There are others working in a mine besid_Dangerous trades

these are those who attend to the roads, fill the waggons (fillers),

push these (trammers), or drive the ponies. There are also deputies or

overlookers, whose work it is to see to the safety of the places the

men work in, both as to freedom from gas and as to the condition of the

roof of the mine. These latter occasionally suffer from nystagmus, and

a consideration of the work they perform will show that it necessitates

the same upward and oblique direction of the gaze. Frequently also

these men have previously worked as coal-getters. The photograph shows

a deputy examining the roof by striking it with his stick to ascertain

its soundness. It must be remembered that the height of the working

places and passages in the mine is nearly always so low that this alone

compels a constrained attitude. “Onsetters,” whose duty it is to see to

the ascent of the full, and descent of the empty coal tubs, sometimes

get nystagmus, as do also “timbermen.” It may be accepted as a rule

that all cases of nystagmus occur in those who are either working, or

have worked, as coal-getters, or that the work in which they have been

employed has been one in which an upward direction of the eyes has also

been necessitated for more or less prolonged periods.

The etiology of the affection must be sought in this constrained

position of the eyes by which chronic weariness is induced in the

elevator muscles of the eyes. Like effects are found in other muscles

of the miner, producing wry-neck, tremors of the head, and quivering

of the eyelids. It is thus similar to other occupation neuroses,

and in the same category as those met with in writers, compositors,

telegraphers, ballet-dancers, and many others.

Nystagmus occurs in miners working with all kinds of lighting. I have

met with it in workers with safety lamps, candles, large open lamps,

and when the artificial light was really good. There is, however,

some reason for believing that the strain is greater the worse the

light, and that nystagmus is met with in greater frequency under such

conditions. Other things, as to the nature of work, being equal, the

disease will probably be most frequent with the worst light.

Nieden says that 5 per cent. of miners suffer, and my observations

support this generally; in some parts, however, the percentage is

higher. For instance, among men working at a colliery with candles I

found that 6 out of a total of 140 were absent from work for nystagmus,

and this represented only a portion of those whom an examination

would have ascertained to be actually affected with the disorder.

Romiée gives the percentage for Belgium as high as 20, but possibly he

includes less marked cases.

The prognosis is good, and, even in old-standing cases, if the

directions as to work are followed, the nystagmus will usually

disappear. Treatment consists essentially of a change of the kind

of work. In some cases it will suffice if the patient ceases from

coal-getting, without altogether stopping work in the mine, but

generally it is advisable, especially if the nystagmus be of high

degree and of some standing, to recommend cessation altogether from

work underground. After relief has been effected return to the mine is

practicable, provided the head can be kept straight, and the upward

turn of the eyes avoided. Resumption of the old kind of work is

followed, sooner or later, by a recurrence of the symptoms. Medicinal

treatment is also of service.

[Illustration: FIG. 80.--Deputy examining roof.

(_Photo. taken in coal mine with Magnesium Flash

Light._)]

Though so peculiarly an affection of miners, nystagmus is met with,

but much less frequently, in other occupations. I have observed it in

various employments, and have collected together a series of cases in

which it occurred, viz., in compositors, metal roller, plate layer,

plank cutter, saw maker, sanitary tube maker, fitter, iron founder,

cage worker in the mine, glass manufacturer, youth in confectionery

warehouse, and a man engaged in hanging up harness, and in another

employed at the screens at the surface of a coal mine. These instances

occurred in circumstances closely comparable to the work in the mine

as to strain of the elevator muscles of the eyeball, and where, of

course, the influence of illumination had no place. They may be held

as definitely corroborating the views set forth as to the causation of

this affection in miners.

_2. Diseases due to occupations involving the use of certain

poisonous substances, such as, dinitrobenzol, bisulphide of

carbon, tobacco, lead, etc._

_Dinitrobenzol_ is largely employed in the making of explosives,

such as roburite, sicherheit, etc., a class of explosives which find

special employment in coal mines.

The dinitrobenzol is brought to the factory in slabs, say 15 inches

square, and about 4 inches thick. The first process is to grind these

to powder in an apparatus with steam rollers. During this process a

good deal of dust is given off, and there is a smell of bitter almonds.

The next step is to take the powder thus obtained to the mixing shed,

where it is mixed with oxidising salts and other materials in a large

pan, and heated with steam. It remains there for several hours, and it

is then cooled by cold water being pumped on the outside of the shell.

When cool, the material is turned out of the mixer. It is during the

removal of the material from the mixer that workmen are especially

exposed to the vapour, but the dangers are lessened by the adoption

of a cowl to the mixer, and also by the use of a fan. The explosive

prepared in this way is put away in cylinders and kept until required.

The next step is to take it to the filling room, where it is put into

cartridges, which are then weighed and stamped, and finally these go to

the dipping room, where the cartridges are waterproofed by being dipped

in liquid paraffin wax.

The most injurious work is that of grinding and mixing, especially the

latter. Men are employed in these processes. For the “filling” of the

cartridges, and for the “dipping,” women and girls are employed. In the

first named, the powder is shovelled into the cartridges and directly

handled; a good deal of dust is given off. Respirators and gloves are

used, as they are also by the men mixing or grinding. The dippers

are apparently the least exposed to the injurious effects, yet they,

nevertheless, suffer. The greasiness about the hands from the paraffin

may also aid absorption. Here also gloves and respirators are worn.

There is not much dust, the powder being confined inside the cases.

Some years ago several patients were under my care whose impaired

vision was due to working with dinitrobenzol. An opportunity was

afforded me of investigating the manufacture of this material, its

effect on vision and the general health of the employés.[167] The eye

symptoms may be summarised as follows: failure of sight, often to a

considerable degree, to a more or less equal extent on the two sides;

concentric contraction of visual field, with, in many cases, a central

colour scotoma; enlargement of retinal vessels, especially the veins,

some blurring of the edges of the optic disc, and a varying degree of

pallor of its surface. The condition of retinal vessels spoken of is

observed in workers with the dinitrobenzol independently of complaints

of defective sight. Cessation of work with dinitrobenzol tends to

recovery. The general effects appeared to be chiefly exerted on the

blood and the nervous system. In some cases there were also gastric

symptoms. With reference to the blood changes, the occurrence of very

marked anæmia in girls, who lived practically in the country, and

who worked in well ventilated rooms, was particularly striking. The

symptoms and physical signs of anæmia in men, working under the same

hygienic conditions, were perhaps still more noteworthy. That some

other change, however, in the blood was also present was evidenced by

the blueness of the lips and finger tips, which was observed in several

cases. The colour of the urine was also remarkable.

The chief nervous symptoms were numbness of the extremities and

unsteadiness of gait. The latter was noticed especially at the close of

a day’s work in the factory, and was much aggravated by indulgence in

alcohol.

Dinitrobenzol may, it appears, either be absorbed through the skin,

ingested, or be taken in through the air passages. What the poison

then becomes does not appear to have been satisfactorily ascertained,

but its action on the blood is definite. Specimens of blood drawn

from the fingers of two of my patients were found to be thin and

black-looking. Dr MacMunn, of Wolverhampton, very kindly examined some

specimens which were forwarded to him, and reported on them (as he did

also of the urine, which was dark, almost black like porter), that,

spectroscopically, all the specimens of blood sent showed nothing

abnormal.

The explosives under consideration are used in coal mines, and cases

have been recorded of men who became affected by dinitrobenzol employed

underground.

At the invitation of Commander H. P. Smith and Dr Dupré, the following

suggestions for preventing the deleterious effects of dinitrobenzol on

those engaged in its manufacture were drawn up by me for their report.

(1) That the different processes should as much as possible be

conducted in the open air, or in large, well-ventilated sheds.

(2) That in the “mixing,” closed vessels should, as much as possible,

be employed.

(3) Fans, which have been adopted in other trades with great advantage,

might also in this one be of service.

(4) Respirators are in use, but their employment is, as far as I am

aware, optional. Those protecting both the nose and mouth are, up to

a certain point, of service. I do not think they are a sufficient

safeguard against the fine vapour entering the respiratory system. It

occurred to me that during the process of “mixing” especially, it might

be possible to shut the workman off from the vapour and fine dust by

means of a kind of diving-bell apparatus, with a communication behind

open to the air. A mask, such as has been used, I believe, in Germany,

might answer the objects desired.

(5) Handling by the bare hand or direct exposure of the skin should

be avoided. The filling could, perhaps, be performed automatically.

The hand should, moreover, be protected by gloves. These should be

capable of being cleaned, and possibly indiarubber might be used by

preference. The cleaning of the gloves is an important matter, because

those worn with any of the substance clinging to the interior, as would

be the case after they had been in use for some time, would allow of

absorption taking place under the still more favourable circumstances

afforded by the warmth and moisture of the hand. Special clothing

should be provided, the workmen and women being compelled to change

their clothing on entering and retiring from work. Dressing-rooms

should be provided, and washing enforced. Food should only be partaken

of away from the sheds where the mixing, filling, etc., take place, and

particularly is it important to insist on washing before meals, and

removal of the special clothing.

When used in the coal mine it is desirable that means should be taken

to prevent any of the powder adhering to the outside of the cartridges,

that combustion should be complete, and that the use of cartridges

should be restricted as much as possible to well-ventilated places,

so that currents of air would speedily dilute and carry away any

deleterious vapours.

As a result of the report by Dr Dupré and Commander Hamilton P. Smith,

notice to observe the “Special Rules” recommended in their report was

served on the different manufacturers.

