should be collected in this country. This is all the more important when it is remembered that even with the most complete statistics, it is extremely difficult to determine all the factors which influence the health and longevity of operatives. Great differences are found. in the conditions under which the work is performed, some of which are entirely avoidable, while others are not, and it is hardly fair to characterize certain trades as dangerous, when experience has shown that no harm results when proper safeguards have been taken. In the consideration of this question the personal element of the workmen, their habits, mode of life, food, home environments, etc., can not be ignored. There are a number of occupations in which the alcohol habit prevails to an unusual extent, perhaps because of the character of the work, perhaps as a result of association, and it would not be fair to attribute the ill health of the operatives altogether to the character of the employment. Again, many persons are engaged in occupations for which they are not physically fitted, while others ruin their health by vice, dissipation, improper food, and insanitary environment at home. In addition to all this there are factors, such as water and soil pollution, for which neither the industry nor the individuals are primarily to blame. Thus, for example, the general anæmia of the agricultural classes in Porto Rico was attributed a few years ago to their occupation and starvation, when as a matter of fact it was caused by the "hook-worm disease." Recent investigations conducted by Doctor Stiles appear to indicate that the same disease prevails to some extent among the textile operatives in the South. All this indicates the need of a thorough study of the conditions affecting health in various occupations, not only to determine the relative health risks and the causes of the undue prevalence of certain diseases in certain occupations, but also to formulate rules which may remove the causes or render the system better fitted to resist them. In this, as in all preventive efforts, a hearty cooperation of the parties interested is absolutely essential for the attainment of the highest measure of success. In this instance the responsibility rests with the state, the employer, and employees; each have certain duties to perform, and the help of all is essential for the mitigation of existing evils. INDOOR OCCUPATIONS. Indoor employment, broadly speaking, is inimical to health, while outdoor work in a pure air favors health and longevity. Without underrating the influence of insanitary dwellings, improper and insufficient food, lack of recreation, and other factors, there is no doubt that one of the chief dangers of indoor life is exposure to vitiated air. The air in dwellings and workshops is never so pure as the outer air, because it is polluted by the products of respiration, combustion, and wtends to vitiate gecomposition, an in The sur with dust gera mae lace ba the skin, mouth, hings, and soir: a taxo hes or per posice is made for the dispersion of fou ar an te maurten of pre air there is much reason for assuming in de mi play a more or less important rôle in what her ml istuet BE pusong." characterized in the ae form jy empores if goes badische, dizziness, and faint. vir her.exerts i bedres oxygenation and purification he do ply evored by the pallor, loss of appetite, anzus, and manuals of piral and mental vigor. All of these effects at leistet win human beings are obliged to occupy rooms will at a stočiy asfent for the proper oxygenation of the bioc, and as a result of this habitual exposure to vitiated air, we note at the prevalence of consumption in crowded workshops, dwings, pes es, pehle institute ns, and formerly also in military barracks and bare sige. Even live stock shows the baneful eilects of insufficient a space. fe tubercak sis among the range cattle of the far west, which are practically without shelter, is comparatively rare, while it affe ts fr 15 to 25 per cent of dairy herds, which are housed, but without suflent regard to light and air. Improved ventilation and increased air spare has everywhere lessened the death rate, and it is chiefly by just such measures that the rate from consumption has been reduced from 11.9 to 1.2 per 1,000 in the British armies. As a matter of fact, an at undance of pure air has been found the most important factor in the treatment of tuberculosis, because it promotes oxygenation of the blood, stimulates the appetite and nutrition, and thereby increases the general resisting power of the system. OCCUPATIONS INVOLVING EXPOSURE TO IRRITATING DUST. It has long been known that the inhalation of dust predisposes to diseases of the respiratory passages, which may result in consumption. The particles of mineral dust produce an irritation of the mucous membranes of the nose, throat, respiratory organs, and eyes, and the hard, sharp, and angular particles of iron and stone dust may cause actual abrasions. According to Arnold (a) the dust which is inhaled lodges on the mucous membranes of the air passages and vesicles of the lungs, there to be coughed up, although some of the finest particles are taken up by the epithelial cells and white corpuscles and carried to the nearest lymphatic glands. The coarser particles, such as iron, stone, or coal dust, usually lodge upon the surface to be coughed with the secretions. If not expectorated they will cause harm by гер clogging up the sand interfere with respiration. taubinhalation, etc., Leipzig, 1885. In the meantime not infrequently an irritation is set up, causing catarrhal conditions of the mucous membranes, or a more serious chronic inflammation of the respiratory organs, so common among persons engaged in dusty occupations. The chronic inflammatory conditions thus produced favor infection with the tubercle bacillus. At all events Hirt's statistics show that men employed in occupations that produce much dust suffer more frequently from pneumonia and consumption than those not exposed to dust and that there is practically no difference in frequency of diseases of the digestive system. The relative frequency of these diseases per 1,000 workmen is as follows: (") CASES OF CONSUMPTION, PNEUMONIA, AND