydrogen gas, 
 poisonous effects of, 62, 74-7 
 
 Sulphuric acid, manufacture of, 
 120, 122 
 
 Sumatra, petrol embarked from, 86 
 
 Summons, Dr. Walter, on the 
 health of miners at Bendigo, 
 295> 297 
 
 Swansea, smelting works at, 219 
 
 Sweden, match industry of, 35 ; 
 export of matches from, 41, 
 
 47 
 Switzerland, compensation of 
 workers in, 26 ; phosphorus 
 necrosis among match makers 
 in, 47 ; use of white phosphorus 
 interdicted in, 48 
 
426 
 
 DISEASES OF OCCUPATION 
 
 Talayrach, Surgeon-Major, on an- 
 kylostomiasis among soldiers, 
 317 
 
 Tanquerel, Dr., 178 
 
 Tatham, Dr. John, his statistics 
 on zinc workers, 221 ; on the 
 high death-rate of steel-grinders, 
 232 ; his statistics on death-rate 
 from cancer in chimney-sweeps, 
 262 ; on death-rate from phthisis 
 in miners, 268-70 
 
 Tavistock, ill-health of workers at 
 the arsenic mines at, 217 
 
 Tea-tasting considered, 366 
 
 Teissier, Professor, quoted on 
 tuberculosis, 14 
 
 Teleky, Dr. Ludwig, his work on 
 the match-making industry, 40, 
 
 Telegraph clerks, health of, con- 
 sidered, 361 
 
 Temperature in mines, 287 
 
 Tenholt, Dr., authority on anky- 
 lostomiasis, 314, 316, 330 
 
 Tetanus in jute workers, 257 
 
 Thenard's method of white lead 
 manufacture, 155 
 
 "Thesis on Caisson Disease," by 
 Dr. Alfred Parkin, 109 
 
 Thorpe, Professor T., on Com- 
 mittee to Inquire into the 
 Dangers attending the Use of 
 Phosphorus, 36 ; quoted on the 
 effect of the fumes of phos- 
 phorus on the teeth, 43, 48 ; on 
 lead poisoning, 140; on White 
 Lead Commission, 159-163, 181 
 
 Tin-mines in Cornwall, health of 
 workers in, considered, 300 
 
 Tin-plate mills, hard and un- 
 healthy life of workers at, 239- 
 241 
 Tirelli, M. L., on ankylostomiasis, 
 
 Tissot, Dr., rescue apparatus in- 
 vented by, 411 
 
 Tobacco factories, health of 
 workers in, 263 ; State mono- 
 poly in France, 265, 266 
 
 Tonite, 133 
 
 Tracy, Miss, 387 
 
 Transvaal, 288, 293 
 
 Trap-drummer's neurosis, 362 
 Traumatism, as a determining 
 cause of tuberculosis, 12-21 ; 
 pneumonia following, 21 ; dia- 
 betes due to, 25 
 Treille, M., report on white lead 
 
 industry by, 147 
 Trillat, Professor, lead test dis- 
 covered by, 183, 184 
 Tuberculosis, injury as a deter- 
 mining cause of, considered, 12- 
 16 ; experiments on animals, 
 16, 17 ; Dr. Mosney's opinion 
 on, 18 ; injury prepares the 
 way for the reception of, 19, 
 20 ; claims for compensation 
 considered, 21-26 ; simulated, 
 31, 32 ; among file-cutters, 168 ; 
 among printers, 178-79 ; dust 
 as a determining cause of, 244- 
 48 ; its prevalence amongst 
 cotton weavers, 249, 250 ; coal- 
 miners' phthisis considered, 
 267-73 ; Rand miners' phthisis 
 considered, 279-85, 293 ; miners' 
 phthisis, 295-300, 302 ; stone- 
 masons' subject to, 305 ; mill- 
 stone builders subject to, 
 306-7 ; its prevalence amongst 
 laundry workers, 390-92 
 