The effect of _bisulphide of carbon_ in causing impaired eyesight

has been shown by many instances. Rubber-making has been the industry

in which those suffering have been mostly observed. The bisulphide is

a very active and penetrating solvent, and it is used to dissolve and

carry into the rubber chloride of sulphur, which is the vulcanising

agent. This process is called “curing,” and it is during it that the

fumes of the bisulphide are given off and act injuriously on the

general system of those exposed to them, as well as in some cases

causing injury to eyesight. Some time since I visited rubber-works

in which about 200 hands were employed, and witnessed the process of

“curing.” The rubber cloth which it was wished to vulcanise was brought

into contact with the wet surface of a wood or slate roller, which

revolved in a trough in which was the bisulphide holding the sulphur in

solution. The shed in which the curing was done was very open, and was

well calculated to allow of the ready escape of the fumes. The vapour

was a heavy one, and tended very much to keep low, especially in wet or

damp weather. Any apparatus to carry off the fumes, therefore, should

be one to draw them downwards. Among the workers I saw one man who had

evidently two years ago suffered from amblyopia, which appeared to

have been characteristic. He changed his work to another part of the

factory, and recovered. A considerable alteration has, I understand,

been brought about in the vulcanising process, and since attention was

first directed to the subject, bisulphide has been much less employed

in rubber-works. The sulphur is now mixed with the rubber, and the

vulcanising is done by subjecting the otherwise finished article to a

high temperature. The bisulphide in the future is even less likely to

be required, and therefore in this class of occupation, at all events,

it may be expected that impaired eyesight will be more infrequent.

_Tobacco_ was the first agent to be recognised as causing toxic

amblyopia. It is doubtful whether it can be classed properly with

occupation disorders. Galezowski,[168] however, asserted that visual

troubles occurred in those engaged in the manufacture of tobacco in

consequence of the absorption of nicotine powder. He further advised

that the working places should be well-ventilated, and recommended

a change of occupation for those affected. This statement finds

corroboration by De Schweinitz, who states that amblyopia may occur

in those who do not use tobacco in any form, but who work in tobacco

manufactories. He has related a very remarkable case of this character

in a young woman. All of the symptoms disappeared when she was removed

from the tobacco factory. On the other hand, Shears[169] has related

that he visited the large factory of Cope Bros., where 1200 men and

women were employed, and that he made careful inquiries in each of the

departments of the foremen, but from none could he learn of instances

of sight failure. Lee at the same time made observations at a large

factory at Chester, with similar results. Sheffield is celebrated

for its snuff, the two kinds, Top Mill and Bottom Mill, being well

known. There are also several smaller tobacco works about the city,

but my attention has in the last twenty years never once, as far as I

remember, been directed to a case of tobacco amblyopia in a worker at

any of these places. Dowling[170] in America has also gone into this

matter. At a factory where 3000 were employed, half being females, he

examined 150, or 5 per cent. Ninety per cent. of the males used tobacco

in some form or other, and 20 per cent. chewed, in addition to smoking

liberally pipe or cigar. These are his conclusions: “When I commenced

my examination I was under the impression that the constant inhalation

of the dust and the odour of tobacco in the workshops would tend of

itself to bring about symptoms of tobacco amblyopia. I am induced to

think this hardly takes place, for in my examination I found those who

did not smoke were uniformly free from troubles of vision of a toxic

nature, and the females were almost universally free from the trouble,

that is as far as I examined them.”

_Iodoform_ is largely used in surgical practice. A few instances

have been recorded of impairment of vision resulting from its

employment as a dressing for large burns, etc. The characteristics of

the affection were similar to those met with in tobacco amblyopia, in

chronic poisoning by bisulphide of carbon, and other toxic amblyopias.

Inquiry addressed to perhaps the largest makers of iodoform in this

country elicited the reply, that they had consulted the Medical

Attendant of their men, and he confirmed the opinion expressed by the

foreman, that they had never known of any injury to the sight from the

manufacture of iodoform. If there was carelessness in the manufacture

pungent vapours would be evolved; but that was always a sign of

something being wrong.

Men employed in dye factories and other manufactories requiring the

handling and preparation of the various _coal-tar_ products are

reported to be subject to visual troubles, cases having been recorded

from time to time.[171] Galezowski gives headache, dizziness, malaise,

deficiency in visual acuity, photophobia, and ciliary injection

as symptoms from which the workers suffer, but, as is pointed

out by Knies, the connection of these ocular complaints with the

_aniline_ used is uncertain.

M’Kinlay[172] has recorded a case of intense pigmentation of the cornea

and conjunctiva in a man who was a worker in aniline dyes. Reduction of

vision was also caused.

_Arsenic_ is extensively used in the arts, and has been the cause

of many cases of poisoning, for example, from wallpaper and articles

of clothing. Its use for artificial flowers and wallpapers has much

abated. Casey Wood mentions that makers of Paris green, painters, and

paperhangers, as well as those who take the drug for medicinal or

cosmetic purposes, are liable to suffer from visual disturbances, from

conjunctival hyperæmia and eczema of the lids, which are regarded as

evidences of arsenical poisoning. Amblyopia and optic neuritis have

been reported as due to arsenic.

The occupations in which _lead_ or its compounds, in one way or

another, are used are multitudinous, and those liable to be affected

by lead poisoning belong, therefore, to a numerous class. Among these

are painters, plumbers, etc., and, in Sheffield, file cutters. In this

latter occupation the file, when being cut, rests on a “bed” made of

lead, and each blow of the hammer causes minute particles of lead to

disperse and to charge the atmosphere of the workroom. Chronic lead

poisoning in file cutters results from inhalation of these particles,

and from the uncleanly habit of wetting the hands at the mouth. In

acute lead poisoning there are no eye symptoms, but in chronic lead

poisoning central and peripheral affections of sight are common.

The brain and nervous system are frequently seriously affected in

chronic plumbism, and kidney disease is also frequently occasioned

thereby. Sight is liable to be affected in association with both these

conditions. Apart from them, however, lesions of the eye are often

occasioned by chronic lead poisoning. Unilateral or bilateral optic

neuritis is met with, and more frequently an affection of the optic

nerve (retro-bulbar neuritis) very similar to that occasioned by

tobacco and other agents producing “toxic amblyopia.” Recovery from

these last-named (peripheral) conditions is frequent. Palsy of one or

more of the eye muscles has been met with.

3. _Diseases due to occupations involving exposure to

excessive light or heat, or both, such as burnishers, steel

melters, electric welders, etc._

Silver, either the metal or electro, when finished, has a very highly

reflecting surface. The most important for our purpose of the processes

by which silver goods have to be brought to the proper polish, is the

finishing or burnishing. This is usually done by girls, who brighten

the surface with a blunt tool. These girls are frequently the subjects

of hyperæsthesia of the retina, by which they are often compelled

to relinquish the work entirely. Coloured glasses and correction of

refractive errors help in some cases. Those engaged in the process

called “buffing” suffer in a similar manner.

Excessive heat associated with intensity of light is met with in

iron and steel works in the different processes connected with the

making of the iron, and the converting of it into steel. There is, I

think, no definite evidence that men exposed to the heat and glare

of the furnaces or from the molten metal suffer materially in their

eyesight, though some assert that disease of the background of the eye

is occasioned in some instances. The men are, in consequence of the

heat, prone to sweat a great deal, and frequently wear little clothing

above the waist. The temperatures before which they work are, to an

outsider, something almost astounding, especially if he remembers

that the temperature of an ordinary well-lighted fire in a grate is

about 500° F. There would seem to be a very marked difference in the

way a temperature is borne, when it is below 2000° F., and when above

it. Up to that figure a man can look at the metal in a furnace with

comparative ease, but before it gets to 3000° F. he is compelled to

wear coloured glasses when doing so. A friend, at some large iron

and steel works, gave me the following notes: “In dealing with cast

iron, the heat of the metal would be about 1800° to 2000°, and the

men employed take no precautions. The heat of the molten metal would

be about 2700° to 2800°, while the heat of the gases in the furnace

would be about 200° or 300° more. The furnacemen have to wear deep

blue glasses to protect their eyes from the glare of the furnace.

With this precaution we have not observed their eyes to suffer in any

marked degree. The heat of Bessemer metal is about 3000° F. to 3200°

F.; in this case there is not the same necessity as in the Siemens to

watch the hot metal, consequently the men do not wear glasses. We do

not observe any ill effects directly traceable to the heat. In the

case of the Siemens men, I should say that without protection the eyes

would suffer considerably. After looking at a Siemens’ furnace without

glasses, it is several minutes before the eye can see ordinary things

again.”

There is, moreover, a further difference between the two processes,

viz., Bessemer and Siemens. The former has, as just mentioned, the

higher temperature and the more dazzling glare, but the steel is melted

and the process completed in about twenty minutes, and it is only

necessary for one man to take close observations, and this he does

by means of a spectroscope, and is as far as 30 feet from the molten

metal. The Siemens process takes ten hours, and during this period the

whole of those engaged will, as the door is frequently drawn up, be

taking observations to see whether the melting is proceeding properly.

This is constant and regular work, and they are obliged to use coloured

glasses.

In addition, in these large works, are the castings, forgings, rolling

of armour plates, and many other things. A huge forging, of perhaps 60

or 80 tons, is drawn out of a furnace with a temperature of from 2000°

to 2500° F., and placed under a powerful hydraulic press of 10,000 tons

power, where, with the men all around, it is hammered with as much

apparent ease as putty is manipulated by one’s fingers.

