CHAPTER V. THE HYGIENE OF OCCUPATIONS. (Part 1)

CHAPTER V. THE HYGIENE OF OCCUPATIONS. OCCUPATION AND HEALTH. The functional activity of organs in the normal way is a physiological condition of health; the disuse, more or less prolonged, of any organ is, as a rule, followed by atrophic changes. While the normal pur- suit of occupation is therefore a condition of health, pursuit of most occupations in the present industrial system is often followed by certain pathological changes in the human body. It is certain that the health of workers is profoundly influenced by the kind of occupation they pursue, and that their very length of life is determined by their particular occupation. Occupation is a potent factor in the determination of human longevity. If the period of infancy and childhood and the hours devoted to sleep are deducted from man's life the greatest part of it is spent in industrial activity and is necessarily largely influenced by the occupation engaged in. The relative number of those who die while in pur- suit of their occupations bears an important relation to the healthfulness of the occupations. Mortality statistics clearly prove this contention. When the mortality of members of various trades is compared, a great difference in the rate of death per thousand occur ATiox .\n iikmtii 1C>7 is t'ouiid. This (litl'tTciicc t"rc(|nciitly ciiihriiccs loii^' periods, larjje nunil)crs, and iiiaii> dilVcrent countries, showint; a uniformity in the increase of mortality-rates of the memhers of one trade over tlie mortality-rate of nieinl)crs of another trade. It is sliown, for instance, accordinj; to Ogle's tahles from tlie experience of (ireat Britain, that clerjiymen liave the lowest death-rate, next to them gardeners and farmers, while members of trades like hakers, tailors, li(|Uor dealers, file-makers, and others suffer from a much higher mortality-rate. The mortality- rate of clergymen is therefore put as 100 in the follow- ing table as a basis for comparison: Mortality- Occupation, ratf. rierK>-mcn 100 Gardeners lOS Farmers 114 Bakers 172 TaUors 189 Glass-workers 214 Liquor dealers 274 File-makers 300 The I'nited States mortalit,\ tables also show that the mortality-rate per thousand of engineers and surveyors was S.2; tailors, 11. S; printers, 12.1; car- penters, 17.2; cigar- and tobacco-workers, 18.7, and millers, 2(1. 0. Thus it is found that the mortality-rate of members of one trade is much higher than the rate for workers in another trade, and if the causes of the increased inortalitN- are sought for, it is usually found that there are some S{)ecific dangers in the occupation whieh shows tiie highest rate of mortality. 168 HYGIENE OF OCCUPATIONS Morbidity. — Not only the length of Hfe of the work- ers is determined by their occupation, but also their state of health during life. If a physical examination of the workers in one trade is made, and the results are compared with those of a similar physical exami- nation in another trade, a difference in the morbidity- rate, according to certain factors existing in each occupation, is usually found. The experience of various sick benefit insurance societies in Germany, Austria, and other continental countries in which state insurance exists, shows a great diflFerence in the rate of disease among the workers in dilTerent occupations. A recent medical examination undertaken by the New York State Factory Investigating Commission of 2283 persons, in the tailors', bakers', tobacco, and furriers' trades, has shown a large percentage of members of these trades suffering from one or more diseases. Tuberculosis. — The most frequent disease in indus- trial life from which the members of various trades suffer is tuberculosis. Indeed, tuberculosis has been named an industrial disease. All statistics confirm this statement. They show that tuberculosis as a cause of mortality in active workers between the ages of twenty-five and forty-four is responsible for from one-third to one-half of all the deaths. Accord- ing to statistics of the Prudential Insurance Company of America presented at the International Congress of Hygiene and Demography in 1912, tuberculosis was shown to be the cause of death of 35.5 per cent, of all occupied males between the ages of fifteen and twenty- four. Among farmers the rate at the same age was 33.1 ; occii'ATiox ..\i> iii:.