 Tunstall, pottery works at, 158 
 
 Turnau, 172 
 
 Tyne, condition of shipbuilding 
 on the, 5 ; bridge making on, 
 91, 92, 93, 97 
 
 Tyneside, chemical industry on, 
 120 
 
 Type-founding, 178 
 
 Typists, health of, considered, 361 
 
 Vahleen, on nickel carbonyl, 74 
 
 Vauginot, Lieutenant, rescue ap- 
 paratus invented by, 411 
 
 Verhaeghe, Dr. D., his report on 
 the health of house-painters of 
 Lille, 186 
 
 Vernon, Dr. H. M., 102 
 
 Vienna, lucifer match industry in, 
 37, 38 ; decline of match industry 
 in, 40, 41 ; commission on lead 
 industry at, 144 
 
INDEX 
 
 427 
 
 Von Krause, his experiments on 
 animals with Koch's bacillus, 
 16, 17 
 
 Voss on traumatism, 15 
 
 W 
 
 Wachholz, his experiments with 
 carbon monoxide, 64 
 
 Wainwright, Dr. F. R., observa- 
 tions on causes of "com- 
 pressed-air illness," 97 ; on 
 decompression, 107, 108 
 
 Wainwright, Dr. J. M., quoted on 
 anthracosis and tuberculosis, 
 270, 271 
 
 Walker, John, first inventor of the 
 lucifer match, 37, 38 
 
 Waller, Dr. G., statistics on com- 
 pressed-air illness at the tun- 
 nelling works, Amsterdam, 105 
 
 Wall-paper staining and colouring 
 considered, 235 
 
 Water-spraying in mines, 315 
 
 Wegner, his experiments upon 
 animals with phosphorus, 45 
 
 Warrington, Dr., of the Liverpool 
 University Pathological Labora- 
 tories, 209, 210 
 
 Water gas considered, 70-72 
 
 Watkin, Mr. R. J., 294 
 
 Wedgwood china, 158 
 
 Weichart, on fatigue, 6 
 
 Weir, Dr. James, on traumatism 
 and tuberculosis, 15, i6 
 
 Weldon process of manufacture, 
 120, 121 
 
 Westminster House, exhibition of 
 leadless glaze ware at, 166, 167 
 
 Westphalia, ophthalmia among the 
 coal-miners of, 274 ; ankylosto- 
 miasis in the miners of, 314-17 
 
 West Riding of Yorkshire, high 
 death-rate from phthisis in 
 miners of, 269 
 
 Wheatley, Dr. James, quoted on 
 health conditions of cotton- 
 weavers, 249, 250 
 
 White, Dr. Sinclair, statistics on 
 steel-grinders, 231 
 
 White, Dr. Prosser, on di-nitro- 
 benzene poisoning, 129 
 
 White lead, see Lead 
 
 White Lead, manufacture, 146 ; 
 Commission, 148 ; findings of, 
 159, 160 ; arbitration on, 161-63, 
 188 
 
 " White-swelling" after an injury, 
 14; compensation for, in Ger- 
 many, 15 
 
 Whymper, Mr., report on tin-plate 
 industry by, 240 
 
 Wielczyk quoted on petrol miners, 
 
 85 
 Witwatersrand, gold mining at, 
 
 283, 321 
 Wolf-Eissner on fatigue, 7 
 Wolverhampton, enamelling in- 
 dustry at, 172 
 Woolsorters' disease, see Anthrax 
 Workmen's Compensation Act, 13 ; 
 claims for tuberculosis followed 
 by injury considered, 21-24 '> 
 simulation of disease con- 
 sidered, 26-35 f lead-poisoning 
 compensated for under, 167, 
 185, 204 ; poisoning by Afri- 
 can boxwood compensated for 
 under, 259 ; miners' ailments, 
 
 273 
 
 Wrist-drop, caused by lead poison- 
 ing, 147, 207, 208 
 
 Writers' palsy considered, 360 
 
 X-ray workers, health of, 356 
 
 Yorkshire, ganister mining in, 
 
 298 
 Young, Dr. T. F., 258 
 
 Zenker, Dr., 264 ; on siderosis, 
 
 311 
 Zinc smelting works, health of 
 
 workers in, considered, 221-23 
 Zografidi, Dr, Stef ., on the diseases 
 
 of sponge-divers, no-12 
 Zuntz on respiration, 116, 117 
 
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 THE HYGIENE OF MIND. Fourth Edition. By T. S. 
 Clouston, M.D., F.R.S.E., Lecturer on Mental Diseases in the Univer- 
 sity of Edinburgh. Demy 8vo, 7s. 6d. net. 
 
