Since, however, we are only concerned at present with dust and its

effect upon the respiratory organs, we shall adhere to a description

of those processes in potteries in which it prevails, and of these

the two that are the dustiest and the most dangerous are “towing” or

smoothing of the ware before it has been fired, also what is known as

the “scouring” or cleaning of china after it has been biscuited. The

scouring of china is generally done by women, sometimes by hand, by

brushing the ware over a wooden trough so that the ground flint can be

collected and used over again. The atmosphere of the workroom is often

thick with dust, while the hair and clothing of the women are literally

white with the fine particles of flint. For dust and danger there is no

comparison between the throwing and turning of unfired clay products

and the cleaning of china that has been once fired. Unless provision

is made by fans for the removal of the dust, the air is so thick that

no person could scour china for even a few weeks or months without

suffering from bronchial irritation or bronchitis, cough and shortness

of breath. Dr Prendergast of Hanley, Staffordshire, informs me that

after two months’ work in scouring china, a healthy woman will often

present symptoms suggestive of phthisis, but happily the condition of

the lung is remediable. Potters’ asthma and consumption, as indeed

all forms of lung disease due to dusty occupations, are becoming

fortunately fewer and fewer every year in this country, owing to the

improved appliances in factories for getting rid of dust. The late Dr

Arlidge told me that the chances of obtaining a good illustration of

potters’ phthisis as a pathological specimen was becoming increasingly

difficult, and the same information has been sent to me from Sheffield

as regards steel grinders’ lung.

In addition to visiting the largest potteries in England and Scotland,

I have had the opportunity of inspecting many on the Continent, and

particularly the porcelain works at Limoges, where I saw something of

the baneful effects upon the French potters of the scouring of china.

In Limoges the porcelain is made from a very fine white clay or kaolin,

which is found in the district. The products made from this kaolin are

dipped in a glaze containing felspar and quartz, and whose composition

is silica 70, aluminium 17, potash 13.

For more than a century porcelain has been manufactured in Limoges, a

town containing 80,000 people, of whom, roughly speaking, 15,000 are

engaged in the potteries in the town and neighbourhood, men and women

about equally. The kaolin is found at St Yrieix, a village twenty-six

miles south of Limoges. There is therefore very little expense incurred

in the railway transport of the raw material. Labour, too, is on the

whole cheap. In Limoges there are sixteen or seventeen large potteries

with almost double that number of smaller workshops. The brushing-off

or époussetage of the fired or biscuited ware is done both by women and

men by means of soft feather brushes. It is a very dusty operation, and

where there are no fans for its removal, as in some of the factories

I visited, the air was thick with dust. The windows were open at the

time, but currents of air obtained by this means exercised no very

appreciable influence upon the dust. It is not this kind of ventilation

that is required under these circumstances. In the matter of the

provision of artificial means for the removal of dust and the renewal

of air in the potteries of Limoges, some of the manufacturers seemed to

me to be rather behind than in advance of the owners of large factories

in Staffordshire. Accordingly I was not unprepared for the information

that among the potters, especially the brushers-off or scourers, in

Limoges, the mortality from pulmonary consumption and chest diseases

is high. The harmful operations in porcelain works are the emptying

of the kilns, the removal of the ware from the saggers, and the

brushing of this ware; while the _hard_ dust that rises during

the polishing of the all but finished articles is equally dangerous.

The polishing has for its object the removal of any roughness from the

edges or surfaces of the ware, and it is generally done on a revolving

wheel by means of a broken piece of china, the workman using this as

the smoothing agent. The men and women employed in these operations

are usually well covered with dust, yet it is seldom that they wear

respirators. Fans for the removal of the dust were present in only

very few of the factories. The employés objected to them on the ground

that they created a strong draught of cold air. Dr Raymondaud, one of

the Professors in the School of Medicine, Limoges, has made a special

study of the diseases of porcelain makers, particularly of pulmonary

consumption and chronic bronchitis. He found that the potteries

furnished a larger number of patients suffering from lung diseases

than did the other trades of the district. Of 75 deaths registered

in Limoges as occurring among china makers, 36 were due to phthisis,

and of 30 potters whom Raymondaud examined, 20 were suffering from

pulmonary consumption. Pulmonary phthisis is regarded as the principal

disease affecting the workers in the Limoges potteries.

The discovery of the tubercle bacillus by Koch has tended to unify

medical opinion as to the cause of pulmonary phthisis. The bulk

of pulmonary phthisis is tubercular and is due to the bacillus.

Other conditions, however, are not without their influence, such

as hereditary predisposition, constitutional weakness, infection

at home, and the effect of chills; but admitting all these, there

is considerable evidence in favour of the view that dust plays an

important part in producing potters’ phthisis, which, as previously

remarked, differs in some respects from tubercular consumption. Dr

Lémaistre, with whom I discussed this subject, had analysed the air

of the Limoges potteries, and he found that the dust in some of the

workshops is composed of earthy particles, fragments of granite, flint,

particles of dried glaze, soot, and wood charcoal. The atmosphere which

the brushers-off, the finishers, and the porcelain makers generally

work in, he found contained 640 million particles of dust to the cubic

metre, while several of the finishers, _i.e._ those persons whose

duty it is to remove the excess of dried glaze on the ware, often work

in an atmosphere containing 680 million particles to the cubic metre.

The particles in the latter instance are smaller than those first

mentioned, and they therefore remain a longer time suspended in the

air of the workroom. This large number of particles of dust in the air

is one explanation of the frequency of bronchitis and of pulmonary

disease, and also of the small chalk-like masses found after death in

the lungs of porcelain makers, but which must not be confounded with

cretaceous tubercles. Whatever may be the influence of the dust-laden

atmosphere of a pottery in causing pulmonary fibrosis, the accidental

presence of the tubercle bacillus in addition would go far to aggravate

existing pulmonary conditions, and tend to transform a non-tubercular

affection of the lungs into one of a true specific character. It is

thus that the presence of a tuberculous person in a workroom becomes

a source of danger to his fellow-workmen. Particles of clay or china

dust, when inhaled, can only act mechanically upon the lining of the

small bronchial tubes and pulmonary alveoli, but by making a breach

upon their epithelial coating they reduce the local vital resistance,

and pave the way for the entrance of the tubercle bacilli. Dust,

therefore, weakens the lung, and by altering its structure, induces

conditions that favour the development of the tubercle bacilli. Apart

from bacillary infection, dust is itself a cause of danger: it is

capable of inducing bronchitis, and if long inhaled causes fibrosis of

the lungs of potters. The pulmonary consumption of porcelain-makers

differs from tubercular phthisis in the fact that it is of slower

development, and is of longer duration; that it less seldom attacks

the young than those of middle life and more advanced age; also that

there may be found in the lungs after death calculous concretions,

which on chemical examination are found to be composed of carbonate and

phosphate of lime, silica, and oxide of iron, with a certain amount of

organic matter. The average age at death of men from fibroid phthisis

in the potteries of Limoges is forty-three, and of women thirty-eight

years. The same symptoms just described as having been observed in

the Limoges porcelain-makers are also found in workers in pottery

in this country, viz., cough, shortness of breath, and progressive

emaciation, but there is a greater tendency to blood-spitting in French

porcelain-makers than Arlidge found among the potters in Staffordshire.

_Symptoms._--It is not until an individual has worked, as a

rule, some months or years at his trade that he shows signs and

symptoms of potters’ phthisis. In this, as in other forms of chronic

pulmonary disease, there is cough on getting up in the morning, but

this circumstance attracts little or no attention, as the general

health usually remains good for a lengthened period. At first white

and frothy, or speckled from the greyish-black dust that has been

inhaled, the expectoration by degrees becomes purulent, while the

cough, no longer confined to the morning, becomes more paroxysmal in

character, and is attended by shortness of breath, which tends to get

worse with time. On examining the chest it is found that the amount of

shortness of breath or dyspnœa is out of all proportion to the amount

of consolidated lung that may be present. It is a fact well known to

every member of the medical profession that tubercular consumption much

more frequently affects the apices or uppermost parts of the lungs,

_i.e._ just below the collar-bones, than the lowest portions, a

circumstance very largely due to the imperfect inflation or ventilation

of those particular regions, so that when they become the seat of

catarrh or of subacute inflammation, the morbid products that are

secreted and effused are, owing to the limited range of movement of

this part of the chest wall, and incomplete aëration of this part of

the lungs, with difficulty expectorated. A catarrh therefore tends

to linger in the apices of the lungs, and offers opportunities for

bacillary infection. In dust diseases of the lungs, on the other hand,

it is not the apices that become affected so much as the lower and

back parts of the lungs. This is an important distinction between the

two, for it shows that a different cause must have been in operation.

Limited areas of dulness, indicating small patches of consolidated

lung, can be detected here and there in the chest, especially at the

base behind or close to the shoulder-blades. In the early stages there

is neither the evening rise of temperature, the feverishness, nor the

accelerated pulse and rapid loss of flesh which are so pathognomonic

of tubercle. Arlidge says there is, too, a wonderful immunity from

blood-spitting. If an afflicted workman, therefore, at this stage were

to give up his employment and seek for some occupation out-of-doors,

the chances are that he would still have a good spell of life before

him; but if, on the other hand, he is contented to remain at his

occupation, sooner or later he becomes the confirmed victim of

potters’ phthisis. His vital resistance becomes gradually more and

more enfeebled. His preference for indoor life, daily exposure to

infection in the factory, and his overcrowded home, lay the individual

open to the chances of a tubercular lesion becoming grafted upon a

fibrotic lung. Dr Arlidge found that the mean age at death of male

potters aged twenty years and upwards was forty-six and a half years,

whilst that of non-potters stood at fifty-four. Dr Prendergast tells me

that potters working in dust generally die at the age of forty-five.

Among potters Arlidge found as the most frequent causes of death

pulmonary consumption, diseases of the heart and nervous system. In the

workpeople of the district other than potters, while the death-rate

from diseases of the chest was 7.86 per cent., the rate for potters was

12.29. Taking the male population generally and their entire mortality

from all causes at the time that Arlidge wrote, we find that the

deaths of male potters from diseases of the respiratory organs were

60 instead of 27 per 1000, and that the decennial period from fifty

to sixty gave the greatest number of deaths, each preceding decennium

back to twenty giving less and less, while the maximum mortality from

phthisis as opposed to diseases of the lungs generally was reached

between the ages of thirty and forty years. Before the age of forty,

therefore, the bulk of the potters who have contracted lung disease,

and who have become tubercular, die; whereas in those who contract the

disease later on they become less liable to the tubercular type of the

malady. Bronchitis is met with among the male pressers who are exposed

to the dust of the clay, but in china scourers pulmonary diseases are

extremely prevalent; as many as 40 per cent. were found suffering from

phthisis and 25 per cent. from bronchitis. As already stated, the

phthisis in potters is in the early stages usually not tuberculous.

So much so is this considered to be the case that Dr John Tatham,[78]

at page xcvii. of Supplement to the Fifty-fifth Annual Report of the

Registrar-General of Births, Deaths, etc., Part II., 1897, in speaking

of potters (earthenware makers) sustaining a mortality from phthisis

and respiratory diseases together far in excess of that experienced by

other groups of workers, _e.g._ 453 as against 100 agriculturists,

says that “potters succumb to non-tubercular disease of the lungs

more rapidly than they do to phthisis, and it is certain that much

of the so-called ‘potters’ phthisis’ ought properly to be designated

non-tubercular cirrhosis of the lung.” Cirrhosis is a medical term

sometimes used instead of fibrosis.

_Prevention._--Ventilation of the workroom should be by means of

fans and not simply by open windows. Scouring of china by hand over an

open trough into which the ground flint falls should be discontinued.

It should be done in semi-closed boxes with a strong down draught on

the offside of the workers, or by revolving brushes driven by machinery

in semi-closed spaces similarly aspirated. Overalls and coverings for

the head should be worn by the workers; and since the form of pulmonary

disease that affects potters develops slowly and is capable of being at

least retarded, if not arrested, in the early stages, in the interests

of the workpeople themselves their chest should be examined by a

doctor once every three or six months, so that those who show signs of

commencing lung disease might be pronounced disqualified for further

employment at towing and scouring.

THOMAS OLIVER.

CHAPTER XXIII

BASIC SLAG

In the manufacture of steel by the Thomas Gilchrist or basic process,

there is a large percentage of waste product, which is known by the

name of basic slag. This, notwithstanding its high percentage of

phosphorus, remained for some years of little or no value, until it was

found that its fertilising properties could be obtained by reducing

it to an exceedingly fine powder. Since that was done, it has been in

great demand as a manure. It is the manufacture of this manure which is

said to produce deleterious effects upon the workmen engaged, and which

has brought it within the meaning and regulations of a dangerous trade.

The composition of basic slag is:--

Lime 41.58 per cent.

Magnesia 6.14 „

Alumina 2.57 „

Peroxide of iron 8.54 „

Protoxide of iron 13.62 „

Protoxide of manganese 3.79 „

Protoxide of vanadium 1.29 „

Silica 7.38 „

Sulphur 0.23 „

Calcium 0.31 „

Sulphuric anhydride 0.12 „

Phosphoric acid 14.36 „

Before crushing, the slag is in large pieces, and it has to be ground

into an almost impalpable powder, so that 80 to 85 per cent. of it will

pass through a mesh of 10,000 to the square inch. There is still a

more impalpable dust given off which, notwithstanding the utmost care,

escapes from the machinery during the process of grinding.

The grinding is performed in several ways, sometimes by means of edge

runners, sometimes by flint pebbles, and sometimes by means of heavy

balls called the Krupp ball system. The following is a description

of the process as carried on at the North Eastern Steel Works,

Middlesborough.