The glare and dazzling in the Bessemer and Siemens processes must

be seen to be realised. Generally speaking, in fact almost always,

it would seem as if the men engaged in these various kinds of work

could submit to exposure to the high temperatures and intense lights

with impunity, if they will only use coloured glasses when employed

with the higher temperatures and the more dazzlingly bright lights.

Occasionally, however, one meets with men who appear incapable of

continuing to bear these conditions. They feel their eyes painful, and

it is some time after cessation of labour before the discomfort passes

away. Such as these have sometimes to seek another occupation. On the

other hand, the readiness with which, it may be after an accident to

one eye, men will often return to their employment before the furnace

or fire, is surprising.

Glassblowers are asserted to be frequently the subjects of cataract,

and it has been sought to connect this tendency with the powerful

heats to which their work exposes them, and also to the sweating which

accompanies it. They work around open-mouthed furnaces and close to

pots of molten glass, and are thus exposed to intense heat and light. I

have, however, seen something of glass-blowers from time to time, and

my experience, whilst it does not allow me to support this assertion

of the frequency of cataract among these men, may be regarded as too

limited to contradict the statements which other observers have made.

Should extreme heat and consequent loss of moisture be regarded as

sufficient causes for the production of cataract, then it should be

found especially among iron and steel workers. My experience does not,

however, show that this is the case.

_Exposure to Electric Light._--Several instances have been

recorded showing the serious effects on the eyes of those exposed to

the glare of this powerful light. The following may be mentioned.[173]

Two men were employed on an electric street railway. One man thrust

a blade of a screwdriver into a motor cylinder and “immediately

he was flashed by the powerful light and stunned by the powerful

current.” When seen five hours after, the eyelids were closed and he

was suffering intense pain, but he was able to resume his work next

day. The second man struck a “live electrical circuit” with a steel

file, and instantly there was a flash of light and he was rendered

unconscious. The eyelashes were singed and the arms burnt, and there

was great pain. It was not until the fifth day that he could return to

work. A more severe case[174] is reported of a man engaged as engineer

in the power-house of an electric car line. He was using a wrench

to some machinery, when accidentally his elbow came into contact

with another machine forming a short circuit. The whole electrical

force--1000 ampères--used to propel the cars several miles, passed

down the forearm and out at the elbow. The electrical discharge was

succeeded by a loud report following an intense flash of light. The

man was knocked down, but only lost consciousness for a few seconds.

When seen an hour after, the skin of the arms, hands, face, and neck,

in fact, of all exposed parts, was burnt; the effects were like those

caused by boiling water; the eyelashes and eyebrows were burnt off.

The ocular conjunctiva looked as if a strong solution of nitrate of

silver had been applied to it, and the corneæ had the appearance of

ground-glass, especially in the centres, so that the impression was

given that they were both destroyed. It was, however, found that only

the epithelial layers were affected. Ultimately sight was recovered,

but photophobia remained for some time.

Of the many ways that the electric light is liable to be injurious

may be mentioned that of _electric welding_. This process is one

that is becoming very largely used in iron works, and it effects its

purpose so rapidly that it is likely to find still further employment.

I have met with many men who have suffered from exposure to the intense

light emitted in electric welding. On several occasions the opportunity

has been given me of witnessing the process. The heat produced is so

intense that metal runs at once like solder. So rapidly, indeed, is

this effected that, without seeing the process, it seems incredible.

To protect the eyes from the intensity of the light, the onlookers use

large shields with glass in the centre arranged in alternate layers of

blue and red, there being four thicknesses. The man engaged in working

the process in one factory with which I am acquainted, uses a helmet to

protect his head and face. In the front of the helmet is a glass window

made up of six layers, alternately red and blue. At another place the

men stand behind a wooden screen about 4 ft. high, with a sliding top,

in which is a glass window for the workman to observe the work upon

which he is engaged. The sliding top can be raised or lowered according

to the height of the man or the nature of the exact work to be done.

The window is made up of four thicknesses of glass, two green and two

blue, and there is a plain glass fixed in front of these, as it can

be more easily replaced, this being required by the liability of the

front glass to be spoilt by deposit on its surface. This arrangement

protects the man much more than the helmet. The men’s trousers may

be burnt by the metal splashing on them, and this screen gives more

protection than the helmet would do. The top part of the screen is

narrower than the bottom, to enable the men to get their arms freely

round it so as to work on the metal in front, and the broad lower part

forms a rest for their arms. Any parts of the body which are exposed

to the light may get burnt, and many suffer severely in this way. If

the eyes “catch” the light they feel the effects at once, but the worst

generally does not come on until some hours afterwards, and most men

will say that the most acute stage is during the night succeeding the

exposure. The eyes feel swollen and as if filled with burning sand, and

the pain is very severe. There is swelling of lids; so much so that

they cannot be opened, and there is lachrymation. All night the pain

will last, but the next day the worst will be over, and often by a day

more the eyes will be quite right again.

Terrier and Malakoff have each published very interesting observations

bearing on this subject, as has also Wildmark. The latter especially

appears to have settled the point as to whether in these cases it is

the heat or chemical rays that act so hurtfully. Taking advantage

of the different actions of glass and crystal--the former absorbing

chemical rays, the latter, or crystal, allowing them to pass--he showed

that if a pencil of light before reaching the skin was made to pass

through a disc of glass, in the centre of which was a hole filled with

a small disc of crystal, the redness of the skin was observed only

in the central area, a proof of its dependence on the chemical rays.

Malakoff pointed out that though the light was so intensely dazzling

the thermometer was only raised 2° C. at a metre distant, but it must

be borne in mind, however, as a workman mentioned to me recently, that

the metal acted upon during welding becomes very hot, so that standing

close by is hardly possible.

Some idea, also, may be given of the heat involved in electric welding

by the following data, supplied to me by an experienced electrical

engineer. He stated that, at one works, the temperature during electric

welding would measure about 3000° C. (7000° F.), and that it was not

an unusual thing to measure 3000° C. in an electric furnace. In the

absence of photometric measurements, he assumed the luminosity of the

arc for electric welding would be about 8000 candle-power.

The action of the electric light upon the eye is to all appearances

confined chiefly to the conjunctival or corneal surfaces. Very

possibly, however, it occasions also a hyperæmia of the retina, and

one case is on record of a boy who got a central scotoma from looking

at an electric light placed in the roof, like those resulting from the

action of direct sunlight.

With the prudent use of the protectors mentioned the light can be

observed with little risk of injury.

4. _Injuries or accidents amongst grinders, iron and steel

workers, masons, coal miners, weavers, etc._

It is difficult to obtain anything like accurate statistics as to the

numbers blinded by accident. Magnus, in his tables, makes 8.5 per cent.

of all cases of blindness as due to accident. In this calculation

no count is made of those blind in one eye only, and the far larger

number who have sustained permanent injury in varying degrees short of

blindness; and even if such a computation were true for the community

generally, the number must be greatly exceeded in large and populous

centres, especially in those in which iron and steel are important

industries.

A brief reference only to statistics is necessary. Mr Watson, the able

Secretary of the Miners’ Permanent Benefit Fund, has given me the

following figures as to the proportionate frequency of eye accidents

among miners, to other accidents. In all these accidents the miners

have been rendered unfitted from continuing their work, at least

temporarily. The figures are for fifteen years arranged in periods of

five years. The number of non-fatal accidents dealt with is 48,262.

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

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

|1884 to 1888 | 16,870 | 857 | 5.08 |

|1889 to 1893 | 12,768 | 670 | 5.24 |

|1894 to 1898 | 18,624 | 979 | 5.25 |

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

| Total | 48,262 | 2506 | 5.19 |

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

The average yearly membership for each period was--1884 to 1888,

22,410; 1889 to 1893, 17,876; and 1894 to 1898, 23,005.

The Equalised Druids Society gives to those of its members who are

permanently incapacitated from following their employment a grant of

£100. The number of cases of all accidents in which this grant was made

during the last five years was 57, and of that number it was given

seven times owing to eye accidents.

My own infirmary figures also testify to the large number of eye

accidents annually occurring in the district with which I am more

particularly acquainted. Of the last 2554 patients who have passed

through my wards at the Sheffield Royal Infirmary, 2038 were men, and

516 women. Of the 2038 men, 622 were admitted for accident, or 30.52

per cent. This percentage has kept fairly uniform, but at periods of

great trade activity the ratio of accidents to other cases admitted

has gone up. Of the 516 women, only 36, or 6.9 per cent., were for

accidents. The important part occupation bears to the number of eye

accidents is well illustrated by these statistics. The men not only

exceeded the women very largely in actual numbers, but still more so by

percentage, this latter being six times as great as for the women.