 A Treatise on Mental Health and Strength; its Genesis, Preservation and 
 Risks from the Evolutionary, Hereditary, Physiological, Psychological, and 
 Medical points of view ; the dependence of Mind on Brain Development and 
 Brain Care in childhood, the school age, adolescence, manhood, and old age ; its 
 connection with mental faculty and bodily function ; its relation to manners, 
 morals, religion, play, sex, temperament, education, and work ; the dangers of 
 the nervous temperament, disease, fatigue, strain, alcohol, and other brain stimu- 
 lants and sedatives ; mental effects of city life v. country life ; the supreme 
 importance for conduct of the Mens Sana in Corpore Sano. 
 
 THE CHILDREN OF THE NATION. By the Right Hon. 
 Sir John Gorst. Second Edition. Demy 8vo. 7s. 6d. net. 
 
 This book calls attention to the national danger involved in neglecting the 
 health of the nation's children. It discusses the political aspects of Infant 
 Mortality, the overwork and underfeeding of children in the elementary schools, 
 medical inspection of schools, the sanitary condition of schools, the mischief 
 done in infant schools, hereditary diseases, child labour in factories and mines* 
 and housing in town and country. It also deals with the question of finance. 
 
THE CARE OF THE BODY. By F. Cavanagh, M.D. 
 
 Demy 8vo. 7s. 6d. net. 
 
 This book begins with a chapter on Sleep, since the body can only be 
 cared for if this has been satisfactory. The value of Bathing and the different 
 kinds of baths are discussed : then the questions affecting Exercise, including 
 Training and Athletics. Proper Clothing, with the most suitable head and foot wear 
 for the different ages, follow. The necessary attentions to the Skin, Hair, Teeth, 
 Feet, and Hands, so that these may perform their various functions most efficiently, 
 are described and explained. In conclusion, chapters are devoted to considering 
 the need of attention to the Position of the body in its varying attitudes of work, 
 and the importance, meaning, and gain to the individual acquired by an under- 
 standing of the formation of " Habit." 
 
 THE DRINK PROBLEM in its Medico-Sociological Aspects. 
 
 Edited by T. N. Kelynack, M.D., M.R.C.P., Hon. Secretary of the 
 Society for the Study of Inebriety. Demy 8vo. 7s. 6d. net. 
 
 This is an authoritative work on the much discussed Alcohol Question. Each 
 section is written by a medical expert. The subject is dealt with in a form 
 appealing to the intelligent layman, as well as meeting the requirements of the 
 medical practitioner. The drink problem is discussed in its biological bearings. 
 The psychological, physiological, and pathological aspects are considered in their 
 relation to sociological conditions and practical measures of temperance reform. 
 The work appeals to all interested in the prevention, arrest, and amelioration 
 of alcoholism, and is of service to those desirous of obtaining a scientific basis 
 for efforts directed towards the care and control of the inebriate. 
 
 DISEASES OF OCCUPATION. By Professor Thomas Oliver, 
 M.A., M.D., LL.D., F.R.C.P., Physician, Royal Infirmary, Newcastle- 
 upon-Tyne; late Medical Expert, Dang^erous Trades Committee, etc., 
 Home Office. Demy 8vo. 19s. 6d. net. 
 
 The work gives a succinct but comprehensive account of the aims of 
 Factory Legislation and what it has accomplished. Among the subjects dealt 
 with are Work and Fatigue ; Women's Work ; Diseases due to impure air 
 in the factory and workshop ; to dust, inorganic and organic ; to working in 
 compressed air (Caisson disease) ; to micro-organisms and parasites : and diseases 
 the result of work in high temperatures, and consequent upon physical strain, 
 electrical shock, etc. 
 