The main building is of three storeys, the ground floor of which is

used for the various pulleys and driving gear for the mill.

On the first floor are six roller mills, and on the top floor are ten

Askam separators, three screens, and a main conveyor, into which each

separator discharges the dust.

Outside the main building, but connected with it, on the ground floor,

is a shed in which are placed four edge runner mills.

The slag is put into the first edge runner, and crushed until it is

fine enough to pass through grids at the bottom of the mill, and it

falls through these on to an elevator, which takes it up to the screen

on the top floor. That which is not fine enough to pass through this

screen falls down into the second edge runner, where it is ground in a

similar manner and again elevated to the top floor.

After the slag has passed through the screen, it is taken into the

first two separators, where the fine dust is taken out and falls into

the main conveyor, and is carried by means of this direct to the

warehouse.

The tailings from the separator fall into the roller mills on the first

floor, where they are crushed up, after which they fall into the second

edge runner mill, where they are ground and treated in exactly the

same way as in the first edge runner mill. This process being repeated

altogether four times, the slag is then found to be pulverised.

The dust made in the separators is conveyed direct to the warehouse,

as above described; but that made by the roller mills on the first

floor is drawn by means of a fan into a long tube, running the whole

length of the building, and from this it passes into a long dust-tight

chamber, called the stive room. The floor of this room is cleaned by

scrapers, which take the dust into the main conveyor above referred

to. The dust is finally received into a hopper, and from this it falls

automatically into bags, in quantities of about a hundredweight.

In the early years of its manufacture, the process was conducted in

such a way that it was undoubtedly a very dusty occupation, and the men

working at it then suffered constantly from what they called the “slag

cough.”

Some two or three years after its manufacture was begun, there was an

outbreak of epidemic pneumonia in Middlesborough, and it was thought

by many to be in some way caused by the new industry. As the disease

(in 1888) assumed very serious proportions, it was thought expedient

by the sanitary authority to invite the co-operation of the Local

Government Board. Dr Ballard came down, and after a most careful

inquiry, he reported that “the slag dust to which the epidemic had

been attributed was not the cause of the pneumonia, but that when from

any cause pneumonia becomes epidemic, persons largely exposed to the

inhalation of this dust may and do suffer more than persons not so

exposed, and that the disease with them is of high fatality.”

In 1893 the attention of the Secretary of State was again called

to the injurious nature of the trade, and Mr Gould, Her Majesty’s

Superintending Inspector of Factories, conducted the inquiry, and made

a report in December of that year, in which he says:--“Being in its

nature extremely fine, it has a tendency, when inhaled, to settle in

the farthest ramifications of the air-passages, and to induce in the

mucous membrane of these a chronic state of irritation, thus rendering

the larynx and bronchial tubes unduly susceptible of further mischief

should the subject take cold; and in general creating a distinct

predisposition to bronchitis and pneumonia. Moreover, it is found that

when pneumonia does supervene, a fatal result not unfrequently follows,

with unusual rapidity. But even in a case of complete recovery from an

acute attack, the patient will be constantly liable to a recurrence of

the same malady, as his breathing apparatus is continually undergoing

deterioration, so long as he is subject to the influence of the dust.”

The summaries of these two inquiries may be taken as representing all

that could be said about the effects of slag dust at that time; and it

remains for me to state whether more recent observations have tended to

confirm these conclusions.

In investigating the subject, I have examined a number of men engaged

in daily occupation at the mill, and I subjoin a short report of some

of them.

S. R., 54, been in the mill twelve years; well nourished; no complaints

except occasional cough after starting in the morning; breath sounds

not very distinct at the base of the lungs, and expansion of chest

rather deficient.

J. R., 32, worked in the mill thirteen years; chest expansion rather

deficient; general health good; occasional cough.

E. F., 31, worked eleven years; good appetite and good health; had

pneumonia fifteen years ago; does not suffer from colds, but coughs

sometimes in the mornings.

W. J., 44, has worked nine years; always has cough, which is worst

about an hour after leaving work; expansion of chest diminished.

J. T., 52, worked thirteen years; health equal to the average. Three

years ago had pneumonia; ten weeks off; colds not common; respiratory

murmur diminished over the bases of lungs; expansion lessened.

N. R., 44, worked eight years; health good, never ill; colds often.

In measuring the chest, it was found that there was only a difference

of about one and a half inches between that of inspiration and

expiration, showing considerable diminution in chest capacity.

With regard to the causation of chest affections there can be little

doubt that it produces increased action of the bronchial mucous

membrane, and consequent cough. But unless this is accompanied by such

influences as wet, cold, exposure, or drink, there is no reason to

think that it is the cause of acute bronchitis. Indeed, notwithstanding

excessive carelessness in their habits, I should say that the tendency

in the great majority of cases is towards a chronic affection of the

bronchial tubes, followed after some years by emphysema.

The men nearly all suffer more or less from cough and some mucous

expectoration, which makes them frequently seek relief from cough

medicines. In the last few years, however, great improvements have

taken place in the grinding mills, and the men now tell me that their

discomforts are greatly reduced.

In the cases examined, there was accelerated breathing in three, and

diminished power of expansion more or less in all of them.

It will be seen from the chemical analysis of the slag that there is

nothing in it of the nature of a poison such as to produce immediate

injurious consequences, beyond such effects as may be traced to

its mechanical action upon the bronchial tubes and air cells. The

phosphoric acid is in combination with the lime as a tetraphosphate,

which is not corrosive, nor generally harmful. There is, however, a

good deal of irritation produced in those unaccustomed to it, for on

the last occasion when I visited the works, I felt some tightness in

the chest, with cough and roughness of the voice, which lasted three or

four hours.

Inquiries have failed to elicit that any undue proportion of

slag-workers have been attacked by pneumonia. As the medical

profession in Middlesborough had come to suspect pneumonia in

slag-workers as infectious, with a view to helping in its investigation

an arrangement was come to with the Health Department of the Town

Council to have the cases of pneumonia notified. Of these, 36 were

labourers, and the other 67 embraced nearly the whole catalogue of

special workers and trades, such as crane men, gantry men, carters,

trimmers, blacksmiths, joiners, fitters, and moulders, besides

printers, barmen, publicans, butchers, teachers, and insurance agents.

During the latter half of 1900, Dr Dingle, the Medical Officer of

Health, received 103 notifications of pneumonia in adult males, which

he inquired into. After a very careful inquiry, Dr Dingle failed to fix

any special degree of susceptibility upon any particular occupation.

Slag dust does not play any prominent part in causing pneumonia.

In the treatment of the immediate effects of the inhalation of slag

dust, the remedies for ordinary catarrhal conditions of the bronchial

tubes answer as well as anything; and as its remote effects are in no

way different from those produced by other dusty occupations, remedies

which prove useful in those, such as potassium iodide, carbonate of

ammonia, digitalis, and strychnine, have, in my hands, proved most

efficacious.

But our efforts must be directed more to the prevention of the initial

ailments, and to the amelioration of their causes than to their

treatment by medicines, for it must not be forgotten that the tendency

is always towards the production of structural changes in the tissues

of the bronchi and lungs.

There is a standing order in all of the works that the men should wear

respirators, and these are provided by their employers. But hitherto

no form of respirator has been suggested which answers the necessary

requirements of being porous and comfortable, and at the same time

impervious to dust. The face bag, which was one of the results of Mr

Gould’s inquiry, ought to be of great service; but it becomes saturated

with the moisture of the expired air, the result being that during

inspiration it is drawn up against the mouth and nose, and a sufficient

quantity of air not being available, the workmen slip it down

underneath the chin, where, of course, it is useless. No contrivance

will ever answer the purpose which does not admit of easy access of air

into the lungs, and of complete expiration without effort. For this

purpose a light, soft wire mask might be made to fit the face, which

should stand out from the mouth and nose. It should contain a shutter,

by which several layers of open webbing could be enclosed, through

which the breath could be easily drawn; and there should be an opening

fitted with a valve, which should open easily for outward, but shut for

inward breathing.

The finished material is placed in packing bags, in the fitting of

which the openings are tightly fixed round the hopper, and by means

of a lever the charge is suddenly dropped into the bag, when a cloud

of dust immediately rises. There is consequently more dust in this

department than there ought to be, and, moreover, it is the finest dust

of all, for it comes through bags of very closely-woven texture. If the

packing material were dipped in size, or rendered impervious in some

other way, this source of danger would be largely reduced.

There is another improvement which might be suggested, and that

is, that the men should be provided with a room, outside the mill

altogether, in which to take their meals. As it is at present, the

grinding goes on without stoppage for meals, which renders it necessary

for the men to be on hand the whole time; consequently there is no

opportunity for open-air breathing time. By a little arrangement the

men could probably go in batches, and have their dinner in comfort, and

for a time be free from the atmosphere of the mill.

JOHN HEDLEY.

CHAPTER XXIV

GANISTER CRUSHING

Workers engaged in crushing basic slag, in the breaking of certain

rocks, in the manufacture of millstones, in stone-mason’s work and

kindred occupations, are peculiarly liable to chronic inflammation of

the air-tubes, caused by the inhalation of dust of an irritant kind.

This, it is believed, leads to lung fibrosis. Where the operatives form

part of a large community in which individuals are employed in many

and varied trades, it is conceivable that fibrosis of the lung may

be mistaken for tubercular pulmonary consumption, and it may not be

realised that the cause is due to the occupation of the sufferer. The

late Dr Arlidge, in a public lecture on “The Sanitation of Industries

and Occupations,” referring to china clay as a silicious material,

states that the dust is most destructive to lung function and lung

integrity, as it sets up chronic inflammation of the air-tubes and of

the lung tissues, itself accompanied by bronchitis and asthma. The

disease thus established terminates in fibrosis of the lung, “a lesion

which symptomatically closely resembles pulmonary consumption.”

The risks referred to have in late years more than ever engaged public

attention. Already great strides have been made in the provision of

remedies. To medical men practising in districts where these dusty

trades form the principal occupation, we may look for information of

a definite and exact nature as to the health of the workers. A highly

interesting article, entitled “Ganister Disease,” was published in the

_Journal of the Sanitary Institute_ for April 1900. The writer, Dr

C. L. Birmingham, lived for several years in the valley of the Don, the

principal centre of this mining industry.

To the general reader it may be well to explain that ganister or

calliard is a hard, close-grained, silicious stone which often forms

the stratum that underlies the coal seam. A footnote in Dr Percy’s

_Fuel_ says--“Dinas rock is believed to be a millstone grit of

the carboniferous system, and the geological equivalent of the bed

termed ‘Ganister’ at Sheffield.” It is found in Yorkshire, Durham,

North and South Wales, and elsewhere. When crushed and ground into

dust it is used as a fire-resistant, chiefly for lining Bessemer and

other steel-converters, for the manufacture of bricks likely to be

subjected to great and continuous heat, and it is sometimes mixed with,

or substituted for, Stannington or other clays, which, together with

ground cinders and old ground pot, are used for the manufacture of

crucibles in which certain kinds of steel are made.

The persons liable to suffer are the ganister miners and those who

manipulate the material in mills known as “breaker-mills.” During

the mining process much dust is generated in the various stages of

blasting, and little doubt exists that it is to this that we must

look for a solution of the very high mortality returns. By many it

is held that the products of combustion from the blasting charges

are liable, when inhaled, to cause (or to predispose the worker to)

chest affections. The ganister, in large lumps, is brought from the

mines to the mills in small trucks running on metals. Where necessary,

these lumps are broken by hand with heavy sledge-hammers, the process

being known as “sledging.” Whilst this is being done a certain amount

of dust arises. The material is next thrown into breaker-mills of

various patterns, for crushing. The mills are in the open air, or in

open sheds. As the lumps are thrown into the mouth of the mill where

the crushing takes place, clouds of dry dust rise in the face of the

workers, and to this operation is attributable much of the illness.

Happily, a remedy generally accepted has been found and is being

adopted. It is simply a jet of steam playing into the mouth of the

mill, damping the material and preventing the dust from rising. In some

works, small fine jets of water, such as would run from an ordinary

water can, are preferred. Time has not yet allowed practical men to

say with certainty that this is an absolute remedy, but they are very

hopeful.

The crushed ganister, in pieces about the size of “metal” used for

road-making, is carried from the breaker-mills by shoots to edge-runner

mills, to be pulverised into a fine dust. During the whole of this

process it is thoroughly saturated with water, rendering the escape

of dust a practical impossibility. In this state it is ready to be

converted into bricks, or to be taken away in railway trucks, carts,

or other conveyances, for use elsewhere. It is sometimes found that

the ganister mortar is too moist, in which case it is “tempered,” that

is, dry ganister-dust, to the necessary amount, is mixed with it. In

this process some dust may here arise, but it is hardly in sufficient

quantity to affect the health of the workers.

The bricks are made in hand presses. It is not a dusty process until

just before closing the press, when many operatives take a handful of

ganister dust and throw it over the surface of the brick, to secure a

clear and clean impress, showing the name of the maker, etc. This is

a dangerous and unnecessary step; damp sawdust is equally efficacious

and is now generally used. The floors of ganister brick-drying sheds,

as in other brick works where the same method of drying is adopted, are

more or less dusty. Under these floors there are pipes heated by steam

or hot air, for the purpose of drying the bricks. Each time a dry brick

is lifted, dry dust is liberated, but seeing that there is little or

no traffic on these floors (except in passages, which can easily be

kept clean), the dust rests on the floor, and does not permeate the

atmosphere. Mechanical fans have been suggested, but practical men

would find it extremely difficult, if not impossible, to find any fan

that would carry this dust, and such men certainly would be sceptical

as to the wisdom of creating draughts where the desire is to keep

the dust on the floor, and not to cause it to fly about. It will be

realised that although fans may be, and are, used with the greatest

advantage in certain dusty occupations, it does not follow that they

will answer in all.