\i.rii H')!t jimoiii: clerks, I.").!) pn- cnit; aiiioii^^ j^Hass-Wdrkcrs, IS.l per cent.; aiiioiiu stone-workers, 17. s per cent.; anionj; plunihers, 42.1 per cent.; ani(»n<,' i)riiiters, I'.t..") per cent.; eigar-inakers, 4')..") per cent.; tailors, is.d per cent.; textile-workers, 47.") per cent. IIoH'inan has also shown the j^reat mortality amonj; workers in dusty trades. According to Somerfeld. the mortality of Berlin workers in non-dusty trades was 2.39 per KKKl, while in dusty o('eui)ations it was r).42 per 1000. Diseases of Occupation. There are a number of diseases which are peculiar to certain occupations, and they have been therefore called industrial diseases. Among these diseases besides tuberculosis, which has been already referred to, the following are the most important: 1. Respirator}/ Diseases. — The term pneumonokoni- osis is applied to an affection of the lungs due to the deposit of dust among its cells. Miners, charcoal drivers, metal and glass polishers, stone-masons and plasterers, and other workers in especially dusty trades are apt to ha\e the du.st lodge in their lungs, where it causes a special fibroid disease which even- tually is followed by an infection with tubercle bacilli and frequently leads to death. Pneumonia, bronchitis, and emphysema are also frequently found among workers. They are due to exposure, ditlerence in temj)eratures, and other factors in the occuj)ation. 2. Xcrvoiis Diseases. — Among the nervous di.seases which are frequently found among workers are tho.se due to overstrain, tension, extremes of heat, shocks, and other untoward occupational factors. There arc 170 HYGIENE OF OCCUPATIONS also certain nervous diseases due to the overstrain of particular organs; the most common of these are writer's cramp, telegrapher's spasm, etc. 3. Diseases of the Eye. — Among the principal eye diseases are eye-strain, nystagmus, and other affec- tions due to excessive light, heat, overuse, overstrain, and accidents. 4. Infections Diseases. — A number of infectious dis- eases are due to infection by materials which are handled by the workers. The most important of these are anthrax, which is often found among workers with hides and cattle, ankylostomiasis, and others. 5. Other Diseases. — There are also a number of diseases of the digestive tract, of the skin, and of other organs, due to the various factors in various occupations. Summary. — The effects of industries on health may be summed up as follows: 1. Sudden death due to accidents, falls, burns, explosions, etc. 2. Total or partial disability from the same causes. 3. Sudden deaths from acute intoxications by poisons, fumes, and gases. 4. Deaths from chronic intoxications by the same elements. 5. Deaths due to infectious material in industries. 6. Diseases due to direct action of dangerous ele- ments in trades. 7. Diseases due indirectly to industries and occu- pations. IXDlSTh-IM. IWcrnh'S I.\Fl.ri:\Cl.(; IIKAI.TIl 171 INDUSTRIAL FACTORS INFLUENCING HEALTH. TluTo are a number of factors in imlii>try and \arions occupations which infhiencc the health and l)rini; al)out occuj)ati<)naI (hseases and the comparative shortenin<; of the h\es of inchistrial workers. Tliey may he grouped as follows: 1 . Personal factors. 2. Work place. ^). Working conditions. 4. Specific occu})ational dangers. Personal Factors. — The personal character of the worker, liis fitness for the occupation whicii he selects, liis industrial training, his capital of bodily health and mental traim'ng, his vital resistance, his age and sex, all arc important factors determining the infhu^nce of the work upon the worker. The greater the sum of health with whicli the worker starts out at the beginning of his career the more efficient will be his work, and the less likel' will it be that he will sufier from the aflverse conditions incident to his work. His suscei)tibility and vital resistance depend partly on his physical health an<l partly on individual idiosyncrasies. There are, for instance, those who are less susceptible to certain poisons than others, enjoying a certain immunity again.st the effect of infections and p(ii>ons to which others (juickly succumb. The pr<tj)er selection of a trade according to fitne.ss is very important. .\ feeble indi\idual selecting a trade which rcfpiircs >trcminus ])hysi(;d exertion will 172 HYGIENE OF OCCUPATIONS succumb sooner to the eflFects of the trade than a robust worker. Age. — The age at which work is begun is also of great importance. There are nearly 2,000,000 chil- dren under the age of sixteen employed in the various occupations in the United States. That the developed organism is unable to withstand the strains of con- tinuous and prolonged muscular or other exertion is o})vious. The mind and body of a child under sixteen should be carefully nurtured and not allowed to be subject to physical or mental strain for long periods. In normal society there should be no economic cause for parents of children under sixteen to need the wages of the child workers or to impose the burden of economic independence upon the physically unripe child. The effects of labor on children may be summed up as follows : 1. Injury to the weaker organism. 