In many trades associated with iron and steel in all its varieties,

small foreign bodies are very prone to become lodged in the workmen’s

corneæ. I take, as an example, the grinders. In the course of the day

a grinder may get several “motes,” as he calls them, fixed in his eye,

or days may elapse without such a mishap. If the cornea of a grinder be

examined carefully with a magnifying glass, it will not infrequently

be found to be studded over with minute nebulæ. Although the damage

done by each foreign body may often not be serious, yet frequent

repetition, by dulling the cornea, will, in many cases, diminish the

acuteness of vision. These particles may either be small fragments of

stone, or, much more frequently, small portions of steel or emery,

which latter is used as a wheel for glazing cutlery, and for other

purposes. Of the two varieties of grinding, the dry grinders are more

exposed to injury from foreign bodies than the wet grinders. A grinder

sits across his bench, or “horse,” and presses the knife or razor

blade on the stone. The wet prevents the particles from flying about a

good deal, but still a man’s face becomes, as he works, bespattered;

nevertheless, a _wet_ grinder seldom gets motes in his eyes. In

_dry_ grinding the sparks fly freely, and it is evident that

very minute particles of steel or stone are being projected about,

and it is the merest chance whether they hit the man’s eye or face,

or scatter about the room. The fans, which it is well known have for

many years been required in the grinding trade in consequence of its

deleterious effects upon the health of the operatives, must be regarded

as in some measure a protection. It is interesting to observe the

remarkable manner in which a fan draws into it the sparks and particles

flying from the wheel. There can, moreover, be no question that the

grinder derives considerable immunity from motes by the employment of

protective glasses. Grinders admit the protection they afford. If

further testimony be needed, it can be found in the condition of the

glasses, after having been used for some time by a grinder: they are

studded over with small dots occasioned by the impact of the motes.

In the great majority of instances the damage occasioned to the grinder

or other operative in which similar mishaps occur is not attended with

serious results. The immediate injury may, however, be serious, either

directly or indirectly, by the ulceration that ensues. There is another

way, also, in which injury results. A man once said to me, pointing

to his damaged finger, “This would not have happened if something had

not got into my eye, because I could not see my finger on the circular

saw.” The operatives, in all the various trades in which iron and steel

are used, are liable, though to a less degree than the grinders, to get

these motes into their eyes.

In all the large works there are men who have a reputation for their

skill in the removal of these motes. The instruments they use are of

various kinds--for instance, a blunt lancet, blade of pocket knife,

or a pin. Generally speaking, they are unsuitable. In many instances

the motes are skilfully removed; in others, there is a good deal of

bungling, and not infrequently cases come under observation in which

sloughing corneal ulcers have resulted.

It seemed to me not unlikely that septic conditions were set up in

consequence of the uncleanly instruments which were so often employed.

Dr Shennan of Edinburgh kindly undertook a bacteriological examination

of some of these instruments for me. I collected 22 tools used by

different men, and Dr Shennan examined the majority of these. Taking

all in all, he found nothing pathogenic excepting the staphylococcus

pyogenes albus, whose virulence is comparatively slight. Of course

there are many sources besides these tools by which a corneal wound

may become septic. But good should result if a cleanly and suitable

instrument could be made available to the men who remove motes. In some

of the works a case, made at my suggestion, is provided, containing

iridium-platinum blunt-pointed spuds, together with a small spirit

lamp, with directions printed on the inside of the case, saying that

before use the extremity of the spud should be sterilised by heating it

in the flame of the spirit lamp, or if this be not accessible, in a gas

or other flame which may be at hand.

[Illustration: FIG. 81.--Grinders. Edge-Tool

Grinding.]

By far the most serious eye accidents happen to men engaged in

working iron or steel. The following figures exhibit this in a very

lurid light:--

_Steel and Iron._

Steel and iron splinters, rivet

chips, pieces of drill, file, wire,

etc. 173

Nail 5

_Burns._

Metal sparks, flashes, etc. 43

Lime 8

Gas explosion 1

Ammonia 1

Gunpowder 4

Cinder 1

Poker 1

_Miscellaneous._

Dynamite, and dynamite explosion

and cartridge 6

Wood, sticks, and peggy 13

Hook 1

Knife 8

Glass, soda-water bottles, etc. 15

Pick 5

Stone 24

Fork 7

Pin 1

Fist 3

Branch of tree 1

Crane handle 1

Cork 2

Cinder 4

Coal 11

Straw 1

Cat’s claw 1

Sand 1

Ball 1

Pen 2

Firework 1

Boiling oil 1

Tin 2

Band strap 2

Band buckle 2

Chain 1

Kick 1

Brick 1

Thorn 2

Elastic, piece of 1

----

Total 359

====

Out of this total of 359 eye accidents to males, taken from the records

for this purpose consecutively, which were so serious as to require

admission to my wards at the Sheffield Royal Infirmary, no fewer than

173 were caused by iron or steel, pieces of rivet, of drill, wire, and

many other means associated with the iron and steel trades. There were

also 43 due to burns from molten metal, sparks, flashes, etc. I am not

sure, also, whether to the former number should not be added 5 put down

as caused by nails, as most, if not all of them, would have occurred to

iron or steel workers.

The opportunities for the infliction of severe injuries to iron and

steel workers are multitudinous. They occur in all branches of the

trade, in the lighter iron and steel industries as well as in the heavy

trades where armour plates and heavy castings of scores of tons are

made. A very large proportion of the accidents are occasioned by what

is called “chipping” and “fettling.” “Dressing” is the name given in

some parts to this process. This work consists in chipping the rough

edges from iron and steel castings, ingots, and all kinds of steel and

iron work, and among other things, even the large armour plates.

Castings of either iron, steel, or brass are the most dangerous to work

upon, because the chippings fly about on account of the metal being

brittle. It is very dangerous chipping castings in the corners, or

where the “chipping” strikes the metal and rebounds. Chippings from the

castings are about ¼ inch to ¾ inch long, and very sharp. When chipping

thin plates on the edges, the chippings are sometimes 1, 2, or 3 inches

long before they break off. All castings are “fettled” at the foundry,

that is, the runners are cut off, and the places where the metal has

run at the joint of the moulding boxes are trimmed off.

Whatever be the special kind of metal or steel to be fettled, the

manner in which it is done is practically the same. A hammer and

chisel, or sate, are used, and with these the roughnesses are removed.

Frequently, also, whilst one man places the chisel, another, or even

two others, called “strikers,” will use a hammer. I understand that at

works where say 1000 men are employed, 200 or more will be occupied

more or less in “chipping.” Many men are frequently working close to

each other, so that the danger is not only to the worker himself, but

to those around. Passers-by are by no means infrequently the victims.

The chipper himself is often hit by the rebound of the splinter after

it has struck some other object. It must be recollected, also, that in

the process spoken of, the danger is not merely from the iron or steel

which is being operated upon; there are three other places from which

splinters may be given off and cause injury, namely, the hammer head,

the chisel head, and the chisel point.

It is obvious that men engaged in work which causes the splinters to

fly about so freely, should be so placed as not to be chipping against

their fellow-workmen, or in a direction from which passers-by may

approach. This is managed in some works by getting the men to chip

against a wall, though not too close to it, or, again, by interposing a

canvas screen between sets of workmen.

[Illustration: FIG. 82.--Men engaged in Chipping.]

[Illustration: FIG. 83.--Chipping against a Screen.

Men wearing Protectors.]

The sizes of the splinters spoken of vary from the most minute to

others measuring some inches in length, and they may be thick or thin.

The injury inflicted differs, of course, in accordance with the size

of the missile and the force with which it is projected. The small

fragments may be thrown off with such velocity that they penetrate

the eyeball and become embedded in its interior, in some instances

passing through the eyelid before reaching the globe. The destruction

to sight in this way is very large. I have myself removed from the

globe, with my electro-magnet, more than two hundred fragments of

steel and iron. One was no heavier than 0.0015 gr.; several were as

light as 0.0030 gr. and 0.0046 gr. The largest weighed 36 grs., and

there were two others 12 and 9 grs. respectively. It would be out of

place to refer here to the results of the extraction of this number

of foreign bodies with the electro-magnet. It will suffice to say,

that many eyes have been saved by its employment which otherwise would

have been hopelessly lost. The injury to the eyeball occasioned by the

large chippings may be so extensive that the eye is at once irreparably

damaged, or so injured that removal of the globe will subsequently be

necessitated.

The dangers of chipping may be minimised by adopting a pneumatic

chipper. In some works, for chipping ingots I have seen one at work

on a large casting. It has the advantage of accomplishing in one hour

what, by hand, would take six or seven hours. It certainly prevented

the flying about of splinters in a remarkable manner. They merely

curled up and rolled over. It more resembled using a cheese-scoop in

a fairly soft cheese than running any tool over hard steel. Up to the

present these pneumatic tools have not been successful for “chipping”

the rough edges from steel castings.

Another class of severe injuries which are of common occurrence are

burns from molten metal. Sparks and flashes fly about freely in almost

every instance that molten metal is run into the moulds, but on some

occasions, of course, more so than in others, and the portions given

off vary much also in size. Injuries caused in this manner were no

fewer than 43 out of the 359 consecutive accidents in males admitted

into the Sheffield Royal Infirmary. In the forgings, also, great or

small, when the iron or steel is being hammered either by hand, or, in

the case of larger castings, by a steam or hydraulic hammer, portions

are given off from the glowing metal, and those working and the

bystanders are exposed to danger of burns.

The knowledge which I have acquired from contact with working men

who have been injured, and from periodical visits to the principal

works, has long since satisfied me that much of the destructive injury

to sight is preventable, and that means should be adopted to lessen

the risks to sight which are at present associated with important

industries. There is less difficulty in enlisting the support of the

employers than in gaining the assent of the men to the adoption of

precautionary measures. I know of one firm who make it compulsory on

men engaged in “chipping,” “fettling,” “turning,” and other work in

which iron and steel splinters are liable to fly off and endanger

sight, to wear protectors, which are provided at the expense of the

firm. This decision was taken in consequence of a workman being blinded

by a chipping.