It has been stated, and probably with some degree of accuracy, that

the “setter’s” work involves exceptional risk. The process consists

in placing the bricks in the kilns for baking, after they have been

dried in the sheds. A man standing in an elevated position catches the

bricks, which are thrown to him by the man at the mouth of the kiln. As

they are thrown, dust is liberated, and seeing that this work is done

in a confined space, it is quite conceivable that injurious results to

health may follow.

In some works ganister is ground dry in what are known as “sieve

mills.” These are ordinary edge-runner mills, with a sieve at the

bottom of the pan. The fine ganister passes through the sieve, and is

taken by elevators to the sifting machine, where what is fine enough

is carried away to the receptacle for holding it, the coarser material

being carried by shoots to be again ground in the mill. In many works

the ganister, although nominally dry, is damped sufficiently to prevent

any escape of dust, and it has been stated by experienced manufacturers

that the damping in no way damages the material, nor does it hinder the

work. This dry ganister crushing is in most cases a subsidiary process,

the quantities required being small, it only being used for the purpose

of making a cement, or mortar, for joining silica bricks or other fire

resistants.

Ganister workers are peculiarly liable to those ailments incidental

to occupations exposing the operatives to extremes of heat and cold,

to damp, and to draughts, but the writer believes that he has, in

general terms, defined the peculiar and exceptional risks incurred in

this occupation. Having done so, it seems difficult to account for

the alarming mortality returns published in Dr Birmingham’s article.

A possible solution may be found in the fact that where ganister

works are situated there are also large numbers of fireclay works in

which are made fire-resisting bricks, tuyeres, pipes, gas-retorts,

etc. To the uninitiated it might appear that ganister and fire-brick

workers were engaged in one and the same occupation, nor would this be

unreasonable when the constitution of the two substances is considered.

Ganister is stated to contain 95 per cent. of silica, whereas,

according to _Chambers’s Encyclopedia_, from which the following

extract is taken, it will be seen that fireclay contains from 54.2 to

65.1 per cent. of silica.

“Ordinary fireclay is chiefly found in beds not usually

much exceeding two feet in thickness, in the coal measures,

interstratified with seams of coal and other rocks. In the

British Islands it is most largely worked about Glasgow,

Newcastle-on-Tyne, and Stourbridge in Worcestershire, at which

last place it is said to have been discovered about 1555 by

some wandering glass-makers from Lorraine. But it occurs, more

or less, in most places where true coal is found. It is mined

in Germany, Belgium, France, the United States, and other

countries. Stourbridge fireclay, owing to its excellent quality,

is largely exported to foreign countries, as well as bricks and

other objects made of it. Refractory clays are found, although

more rarely, in other formations besides the coal measures.

For example, some of Tertiary age found in Dorsetshire and

Devonshire are made into firebricks. The following table shows

the principal constituents of fireclay:--

+----------------+--------+--------+--------+--------+--------+

| | No. 1. | No. 2. | No. 3. | No. 4. | No. 5. |

+----------------+--------+--------+--------+--------+--------+

| Silica | 65.10 | 51.10 | 59.49 | 53.52 | 54.20 |

| Alumina | 22.22 | 31.35 | 28.95 | 33.68 | 33.80 |

| Potash | 0.18 | ... | ... | Trace | Trace |

| Lime | 0.14 | 1.46 | Trace | 0.76 | Trace |

| Magnesia | 0.18 | 1.54 | ... | 0.14 | 0.02 |

| Oxide of iron | 1.92 | 4.63 | 1.05 | 0.52 | 0.01 |

| Water | 9.28} | 10.47 | {11.05 | 11.34 | 10.86 |

| Organic matter | 0.58} | | { ... | ... | 0.15 |

+----------------+--------+--------+--------+--------+--------+

No. 1, Stourbridge; No. 2, Newcastle-on-Tyne; No. 3, Gartsherrie,

Scotland; No. 4, Poole, Dorsetshire; No. 5, Morgantown, West Virginia,

United States.”

Ganister is pulverised in the wet state. Fireclay is not moistened, but

ground into a fine dry powder, certainly suggesting greater risk to the

workers.

Into other industries, such as the manufacture of steel-melters’

composition, the crushing of ganister largely enters. This composition

is used for the manufacture of heavy castings, and contains large

proportions of old ganister and fireclay crucibles, bricks, mortar,

etc., which are ground in open edge-runner mills in the dry state,

fed, and often sifted by hand. The work is generally done in the open

air or in open sheds, where the dust is blown about, and where it

is a practical impossibility for the worker to avoid inhalation of

this irritant. The use of closed mills, closed cylindrical worm-screw

conveyers, and mechanical sieves, would largely avoid unnecessary risk,

and these labour-saving appliances (the writer believes) would soon

more than repay any original cost.

The sickness and mortality amongst ganister workers engaged the

attention of the poor-law authorities in the district of Deepcar, near

Sheffield. Statistics were prepared for them, and a very carefully

considered report dealing fully with the subject was submitted by Dr

Robertshaw of Stockbridge, Medical Officer of Health for the division.

The attention of Dr Legge, H.M. Medical Inspector of Factories, was

called to the subject recently, and he obtained from Dr Robertshaw the

lung of a ganister miner, who had presumably died from pneumoconiosis.

The following is an extract from the valuable report by Dr F. W.

Andrews, Pathologist to St Bartholomew’s Hospital, of the anatomical

changes in this lung induced by the inhalation of ganister dust,

published in Dr Legge’s Report to the Chief Inspector of Factories for

the year 1900.

_Report on Portions of Lung from a Ganister Miner._

The upper lobe is densely indurated, black and fibrotic. The pleura is

thickened, especially at the apex. The lower lobe shows less advanced

changes; numerous blackish nodules, about the size of a hemp-seed,

are scattered throughout its substance with tolerable uniformity.

Under a lens many of these indurated patches are seen to contain a

minute cavity, as if they had been formed around minute bronchi or

blood-vessels. The intervening lung tissue is greyish, scarcely at all

pigmented, and not indurated; it has the appearance of slight uniform

emphysema. The large and medium-sized bronchi stand out prominently. To

the naked eye the lung nowhere shows any evidence of tubercle.

_Microscopic Examination._--Seven different blocks of lung tissue

were selected illustrating as far as possible the different degrees of

fibrotic change present, from an area almost normal up to the densest

induration. These were sectioned. The method of staining found most

suitable was that known as Van Giesson’s--viz., staining in hæmalum,

followed by a counterstain of acid fuchsin with picric acid. In this

way the distribution of the fibrous tissue was demonstrated with great

minuteness. Nuclear staining was not very well marked, because the

tissue had been lying so long in spirit.

All sections show an abundance of foreign mineral particles of a black

or brownish colour. The majority of these are minute, irregular,

sometimes angular in form. Seen singly they are semi-transparent

and brownish, but they are commonly collected into blackish heaps,

included in cells, and then appear opaque. Careful focussing, however,

reveals the presence of the angular semi-transparent particles in these

accumulations. The pigment masses have not the soft and rounded outline

of the carbon masses seen in the lungs of town dwellers; nevertheless

very finely divided jet black particles are present, which are probably

carbon, but they are less abundant than the brownish semi-transparent

masses. The pigment masses occur chiefly in connection with the

fibrotic areas.

A few simple chemical tests were applied to microscopic sections,

and their effect watched under the microscope. Caustic potash (10%)

produced no change whatever in the pigment. Glacial acetic acid

likewise caused no change. Fuming nitric acid caused liberation of gas

bubbles under the coverglass, but the colour and amount of the pigment

were in no way altered. From this it may be concluded that the colour

does not depend upon altered blood or any organic product, but that the

pigment is purely mineral in character--carbonaceous or siliceous. The

liberation of gas by nitric acid indicates the presence of traces of

carbonates.

The characters of the fibrotic change and its localisation and

development could be traced from its earliest commencement. Sections

of the least affected portions of the lung present the following

appearances. The pleura is scarcely thickened over much of the lower

lobe. There is a slight degree of diffuse emphysema; apart from the

indurated patches there is a very slight increase in the amount of

fibrous tissue present in the alveolar walls generally, but in some

places this is barely perceptible. Careful search in the alveolar

walls reveals the presence of scanty mineral particles scattered in

the tissue. In places these form larger clumps. Some few detached

epithelial cells, laden with pigment, are seen here and there in the

alveoli; but on the whole, except around the fibroid nodules, the

pulmonary epithelium shows no sign of proliferation or catarrh. There

is no evidence of general broncho-pneumonia and none of vascular

congestion.

The development of the fibroid nodules appears to take place in the

first instance around the small arteries, veins, and bronchi. Where a

vessel chances to be cut longitudinally, the perivascular thickening

is seen to be irregular and patchy, whence arises the appearance

of discrete fibroid nodules. When cut transversely, nearly all the

blood-vessels display some degree of perivascular fibrosis. This is

true also of the bronchi; but these have undergone so much loss of

mucous membrane that it is not always easy to say which are bronchi and

which blood-vessels. It is not possible to be sure that all the young

fibroid nodules have this perivascular or peri-bronchial origin. Some

appear to be independent of vessels or bronchi, but it is possible

that they are tangential sections of such thickenings. It seems clear,

however, that most own such an origin. In any case the relation between

the accumulation of mineral particles and the production of new fibrous

tissue is obvious and beyond dispute.

Older and denser nodules, such as are visible to the naked eye, as

the hemp-seed structures above described, illustrate the further

development of the process. In those the vessel or bronchus around

which they have presumably arisen has usually disappeared, and they

present concentric zones which represent different stages in their

formation, and illustrate the manner in which they increase in size.

The outermost zone shows the earliest stage: large black pigment-laden

cells accumulate; they may be in part leucocytes, in part pulmonary

epithelial cells or fixed connective tissue corpuscles. The pulmonary

epithelium is here often in a condition of catarrhal proliferation--a

localised broncho-pneumonia--each cell full of mineral particles.

The next zone consists of a loose connective tissue, the meshes of

which contain the large pigment-laden cells previously mentioned. The

mineral matter is almost entirely intracellular. The central mass is

composed of a dense fibrous tissue in which the cells have almost

entirely disappeared, the mineral particles now becoming free and less

conspicuous because they are no longer aggregated into dense black

clumps. It is easy to realise from the structure of such nodules how

they increase in size at the expense of the lung tissue. Beneath the

pleura a similar development of new pigmented fibrous tissue similarly

occurs. It is to be observed that all this fibrotic change corresponds

in its localisation with the distribution of the lymphatic system of

the lungs. The lymphatics, originating by stomata between the pulmonary

epithelium, fall into two sets--(1) the sub-pleural network, and (2)

those which closely accompany the blood-vessels and bronchi, forming a

perivascular and peri-bronchial network.

The final stages in the process are shown by sections taken from the

upper lobe of the lung, in which the fibrosis is much more dense and

complete. Here the individual nodules have so encroached upon the

lung tissue that they have more or less completely coalesced. In the

most advanced portions, little or no normal lung tissue can be seen,

although the focal character of the fibrosis is still perceptible,

since islands of dense fibrous tissue are connected by areas in which

the pigmental cells are enclosed in a looser connective tissue. The

mineral particles are here even more abundant and conspicuous than in

the lower lobe of the lung. In one single nodule (in the lower lobe)

calcification was seen, but this stage is absent elsewhere.

Although to the naked eye there is no evidence of tubercle in the

lung, yet microscopically such evidence exists in at least one of

the seven blocks. The process of fibrosis has been traced from its

earliest stages, and is most positively non-tubercular in its origin.

The evidence of tuberculosis is present, as a recent and accessory

phenomenon, only in the most advanced stages of the fibrotic change.

It consists in the presence of small miliary tubercles embedded in the

fibrous tissue, and showing the characteristic structure of tubercles,

with typical giant cells. Even in these no tubercle bacilli can be

demonstrated.

The conclusions to be drawn from the preceding observations are as

follows:--

The inhaled mineral particles are, in the first place, deposited

uniformly in the pulmonary parenchyma. They are at once taken up hence

by the lymphatics and carried along by the lymph stream. The lymphatics

have a perivascular, peri-bronchial, and sub-pleural distribution, and

in these situations the mineral matter specially accumulates, because

the amount is greater than can be got rid of by the lymphatics. It is

here chiefly found enclosed in cells (phagocytes), and exercises an

irritant action leading to the production of new fibrous tissue in

these situations. The fibroid areas increase at the expense of the

adjacent lung, in part at least by the development of a localised

broncho-pneumonia, and in part by thickening and induration of the

alveolar walls. When the fibrous tissue is fully formed the cells

containing the mineral particles break up and degenerate, and the

particles again lie free amongst the fibrous tissue. By the spread and

coalescence of the fibroid areas, the lung tissue in the most advanced

areas completely disappears. A secondary tubercular infection has now

taken place, and miliary tubercles appear in scanty numbers in the

fibroid areas.

_Chemical Analysis._--Portions of the lung were handed to Mr H. A.

Schölberg, M.B., who furnishes the following analyses.

The material supplied was dried at 100°C. on a water bath for three

hours. The dry lung tissue thus obtained was used for analysis.

(1) _Analysis for total Ash._

Grammes of dry lung taken 2.2675

Loss of weight on combustion in muffle furnace 1.1900

Residue of ash 1.0775

∴ Percentage of ash in dried lung = 47.519

(2) _Estimation of Silica._

Grammes of dried lung taken 0.1505

Silica in the same 0.0100

∴ Percentage of silica in dried lung = 6.644

HAMILTON P. SMITH.