2. Interference with their growth and physical development. 3. The production of special and other bone deform- ities. 4. The lowering of vital resistance and the predis- posing of the body to disease. 5. The stunting of mental and moral development. 6. The physical, moral, and mental degeneration. 7. The shortening of life. The Labor of Women. — Under the present economic conditions a large number of women are employed in gainful occupations, and form a very important part of the industrial population. There is hardly a trade or industry in which women do not participate. rXDL'STh'lM. lACTOh'S I XFIJKMI XC IIEMJIl ho Tlu' (|ucsti(>n what cHVct, if any. occupation lias upon wo.ncn has hct'u stuiHcd l)y many in('stij,'ators, ami certain conchisions ha\c hccn reached which are at present uni'ersall- accepted. These conclusions regarding women's lahor may be summed up as follows: 1. That there are certain forms of labor, especially those requiring great physical exertion, which should not be followed by women because of their compara- tive physical weakness. 2. That women cannot bear with impunity as long hours of labor as men; that therefore the hours of labor should be shortened, and should not exceed eight per day. o. That there are certain periods each month during which women should not be allowed to work at all, because they are in a semipathological state. 4. That women who bear the burden of pregnancy and childbirth should not be allowed to work during these periods. ."). That night work is injurious to the health of women. 0. That those women who are burdened with the care of children or of a household should not be ex- pected to particijjate in industries to the same extent as those who are free from these burdens. 7. That owing to the greater susceptibility of women to certain industrial i)oisons, they should be excluded from work in all indn-^tries in which these poisons are produceil. The Work Place. The j)lace where the work is car- ried on has a great influence upon the health of the wf)rker. The effect of the factory or workshoj) uj)on 174 HYGIENE OF OCCUPATIONS the health of the worker depends upon its proper construction, upon the fire protection, the provision for hght and ilhnnination, adequate ventilation, proper heating, the drainage, plumbing, and general sanita- tion of the place. At present much work is done at home, especially by women and children. The injurious effects of "home work" or "sweat-shop work" are due partly to the unsanitary conditions under which the home- workers are compelled to work, and partly to other causes, such as the tendency in home work for small children to participate, the longer periods of the work at home, the danger that the home will be infected by the dust and manufactured materials' brought into it, or that the materials will carry infection from the home. A great many of the factory buildings are entirely unsuited to the purpose of manufacture and are unfit for the workers. The existence of so many unfit factories is a cause of a great many of the evils of modern factory system. The dangers from fire in factories and workshops, as they are ordinarily con- structed, are very great. These dangers are due to: 1. The congestion of factories in certain areas. 2. The toogreat heightof many buildings in large cities. 3. Faulty internal construction. 4. Bad internal arrangements. 5. Too many workers on each floor. 6. Insufficient exits. 7. Improper exits. 8. Insufficient fire-escapes. 9. Inadequate means of extinguishing a fire and of preventing panic. I.\l)f STh'lM. r.( Toh'S l.\ILli:.(l.&lt;; llllM.TIl 175 Another of the great dangers in many indnstrial establishments is <hie to tlie improper sal'eguaniing of machinery. It has l)een estimated that there are nearly l.()(K),()(l() accidents to workers in the I nited States every year, and that several Jumdred tlionsand persons are disabled, while many thousands are killed outright, through accidental injuries in factories. Most of these accidents can be prevented and avoided by tlie proper safeguarding of machiner'; and the hazards of industry may be greatly reduced by proper care on the part of the eiuployers and managers to whose care the lives of the workers are intrusted. The proper light and illumination of the work places are of great importance to tlie liealth of the workers. It is to the interest of the employer that the wf)rkman should be able to see wliat he is doing. It is to the interest of the work itself that the worker should not strain his eyes in the performance of his functions. A large number of factories and work- shops are improperly lighted and illuminated, causing injury to the eyes and general health of the workers. 