 THE CONTROL OF A SCOURGE; or, How Cancer is 
 
 Curable. By Charles P. Childe, B.A., F.R.C.S. Demy 8vo. 7s. 6d. net. 
 The aim of this book is to acquaint the public with the favourable outlook 
 which surgical operation to-day offers in the treatment of Cancer as compared 
 with a quarter of a century ago. Further, its object is to show, both firom a 
 consideration of modern views of the nature of Cancer as well as from actual 
 results obtained in its treatment, the improvement that might be anticipated, 
 were it not for the deplorable ignorance that exists of its early signs and the dread 
 of seeking advice at the only time when it is possible to cure it. It claims to 
 establish that by improved education, and by this means alone, can the prospect 
 be rendered generally hopeful. 
 
 THE HYGIENICS OF EDUCATION, MENTAL AND 
 PHYSICAL. By W. Leslie Mackenzie, M.A., M.D., D.P.H., 
 M.R.C.P.E., F.R.S.E., Medical Member of the Local Government Board 
 for Scotland. Demy 8vo. [In preparation. 
 
 This book aims at presenting the problem of Education from the standpoint 
 of the Physician. The child, as a growing mind in a growing body, is subjected 
 to stresses. Education is conceived as at once the superintendence of growth 
 and the '* provision of an environment." The leading mental processes, the 
 groundwork of acquisition, fatigue mental and physical, are discussed in the light 
 of recent research. Consideration is also given to the signs and morbid results 
 of overpressure, abnormalities of the organs of sense, diseases incident to the 
 educational life from birth to adolescence, the health conditions of life at school, 
 co-education, and other practical problems. 
 
THE PREVENTION OF TUBERCULOSIS (CONSUMPTION). 
 
 By Arthur Newsholme, M.D., F.R.C.P., Medical Officer of Health 
 of Brighton ; President of the Incorporated Society of Medical Officers 
 of Health (i 899-1 900) ; Examiner in Public Health to the Universities 
 of Cambridge and Victoria ; late Examiner in State and Preventive Medicine 
 to the Universities of London and Oxford. Demy 8vo. 
 
 [In preparation. 
 The main object of this book is practical. It is intended as a guide not only 
 for medical officers of health, but for all engaged, whether on hospital committees 
 or local governing bodies, in administrative measures for the control of tuberculosis 
 and the advancement of the public health. A large part of the book therefore 
 will consist of a discussion of measures of sanitary reform and of social improve- 
 ment which are the chief indirect means ; and of measures such as notification, 
 visiting and advising patients, disinfection, sanatorium treatment and training of 
 patients, and hospital segregation of advanced patients, which are the all- 
 important direct means of controlling the disease. The relative importance of 
 the above and allied measures can only be understood when the pathology and 
 causation of tuberculosis are known. The prevention of Consumption must be 
 based on a knowledge of its causation, 
 
 NUTRITION. By Ralph Vincent, M.D., B.S., M.R.C.P., 
 
 Physician to the Infants' Hospital ; late Senior Resident Medical Officer, 
 Queen Charlotte's Lying-in Hospital. Demy 8vo. \In preparation. 
 
 Nutrition, as the index of national power, is the leading feature of this 
 work. The health and strength of a nation are primarily determined by its 
 power of reproduction. The rearing of healthy infants and the prevention of 
 defective structure arising from malnutrition are of cardinal economic importance. 
 The present conditions, so seriously threatening the welfare of the country, and the 
 practical remedies are discussed in detail. Diet, in relation to nutrition and 
 structure, necessarily receives special attention. 
 
 DRUGS AND DRUG HABITS. By H. Sainsbury, M.D., 
 
 F.R.C.P. DemySvo. \In preparation. 
 
 On the subject of drugs, so called, very erroneous conceptions prevail. For 
 some they are synonymous with poisons, yet many forget that this latter term 
 has a significance which is relative only, and few, outside the ranks of those who 
 practise medicine, realise how difficult it is to isolate drugs as a class, and to 
 frame a definition which shall satisfactorily separate them from aliments. To 
 draw attention to these misconceptions ; to point out the more precise relations in 
 which medicaments stand to disease, and the problems which disease puts before 
 us for solution ; to make prominent the fact that drug habits — including the use 
 of tea, coffee, and tobacco — are but instances of a law which is fundamental, and 
 in the manifestation of which temperament and education play primary parts, — 
 these are the purposes of the present volume. 
 