CHAPTER XXV

MILLSTONE BUILDING: FRENCH BUHRSTONE

In the Final Report of the Dangerous Trades Committee of the Home

Office,[79] the subject of the building or making of millstones by a

hard, flint-like stone known in the trade as French buhrstone, and

which is imported into this country from Epernon in the Valley of the

Seine, and from Fierté-sous-Jouarre, is fully discussed and the dangers

exemplified. Buhrstone is one of the hardest stones in nature. It is a

variety of quartz, and is so hard and destructive to the steel tools

used by the workmen that in ten minutes a workman will knock off the

points of as many chisels. The stone has to be shaped into wedges of

varying size. These wedges are placed together in the form of a circle

cemented together, and subsequently surrounded by one or more strong

iron hoops. The millstones are used for grinding flour, cement, feeding

stuffs, etc. The chiselling of the buhrstone is generally conducted in

the open air or in a shed open at the sides, the rough stone resting

meanwhile upon a tub filled with sand, or upon some other solid

support. Fortunately French millstone building is a small industry,

for it is one that is most destructive to human life. Millstone masons

are a short-lived body of men. Their work is hard, most of it is

done practically in the open, without adequate protection from cold,

wind, and rain; the wages earned are good, often as much as fifty or

sixty shillings a week, but as a class the workmen are intemperate

and careless. No doubt alcoholism and indiscretion play their part in

shortening the lives of the men. As the stone is very hard, and the

point of the steel tools with which the men chisel is readily knocked

off, the workmen are exposed to two dangers: (1) splinters of steel

and stone striking the eye; and (2) inhalation of the dust given off

with each stroke of the hammer. Considering the compactness and the

great weight of the stone, it is astonishing that the dust evolved in

chiselling ever reaches the lungs at all. In dealing with the question

of dust generated in any trade, it is to be remembered that while the

dust that is seen lying about in a factory may seem to be heavy and

the particles large, yet there is a finer and more impalpable dust

created at the time the particular work is being done, and it is very

largely this which is inhaled and inflicts the damage. When a workman

is chiselling a piece of buhrstone, two different kinds of particles

are given off, mineral particles from the stone, and metallic from

the chisels. These mingle together and form the dust that is inhaled.

That steel particles are present in the dust rising from the stone was

indicated to my colleagues on the Departmental Committee and myself

by a workman who, having magnetised the blade of a pocket knife,

placed the same in his waistcoat pocket, and “after moving it about

a few moments withdrew it, when it was found to be covered along its

edge with a fern-like coating consisting entirely of minute particles

of steel.” It is to the presence of very small fragments of steel

imbedded in the skin of the arms of the men, who frequently chisel with

their sleeves rolled up, that is due the bluish-black mottling of the

forearms of millstone builders.

The men, as already stated, are short-lived. Several whom I examined in

the stoneyards on the banks of the Thames acknowledged the unhealthy

character of their employment, and said that they and their comrades

knew they might be able to follow their calling for only ten or

fifteen years, seldom more, and that probably before the tenth year

was reached, symptoms of pulmonary consumption would show themselves,

attended by cough and blood-spitting. Hæmoptysis is a very common

symptom, and in this respect, as also in the rapid course of the

illness, the pulmonary consumption of millstone builders differs from

the phthisis of potters in which hæmorrhage from the lung is rather

infrequent. Once destructive changes have been started in the lungs

of a buhrstone chiseller, the disease progresses quickly to a fatal

termination. The Dangerous Trades Committee found that men who began

this occupation when very young seldom lived beyond thirty-six to forty

years of age.

_Prevention._--It is such a dangerous occupation that if the industry

were swept out of existence altogether it would be no great loss either

to the commercial world or to civilisation at large. The number of men

employed in it is small, and as steel rollers have to a large extent

replaced French millstones in the grinding of food and other stuffs,

milling can be just as successfully accomplished without as with these

stones. The trade will probably die a natural death, but so long as

the industry continues, the men ought to wear respirators. If this

were done much illness would probably disappear. The men complain of

the irksomeness of respirators, and of the heat that they cause. The

laborious nature of their employment creates a need for free, full,

and easy respiration. The dust that is given off in chiselling the

stones is very heavy, and is therefore capable of being readily carried

downwards and away from the workmen by powerful suction, yet the

conditions under which the work is carried on, viz., in open places and

unprotected sheds, makes the use of fans difficult, if not impossible.

The wearing of goggles or eye-guards should be insisted upon.

THOMAS OLIVER.

CHAPTER XXVI

STEEL GRINDING

The process of grinding cutlery and other steel implements is

conducted by a class of workmen known as “grinders.” Their trade is a

highly specialised one, necessitating a long apprentice-ship before

proficiency is attained; and in the majority of instances the calling

has been handed down through many generations. The trade is quite free

from the adulteration of casual labour, and consequently statistical

data respecting “grinders” possess a relatively high value. For the

most part they earn good wages, and being keen sportsmen, get a fair

amount of outdoor recreation. Their hours of work are seldom excessive,

and their homes and mode of living are up to the average standard of

comfort obtaining in the artisan class of the population.

Grinding is done on circular stones turned either by steam or water

power. The stones vary in diameter from an inch up to several feet, and

are of different degrees of hardness according to the work required of

them. On the stones, articles of cutlery are reduced to their proper

shape and thickness, and are given their cutting edge, while many

other steel implements are ground to remove the roughness of their

surfaces. For the most part “grinders” sit astride the grinding stone

on a saddle, leaning forward, more or less according to the size of the

stone. The position is not an ideally healthy one, but the assertion

that it interferes with the free expansion of the lungs is only to a

very slight extent true. The attitude, however, renders the workmen

peculiarly vulnerable to accident when a stone breaks.

Grinders are divided into two classes, known respectively as “dry

grinders” and “wet grinders.” The former are engaged in grinding steel

forks, augers, gimlets, needles, and a few other articles; while the

latter grind the blades of knives, scissors, razors, and most other

cutting implements.

Certain articles of cutlery are ground partly on a wet and partly on

a dry stone. Thus the backs of razors and scissors and the bolsters of

table-knives are ground dry, while the rest of the blade is wet ground.

Dry grinders form a comparatively small class of workmen, but owing to

the excessive mortality which formerly obtained among them they have

long attracted the attention of the trade sanitarian. The attrition

of the steel against the dry grinding stone gives rise to enormous

quantities of steel and stone dust, which renders the atmosphere of

the workshop very irritating to the lungs, and produces a pathological

condition known as grinders’ phthisis.

The following account of the pathology and symptomatology of the

disease has been very kindly written for this article by Dr Duncan

Burgess, Senior Physician to the Sheffield Royal Hospital:--

“Grinders’ Phthisis, Grinders’ Asthma, Grinders’ Rot.--This disease

is due to the inhalation of dust composed for the most part of gritty

particles from the grinding-stone, but also containing fine particles

of steel from the implement ground. It has been asserted that steel

particles are not found in the grinders’ lung, but a very beautiful

microscopical section of an affected lung, appropriately stained, in

the possession of Dr Arthur Hall, shows unmistakably traces of iron.

Steel dust, however, constitutes only a minute fraction of the foreign

pigment in the diseased lung, and its effects compared with those of

stone dust may be neglected.

“The frightful mortality among dry grinders before the introduction

of fans made the lung diseases of this class of workmen so notorious

that the name ‘grinders’ phthisis’ still signifies outside Sheffield

the very severe indurated broncho-pneumonia, which past generations of

fork grinders were subject to. This extreme form of grinders’ phthisis

is now practically extinct, but a modified form of the disease is

still very prevalent among Sheffield grinders and cutlers. The whole

respiratory tract is exposed to the action of the dust, but its effects

on the larger passages are comparatively unimportant. The disease

usually manifests itself in the first instance in the form of chronic

bronchitis with emphysema. Immunity from symptoms may continue for

decades, then in the winter or during foggy weather cough with some

expectoration in the morning may be noticed. The cough gradually gets

worse, and it may last more or less throughout the winter. Shortness

of breath is now complained of, and the grinder may have to leave off

work for weeks together from time to time. Finally his cough persists

through the summer, and his shortness of breath on exertion forces

him to leave off work altogether, it may be after the age of sixty,

or even twenty years earlier. If he be examined now his skin and lips

will be dusky, and his chest fixed as at the end of inspiration. The

breathing is mainly diaphragmatic, and though the auxiliary muscles

of respiration stand out in strong contraction, there is very little

expansion of the chest. In addition to the ordinary physical signs

of bronchitis there may be areas in which the breath sounds are very

feeble or absent, and areas in which they are comparatively loud. The

grinder is especially liable to have tuberculosis grafted on to his

bronchial lesion, and this may occur quite early, or be deferred until

late. Wasting, night sweats, and hæmoptysis mark the onset of the rapid

change for the worse which follows tubercular infection. The dyspnœa

is naturally greater than in ordinary phthisis, and the emphysematous

condition of the lung may mask for a time tubercular infiltration. The

sputum is at first very scanty, and consists of mucus with dark spots

and patches. Later it is more abundant and becomes muco-purulent, with

black spots and patches, and occasionally gritty particles. In the

terminal stage tubercular bacilli are present, together with other

pathogenic organisms. Grinders suffer inordinately from pleurisy and

pneumonia.

“The pathological feature of dry grinders’ phthisis is the presence in

the cut section of the lung of groups of dark, hard nodules about ⅓

of an inch in diameter. Under the microscope these nodules are found

to consist of dense fibrous tissue arranged more or less in layers.

Black amorphous masses may be conspicuous in or near the centre of

the nodule. The lung tissue in immediate contact with the nodules is

converted into less dense but more deeply pigmented fibrous tissue.

This merges into air-cells with thickened and pigmented walls. The

apices of the lungs are more frequently the seat of nodules than the

bases. In an extreme degree of grinders’ phthisis the entire upper lobe

may be replaced by a solid, hard, black mass, which on section presents

a mottled appearance from the innumerable nodules, thickened bronchi,

and pigmented airless lung tissue. The pleura is irregularly thickened,

in places forming a milky or thick yellow layer, which may be adherent

to the chest wall. A tubercular cavity of considerable extent may be

found at the apex or elsewhere.”

At one time dry grinding was perhaps the most unhealthy trade in the

country. The late Dr J. C. Hall of Sheffield, in a paper read before

the Social Science Congress in 1865, stated that “excluding boys, the

average age of dry grinders was only twenty-nine years;” and there

can be little doubt that comparatively few workmen were to be found

following their employment after the age of forty years. Of late the

introduction of fans for carrying away the dust has greatly improved

the conditions under which dry grinders work, and, as I shall presently

show, this has been followed by a corresponding improvement in health

and length of years, but the trade is still an unhealthy one.

Wet grinding is much the more important branch of the grinding trade,

and in Sheffield alone it gives employment to several thousand

workmen. In revolving, the grinding-stone passes through a thin layer

of water placed in a trough beneath the stone, and is always wet,

so that comparatively little dust is produced; but as certain other

dust-producing processes are usually conducted in the wet grinding

workrooms, the atmosphere is not quite free from dust. The processes

referred to are:--

(1) _Glazing._--Most articles of cutlery after having been ground

are “glazed.” This is done on a wooden wheel covered with leather which

has received a coating of emery and glue. The rim of the wheel is from

time to time rubbed with a cake composed of emery, suet, and beeswax.

The “glazer” is used for the purpose of removing marks on the blade

left by the grinding-stone. Owing to the greasy nature of its surface

there is not much dust formed.

(2) _Polishing_ is employed to give a highly-finished appearance

to certain blades. The “polisher” is also made of wood, covered with

leather, but instead of emery a fine powder containing oxide of

iron, and known as “crocus,” is used. The process gives rise to a

considerable amount of dust.

(3) _Lapping._--The blades of pen-knives and many razors are

subject to a process called “lapping,” which is done on a lead-rimmed

wheel called a “lap.” The process is chiefly interesting as being a

possible source of lead poisoning, but after careful inquiry I have

failed to find any one showing evidence of plumbism from this source.

(4) _Racing the Stone._--The grinding-stones are received from

the quarries in a rough condition, and the “grinder,” after mounting

the stone on its axle, reduces its circumference to the proper shape

and degree of smoothness by applying a steel bar to it while it is

revolving slowly. This process, which is known as “racing the stone,”

gives rise to enormous volumes of dry dust, so that the air in the

immediate neighbourhood of the stone is almost unbreatheable. All

stones, whether for wet or dry grinding, require to be “raced” in the

first instance.

But while wet grinders cannot be said to suffer much from the

irritation of dust, they show an appalling mortality from phthisis and

other diseases of the lungs, and there is no room for doubt that the

damp, stagnant atmosphere in which they work is the principal cause of

these diseases. The grinding-stones are constantly throwing off water,

which soddens the floor and saturates the air of the grinding-room

until, owing to the absence of efficient ventilation, it becomes very

like that of a damp cave.

Another danger to which grinders are exposed is the breaking of the

grinding-stone when in motion. These accidents are unfortunately

common, and often cause frightful injuries and death. They are due to

a variety of causes, such as departure from the circular shape owing

to one side of the stone wearing faster than the other; flaws in the

stone; allowing the lower part of the stone to remain immersed in the

water trough when not in use; fixing the stone on its axle by means

of wedges instead of using plates and screws for this purpose; and

permitting the stone to revolve too rapidly.