'J'he provision of sufficient air in workshops is of the utmost im|)ortance to the health of the worker. Lal)or in confined rooms is injurious to the health, does not furnish sufficient oxygen to the body, com- pels the worker to insj)ire deleterious substances, and predisposes him to various diseases, especially tuber- culosis. During work more air is needed than during rej)ose, aufl it is of the greatest importance that work- slu)ps should be well ventilated and the air therein l)e of a proper temj)erature, not overheated, and frcfpH-ntly changed. 176 HYGIENE OF OCCUPATIONS While it is possible to provide adequate ventilation in homes and dwellings by natural methods of ventila- tion, such as windows, doors, transoms, and occasionally special devices, it is of the utmost difficult^' to provide adequate ventilation in factories and workshops by these methods. In all factories and workshops there should be provision made for artificial ventilation by mechanical means, which should allow the entrance of a large volume of air into the workshops without draughts, and every effort should be made to insure an equable temperature in the workshops. The general sanitary cleanliness of factories and workshops is important to the health of workers. There should be provision for an adequate number of wash rooms, dress rooms, lunchrooms, emergency and rest rooms, as well as insurance for the cleanliness of the walls, ceilings, floors, and windows; for the proper disposal of rubbish and garbage; the prevention of spitting on floors, and provision for toilet accommo- dations and their cleanliness. Working Conditions. — Besides the personal factor and the influence of the place of work there are many other conditions in industrial life which have a dele- terious influence upon the health of the worker. Among the most important of these conditions are: 1. Too glaring light. 2. Too great relative humidity of the air in the shops. 3. Extremes in temperature. 4. Improper positions and attitudes during work. 5. Great differences in the air-pressure. 6. Too prolonged work and exertion and consequent overfatigue. Sl'I'J ll'IC ()<■<■( I'MIOXM. DAM.KIi'S 177 7. Iii>iiliici(Mit |);nls(■^ diiriiii,' work. S. '!'()(» uiH-at tension ami ])liysical (ir iiinital >traiii (hiriiij; the work. It. Last l)Ut not least, inadecjuate (■onij)ensation (»t' the workers. The other injnrions influences to w Inch the indu.strial popnlation is exposed are iniproi)er standards of livinj;, ij^noranee of jx-rsonal h\ j^iene, the nnsaiiitary housing of the working classes, improper feeding, etc. SPECIFIC OCCUPATIONAL DANGERS. There are certain specific dangers found in many trades and industries. These dangers are mostly due to the materials wliich may l)e grouped as follows: 1. Infectious materials. 2. Dusts. 'A. Poisons, gases, and fimies. Infectious Materials. — Certain materials, like gar- ments, underwear, rags, etc., may he infecte(l with the germs of scarlet fever, ty})hoid, diphtheria, etc., and .spread infection to the workers, (hardeners may he infected with tetanus; horsemen and coachmen with glanders; tanners, wool-workers, etc., with an- thrax; nurses with the various comnumicable diseases of the persons of whom they are taking care; tunnel workers with ank> lo^tomia^is. Dusts. There are man' industries in which a great amount of dn>t i> creatcil during the work. The ell'ects of the dust upon lie.-dth \ary with the amount ot dust inhaled, the kind and character of the dust, the period of exposure, the individual health of the worker, and 12 178 HYGIENE OF OCCUPATIONS many other factors. All tkists cause some irritation to the mucous membrane of the eyes, nose, mouth, and throat. Metal or mineral dusts may also cause mechanical injury to the mucous membranes of the respiratory passages. Hoffman classifies dusty trades according to the dust produced, as follows : Group I. — E.rposing to MetaUic Dust: Grinders, pol- ishers, tool- and instrument-makers, jewellers, gold- beaters, brass-workers, printers, compositors, engravers, pressmen. Group II. — Exposing to Mirieral Diist: Stone-, marble- and cement-workers, glass-cutters, diamond- cutters, potters, plasterers, paperhangers, molders, core-makers, lithographers. Group III. — Exposing to Animal and Mixed Dust: Furriers, taxidermists, hatters, silk-, wool-, and worsted- workers, carpet-, rug,- rag-, and shoddy-workers, hair- mattress-makers, upholsterers, etc. Group IV. — Exposing to Vegetable-fiber Dust: Cot- ton ginners; textile, flax, hemp, cordage, and paper manufacturers; weaAcrs, spinners,