 AIR AND HEALTH. By Ronald C. Macfie, M.B. DemySvo. 
 
 \In preparation. 
 This book deals with the physical and chemical properties of air, particularly 
 with reference to health and disease. The physiology of respiration will be 
 considered in its practical bearings, and chapters will be devoted to the question 
 of climate and to relevant questions of dust, fog, germs, air-borne epidemics, etc. 
 Ventilation will be fully discussed, both in its private and public aspects. 
 
 FUNCTIONAL NERVE DISEASES. By A. T. Schofield, 
 
 M.D. Demy8vo.7s.6d.net. \In preparation. 
 
 This book is called for, not only on account of the increasing im{)ortance of 
 the subject, but because the treatment of these diseases is rapidly altering in 
 character, and is taking more account of the psychic factors and laying less stress 
 upon the physical. The present work seeks to present the newest view on this 
 subject, and to be a practical handbook to medical psycho-therapeutics as far as 
 they are applicable in these diseases. At the same time, various terms of quackery 
 and pseudo-religious varieties of treatment will be described and their evils pointed 
 out. Special allusion will also be made to functional nerve diseases in children. 
 
ABNORMAL AND MENTALLY DEFECTIVE CHILDREN, 
 THEIR EDUCATION AND TRAINING. By Henry Ashby, M.D., 
 F.R.C.P., Lecturer on Diseases of Children, Victoria University. *^ Illus- 
 trated. DemySvo. [In preparation. 
 Children differ from one another, in physical, mental, and moral characters. 
 An attempt is made to describe those who are well below the normal line, and 
 the effect which education and training has upon their defects. Neurotic 
 children, the dull and backward, those with minor mental abnormalities, as 
 well as the large and varied class who are feebly gifted as regards mental 
 powers, come in for consideration. Reference is also made to "moral 
 imbeciles," and those with convulsive disorders ; while deaf-mutes and those with 
 speech defects are also dealt with. A good deal of space is given to testing the 
 mental capacities of defective children and to their education and training. 
 
 THE PRINCIPLES OF VACCINATION AND SERUM 
 THERAPY. By Allan Macfadyen, M.D., B.Sc, F.I.C., Head of 
 Bacteriological Department, Jenner Institute ; FuUerian Professor of 
 Physiology, Royal Institution. Demy 8vo. [In preparation. 
 
 The parasitic doctrine has revolutionised the conceptions of disease processes 
 and the methods for their prevention and treatment. The knowledge that has 
 been gained of the nature and mode of action of the living agents that invade the 
 body and produce disease has led to the most notable advances in medicine, 
 surgery, and hygiene. One of the most fascinating chapters of medical discovery 
 is that relating to the evolution of a new therapy, based on scientific observation 
 and experiment. The present volume relates, without undue technical detail, the 
 facts and conceptions upon which the methods of Serum Therapy and Vaccination 
 are based. 
 
 THE INSANE. By George R. Wilson, M.D., F.R.S.E., etc. 
 
 Illustrated. Demy 8vo. *• [In preparation. 
 
 This book is intended to be an Introduction to the study of Insanity, and is 
 specially designed for the medical student, the general practitioner, and the 
 educated layman. It will deal with the nature and meaning of Insanity, and 
 with the history of the subject ; with the causes of mental disease, its frequency, 
 and its importance as a social factor ; and it will give a description of the 
 varieties of Insanity now recognised by specialists, their pathology and their 
 classification. But it will aim chiefly at practical rather than theoretical value, 
 and will present cases of all varieties, especially in the early stages, and will 
 discuss their management and treatment. The book will be Ulustrated by 
 diagrams and photc^raphs. 
 
 A TEXT-BOOK OF HEREDITY. By Archdall Reid, M.B., 
 F. R. S. E. Demy 8vo. [In preparation. 
 