In the hafting of certain classes of knives an emery wheel is used

for shaping the knife handles, and it produces dense volumes of dust

composed of steel particles from the rivets and tangs, also of emery

from the wheel, and of bone or other material of which the knife

handles are made. This emery wheel is known as a “cutler’s glazer,”

and is a comparatively recent invention, having come into general use

only during the last twenty-five years, previous to which all handles

were shaped with a file. It is most injurious when used for shaping the

handles of knives that have scale tangs.

The cutlery manager of one of the largest firms in Sheffield assures

me that cutlers as a class have become much more unhealthy since the

introduction of the glazer. This opinion is endorsed by other competent

observers, and there is no difficulty in accepting the accuracy of it

if we reflect that the modern scale tang cutler who uses a glazer is

virtually a “dry grinder.”

Grinding is carried on either in separate buildings, which are known as

“grinding wheels,” or on premises where other branches of the cutlery

trade are conducted. In either case the grinding of heavy articles is

done on the ground floor. The rooms, or “hulls,” as they are called,

are sometimes sunk below the level of the ground, and are as a rule

bounded on three sides by blank walls without adequate provision for

cross ventilation. The windows and doors are in the fourth wall,

and the former are usually devoid of glass because the mud from the

grinding-stones would speedily obstruct the light if glass were used.

The hulls are provided with fires for drying the blades, but the

fireplaces are situate in front or in one of the lateral walls, and

consequently their utility as ventilating agents is not great. Each

hull contains one, two, or more troughs which run from front to back,

and in them are placed the grinding, glazing, and polishing wheels in

the order mentioned. The floors are wet and dirty, and the atmosphere

damp and stagnant, particularly at the back, where it is further

defiled by the dust given off from the polishing wheels. The cubical

space per worker would as a rule be ample if the ventilation was good.

Dry grinding and the lighter branches of wet grinding are carried on

in rooms in the upper stories. Better ventilation exists here, but on

the other hand the rooms are often overcrowded, and when dry grinding

is done there is of course much dust. In the majority of dry grinding

rooms fans for the removal of dust are to be found, but occasionally

these are absent. One fan is as a rule sufficient for several workmen.

Attached to it is a number of tubes, each of which ends in an expansion

or hood in front of the grinding-stone. The tubes are put down by the

owner of the factory, who likewise occasionally supplies the fans;

but as a rule the fans and hoods belong to the workmen, who are known

as “piece workers.” When properly constructed and looked after, the

fans act admirably for removing dust, and also aid in ventilating the

workshops; but as several workmen commonly occupy one room and share

responsibility for its sanitary condition, there is the usual failure

to carry out efficiently that which is the duty of one in particular.

For this reason the tubes are apt to become choked from not being

periodically cleaned out, or a trivial defect which a few minutes would

suffice to remedy, is allowed to render the fan inoperative for days

together. Again, a careless grinder by neglecting to use a hood will

seriously discount the efforts of his more careful shopmates to keep

down dust. Hence it happens that in many workshops where dry grinding

is done the dust accumulates in large quantities on the floor, to rise

in dense clouds each time it is disturbed.

In the manufacture of scale tang cutlery, in which glazers are

extensively used, the atmosphere under the most favourable

circumstances is charged with fine dust. This is especially noticeable

where bone is employed for hafting. Moreover, manufacturers complain

bitterly that the workmen will sometimes block up ventilators and

dispense with the use of fans unless strict vigilance is maintained. It

is almost incredible that any one should pursue so suicidal a policy,

yet personal observation compels me to admit that these allegations are

not altogether groundless.

Another grave defect is the indiscriminate mixing of various classes of

workers. Thus in a shop where a dozen men work, only two or three may

be engaged in dust-producing processes, yet all are obliged to inhale

the dust-laden atmosphere.

The buildings in which grinding and hafting are done vary widely in

their sanitary aspects. Many of these places are as perfect as it is

possible to make them, having regard to the nature of the work carried

on therein; but not a few are just the reverse. Dilapidated buildings,

constructed in the first instance without regard to the requirements

of health, are sadly too common. In these overcrowding, defective

ventilation, and a dust-laden atmosphere are the rule rather than the

exception. Externally the condition of affairs is often no better, the

factories being shut in by other buildings which exclude sunlight from

the lower rooms, and interfere with the circulation of the air.

Trade mortality tables have been carefully compiled by successive

Medical Officers of Health for the city of Sheffield, showing the

number of deaths, the principal diseases which cause death, and the

age at which death took place in a number of trades. The figures have

reference to males over the age of fifteen years, and when contrasted

with the corresponding figures of the Registrar-General for the entire

male population of the country they indicate fairly accurately the

relative unhealthiness or otherwise of the workmen concerned. An

examination of the returns for grinders shows an appalling death-rate

from phthisis and other diseases of the respiratory organs. Thus in

every thousand deaths among grinders phthisis causes 345, and other

respiratory diseases 295, or collectively these diseases account for

64 per cent. of the entire mortality, whereas among the entire adult

male population of the country phthisis accounts for 144, and other

respiratory diseases for 182, in every thousand deaths, or collectively

to 32.6 per cent. If we examine the ages at which deaths occur, a

similar unsatisfactory contrast obtains. Thus 458 grinders in every

thousand die between the ages of thirty-five and fifty-five years, as

compared with 261 in every thousand obtaining among the entire male

population of the country; while only 140 grinders in every thousand

have attained the age of fifty-five years and upwards at death, as

compared with 391 in every thousand for the entire adult male community.

The dusty nature of a dry grinder’s occupation prepares us to accept

these figures as applied to him; but it must not be lost sight of

that dry grinders form a very small minority of those engaged in the

grinding industry. Moreover, my investigations lead me to believe that

dry grinders, although they still show an enormous mortality from

phthisis and other respiratory diseases, live to a much greater age

than formerly. Thus I found the average age of twenty-two unselected

fork grinders to be forty-three years, which is a marked improvement

compared with the late Dr Hall’s estimate of twenty-nine years. Again,

during the four years 1889–92 the average age at which fork grinders in

Sheffield died was forty-five and a half years.

Owing to the conditions already set forth as existing in many grinding

rooms, wet grinders are frequently compelled to inhale dust-laden air,

and this no doubt is a factor in producing the high mortality which

prevails among them. But important as this evil is, it is altogether

overshadowed by the baneful influence of the damp, stagnant atmosphere

of the wet grinding “hulls,” an atmosphere which is peculiarly

favourable for the propagation of diseases of the lungs.

The legislature of this country has done much to improve the conditions

under which workmen pursue their various callings, but local

peculiarities and unforeseen contingencies sometimes frustrate the

beneficent intentions of our legislators, and this is markedly the case

in respect of the grinding industry. With few exceptions grinders are

“piece workers,” and pay rent for their “stalls” and the motive power

which drives their stones. The grinding wheels and cutlery works are

frequently owned by individuals or companies who are not themselves

manufacturers, but are merely the landlords of the premises, letting

off rooms or portions of rooms to workmen who, in the eyes of the law,

are the occupiers, and therefore responsible for carrying out the

requirements of the Factory Acts. It follows that the owners of the

premises are able to repudiate responsibility for sanitary control and

that the Factory Inspector, when he wishes to insist on fans or other

needful appliances being provided, must proceed legally against the

workmen. The outcome of all this is that it is difficult or impossible

to apportion responsibility for sanitary requirements; the Inspector’s

work is enormously increased, and often rendered excessively irksome;

while the amount of good he can do is proportionally lessened. There

is but one remedy for this state of things. Sooner or later the

legislature will have to fix on the individual, or company, who lets

off rooms and power to workmen, the responsibility for carrying out the

provisions of the Factory Acts. We shall be told that an enactment of

this kind would disturb long-established trade usages, and be unfair to

the manufacturers; but apart from the fact that it is the only feasible

way out of the difficulty, it would merely place cutlery manufacturers

on the same footing as that occupied by most other employers of labour

in the country. Moreover, some of the best cutlery firms already

recognise their moral responsibility in this respect, and provide

for the use of their workmen fans and all other contrivances of a

health-saving nature.

The sanitary condition of the workshops in which grinders, particularly

wet grinders, work admits of much improvement. These rooms should

always be above the level of the ground, and so situated in regard to

surrounding buildings as to allow of free entrance of fresh air and

sunlight. The floors should have a fall to the front, and be composed

of concrete or some similar impervious material. Better ventilation is

urgently required, especially towards the back of the rooms, and the

fireplaces might with advantage be placed at the back. The polishing

wheels should be provided with hoods connected with a fan for the

removal of dust and the better ventilation of the room.

Grinding-stones should not be mounted until they have been inspected by

some competent person with the view to detecting flaws, and it should

be obligatory to use plates and bolts instead of wedges for fastening

the stones on their axles.

Dry grinding should be done in rooms specially set apart for this

purpose, and not, as is sometimes the case, in rooms where other

processes are carried on. The “racing” of stones should be conducted

at a time when there are few workmen present, and those engaged in the

process should wear some form of respirator.

SINCLAIR WHITE.

CHAPTER XXVII

PHOSPHORUS AND LUCIFER MATCHES

However useful phosphorus has been to man, its manipulation has been

a constant source of danger. As there are two forms of phosphorus,

so there are two kinds of matches: the _safety_, which-only

ignite on the box, and the ordinary _strike-anywhere_. Safety

matches are made from red or amorphous phosphorus, and the ordinary

matches from white or yellow. Oldbury, near Birmingham, is the seat

of the manufacture of yellow phosphorus. Although white phosphorus is

a dangerous substance, there have been very few cases of ill-health

among the men who make it, owing very largely to the fact that in its

production from bone, very few people are employed, and the processes

of manufacture are such that the workmen are not brought directly into

contact with the dangerous substance. Sixty tons of the phosphorus

annually manufactured in Oldbury are consumed in lucifer match works in

Britain.

The death of a lucifer matchmaker in London five years ago, and the

announcement in the daily press of the contemporaneous occurrence of

a large number of cases of ill-health in a Metropolitan match works,

aroused an amount of feeling, and created such an adverse public

opinion in regard to this industry in England, that the Home Secretary,

Sir Matthew White Ridley, appointed a Commission, composed of Professor

T. E. Thorpe, Dr George Cunningham, and myself, to undertake an

inquiry into certain important questions which had arisen with regard

to the effect of work in lucifer match factories on the health of the

workpeople.

The questions which at the time engaged the attention of the Home

Office were:--

(1) The nature and extent of the dangers attending the use of yellow

and white phosphorus.

(2) The means whereby these can be lessened.

(3) The practicability of discontinuing the use of yellow and white

phosphorus.

Many match works, both at home and abroad, were visited by the members

of the Commission, whose views and opinions upon these questions are

embodied in a Report[80] that describes the methods of manufacture, and

the legislative measures adopted in most of the countries in Europe to

abolish or diminish the ill-effects of the industry upon the health of

the workpeople.

The principal malady of the lucifer matchmaker is a localised

inflammatory affection of the jawbone, followed by suppuration

and death of the bone, constituting what is known as phosphorus

necrosis--“phossy jaw,” as it is sometimes called in this country, and

_mal chimique_ in France. Other diseased conditions are also met

with, but these and the subject of phosphorus necrosis generally will

be dealt with further on.

Commercial phosphorus is made from bone-ash by treating it with

sulphuric acid, filtering and evaporating the product, heating this

with charcoal, and afterwards distilling it. The substance known as

white or yellow phosphorus was discovered as far back as 1669, by

Brandt of Hamburg, and is, when pure, colourless and transparent, but

when exposed to the light it becomes yellowish. During absorption

of oxygen from the atmosphere it becomes phosphorescent. The

greenish-white light thus evolved can at once be checked by such

essential oils as turpentine and eucalyptus. The glow of phosphorus is

an indication that oxidation is taking place, and that both phosphorous

and phosphoric oxides are being formed, ozone being probably present at

the same time. White phosphorus is extremely inflammable: it ignites

at a temperature of 34° C., and forms with a plentiful supply of air

phosphoric oxide P_{4}O_{10}, but if the supply of air is limited,

phosphorous oxide is formed P_{4}O_{6}. It is with a paste made from

white phosphorus that the ordinary strike-anywhere matches are headed.

Red or amorphous phosphorus, from which safety matches are made, has

been known only since 1845. It was discovered by Schröter of Vienna,

and is obtained by exposing ordinary phosphorus for some time in a

closed vessel to a temperature of about 250° C. Red or amorphous

phosphorus differs from yellow both physically and in other respects.

It can be handled, for example, with impunity, and does not take fire

when rubbed on any rough surface. It is non-volatile, and since it

is not acted upon by the digestive juices of the alimentary canal it

is non-poisonous. As much as an ounce of amorphous phosphorus has

been given to animals without any bad effects, while one to three

grains of the ordinary metalloid have caused death. In order to ignite

red phosphorus, it has to be rubbed upon a surface that contains

substances rich in oxygen. The heads of safety matches are composed

of potassium chlorate and chromate, and other compounds that contain

large quantities of oxygen, while the red phosphorus is present in the

brownish-red layer that has been pasted on the side of the matchbox. It

is significant of the habits of our countrymen that while sixty tons

of white phosphorus are converted into the ordinary strike-anywhere

matches every year in Britain, only three and a half tons of red

phosphorus are required to satisfy the public demand for safety-matches.

White phosphorus is volatile at ordinary temperatures, and its vapour

when pure is said by Schonbein to be odourless; the odour that is

perceived is a mixture of ozone and phosphorous oxide. On analysing

the fumes given off by phosphorus eight-tenths are found to consist of

oxides of phosphorus.