In considering what kind of protectors men should use, it must be borne

in mind that the cost must be very moderate, and that sight should be

interfered with as little as possible, if at all. Among iron-workers,

glass is practically out of the question. Even thick rock crystal,

which has been suggested for some kinds of work, in consequence of

its thickness and peculiar manner of fracture, would hardly do. Gauze

wire, fitting close to the eye like a cup and attached to the head by a

string, is employed by stonebreakers and in some ironworks. Complaint

is made of such protectors as being hot and interfering with sight,

but there is no question that they afford considerable immunity from

accident. Another practical point about protectors is that they should

not be liable to rust. For this reason galvanised iron wire, or better,

aluminium wire, is of service. The mesh should be sufficiently strong

and fine, and sufficiently close to prevent, as far as possible, even

small chippings passing through it, and yet to interfere with sight as

little as need be. I have had experiments made by allowing men engaged

in fettling to “chip” against wire gauze which has been suspended for

the purpose, to ascertain how far a mesh answered before deciding to

adopt a given size. I have had this netting made[175] into protectors

which cover the eyes and adjacent parts. The portion over each eye is

bulged forward so as to allow very free play to the eye underneath; the

convex surface is a greater protection than one merely flat would be.

I have supplied workmen with these protectors, who have used them when

chipping, steel melting, and in other dangerous iron and steel work. I

learn that they are regarded as satisfactory, that they answer their

purpose well as protectors, and that the interference with sight is

very little.[176]

[Illustration: FIG. 84.--Protectors. (_Author’s

pattern._)]

I would sum up my suggestions as to the means for protection as

follows:--

1. The grinder will find that large glasses made of plain glass, or,

indeed, his own spectacles, should his refraction require their use,

will afford great protection. Or he may use other protectors, made with

glass in front, and gauze surrounding it.

2. The use of protectors should be compulsory for those workers in iron

or steel whose employment renders them liable to be injured by iron or

steel splinters, or who are exposed to danger from molten metal.

The gauze eye-shield I have described will, I believe, answer the

purpose well. The cost is low, and it is worth the employers’ while to

supply their men with them.

Other means to be adopted are:--

(_a_) The use of a pneumatic chipper whenever practicable;

(_b_) the proper arranging of the men at their work; and

(_c_) the use of screens, so as to avoid injury to their

fellow-workmen and to passers-by.

It is my belief that a consideration of the facts here advanced will

lead to the conviction I have myself long held--that very many eye

accidents associated with trades are preventable, and to the view that

preventive means should be adopted.

In addition to the classes of workmen more particularly alluded to

in the foregoing remarks on eye accidents and their prevention, the

following occupations may be briefly touched upon.

_Coal miners_ are prone to be injured by portions of coal striking

the eye, and either becoming embedded in the cornea (like the grinders’

motes) or causing abrasion of the surface, or wounds of the eyeball.

Eye injuries in the miner appear to be more than usually prone to

become septic. Injury may also be occasioned by splinters flying from

the pick point, and either sticking in the cornea or penetrating and

becoming lodged in the eyeball, in a similar manner to that which

happens in “chippers.”

_Agriculturists_ are liable to eye accidents in many ways. In

“hedging” injury is often caused by the eye being struck by branches

or twigs of bushes, or a thorn may wound the surface or penetrate

and remain lodged in the interior of the globe. In threshing and

chaff-cutting, among other processes, the lodgment of foreign bodies

under the eyelids may occur, or abrasion of the surface of the eye be

effected. A special form of ophthalmia has been described as occurring

among _hop pickers_. It is characterised by muco-purulent

discharge and swelling of the lids. Dr Percy Adams, who has described

this affection, considers it is caused by the introduction into the

conjunctival sac, or into the cornea, of the small, thorn-like, hairy

processes which are found on the hop leaves, bracts, and bines.

It may be generally stated that all engaged in dusty occupations are

prone to have their eyes irritated or to suffer from conjunctivitis.

This is the case, for instance, in a very dusty coal mine, a dust-laden

flour mill, etc.

All workers with stone are liable to eye injury from portions of stone

flying off and striking the eye, as they are also from splinters

coming from the chisel or hammer. Stonecutters are very liable to have

motes in their eyes, and more rarely the injury is much more serious.

Stone-masons, masons, bricklayers, and stonebreakers come under this

class. Protectors are sometimes used by stonebreakers at their work.

Stone “cutting” or “dressing” in the streets is often a source of

danger to the passers-by as well as to the workers themselves. Such

work should be so arranged that the cutting or dressing is directed

against a hoarding or wall.

In the preparation of grindstones there is considerable danger to

sight. “Millstone building,” in which buhrstone is used, is only a

small and decaying industry. Buhrstone comes from France in blocks,

which have to be chiselled into wedges to form sections of the circular

millstone, which are joined by cement and bound round with hoops

of iron. Pieces of stone or tool are liable, during the process of

chiselling, to fly about and endanger eyesight.[177]

The workers in quarries are exposed to dangers to eyesight like the

cutters and dressers of stone, but the fragments will frequently be

larger. Another danger is added, viz., that of blasting. The gravity of

the injury inflicted varies considerably. In some, powder grains are

studded about the face and eyelids and embedded in the front of the

eyeball, occasioning serious danger to sight. In others, the injury

may be so severe that sight is irrecoverably lost. It is unfortunate,

also, that not infrequently in these serious accidents both eyes are

implicated. The same dangers apply to all kinds of work in which

explosives are used for blasting purposes, whether above or under

ground, as, for instance, in the latter, coal and ironstone mining.

There are only a few parts of the country where ganister is obtained.

The largest works of the sort are situated at Deepcar, near Sheffield.

The effect of the fine powder produced in the processes required for

making the bricks is recognised as hurtful to the lungs of the employés

engaged. Besides this, however, the extreme hardness of ganister

necessitates blasting, and this is mostly done by dynamite. Two men,

within a short time of each other, came under my observation, who had

been blinded from this blasting. This occurrence induced me to pay a

visit to the ganister works. I found ganister was obtained by quarrying

and also underground, where it is found lying underneath a seam of

coal. In “scrapping” or breaking the ganister into smaller pieces there

is a danger of pieces striking the face or eye, a greater risk probably

than in ordinary stone-breaking. The ganister is afterwards broken, in

a machine, into small portions. Fragments not infrequently fly off, and

might cause injury. From this machine the ganister goes to another,

where it is ground quite small and churned up into a thick pea-soup

consistence, whence it is taken and placed where the bricks are made,

and afterwards burnt in a kiln heated to 2000° F. The dangers attending

the working of ganister are not so great as to call for special notice,

and, moreover, the industry is a small one.

Burns caused by lime must be mentioned. All workers with lime and

mortar are exposed to this danger from these substances getting

into their eyes, resulting sometimes in destruction of the cornea

and adhesions of the eyelids to the globe. Masons, plasterers, and

bricklayers belong to this class. Besides the actual burning, the

irritating qualities of lime and cement may occasion conjunctivitis,

with ulceration of cornea, and endanger sight.

In wire-drawing, not infrequently the breaking of the wire is a cause

of eye accident. The wire is put on a reel, and passed through the

plate, and wound round the wire-drawing block. During this process, the

tension is, of necessity, very great, but of course depends on the size

of the wire. Generally speaking, it is three-fourths of the breaking

strain of the wire. If the wire breaks on this block, the “back-lash”

may strike a man on the face or head, and then also the last end of

the piece might slip and strike a man. The wire is not likely to break

until it has passed through the wire-plate or “wortle.”

In the weaving shops one peculiar danger to which persons working are

subject is the liability to be struck in the face, or, more especially,

in the eye by flying shuttles. This risk has been known and appreciated

for many years. The matter formed the subject of a report ordered by

the House of Commons in April 1891.

Since then, greater attention has been paid to the provision of guards

to prevent accidents. There are many patterns of guards on the market.

In principle they are of two classes: 1st, what are known as wing

guards, that is, a wire screen of fine mesh canvas placed between the

looms. In this case should the shuttle fly, it would be caught by the

wing, and thus danger to the weaver at the adjacent loom is obviated.

The other system is to provide a rod on the traversing beam which is

always over the beam of the shuttle. Should there be a tendency for

the shuttle to rise, this would prevent it. With most guards of this

description it is practically impossible for any shuttle to fly, but in

less efficient ones the shuttle may escape. If it does so, however, it

will always be at a low angle, and instead of striking the worker at

the adjoining loom or any passer-by in the face or dangerous part, it

will simply strike the clothing, and little or no serious result need

be anticipated. Since the adoption of these guards the percentage of

accidents has been very appreciably reduced.

In a recent case of serious eye injury to a young girl, it was

ascertained that the guard for some reason or other had been left off,

and the shuttle had flown up and struck her. The liability to accident

among these operatives is shown by the statement of this girl, that she

had been struck once before on the eyebrow, and at least twenty times

on other parts of the body. All the girls working with her had also

been struck several times. She had, however, in five years only known

of one serious eye injury similar to her own.