DIGESTIVE DISORDERS PER 1,000 WORKERS IN CERTAIN OCCUPATIONS. Perlen in his "Inaugural Dissertation," Munich, 1887, () discussed the records of the Munich Polyclinic, where 65,766 persons were treated between 1865 and 1885, including 4,177 tubercular patients. Of these, 1,425 patients had been engaged in occupations where they were exposed to dust, viz: 30 per cent were by reason of occupation exposed to metallic dust. According to the reports of the census of 1900 the consumption death rate of marble and stone cutters in the United States is nearly six times that of bankers, brokers, and officials of companies, and the rate in fifty-one other employments ranges between these extremes. The amount of dust is perhaps less important than the character of the particles which compose it. The susceptibility to consumption among metal workers and stonecutters can be explained only by the fact that the hard, sharp, and irregular particles of this kind of dust are more apt to produce injury of the mucous membranes of the respiratory tract. But it is not fair to assume that the less irritating dust is free from danger, for as pointed out by E. Roth() even the inhalation a Cited by Harrington, Practical Hygiene, 1901, p. 664. Cited by Uffelmann, Handbuch d. Hygiene, 1890, p. 587. c Kompendium der Gewerbekrankheiten, Berlin, 1904, p. 106. f S fi W decomposition, and the presence of individuals also tends to vitiate the air with dust, germs, and organic matter from the skin, mouth, lungs, and soiled clothing. Unless proper provision is made for the dispersion of foul air and the introduction of pure air there is much reason for assuming that these impurities play a more or less important rôle in what has been designated as "crowd poisoning," characterized in the acute form by symptoms of oppression, headache, dizziness, and faintness, while the chronic effects of deficient oxygenation and purification of the blood are plainly evinced by the pallor, loss of appetite, anæmia, and gradual loss of physical and mental vigor. All of these effects are intensified when human beings are obliged to occupy rooms with an air supply insufficient for the proper oxygenation of the blood, and as a result of this habitual exposure to vitiated air, we note an undue prevalence of consumption in crowded workshops, dwellings, prisons, public institutions, and formerly also in military barracks and battle ships. Even live stock shows the baneful effects of insufficient air space, for tuberculosis among the range cattle of the far west, which are practically without shelter, is comparatively rare, while it affects from 15 to 25 per cent of dairy herds, which are housed, but without sufficient regard to light and air. Improved ventilation and increased air space has everywhere lessened the death rate, and it is chiefly by just such measures that the rate from consumption has been reduced from 11.9 to 1.2 per 1,000 in the British armies. As a matter of fact, an abundance of pure air has been found the most important factor in the treatment of tuberculosis, because it promotes oxygenation of the blood, stimulates the appetite and nutrition, and thereby increases the general resisting power of the system. OCCUPATIONS INVOLVING EXPOSURE TO IRRITATING DUST. It has long been known that the inhalation of dust predisposes to diseases of the respiratory passages, which may result in consump tion. The particles of mineral dust produce an irritation of the mucous membranes of the nose, throat, respiratory organs, and eyes and the hard, sharp, and angular particles of iron and stone dust may cause actual abrasions. According to Arnold (2) the dust which i inhaled lodges on the mucous membranes of the air passages and vesi cles of the lungs, there to be coughed up, although some of the fines particles are taken up by the epithelial cells and white corpuscles an carried to the nearest lymphatic glands. The coarser particles, such iron, stone, or coal dust, usually lodge upon the surface to be cought up with the secretions. If not expectorated they will cause harmb clogging up the air vesicles and interfere with respiration. In tị a Untersuchungen über Staubinhalation, etc., Leipzig, 1885. meantime not infrequently an irritation is set up, causing catarrhal conditions of the mucous membranes, or a more serious chronic inflammation of the respiratory organs, so common among persons engaged in dusty occupations. The chronic inflammatory conditions thus produced favor infection with the tubercle bacillus. At all events Hirt's statistics show that men employed in occupations that produce much dust suffer more frequently from pneumonia and consumption than those not exposed to dust and that there is practically no difference in frequency of diseases of the digestive system. The relative frequency of these diseases per 1,000 workmen is as follows:(9) CASES OF CONSUMPTION, PNEUMONITA, AND DIGESTIVE DISORDERS PER 1,000 WORKERS IN CERTAIN OCCUPATIONS. Perlen in his "Inaugural Dissertation," Munich, 1887, () discussed the records of the Munich Polyclinic, where 65,766 persons were treated between 1865 and 1885, including 4,177 tubercular patients. Of these, 1,425 patients had been engaged in occupations where they were exposed to dust, viz: 30 per cent were by reason of occupation exposed to metallic dust. According to the reports of the census of 1900 the consumption death rate of marble and stone cutters in the United States is nearly six times that of bankers, brokers, and officials of companies, and the rate in fifty-one other employments ranges between these extremes. The amount of dust is perhaps less important than the character of the particles which compose it. The susceptibility to consumption Among metal workers and stonecutters can be explained only by the act that the hard, sharp, and irregular particles of this kind of dust re more apt to produce injury of the mucous membranes of the respi-tory tract. But it is not fair to assume that the less irritating dust free from danger, for as pointed out by E. Roth() even the inhalation b Cited by Uffelmann, Handbuch d. Hygiene, 1890, p a Cited by Harrington, Practical Hygiene, 1901, p. 664. c Kompendium der Gewerbekrankheiten, Berlin, 1904, p. 106. p. 587. |