Professor Thorpe found that when decayed human teeth were exposed to

the fumes of phosphorus for twelve hours they lost 0.37 per cent. of

their weight, and that carious teeth when crushed and exposed to a

dilute solution of phosphoric acid (1 per cent.) lost 8.9 per cent.

of their original weight. When, therefore, the fume of phosphorus

co-operates with the saliva of the mouth, it must clearly exercise

a solvent action upon the teeth. In the air of the dipping room of

a match factory, Thorpe found O.02 milligrammes of phosphorus per

100 litres of air, while the same quantity of air of the boxing-room

contained O.12 milligrammes of phosphorus. On analysing the water

in which twenty-two of the workpeople had washed their hands, after

working a certain number of hours in the factory, 37.3 milligrammes

of phosphorus were found, or an equivalent of 4.2 milligrammes of

phosphorus per person for each ten hours’ work.

The lucifer match industry of Great Britain and Ireland gave employment

during 1898 to 4270 persons, of whom 1166 were males and 3104 females;

about 1700 of these were working in phosphorus processes. Of persons

under eighteen years of age there were 466 males and 1077 females.

The match works were distributed as follows: in England and Wales 17,

Scotland 2, and in Ireland 5, making a total of 24. Dr Whitelegge sends

me the following information regarding the number of lucifer match

works in January 1901--

Number in which yellow phosphorus is being used 15

Number in which the use of yellow phosphorus has

been discontinued 3

Number not yet working 1

Number closed during past twelve months (one temporarily) 5

--

Total 24

The Chief Inspector of Factories, in his Annual Report for 1899, p.

318, states that the total cases of industrial phosphorus poisoning in

this country within the last twenty years, of which there is a definite

record, number 102. Before 1898 there were 92 cases of phosphorus

necrosis, 6 in 1896, and 4 in 1899. Three other cases were reported

in 1899, and are included in the return, but they did not reach the

stage of necrosis. It has been urged with reason that such doubtful

cases, when notified, should be placed on a “suspended” list, and

judgment deferred until the diagnosis is quite clear. Of the 102 cases

19 terminated fatally. Dr Whitelegge informs me that three cases of

phosphorus poisoning were reported during 1900; this brings the total

number up to 105 in twenty-one years.

The ordinary lucifer match is dipped in a paste composed of glue,

phosphorus, chlorate of potass, powdered glass, sometimes magnesia

or lime, and coloured by a magenta dye. On an average there is 5 per

cent. of phosphorus present in the paste, but sometimes it is double

this amount. The paste or composition, when about to be used, is spread

upon an iron slab kept at a moderate temperature. Into this paste the

dipper, always a male in this country, quickly plunges the tips of

prepared wooden splints that are projecting at a uniform level from a

frame, and at once hands them over to a fellow-workman, who removes

them to the drying chambers, which are ventilated by means of fans to

renew the air, and to hasten the drying of the matches. At the distal

end of the slab upon which the dipper heads the lucifers, there is, or

ought to be, a fan towards which, when in operation, the fumes of the

phosphorus as they rise from the paste can be seen travelling away from

the face of the worker. Since the introduction of fans on the far side

of the slab, the occupation of dipping in match works has become much

less dangerous.

The boxing of matches, when done by hand, is attended by considerable

risk to health, especially if the workroom is badly ventilated. In

addition to the phosphorus fumes which pervade the boxing-room, the

atmosphere is from time to time rendered more unhealthy by dense clouds

of smoke given off by the matches that are frequently catching fire.

It was Lorinser of Vienna who first drew the attention of the medical

profession to phosphorus necrosis, or disease of the jawbone, in

lucifer matchmakers. This was in 1845, or about eleven years after

the establishment of the match industry in Austria. Between the years

1839–1845 he had examined nine cases of phosphorus necrosis. Shortly

after Lorinser had published his cases, Sir Samuel Wilks in our

own country reported the occurrence of disease of the jawbone in a

matchmaker, attended by suppuration, and followed by exfoliation of

the bone. Since then in every country where ordinary lucifer matches

have been made, the use of phosphorus has been followed by such an

amount of ill-health and suffering on the part of matchmakers, that

almost all the preventive measures which industrial science and

legislation could suggest, short of total prohibition, have had a

trial without rendering the industry completely safe. More than twenty

years ago Denmark interdicted the use of white phosphorus, and the

importation of ordinary strike-anywhere matches. France, several years

after having made the manufacture of matches a Government monopoly,

and having been obliged to pay large sums of money as compensation

to the diseased matchmakers of Pantin-Aubervilliers, has commenced

to manufacture matches from a harmless sesquisulphide of phosphorus;

matches which, while possessing all the freedom from poison claimed

for _safeties_, have the property of striking anywhere. Belgium

has not only insisted upon the reduction of phosphorus in the paste

to 8 per cent., but with the view of stimulating the manufacture of a

satisfactory non-poisonous strike-anywhere match, has offered a prize

of 50,000 francs (£2000). Holland[81] insists upon 5 per cent. of

phosphorus in the paste, and allows no young person under sixteen years

of age, and no woman to work in a match factory where yellow phosphorus

is used. In Norway 28 cases of phosphorus necrosis occurred in fourteen

years out of a total number of 600 workers. The match industry

of Sweden gives employment to about one-twentieth of the artizan

population. In the twenty-seven match factories of that country, 5500

persons find employment, males and females about equally. Although

a large proportion of Swedish matches are safeties, yet as a matter

of fact 80 per cent. of the matches produced are made from ordinary

phosphorus. There is a large home consumption of strike-anywhere

matches in Sweden. As a consequence of their manufacture, phosphorus

necrosis is not unknown in that country, and on more than one occasion

the question of the total prohibition of ordinary phosphorus has been

discussed in the Rigsdag. Were such a thing to become law the match

industry of Sweden, in the absence of an international agreement, would

be seriously crippled. During the year 1891 there were 19 cases of

phosphorus necrosis reported from thirteen factories. The Commission

appointed by the Swedish Parliament to consider the prohibition of

ordinary phosphorus did not feel justified in recommending such a

sweeping change, believing that in better ventilation of the workrooms,

repeated medical examination of the workers, and scrupulous attention

to details in the various processes, the manufacture of matches could

be robbed of much that had hitherto caused it to be regarded as a

dangerous industry. Of the ninety match factories in Germany about

thirty make ordinary lucifers. Several cases of phosphorus necrosis

have occurred, but since the introduction of stringent regulations

in 1884, requiring special ventilation, medical examination of the

workers, personal cleanliness and separation of the workrooms,

the amount of sickness has, within the last few years, materially

diminished. In Austria-Hungary there are upwards of ninety match

works. It is an important industry in Bohemia, Galicia, and Hungary.

The matches chiefly find their way into Servia, Bulgaria, Roumania,

and Turkey. In eighteen years 140 cases of phosphorus necrosis were

reported to the Factory Inspectors; as many as 47 cases of phosphorus

necrosis having occurred in the year 1888. This unhappy circumstance

is to be explained by the fact that the manufacture of lucifers at

this time was extensively but secretly carried on as a home industry.

Experience has shown that this clandestine practice is always extremely

dangerous. Fortunately the authorities have practically succeeded in

abolishing this home industry. The regulations in Austria-Hungary

resemble those of Germany. Switzerland in 1879 introduced a Bill

for the prohibition of the use of yellow phosphorus, and two years

afterwards it became law. Instead of abolishing phosphorus necrosis,

however, the disease became not only more prevalent, but of a severer

type, owing to the manufacture of matches as a home industry. As the

interference of the Government defeated the object it had in view,

viz., safe-guarding the health of the workers, the Act of 1879 was in a

sense repealed. Whilst in Switzerland the importation and manufacture

of matches made with yellow phosphorus is forbidden, the manufacture

of lucifers is under the control of each canton, the Federal Council

holding itself responsible for the conditions that are requisite for

the health and safety of the workers, and also of the public.

_Phosphorus Necrosis._--It is difficult to say what is the actual

cause of necrosis of the jawbone in lucifer matchmakers. As to whether

it is a primary lesion or one secondary to a general or constitutional

form of poisoning, medical opinion is still divided. Most writers

attribute the disease of the bone to the fumes of phosphorus,

_i.e._ to the oxides of phosphorus, acting upon the decayed teeth

of the workpeople. The fumes are supposed to penetrate a carious tooth

and induce a periostitis or inflammation of the covering of the bone.

The gum becomes swollen and painful. To such an extent has this been

regarded as the explanation of the cause of necrosis that two of the

large match works in this country had at their own expense appointed

dentists to examine and keep in good order the teeth of the workpeople.

Subsequently the Home Office, as a result of the opinions expressed

at an Arbitration with the Match Manufacturers, decided to accept

periodical examination of the teeth of the workpeople by a qualified

dentist as a substitute for medical inspection. While regarding decayed

teeth as a necessary preliminary to inflammation of the dental socket,

Roussel holds that it is phosphoric acid that is the destructive

agent. Gubler and Lailler,[82] on the other hand, maintain that they

have met with phosphorus necrosis in the inferior jaw of a matchmaker

whose teeth were perfectly sound, and that if phosphoric acid were the

destructive agent the teeth ought to become softened and translucent.

Gubler holds, but on what grounds we do not know, that it is phosphorus

itself that penetrates into the soft tissues and destroys the nutrition

of the covering of the bone. Under all circumstances “phossy jaw” is

a painful affection, especially in the early stages, and although

naturally it might be expected to occur with greater readiness in

workpeople who are ill-nourished, scrofulous, or tubercular, yet I have

seen it in male and female matchmakers who were physically strong and

otherwise perfectly healthy. This circumstance, therefore, is rather

in favour of phosphorus necrosis being in the first instance a local

affection and primary. Once suppuration occurs, the painful tooth

removed, and the pus thereby allowed to escape, pain is subsequently

not a marked feature in the case. As the periosteum is usually

separated, the affected portion of bone lying underneath dies and is

exfoliated. A piece of bone varying from half-an-inch to three inches

is thus thrown off. The process of separation of the bone by ulceration

is extremely slow. It may extend over months or years if the bone is

not surgically treated, and all this time there is a constant oozing

of pus into the mouth of the patient, some of which must be swallowed

along with the food, thereby undermining the health and causing anæmia

or cachexia, or during sleep it may trickle down the throat into the

respiratory passages and set up an unhealthy inflammation of the lining

membrane, or it indirectly prepares the way for tubercular disease of

the lungs. Either jaw may become necrosed. If anything, the inferior

maxilla is more frequently affected than the superior. When the upper

jaw is diseased there is a tendency for the inflammation to extend

to the base of the skull and to induce a septic inflammation of the

membranes of the brain, which is invariably fatal. In France both Dr

Magitot of Paris and Dr Arnaud of Marseilles described a constitutional

condition or cachexia in matchmakers to which they gave the name of

_phosphorisme_, of which pallor, dyspepsia, albuminuria, and

a tendency to bronchitis are the prominent features. Arnaud, with

whom I had the opportunity of discussing this subject in Marseilles,

found that as many as 28 per cent. of lucifer matchmakers, especially

young women under eighteen years of age, suffered from bronchitis,

but he did not think that matchmaking _per se_ was a cause of

tubercular lung disease, nor was it his experience that pregnant

female matchmakers aborted more frequently than their sisters engaged

in other occupations. Phosphorisme does not occur to any extent in

English matchmakers. In visiting the match factories of Belgium,

particularly of Grammont, where I met Dr Brocoorens, who from his large

experience of industrial phosphorus poisoning had been invited to give

evidence before the French Commission, my attention was drawn to the

interesting fact that men who had been dippers and who had suffered

from necrosis of the jawbone and recovered, exhibited an unnatural

tendency to spontaneous fracture of their long bones, especially the

femur. During twenty-five years in Grammont alone, which is not a

large town, with six match factories giving employment to 1100 people,

Dr Brocoorens treated 30 cases of fracture of the long bones, caused by

muscular effort, in dippers who had previously suffered from necrosis

of the jaw. This circumstance would rather suggest that in addition

to the local disease of the maxillæ caused by phosphorus, there was

also induced a wider spread morbid state, which was capable of showing

itself long after recovery from the primary lesion. Spontaneous

fracture of the long bones of matchmakers is not unknown in England. Dr

Garman of Bow, medical officer to Messrs Bryant & May, informs me that

he knows of nine cases in which the long bones of the arm and leg of

matchmakers have become broken without any injury being received, and

Dr Dearden of Manchester relates[83] the case of two dippers, “each of

whom has had separately and at different times both thigh bones broken

in a ridiculously simple fashion.” Dr Kocher of Berne had experience

of a matchmaker who broke his thigh bone five times. These facts

indicate that the osseous tissues of the body are in some way or other

influenced either by phosphorus itself or its compounds, whereby they

become unable to withstand external violence. Dearden is of 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. In this circumstance may possibly be found an

explanation of the _fragilitas ossium_ of lucifer matchmakers.

A brief notice of some experiments performed by Wegner may not

be out of place here. He believes that phosphorus has a specific

action upon bones, especially those of young animals. Wegner found

that the administration of very minute doses of yellow phosphorus,

¹⁄₁₀ to ⅕ mgrm., for several weeks to young rabbits was followed by

characteristic changes in the growth of the long bones, owing to the

phosphorus acting as an irritant or stimulant to the bone-forming

cells. Where loose cancellous bone was being formed from cartilage,

phosphorus caused the deposition of a layer of dense bone, and if

the drug was pushed a little longer, the soft, cancellous bone,

formed before the phosphorus treatment was begun, became gradually

absorbed. In this way the central or medullary cavity of the bone

became enlarged, so that in the case of the long bones this cavity

extended into the epiphyses or ends of the shafts. In other instances

the newly-formed bone which had developed under the influence of the

phosphorus, and also that which grows normally from the periosteum,

became denser, so that in fowls Wegner found the medullary cavity

obliterated by the deposition of hard bone. When lime salts were

withheld from the food of the animals treated by phosphorus, the

activity of the bone-forming cells continued, but no lime was

deposited, and so there was produced a condition of bone such as is

found in rickets. Kassowitz by similar means produced appearances

closely resembling the soft and yielding bones that are met with in

rickety children. Wegner, by exposing the bared tibia of an animal to

the influence of phosphorus fumes, induced periosteal irritation and

the deposit of new layers of bone.