 This volume covers the whole field of heredity, but especial attention is paid 
 to practical problems affecting human beings. Among the subjects dealt with 
 are the method of the evolution of the race, the method of the development of 
 the individual, the distinction between the different classes of traits of the 
 individual, the function of sex, the various forms of inheritance, the development 
 of mind and body in the human being, as well as the problems of heredity and 
 evolution which arise in relation to disease, alcohol, civilisation, and education. 
 Great care is taken to ensure lucidity. There is much original matter. 
 
 INFECTION. By Sims Woodhead, M.D., F.R.S.E., etc., 
 Professor of Pathology in the University of Cambridge. Demy 8vo. 
 
 [In preparaiion. 
 
 IMPERIAL HYGIENE. By W. J. Simpson, M.D., etc., 
 Professor of Hygiene in King's College, London. Demy 8vo. [In preparation. 
 
 METHUEN & CO., LONDON. 
 
A SELECTION OF BOOKS 
 
 PUBLISHED BY METHUEN 
 
 AND CO. LTD., LONDON 
 
 36 ESSEX STREET 
 
 W.C. 
 
 
 CONTENTS 
 
 
 
 »AGE 
 
 
 PAGE 
 
 General Literature 
 
 
 a 
 
 Little Quarto Shakespeare 
 
 19 
 
 Ancient Cities. 
 
 
 la 
 
 Miniature Library 
 
 19 
 
 Antiquary's Books. 
 
 
 IS 
 
 New Library of Medicine 
 
 19 
 
 Arden Shakespeare 
 
 
 13 
 
 New Library of Music 
 Oxferd Biographies 
 
 19 
 
 ig 
 
 Classics of Art 
 
 
 13 
 
 Three Plays . 
 
 30 
 
 "Complete" Scries 
 
 
 13 
 
 States of Italy 
 
 20 
 
 Connoisseur's Library . 
 
 
 »4 
 
 Westminster Commentaries 
 
 20 
 
 Handbooks of English Church 
 
 
 "Young" Series 
 
 30 
 
 History .... 
 
 . 
 
 M 
 
 Shilling Library . 
 
 31 
 
 Handbooks of Theology 
 
 . 
 
 »4 
 
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 21 
 
 "Home Life" Series . 
 
 
 14 
 
 
 
 Illustrated Pocket Library of 
 
 
 Some Books on Art. 
 
 31 
 
 Plain and Coloured Books 
 
 15 
 
 Some Books on Italy 
 
 23 
 
 Leaders of Religion 
 
 
 15 
 
 Fiction 
 
 23 
 
 Library of Devotion 
 
 
 16 
 
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 27 
 
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 16 
 
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 27 
 
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 17 
 
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 28 
 
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 17 
 
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 Little Library . 
 
 
 18 
 
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 29 
 
 JULY 1912 
 
A SELECTION OF 
 
 MESSRS. METHUEN'S 
 
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 THE DOLLY DIALOGUES. 
 
 Hornung (E. W.). DEAD MEN TELL 
 NO TALES. 
 
 Hyne (C. J. C). PRINCE RUPERT THE 
 BUCCANEER. 
 
 Ingraham (J. H. 
 
 DAVID. 
 
 THE THRONE OF 
 
50 
 
 Methuen and Company Limited 
 
 Le Queux (WJ. THE HUNCHBACK 
 
 OF WESTMINSTER. 
 THE CROOKED WAY. 
 THE VALLEY OF THE SHADOW. 
 
 THE TRAITOR'S 
 
 Levett- Yeats (S. K.). 
 
 WAY. 
 ORRAIN. 
 
 Linton (E. Lynnl. THE TRUE HIS- 
 TORY OF JOSHUA DAVIDSON. 
 
 Lyall (Edna). DERRICK VAUGHAN. 
 
 Malet (Lucas). THE CARISSIMA. 
 A COUNSEL OF PERFECTION. 
 
 Mann (Mrs. M. E.). MRS. PETER 
 
 HOWARD. 
 A LOST ESTATE. 
 THE CEDAR STAR. 
 THE PATTEN EXPERIMENT. 
 A WINTER'S TALE. 
 