In the manufacture of aerated waters there is danger to eyesight from

the bursting of the bottles. The industry is carried on extensively in

most of the larger towns. Usually the bottles or syphons are filled

by machinery, and, in a similar manner, the cork is inserted, or some

other method is adopted for sealing the bottles, whether it be a glass

ball or screw stopper. If “wiring” is needed, it is then done and the

label attached. In addition the bottles are “sighted,” or held up to

the light, to see that they leave the factory clean. Another process

consists in cleaning the returned empties. In all these processes, but

especially so in “bottling,” there is danger of the bottles bursting,

and inflicting serious injury to the eye, or cuts on the face or body

from the fragments of broken glass. To obviate these dangers the use of

faceguards or eye protectors is absolutely necessary, and all machines

used for bottling or corking should be fenced round. The manufacture

of aerated waters was reported on by the Dangerous Trades Committee

(1896),[178] who recommended that all bottlers, wirers, sighters,

and labellers, whilst at work, should be provided with faceguards,

masks, or veils of wire-gauze. They also recommended the providing

of gauntlets for the arms. They further advised the fencing of all

machines for bottling, to avoid the possibility of fragments of a

bursting bottle striking any worker.

_Bursting of Water-Gauges on Boilers._--Many cases of serious eye

injury have come under my notice from the breaking of water-gauges.

The liability to danger exists in every description of steam boiler,

and breakages frequently occur. Injury may be occasioned by fragments

of glass or from scalding, owing to the escape of boiling water and

steam. Protection of some sort is necessary. Encasing the gauge in

wire netting would suffice to prevent injury from fragments of glass,

but it would still allow of the escape of steam and water. Another

method is to surround the gauge with a metal casing, in front of which

is inserted a window of plate glass to permit of the gauge being

visible. A man of considerable experience suggested to me that this

metal casing should be left open at the back, so that, in the event of

the water-gauge glass breaking, the force of the explosion would be

sent backwards. Too frequently no safeguard has been provided, but men

occasionally devise means of protection themselves.

SIMEON SNELL.

CHAPTER LIX

MISCELLANEOUS TRADES

_Silicate of Cotton._

The name silicate of cotton is misleading, for the manufacture of this

substance has nothing whatever to do with cotton. It is a fleecy,

white substance, hence the name. The danger in its manufacture is not

from dust but from fluff of a metallic nature. Silicate of cotton is

made from the refuse basic slag of ironworks. It is manufactured in

Middlesborough, Redcar, Skinningrove, Hazlehead, etc. It is a small

industry, and gives employment to very few people. The process of

manufacture is simple. It consists in allowing a small, thin stream of

molten slag to flow in a special direction, so that at a particular

spot the stream is met by a strong blast of steam blown through a

narrow pipe. Very minute particles of slag are thus formed, which are

driven with great velocity into a collecting chamber in which no person

could stand at the time. The small particles of slag are extremely

viscous, and as they are blown through the air with very great velocity

and meet resistance they become drawn out into very fine filaments

like cotton wool, and fall to the ground as a loose, spongy material,

not unlike snow or very fine spun glass. The material is then known as

silicate of cotton, or slag wool. It contains the ordinary constituents

of slag, viz., silica, lime, alumina, with a small percentage of

iron and magnesia, etc. As it is a non-inflammable material and a

non-conductor of heat, it is used for packing the pipes that come away

from steam boilers, and for laying between floors to deaden sound, etc.

The danger to the health of the workmen lies in the inhalation of the

fine filaments of slag wool, for they are extremely light, and this

occurs mostly during the act of packing the silicate into bags. At this

time the filaments are apt to get on to the skin and to adhere to the

clothing, particularly where it meets the skin. On account of their

sharp needle-like form they cause considerable irritation and induce

an itchiness of the skin which is extremely trying, for it endures by

night as well as by day, robbing the individual of his sleep, and as

he is likely to scratch himself, the inflammation of the skin leads

to eczema. Beyond this itchiness or pruritus, the Dangerous Trades

Committee, whose description of the process of manufacture I have

largely reproduced, did not find anything in the trade that could be

considered prejudicial to health. The industry had been previously

inspected by Mr Edward Gould, now Deputy Chief Inspector of Factories,

but he did not observe anything in the occupation to cause it to be

regarded as really dangerous. Yet it is scarcely an industry for

growing lads to be sent to, as they seem to suffer more than men,

probably on account of being more impatient under the influence of

pruritus, and being less able to bear the effects of loss of sleep from

it. The working shifts ought to be short, and the men when engaged in

packing the slag wool ought to wear a veil or respirator. As it is

desirable to cover the ears, nose, and eyes, a loose gauze or muslin

veil is preferable. The men ought not to enter the chamber into which

the slag wool has been blown until the atmosphere has become clear,

through the settling down of the fleecy filaments.

_Upholsterers’ Occupation._

As the work of the upholsterer is largely concerned with the

manipulation of feather, flock, hair, etc., the subject is indirectly

dealt with under Shoddy and Rags. The dust is provocative of

respiratory troubles. If the rags, feathers, and hair have not been

previously cleaned, the dust not only causes bronchial irritation, but

may be the means, owing to morbific germs adherent to these products,

of causing infectious diseases such as smallpox and erysipelas, and

such intestinal derangements as vomiting and diarrhœa.

The manufacture of mattresses is an unhealthy occupation, for the

dust that escapes from wool and horsehair during the operation of

carding often causes cough, difficulty of breathing, and retching,

and if these have not been previously sterilised, the dust may cause

blood-poisoning. Ramazini alludes to the ill-health of the Jews in

Italy who undertook this work, and to the fact that they became

emaciated.

Mattresses that have been lain upon by persons who have died of

infectious diseases occasionally find their way into third-rate

upholsterers’ shops, where their contents are picked and mattresses

are re-made. It is very dusty work when the picking is done by hand,

and besides, there escapes an unpleasant, sickening odour which causes

headache and a feeling of malaise. When mattresses have become fouled

in places by discharges from patients suffering from infectious

diseases, considerable risk is incurred by those who by hand teaze the

contents of such bespoiled bedding.

A short while ago a Commission in France dealt with the subject of

the cleansing of bedding. It reported that used mattresses often

harboured the germs of smallpox, scarlet fever, measles, diphtheria,

and typhoid fever. Before any old mattress is picked, it ought to be

exposed to a very high and dry temperature, say 100° C. or 212° F.

Woollen and other flock materials should be previously exposed to

superheated steam and afterwards to sulphurous acid vapour, which can

be got from burning sulphur. In ordinary medical practice, particularly

in large towns, many of the municipal authorities not only provide

the means for sterilising, but require that the bedding that has been

used in infectious cases shall be disinfected. It is desirable in the

interests of the public that the Sanitary Authorities should also offer

facilities to furniture dealers for the disinfection of second-hand

mattresses, and that upholsterers who re-make these mattresses should

not be allowed to have their contents picked by hand until they

have been dry stoved. Cardage by machinery is fortunately replacing

hand-picking, but in places where hand-picking is still carried on

the workers should wear respirators, and the ventilation so arranged

whereby the dust may be carried away from them.

From _feathers_ dust of a suffocating character is also given

off. Sometimes it induces ophthalmia, also diseases of the bronchial

tubes and lungs, but as feathers can be very readily disinfected by

means of steam, and the industry is a small one and offers work only at

irregular intervals, the number of people who actually suffer in health

from feather dust is not large.

_Joiners and Carpenters: Workers in Sequoia Wood._

The occupation of joiners and carpenters is on the whole healthy.

Beyond a greater amount of exertion required in some branches of

the trade than in others, and greater exposure to the weather, the

industry calls for very little consideration here. The removal of

timber in dockyards is heavy work, but it is undertaken by labourers.

A few years ago, when sawpits were more in use than now, the act of

sawing imposed a considerable strain upon the men, and as the sawpits

were often out of doors or at the best very imperfectly covered, the

sawyers often suffered from rheumatic affections, bronchitis, and

asthma. Thirty years ago, before machinery had so generally supplanted

hand-sawing, sawyers occasionally came to the Newcastle Infirmary

suffering from disease of the aortic valves, and presenting such other

signs of cardio-vascular degeneration as are found in men whose work

is hard, and who have been exposed to all kinds of weather. Beyond

the large but diminishing number of surgical accidents caused by

the circular saw, the use of this implement, especially when acting

upon soft wood, cannot be regarded as the cause of ill-health to men

employed in the joiner’s shop.

Carpenters are said to suffer from contracted tendons of the hand,

owing to the protracted use of the chisel, and in men who plane much

the hands become enlarged. As these workmen stand on their feet all day

they run the risk of suffering from hernia and varicocele, but I am not

disposed to admit that their liability to these affections is very much

greater than in men in other trades, nor have I noticed to any extent,

in turners, the depression of the left shoulder, the bulging of the

shoulder-blade, and protrusion of the left hip, through the individual

throwing the weight of his body upon the left leg when at work, to

which some authors allude as of common occurrence.