Although it takes a long time for the sequestrum of a diseased jawbone

to be thrown off in a person the subject of phosphorus necrosis, yet

once it is expelled and the wound closed, the patient generally feels

well enough to return to work in a match factory, and is placed in a

department wherein he runs no further risk. Despite the tediousness

and the unpleasantness of the malady, most of the patients recover. Dr

Garman of Bow, treating his cases by the expectant method and allowing

the sequestrum to be naturally separated, found that 83 per cent. of

his cases recovered; Kocher of Berne prefers to remove by means of a

surgical operation the affected portion of bone, and 83.7 per cent. of

his cases recovered; while Kuiper of Jena, treating his patients on

similar lines to Kocher, had 89 per cent. of recoveries.

This account of the diseases of bones of matchmakers allows us now

to return to the original question, viz., the cause of phosphorus

necrosis. Fume is generally regarded as the cause, but it is probably

only an incident. In the pus that keeps oozing away from the necrosing

jaw of an affected matchmaker, I have found numerous pus-forming

micro-organisms, viz., putrefactive bacilli, streptococci and

staphylococci pyogenes, and as Professor Stockman of Glasgow detected

in addition in the pus a few tubercle bacilli, he is disposed to

regard the “phossy jaw” of lucifer matchmakers as a true tubercular

process. In several of the specimens of pus taken from the diseased

jawbone of matchmakers sent to me by Dr Garman of Bow, I could find

no trace of tubercle bacilli, although these were carefully searched

for. The presence of the bacilli of tubercle in Professor Stockman’s

specimens, which by the way I have had the privilege of examining

and confirming, is an extremely interesting fact, and it certainly

creates a bias in favour of the lesion being tubercular. On the other

hand, the human mouth under all circumstances contains large numbers

of micro-organisms, some of which are capable of becoming extremely

virulent under altered conditions, and there is no reason why some of

these might not find their way through a carious tooth to its socket in

the jawbone or to the periosteum, where phosphorus fumes had previously

gained entrance and set up irritation. In these tissues thus prepared

microbes would find a suitable nidus for their multiplication. As the

same remark applies to tubercle bacilli, it is clear that the final

answer has not yet been given to the pathological problem of phosphorus

necrosis. There is something in the causation of phosphorus necrosis

that is still unknown to us, some peculiar action of phosphorus on the

human subject that is not yet fully explained.[84] It is an extremely

difficult thing to produce phosphorus necrosis in animals, either by

exposing them to the fumes of phosphorus itself, or to clouds of smoke

from burning matches.

In many instances where “phossy jaw” has occurred, the workpeople were

at the time following their occupation, and had done so for many years.

Acute phosphorus poisoning, practically speaking, does not occur in

matchmakers. The poisoning is always chronic. Phosphorus necrosis was

not recognised in Vienna until the industry had been established seven

or eight years. The malady might have existed, and of course not been

diagnosed. Most of the patients with “phossy jaw” whom I have seen

had worked from seven to fifteen years at the trade, but the disease

has been known to occur within twelve months after entering a match

factory. Dr Garman has kept a register of all the cases of phosphorus

necrosis that have occurred in Messrs Bryant & May’s for the last

twenty years. During this period there have occurred 51 cases--31

females and 20 males. The upper jaw was affected fifteen times, and the

lower sixteen, in the women: while in the men the numbers were eleven

and nine. The severer type of the malady formed 70 per cent. of the

cases in females, while in males, who as dippers are more exposed to

the fresh fumes of phosphorus, it formed 85 per cent. Of these 51 cases

of phosphorus necrosis nine ended fatally; 83 per cent. recovered and

returned to work. On examining the register as to the ages at death, I

find that these were nineteen, twenty-three, twenty-one, twenty-two,

twenty-seven, twenty-seven, nineteen, twenty-two, and twenty-two years.

Clearly, therefore, it is not necessary to have a very lengthened

exposure to the fumes in order that a fatal result may follow.

Co-existing pulmonary consumption was present in two of the patients,

and doubtless contributed to the fatal ending. In Great Britain less

than 1 per cent. of matchmakers suffer from phosphorus necrosis: in

Switzerland it used to be 1.6 to 3, and in France formerly 2 to 3 per

cent. Phosphorus necrosis, it is well to remember, does not always

develop during the time an individual is following his employment in

a match work; it has been known to occur two years after leaving the

factory. The early age at which Garman’s patients died suggests that

the vital resistance to the malady at this period is less than in later

years.

_Prevention of Phosphorus Necrosis._--Since the manufacture of

lucifer matches is capable of inducing in the workpeople necrosis

of the jawbone, which in the early stages is admittedly a painful

affection, but fortunately one not often followed by any marked

deformity, it is apparent that to the public must be given by the

manufacturers some satisfactory assurance, if the use of yellow

phosphorus is to be continued, that the industry which at present is

harmful shall be converted into one that is free from danger. Is this

event possible? Experience of match works, both at home and abroad,

shows that where the industry is conducted on the best hygienic lines

possible, phosphorus necrosis is practically unknown. This, so far

as it goes, is satisfactory. It cannot be said, however, that the

employment of white or yellow phosphorus can under all circumstances

be rendered absolutely free from danger. The education of the working

classes to use only safety matches would of itself very largely

diminish the danger by reducing the demand for ordinary strike-anywhere

matches. Dipping of the wooden splints in cold composition instead

of hot would, as in the case of vestas, in the manufacture of which

“phossy jaw” does not occur, also tend to diminish the ill-health of

the workers. It has been demonstrated that certain essential oils

are capable of checking the oxidation of phosphorus, which is one of

the possible causes of phosphorus necrosis. It has, therefore, been

recommended to circulate the vapour of turpentine through the dipping

and boxing rooms. In some American factories the workpeople wear

suspended round their necks small vessels containing turpentine. Of

all hygienic measures full and free ventilation is the best. Years ago

the scourge of matchmakers in Belgium was “phossy jaw,” but shortly

after the introduction of hygienic measures and the reduction of

phosphorus to 8 per cent. in the paste, there was observed a very

notable declension in the number of cases of necrosis, and in our own

country the removal of phosphorus fume by powerful aspiration from

the dipping slab, frequent renewal of the air of the drying chamber,

and ventilation of each of the benches at which the boxing is done by

women by hand, have exercised an undoubted influence in preventing

phosphorus necrosis. Periodical examination of the teeth of matchmakers

by a dentist, with the necessary local treatment, including temporary

suspension from work on the detection of disease in the early stages,

will be beneficial. It is one of the requirements of the Home Office

that this dental examination shall be periodically made. Whether of

itself it is sufficient to permanently obviate the necessity for a

medical examination of the workers by a doctor in addition remains

yet to be seen. Since the frequent firing of matches is a cause of

pollution of the atmosphere of the boxing-room, and filling of the

matchboxes by hand brings the worker into direct contact with dried

phosphorus paste, it is advisable to discontinue the practice of

cutting wooden matches once they have been headed, and to substitute

machinery for all hand labour, which, as in the case of the Diamond

Match Company, Liverpool, dips, dries, and boxes the matches in large

and well-ventilated rooms, and has thereby practically made lucifer

matchmaking a harmless industry. It is absolutely necessary that

personal cleanliness should be attended to, and that there should be

adequate provision of washing appliances with hot and cold water,

plenty of soap and towels, that overalls should be worn, frequent

change of occupation from one department in the factory to another, and

that no food should be allowed into the workroom.

Can any substitute be found for yellow phosphorus, capable of producing

a non-poisonous match that will strike anywhere, and yet conform to the

same conditions as ordinary phosphorus? France has, within the last

three years, ceased to manufacture matches from yellow phosphorus. In

that country the manufacture of matches is a State monopoly. A short

while ago the Government felt itself obliged to change the method of

manufacture, partly on humanitarian grounds, but very largely owing

to the numberless claims for compensation by the workpeople upon the

Minister of Finance. In the match works at Pantin-Aubervilliers, there

were, in 1894, 32 cases of phosphorus poisoning, 125 in 1895, and in

1896 the number rose to 223, or one-third the effective force of the

factory. Many of these must have been of a mild nature, and probably

some of them were cases of imposition, for when analysed carefully

it would appear that between 1888 and 1896 there were eight cases of

deforming necrosis, 12 of necrosis requiring surgical treatment, 21

probable cases of phosphorus necrosis, and 18 of phosphorisme, making

a total of 59. At this time the match paste, in addition to lead,

contained often as much as from 20 to 30 per cent. of phosphorus.

From the 1st January to 31st December 1896, the State paid 400,000

francs as allowances to sick-workers, men and women, employed at

Pantin-Aubervilliers, or an average of 650 francs per head employed.

It was in consequence of this experience that in order to encourage

research, which would lead to the manufacture of a non-poisonous

match, the State granted financial help. After many experiments--such,

_e.g._, as the matches of M. Ponteau, made from acetate of amyl,

during the manufacture of which a splitting headache, a feeling of

cerebral fulness, and a throbbing of the head were complained of by the

workers, a circumstance that led to their manufacture being abandoned;

also the lucifers of M. Miram, which met with a similar fate, since

they contained lead, and therefore one poison was simply being

substituted for another,--the French Government at present believes

that in the substance known as sesquisulphide of phosphorus it has

found an answer to the question raised at the head of this paragraph.

The toxicity of the sesquisulphide of phosphorus is small. Messrs

Sevène and Cahen gave repeated doses of 3 centigrammes (⅖ grain) of

the substance daily to guinea-pigs without these animals appearing

to suffer, although the ingestion of 3 milligrammes (¹⁄₂₅ grain) of

white phosphorus caused rapid death. The dose of 3 centigrammes (⅖

grain) to a guinea-pig would correspond to 3.5 grammes (54 grains)

for a human adult, that is to say, to the amount of sesquisulphide of

phosphorus present in 6000 matches. For these and other reasons based

upon experience, the French inventors maintain that sesquisulphide of

phosphorus matches are harmless. The following is the composition of

the paste employed:--

Sesquisulphide of phosphorus 6

Chlorate of potass 24

Zinc white 6

Red ocre 6

Powdered glass 6

Glue 18

Water 34[85]

The sesquisulphide is almost inodorous as a powder, and is

non-poisonous. When matches are headed with a paste made from it,

they are capable of striking anywhere. The only impurity which the

sesquisulphide can contain is some red or amorphous phosphorus. At

first manufacturing chemists expressed doubtful opinions as to the

keeping properties of the matches, also as to their capability of being

transported across the seas, and of remaining good in all climates. Two

years’ experience of the manufacture of matches from sesquisulphide

of phosphorus has demonstrated such fears to have been groundless.

Dr Courtois-Suffit, the Medical Inspector of the Match Works at

Pantin-Aubervilliers, says that “since substituting sesquisulphide for

yellow phosphorus, not only have the workpeople been more healthy,

but that there has been no complaint on the part of the consumers.”

No match is superior to the lucifer made from yellow phosphorus.

French matches have never been regarded as equal to those of English

manufacture. France is not an exporting country. While, therefore, the

introduction of what is called a _sans phosphore_ match in France

has answered satisfactorily, it does not follow that the manufacture

of this particular kind of lucifer is the best for all countries, and

especially for such a large exporting country as Britain.

In Italy the same subject has received the attention of scientists. M.

Bertarelli,[86] in a lecture at the University of Turin, demonstrated

the properties of a non-poisonous match made by Dr G. Graveri of

Villanova-Sollaro, the principal ingredient of which is persulphocyanic

acid, a substance obtained from the residue of gas-works, of a yellow

colour, crystalline, soluble in alcohol, ether, and boiling water,

decomposing at a temperature of 220° C., and giving rise to sulphide

of carbon, ammonia, and sulphur. This is made into a paste with

sulphur and antimony trisulphate. The matches ignite when rubbed

briskly upon a rough surface, and no cyanogen is evolved. Bertarelli

states that he has given to dogs for several days 3 to 4 grammes (46

to 60 grains) of the paste used for heading the matches, and beyond

slight vomiting he has not noticed any accident, whilst 0.7 grammes

(11 grains) of ordinary phosphorus paste caused death. It is claimed

for his matches that they cost less to produce than ordinary matches,

they ignite noiselessly, and develop no odorous gases, that they are

non-hygroscopic and non-poisonous. The only drawback is stated to be

the escape of hydrochloric acid fume during their manufacture, but this

can be overcome by efficient ventilation.

Great Britain is not only a consumer but a large exporter of lucifer

matches, and it is this circumstance that raises a difficulty in

regard to the total abolition of the use of yellow phosphorus in

this country. If other matchmaking and large exporting countries,

such as Belgium, Sweden, the United States, and Japan, could come to

some satisfactory terms of international agreement with Britain not

to manufacture lucifer matches from yellow phosphorus, the question

would be settled, if not permanently, at least for a time. It would be

useless for Britain with her free trade to abolish yellow phosphorus,

thereby crippling her own matchmaking industry, and at the same time

allow matches made from the poisonous phosphorus to be imported from

other countries wherein Government supervision is perhaps less strict

than in ours. Such a course would only transfer phosphorus necrosis

from our own to other countries. English methods of manufacture, like

national customs, die hard. It is pleasing to observe, however, that

the objection on the part of British match manufacturers to the use of

substitutes for yellow phosphorus is gradually disappearing. Messrs

Bryant & May no longer use yellow phosphorus. Mr Gilbert Bartholomew,

the Managing Director of the firm, in answer to some queries I

addressed him (1901), informs 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. We have not used an ounce of yellow or poisonous phosphorus

for nearly ten months.... We do not think there is an increased

demand for safety matches; the great demand is for strike-anywhere.”