 Mapchmont (A. W.). MISER HOAD- 
 
 LEY'S SECRET. 
 A MOMENT'S ERROR. 
 
 Mapryat (Captain). PETER SIMPLE. 
 JACOB FAITHFUL. 
 
 March (Richard). A METAMORPHOSIS. 
 THE TWICKENHAM PEERAGE. 
 THE GODDESS. 
 THE JOSS. 
 
 Mason (A. E. W.). CLEMENTINA. 
 
 Mathers (Helena HONEY. 
 GRIFF OF GRIFFITHSCOURT. 
 SAM'S SWEETHEART. 
 THE FERRYMAN. 
 
 Meade (Mrs. L. T.). DRIFT. 
 
 Miller (Esther). LIVING LIES. 
 
 Mitford (Bertram). THE SIGN OF THE 
 SPIDER. 
 
 THE ALIEN. 
 THE HOLE 
 
 IN 
 
 Montresop (F. F.). 
 
 Morrison (Arthur). 
 THE WALL. 
 
 Ncsbit (E.). THE RED HOUSE. 
 
 Norris (W. E.). HIS GRACE. 
 GILES INGILBY. 
 
 THE CREDIT OF THE COUNTY. 
 LORD LEONARD THE LUCKLESS. 
 MATTHEW AUSTEN. 
 CLARISSA FURIOSA. 
 
 Oliphant (Mrs.). THE LADY'S WALK. 
 SIR ROBERT'S FORTUNE. 
 
 THE PRODIGALS. 
 
 THE TWO MARYS. 
 
 Oppenheim (E. P.). MASTER OF MEN. 
 
 Parker (Sir Gilbert). THE POMP OF 
 
 THE LAVILETTES. 
 WHEN VALMOND CAME TO PONT .AC. 
 THE TRAIL OF THE SWORD. 
 
 Pemberton (Max). THE FOOTSTEPS 
 
 OF A THRONE. 
 I CROWN THEE KING. 
 Phillpotts (Eden). THE HUMAN BOY. 
 CHILDREN OF THE MIST. 
 THE POACHER'S WIFE. 
 THE RIVER. 
 
 • Q ' (A. T. Quiller Couch). THE 
 WHITE WOLF. 
 
 Ridge (W. Pett). A SON OF THE STATE. 
 
 LOST PROPERTY. 
 
 GEORGE and THE GENERAL. 
 
 A BREAKER OF LAWS. 
 
 ERB. 
 
 Russell (W. Clark). ABANDONED. 
 A MARRIAGE AT SEA. 
 MY DANISH SWEETHEART. 
 HIS ISLAND PRINCESS. 
 
 Sergeant (Adeline). THE MASTER OF 
 
 REECHWOOD. 
 BALBARA'S MONEY. 
 THE YELLOW DIAMOND. 
 THE LOVE THAT OVERCAME. 
 
 Sidgwick (Mrs. Alfred). THE KINS- 
 MAN. 
 
 SuPtees (R. S.). HANDLEY CROSS. 
 MR. SPONGE'S SPORTING TOUR. 
 ASK MAMMA. 
 
 Walford (Mps. L. B.). MR. SMITH. 
 
 COUSINS. 
 
 THE BABY'S GRANDMOTHER. 
 
 TROUBLESOME DAUGHTERS. 
 
 Wallace (General Lew). BEN-HUR. 
 
 THE FAIR GOD. 
 
 Watson (H. B. Marriott). 
 
 TURERS. 
 CAPTAIN FORTUNE. 
 Weekes (A. B.). PRISONERS OF WAR. 
 Wells (H. G.). THE SEA LADY. 
 
 Whitby (Beatrice). THE RESULT OF 
 AN AXIDENT. 
 
 THEADVEN- 
 
 White (Percy). 
 GRIM. 
 
 A PASSIONATE PIL- 
 Williamson (Mrs. C. N.). PAPA. 
 
PRINTED BY 
 
 UNWIN BROTHERS, LIMITEH, 
 
 LONDON AND WOKING. 
 

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