_Sequoia Wood._--A short while ago my attention was directed by

Sir James Russell of Edinburgh to a series of symptoms said to be

experienced by joiners when working with sequoia wood. To Councillor

Telfer of the same city I am indebted for a short account of the

supposed effect of the sawdust on those who saw and chip the wood, also

for samples of the sawdust. The symptoms produced resemble those of a

bad cold in the head and chest. There is a running at the nose, with

frequent fits of sneezing, irritation in the throat and chest, followed

by coughing, laboured breathing and quickened pulse, and later on by a

sense of oppression at the pit of the stomach and a smarting sensation

in the eyes. The symptoms usually last for only twenty-four hours, and

are especially pronounced in men working for the first time with the

wood. By next morning the unpleasant symptoms just described have, as a

rule, disappeared. A kind of tolerance comes in time to be established,

although in the case of men who are the subjects of asthma and throat

affections, their experience is painful and the effects enduring. I

am informed that if a splinter of the wood penetrates the skin to

any depth the wound almost invariably suppurates. The sequoia tree

is a conifer, and is found in California. It requires a good deal of

moisture, grows well in fog, which is said to be essential to its life,

for on passing through the fog belt into clearer air no sequoia trees

are to be found. It is a wood not unlike mahogany in appearance, and

is used for house panelling. Dr R. A. Bolam and myself have examined

sequoia sawdust both chemically and microscopically without finding

in it anything definite to explain the symptoms attributed to working

with the wood. It can be kept mixed with water without giving an acid

reaction. I covered the floor of a rabbit’s hutch with sequoia sawdust

instead of ordinary sawdust, but the rabbit confined in the cage,

although thus exposed to it for several weeks, took no harm. Rats, on

the other hand, seemed susceptible to sequoia sawdust; they suffered in

a few instances from running at the nose. That the dust of some kinds

of wood are more irritating than others has long been known. Rosewood,

for example, has had a bad reputation in this respect. The presence

of a large amount of inorganic matter in wood causes the sawdust to

be much more irritating than that obtained from wood in which such

inorganic matter is, comparatively speaking, absent.

_Manufacture of Celluloid._

In the manufacture of _celluloid_ two risks are incurred: (1) fire, and

(2) inhalation of harmful vapours.

Celluloid is a complex product formed from pyroxiline, camphor, and

alcohol. It was invented by an American named Hyatt in 1869. When

rolled and compressed after having been very gently heated, it forms

a hard, elastic, transparent substance, capable of taking a beautiful

polish, and as various pigments can be added to it, celluloid can be

made to resemble coral, ivory, ebony, malachite, etc. Heat quickly

softens it. If brought into contact with a naked light it is readily

ignited, producing a smoky flame and a disagreeable camphor-like odour.

Several explosions and burns have been known to occur when hairdressers

have been using celluloid combs in close proximity to a naked light.

Celluloid is used for making billiard balls, knife and umbrella

handles, combs, frames for eyeglasses, also washable imitations of

linen,--for example, American cuffs and collars, etc.[179]

One of the principal dangers in regard to using celluloid is fire. No

naked lights, therefore, should be allowed near at hand, nor should

there be any open hearths where celluloid is being manufactured or

stored. Should celluloid by any chance become ignited, sand and water

will extinguish the fire.

There are also dangers incidental to its manufacture. Pyroxiline is

prepared from vegetable cellulose by treating it with nitric and

sulphuric acids. Apart from the burning accidentally caused by these

acids, the workpeople breathe while in the factory an atmosphere

charged with nitrous vapour, which causes cough, a feeling of

suffocation followed at times by bloody expectoration and signs of

pulmonary congestion. No mixing and pounding of the celluloid should be

done in open tubs, but in hooded receptacles, so that the irritating

fumes are carried away from the workmen. Gloves ought to be worn. No

young person should be employed in the industry.

_Tobacco and Cigar Manufacture._

Medical opinion is divided as to whether the manufacture of tobacco

and cigars really exercises any injurious influence upon the workers.

As far back as 1846 this subject was carefully investigated by Dr

Melier at the request of the Academy of Medicine of Paris. In the

manufacture of tobacco for smoking it is generally conceded that during

the chopping up of the leaves and their subsequent exposure to a high

temperature in shallow vessels, certain fumes are given off that are

obnoxious to the workmen engaged in this operation, also that during

the grinding of snuff irritating gases and dust are evolved. Apart

from these, however, the industry is on the whole a healthy one. Some

people have an idiosyncrasy which causes them to be easily affected

by tobacco. New hands on entering a tobacco factory for the first

time often experience a good deal of nausea, headache, and giddiness,

and they sometimes too have a sense of faintness, but by degrees

they become accustomed to the odours. At the Newcastle Dispensary I

am occasionally consulted by female tobacco-spinners on account of

persistent headache, nausea, dislike to food, anæmia, and muscular

feebleness. I have never observed the transient loss of sight nor

the pharyngeal catarrh alluded to by some writers. Melier held the

opinion that working in tobacco arrested tuberculous disease, but

this is simply an opinion, and is uncorroborated by the experience of

others. Poisson and Eulenburg take the opposite view, and maintain that

tuberculosis is a very frequent disease indeed in tobacco workers,

especially in females. In the lungs of tobacco-workers, both at home

and abroad, there have been found pigmentation and patches of brown

induration. Similar lesions have been observed in the lungs of animals

experimentally exposed to tobacco dust; but at the best these changes

in the human subject must be regarded as of extremely rare occurrence,

and are more than likely due to the inhalation of vegetable and

mineral dusts which dry tobacco often contains. Given a healthy man or

woman, and a well-ventilated factory provided with the proper means

for removing dust and foul air, there is nothing in the manufacture

of tobacco or in the making of cigars to cause the occupation to be

regarded as one very prejudicial to health. Anæmic girls and those

with an idiosyncrasy to tobacco are not good subjects. As to the work

causing excessive menstruation and producing sterility, confirmation

is required; and the same remark applies to the supposed frequency

with which pregnant tobacco-workers and cigar-makers are said to

miscarry. In _Poisons Industriels_, p. 201, it is stated that the

midwives who attend the female tobacco-workers of the Rue Jean-Nicot

in Paris often remark upon the readiness with which pregnant cigar and

cigarette makers abort, and that the only way by which it is possible

for a pregnant tobacco-worker to carry her child to term is to give up

her employment for the time being. It is also stated that the infants

are either born dead or die soon after birth. Out of 100 pregnancies

in female cigar-makers, Dr Jacquemart observed 45 miscarriages.

Personally I do not attach much importance to these statements, nor to

that regarding infants suckled at the breast, who are said to suffer

from colic after a meal, and to die from inanition. In Madrid infants

are taken at certain hours of the day to the large cigar factories

to be suckled by their mothers. While I am far from countenancing

the practice, I must admit that, having examined as many as 30 and

40 infants being thus fed at a time, the children looked plump and

healthy; so, too, did the mothers. Tobacco is not an emmenagogue. Its

abortifacient properties, it seems to me, have been exaggerated; and in

this I am supported by Poincaré, and also by Ygonin, who found in 750

female cigar-makers that miscarriages were by no means more frequent

than in women engaged in other occupations.

The subject of amblyopia or loss of vision in tobacco-workers is dealt

with in another part of this book by Mr Simeon Snell.[180]

An interesting contribution to the subject of the manufacture of

cigars, from the social and hygienic standpoint, appears in the

_Economic Journal_, December 1900, from the pen of Miss Grace

Oakeshott. It is the result of an inquiry undertaken by the Women’s

Industrial Council. Smokers need hardly be reminded that two kinds of

cigars are made, the machine or moulded, and the handmade cigar, nor

is it necessary to do more than mention the superiority of the latter

over the former. A woman requires rather a long apprenticeship, nearly

five years, before she becomes an adept in making handmade cigars.

Miss Oakeshott had several opportunities of coming into close contact

with female cigar-makers, from whom she learned that they themselves

believe there is nothing in the work that is unhealthy nor in any way

trying to an ordinarily healthy woman. The occupation is decidedly

sedentary, and it is more than probable that the women sit too long. As

to a supposed protection to the workers from epidemic disease afforded

by tobacco, I am not in a position either to support or contradict the

statement. I doubt it. In 1862 a Parliamentary Report was published on

the tobacco manufactories of Lancashire. It dealt especially with the

female workers in Liverpool. The medical men gave it as their opinion

in the report that tobacco had no permanent effect upon the health

of the workers, and that “though at first the women were attacked by

sickness and faintness due to the smell of tobacco and to insufficient

ventilation, they soon grew accustomed to this, and that, moreover, at

the time of a cholera epidemic the cigar-makers in the town were free

from the disease altogether.”

Women, taken all in all, are slower cigar-makers than men. Men will

make from 800 to 1270 cigars in a week, and women from 400 to 800, and

yet it occasionally happens that a woman who is an exceptionally quick

worker will beat the best male worker. The cigar trade is one that

requires deftness and skill in manipulation, and as both of these are

possessed by women’s fingers, the occupation is one particularly suited

for women. The work is neither hard nor laborious; it is quiet, and on

the whole it is well paid.

_Engine-Drivers and Railway Employés._

What strikes one most in dealing with the subject of workmen employed

on railways is the large number of accidents that befall them. It is

a general opinion that engine-drivers are a healthy class of men. The

records of their Insurance Societies show this, and medical experience

confirms it. The wages that drivers receive enable them to buy good

food. As they have few opportunities of getting much physical exercise,

several of the men become rather obese. My own professional knowledge

of engine-drivers is limited. Most of those whom I have had medically

to deal with have suffered from acute inflammatory affections of the

chest, or from dyspeptic troubles due to their long and irregular

hours, their long journeys, and lengthened absence from home. These

irregularities oblige drivers and firemen to take with them on the

engine food already cooked, and often to eat it when they can. Their

duties are of an anxious nature, and are accompanied by a considerable

amount of nerve tension, which may cause them to break down in health.