It is gratifying to know that some of the smaller firms of lucifer

matchmakers have also undertaken to produce ordinary strike-anywhere

matches from a non-poisonous substance. How far these non-poisonous

substances are quite free from danger and as sources of irritation,

remains to be seen, for conjunctivitis, œdema of eyelids, and eczema

have been noticed in the workers.[87]

_Treatment of Phosphorus Necrosis._--It is unnecessary to enter

into this at any length. Such preventive measures as a medical and

dental examination of the workpeople before entering the factory, and

from time to time afterwards, combined with suspension when necessary,

personal cleanliness, and the use of terebinth gargles, wearing of

overalls, and a change of employment in the factory, also thorough

ventilation of the workrooms and of the dipping tables by reliable

artificial means, will, if carefully carried out, do a very great deal

to make and keep the workpeople healthy.

Once phosphorus necrosis has developed, it may either be treated by

antiseptic mouth-washes, maintenance of the general health by good

nourishing food, and a life spent in the open air, thus allowing

time for exfoliation of the necrosed bone to take place naturally, a

process which, as we have seen, may extend over many months; or it may

be treated surgically by removal of the piece of diseased bone. Each

method has its advocates, but the results are practically the same,

viz., upwards of 80 per cent. of recoveries.

THOMAS OLIVER.

CHAPTER XXVIII

DANGERS IN THE USE OF MERCURY AND ITS SALTS

_Introduction._--The number of industries and the number of persons

coming into contact with mercury in this country is not large.

Probably not more than 500 to 1000 persons are exposed to the danger

of industrial mercurial poisoning in Great Britain, but no matter how

the metal or its salts are used, those handling it run considerable

risk. In some industries, indeed, as, for instance, the silvering

of mirrors with an amalgam of tin and mercury, which was for over a

century the great source of mercurial poisoning, the matter is now only

of historical interest, as the process in question has been replaced

within the last twenty years by an innocuous one in which mercury is

not used. On the other hand, fresh industries arise in which the metal

is used, as, for example, the manufacture of electrical meters and

incandescent electric lamps.

_Historical._--As far back as the year 1665, in the _Philosophical

Transactions_ of that year, a reference is made by Dr Walter Pope to

the tremor affecting the hands of a worker in some cinnabar mines

in Italy. In 1721 Antoine de Jussieu[88] described the symptoms of

salivation, ulceration of the gums, and tremor which affected the

workers in the quicksilver mines of Almaden, in Spain. In the various

translations of Bernardino Ramazzini’s work, _De morbis artificum

diatriba_, originally published in 1702, an account is given of the

effect of mercury on miners and gilders.

One of the first references to the occurrence of mercurialism in the

process of silvering of mirrors was made by Bateman[89] in 1812, but

the great work which still remains the classical work on the subject

of chronic industrial poisoning, due to mercury, was published in

1861 by Adolf Kussmaul,[90] Professor of Medicine in Erlangen. The

splendid use which he and other medical men made of the opportunities

offered them of studying the clinical symptoms among persons employed

in the silvering of mirrors in Fürth and Nuremberg, the principal seats

formerly of the industry on the Continent, and the publication of their

observations, led up to the introduction of the stringent regulations

which have since caused the process to be given up.

In 1829, Dr Reitz[91] of St Petersburg published an account of the

danger to health in hatters furriers’ processes in that city, and

showed that the solution (regarded then as it still is as a secret),

contained mercury, arsenious acid, and nitric acid.

He does not particularly refer to the occurrence of tremor, but

describes the death of three men from acute bronchitis after mixing the

nitrate of mercury solution.

_Industries in which Poisoning may occur._--The industries in

which mercurial poisoning may occur are:--

1. Recovery of the metal from the ore.

2. Separation of gold and silver from their ores by means of an amalgam

with mercury.

3. The manufacture of barometers and thermometers and other

philosophical instruments.

4. The manufacture of incandescent electric lamps, where mercurial

pumps are used to create a vacuum.

5. The manufacture of electrical meters.

6. Gilding and silvering, generally known as water-gilding: where an

amalgam of gold or silver is applied to the objects, and the mercury

volatilised by heat.

7. Chemical works: where pharmaceutical mercurial preparations are made.

8. Paint and colour works: where anti-fouling paints or vermilion are

made.

9. In hatters furriers’ workshops: from the brushing of rabbit skins

with an acid solution of nitrate of mercury.

10. Bronzing with a solution of nitrate of mercury: as in bronzing the

inside of field-glasses.

In the first six the poisoning takes place almost entirely through

the inhalation of mercurial vapour, and hardly at all from dust; in

(7) it may arise either from vapour or from, as is the case in (8),

contamination of the hands and subsequent ingestion of the salts;

in (9) it results from the inhalation of fumes or the ingestion of

particles of fur impregnated with nitrate of mercury.

Other processes which deserve mention as a possible source of

mercurial poisoning are: electrical engineering, mercury being used in

amalgamating zinc plates; taxidermy when corrosive sublimate is used;

the manufacture and use of fulminate of mercury in explosive factories;

sole-stitching by the “Blake sole-stitching machine,”[92] in which

mercury is used to prevent the escape of gas.

_Mode in which Poisoning is brought about._--Mercury in the

liquid form, even when swallowed in large amount, rarely gives rise to

poisoning. When absorbed in the form of vapour it frequently does, but

it would be wrong to suppose that the vapour can as such pass through

the lining walls of the alveoli of the lungs. It must first undergo

condensation, and the tiny globules so formed become oxidised and then

dissolved. In view of the fact that expired air is warmer than that

inspired, it is difficult to see where this condensation takes place.

Von Renk[93] carried out a series of experiments to see whether the

mercury that was scattered in rooms where the silvering of mirrors

was carried on could be swallowed with the dust. He found, however,

such small quantities of dust in the air (only 7.3 milligrammes in 712

litres of air) that he concluded absorption of mercury in this way was

improbable. On the other hand, mercury gives off vapour at ordinary

temperatures, the amount depending on the vapour tension, and he found

appreciable quantities (2 milligrammes) in a cubic metre of air in a

room without special ventilation immediately above a layer of mercury

half a square metre in area. As in eight hours a worker inhales and

expires about 3 cubic metres of air, if the air breathed were charged

only to an extent of 1.5 milligrammes per cubic metre, it would mean

that 4.5 milligrammes entered the lungs. Were this continued day after

day, injurious effects would necessarily ensue.

The reactions which enable mercury to enter the circulation are only

imperfectly understood. It is acted on more readily by salt solution

than by dilute acids. The presence of both salt solution and free acid

must favour greatly the solution of the metal. Corrosive sublimate

forms an albuminate with albumen insoluble in water, but readily

soluble in the presence of salt solution. In this remarkable reaction

of the solubility of albuminate of mercury in presence of sodium

chloride lies the probable explanation of the occurrence of mercurial

poisoning.[94]

_Symptoms._--Although in industrial mercurial poisoning the

symptoms occasionally resemble those which result from the internal

administration of full doses of mercury, such as excessive salivation,

swelling and ulceration of the gums with fœtor of the breath, followed

in severe cases by looseness and falling out of the teeth, they are

as a rule much slower in their onset and more insidious in character.

For years the only sign may be more or less gastric disturbance, a

gradually increasing anæmia, a slight increase in the secretion of

saliva with tendency to ulceration of the gums, and slight tremor of

the muscles of the face and hands, accompanied by a certain amount of

nervousness.

Kussmaul, from his wide experience among the silverers of mirrors in

Fürth, describes three stages in industrial mercurial poisoning: first,

erythism or psychical changes; secondly, tremor; and thirdly, the final

or cachectic; and my own experience points to the correctness of his

description.

The first commences usually in the digestive tract with slight

stomatitis and salivation. The worker becomes pale and loses his

appetite. He frequently has headache, giddiness, and transitory pains

in the limbs. The muscles of the face twitch, the fingers tremble when

spread out, and the tongue is also tremulous when protruded. The mental

condition undergoes change. Workers assured of their skill become shy

and nervous, especially when watched. Sleep is often interfered with

and broken by nightmare. Sometimes the tonsils and pharynx become

involved in the inflammatory processes affecting the mouth.

At this stage if the employment be given up, the symptoms disappear

in about three weeks. If not, the weakness of the muscles increases.

Palpitation, headache, sleeplessness, and emaciation all become worse.

In the second stage of tremor, disturbance of the muscular system

preponderates. It is observed principally in the muscles of the face,

hands, and arms; more rarely in the legs. At first it may amount only

to slight tremulousness, but gradually it advances until the movements

become convulsive in character, and the hand cannot be directed with

certainty to any particular object. The speech, from involvement of the

muscles of articulation, becomes slow and indistinct. The psychical

condition changes to one of depression or despondency. There may

be hallucinations, loss of memory, and dulness of the intellectual

faculties. In women, menstruation is diminished or ceases. Miscarriage

is frequent, and the offspring is liable to be the subject of rickets

or scrofula.

The condition of the teeth of persons exposed to the fumes of nitrate

of mercury in hatters furriers’ processes deserves separate mention.

The typical appearance in the teeth of those who are engaged in

“carotting,” that is, brushing the rabbit skins with the dilute acid

solution for several years, is loss of the molar teeth in the upper and

lower jaws. The upper incisor and canine teeth are not infrequently

absent, and such teeth as remain (generally the lower incisors and

canines) are characteristically blackened and often loose. They show a

marked tendency to erosion (a process quite distinct from caries, as

the enamel and not the dentine suffers most) from the acid fumes, and

frequently the gums recede, so that the anterior surfaces of the roots

are exposed.

Chronic mercurial poisoning does not frequently lead directly to death.

It appears to lower the vitality of the tissues markedly, and Kussmaul

calls attention to the frequency with which mercurial workers die of

phthisis.

_Recovery from the Ore._--The principal ore from which the metal

is obtained is cinnabar, or sulphide of mercury. It occurs principally

in Idria in Illyria, where the greater part of the male inhabitants are

concerned with its extraction, in Almaden in Spain, and also in China,

Peru, California, and in smaller quantity in some of the German States.

The extraction of the metal depends on the principle that by heating

the ore in the presence of air, oxidation of the sulphur present

results, while the mercury is liberated in the form of vapour, which is

condensed in suitable flues kept constantly cool by a stream of water.

Complete condensation of the vapour is difficult.

In the actual mining of the ore, poisoning does not occur. Danger

principally attaches to the smelting operation, to the cleaning out of

the flues, and to the packing of the quicksilver.

The amount of illness caused may be judged from the fact that between

the years 1879–1884, of 1000 workers, 112 suffered from mercurialism,

although this figure does not take account of gastric symptoms, which,

if included, would raise it to 200 or 250 per 1000.[95]

The dangers can be best avoided by suitable arrangement of the furnaces

so as to prevent the escape of fumes, the wearing of overalls, and

ample provision of washing and bath accommodation.

_Making of Thermometers._--In the making of thermometers a small

funnel is blown on the top of a capillary glass tube and filled with

mercury. Heat from a spirit lamp or gas jet is applied to the bulb,

and the expanded air partially escapes. On cooling, a portion of the

mercury passes into the bulb to take the place of the air which has

escaped. This process is repeated until the bulb and part of the tube

are full of mercury. The mercury is then heated to boiling, mercury

vapour escapes, carrying with it the air and moisture which remain

in the tube. The tube, when full of the expanded mercury and mercury

vapour, is hermetically sealed at one end.

The number of persons employed in the industry of thermometer and

barometer making is small. They generally describe themselves as

experimental glass-blowers. The processes are usually carried on in

small workrooms, the conditions in which, owing to the wooden benches

and floors affording lodgment in the crevices for particles of mercury

and to the gas jets alight at every bench, are not conducive to health.

Close observation of almost every worker who has been employed for

a few years (and when once entered on it is rarely exchanged for

another), reveals the presence of chronic mercurialism either in slight

tremor of the muscles of the face or hands, or the characteristic

earthy complexion.[96]

_Incandescent Electric Lamps._--In the manufacture of incandescent

electric lamps, if mercurial pumps are used to produce the vacuum in

the glass envelope, the danger from the scattering of mercury, which

not unfrequently happens through breakage and careless manipulation, is

considerable.

In Berlin and Buda Pesth[97] several cases of chronic poisoning from

this source occurred a few years ago. The industry, so far as the

operations in the pump-room was concerned, was placed under special

regulations in Berlin, requiring (1) mechanical ventilation; (2)

overalls and head coverings for the persons employed; (3) provision

of a meal room and the washing of hands and face with soap, and the

rinsing out of the mouth with potassium chlorate before meals; (4) a

warm douche bath three times a week; (5) medical examination of the

workers once a week. The effect of these regulations was a cessation

almost at once of mercurial poisoning, and they soon led to the

introduction of mechanical pumps to replace those of mercury.

In this country no case has been reported in this industry, and the

evidence I have found so far of mercurialism among the workers is

slight.

_Electrical Meters._--The same dangers from the free use and

handling of mercury is to be found in workshops where electrical meters

are made, and they can only be satisfactorily met by the adoption of

the precautions mentioned in the last section of this chapter.

_Gold and Silver Extraction._--Both gold and silver are

occasionally separated from the ores in which they are found by

amalgamation with mercury, the latter subsequently being removed by

distillation.