Dr Alexander Scott, of Glasgow, at the meeting of the British Medical

Association at Cheltenham, August 1901, expressed the opinion that most

of the accidents on the line are the result of nervous tension on the

part of railway servants. He cited instances of signal-men becoming

paralysed through fear, and of experienced engine-drivers losing their

head and suffering from temporary mental aberration. Nervous tension

causes headache, weariness of brain, and sleeplessness. Whether it

is in consequence of this nerve strain that engine-drivers as a

class suffer more frequently from diabetes than men engaged in other

occupations, I am not prepared to say. Dr Atkinson, of Crewe, states

that engine-men are usually long lived, but that they are subject to

bronchitis in winter, while their common complaints are indigestion,

varicocele, and varicose veins, the latter in consequence of their

prolonged standing. Out of 4000 men employed at Crewe, not more than 6

die annually from phthisis.

Through the kindness of Dr Atkinson, of Crewe, I have been furnished

with the Annual Reports of the London and North-Western Railway

Insurance Society for Drivers and Firemen for the last six years. The

average number of men in the society has been 10,817. The average

annual number of deaths during these six years has been 91, and the

average annual number of deaths from accidents 9.6; that is to say,

one-tenth of the deaths is due to accidents received when at work.

On looking over the causes of death, it is noticed that the largest

number of men die from old age, and that pneumonia, heart and kidney

diseases, also the combined influence of these two latter, carry off

by far the next largest proportion. I am struck, however, by the

number of deaths from diabetes. They vary from one to four per annum;

no age period is spared, but the maximum rate of mortality is above

fifty years of age. More of the men die from pneumonia than phthisis,

probably in consequence of exposure. Dr Atkinson concludes a letter by

remarking that drivers and firemen “are very long lived and healthy,

and fewer of them suffer from hernia than the public generally.”

Stokers are said to suffer from pulmonary anthracosis, a form of

consumption like coal-miners’ phthisis, but I am doubtful of the

prevalency of this ailment among stokers, just as I am of their

becoming deaf owing to the soundings of the whistle. Men employed in

the sheds cleaning the engines with soda and potash often become thin

and anæmic, but if they are given outside work they rapidly regain the

appearance of health.

_Labourers_ on the railway employed to look after the transport

of living cattle, or who have to handle the carcases of dead beasts,

skins, and hides, run the risk of contracting blood-poisoning. As

the identity of human and bovine tuberculosis has recently been

disputed by Koch, the following fact is of considerable importance.

Two labourers employed on an American railway to clean and repair cars

used for transporting cattle, suffered from local tuberculosis of the

skin, following a slight injury to the hand caused by a splint of

wood. One of the men died a year afterwards from tuberculous disease

of the lungs. There is every reason, therefore, why infected cattle

and carcases should not be allowed to be carried by rail. In our own

country we know how often anthrax has been traced to the importation

of diseased hides and infected hair (see “Anthrax”). While people may

thus become infected, not only on the railways but in the factories,

it is absolutely necessary that diseased cattle should not be allowed

to travel either by road or rail. In the event of infected animals

having been conveyed by rail, complete disinfection of the waggons

is an absolute necessity. This is sometimes done by washing out the

interior of the waggons and brushing them with quicklime. Superheated

steam is by many believed to be better than antiseptic solutions, for

if these are to be of any service they must be used strong. Pasteur

taught that all disease-causing germs were destroyed at a temperature

of 110° C., or 233° F., and that moist heat is superior to dry. A few

minutes’ exposure to superheated steam kills even the most resistant

microbes, so that where vehicles have been employed in the transport of

infected cattle, patients suffering from enteric fever, and in warfare

of soldiers with discharging wounds, disinfection should be resorted to

immediately after discharge of the cargo.

(For further remarks on disinfection, see article “Anthrax,” p. 642).

_Drivers of Public Vehicles._

Drivers of public vehicles suffer and become prematurely old in

consequence of their exposure to inclement weather, late hours, and

irregularity in getting their meals. Alcoholism and exposure to cold

are responsible for their tendency to develop gout and rheumatism, and

through these disorders to secondary affections of the kidneys, heart,

and respiratory organs. They die at the rate of 1482 to 1000 of the

male population generally.

_Cooks._

The average age at death of cooks is fifty-four years. Heat affects

cooks differently; some become extremely stout and unhealthy looking,

while others, in consequence of the heat, working in cellar kitchens by

artificial light, and deprived of the fresh air, become pale, suffer

from headache, lose their appetite, and have occasional bleedings

at the nose. Many of them suffer, too, from varicose veins, owing

to standing so long on their feet. Others suffer from eczema of the

hands. Subterranean kitchens are bad from a hygienic point of view.

Every kitchen should be well ventilated and have good daylight. The

introduction of gas stoves into kitchens has not improved matters.

They are very convenient, but ventilation is interfered with, and

the atmosphere is liable to be contaminated when the gas stoves are

not provided with adequate means for carrying off the products of

combustion. Often, too, the indiarubber tube that carries the gas emits

an unpleasant odour. The tube may become cracked, allowing coal-gas

to escape, and as arsenic has been found in some indiarubber tubes,

this substance may enter into combination with the gases that are of

themselves harmful, and thus further help to undermine the health of

those working in the kitchen.

_Confection Makers._

Confection makers suffer from caries of the teeth, and from ophthalmia

and headache, and from the effects of great heat.

_Domestic Servants and Housemaids, etc._

Domestic servants in well-to-do and upper middle-class families are

not unhealthy. They are well fed, but either do not get or take as

much open air exercise as they ought. It is in the maid-of-all-work,

and in servants employed in the smaller houses where there are large

families, and in lodging-houses, that we find the worst indications

of the effects of domestic service. The sleeping accommodation for

servants, even in large houses, is not always as good as it should

be. Their rooms, which are at the top of the house, are small, badly

lit, often without a fireplace, and therefore badly ventilated. Their

hours of toil are long, and the demands made upon domestic servants

are numerous, often exacting, and frequently protracted well on into

the evening. Small wonder that, owing to their deprivation of fresh

air, the monotony of their work in many instances, the conflict of

tempers, and the imperfect food obtainable in poorer families and

lodging-houses, many young women break down in health, become anæmic,

suffer from headache and derangement of the digestive and pelvic

organs. There is one illness domestic servants seem to be very prone

to, and that is ulcer of the stomach. It used to be stated in medical

text-books that cooks were more liable than any other class of female

servants to ulcer of the stomach, a circumstance that was attributed

to their frequently tasting very hot foods. My own experience at the

Newcastle Infirmary is that housemaids suffer in at least as large a

proportion as cooks do from ulcer of the stomach, but why I cannot say,

unless it be that as a class they are more anæmic, and anæmia is a

predisposing cause to gastric ulcer. It is an opinion held by several

asylum physicians and others, that domestic servants form a very large

percentage of the inmates of asylums. I have taken pains to ascertain

the facts upon which this opinion rests, by applying to Dr McDowall,

of the Northumberland County Asylum, and to Dr Calcott, of the

Newcastle-upon-Tyne Asylum at Cox Lodge. The total admissions of women

into the Northumberland County Asylum for five years, 1886 to 1890

inclusive, were 415. Of these, 48, or 11.3 per cent., were domestic

servants, 15 were housekeepers, and 189 housewives, by which is usually

meant married women. The area from which these patients are drawn is

agricultural and mining. Taking outdoor work as a healthy but often

badly paid occupation as a contrast, I find that 11 field-workers were

admitted as against 48 domestic servants. Dr McDowall does not think

“there is an excessive amount of insanity among domestic servants.”

It is only right to add that in addition to the above there were 101

females admitted classed under “no occupation,” and that many of these

were young women who were at home and helped in housework.

The Newcastle-upon-Tyne Asylum, on the other hand, draws its patients

from the city, where the typical domestic servant is more likely to

be found than in the districts that supply the County Asylum. Dr

Calcott has been good enough to send me a table showing the occupation

of female patients received into the Newcastle City Asylum during

the past twenty years, and embracing 1000 cases. The following is

the percentages:--Housewives, _i.e._ married women, widows, and

daughters acting as housekeepers to fathers, brothers, and relatives,

47.7 per cent.; domestic servants, 14.60, or, including women keeping

house for artisans, 2.03, a total percentage of 16.63. This is a large

percentage for domestic servants compared with 0.46 for shop girls.

The Whittingham Asylum, near Preston, Lancashire, draws patients from

a different class of occupations to those in Newcastle. I find in the

Report of that Asylum of 1899, that there were 196 females admitted

during the year. Of these, 26 were domestic servants; housekeepers and

housewives numbered 102, contrasted with 24 mill hands and factory

operatives. Next to housekeepers, which includes married women,

domestic servants stood highest in the list of admission.

“Housemaids’ Knee” is an inflammation of the bursa in front of the

knee-cap, and is caused by pressure and friction.

_Barmen and Dealers in Alcoholic Drinks._

Publicans and licensed victuallers are notoriously a short-lived class.

The modern tendency of brewers to buy out the smaller publicans and to

form “tied” houses is causing the older type of landlords to disappear,

and is replacing them by men often drawn from an inferior rank of

life. In large industrial centres the men who are placed in charge of

bars or who take over public-houses for themselves have frequently

been previously engaged in the ordinary trades of the district. As

subsequent events too often show, the life adopted, however gilded it

may appear, is attended with considerable danger. The occupation of

the publican is sedentary. Without any exercise in the open air, his

long day is too often spent in an atmosphere reeking with the odour

of spirits, tobacco smoke, and emanations from the men and women who

lounge at the bar; and this, coupled with the numerous temptations to

drink, and his irregular meals, sooner or later induces structural

alterations in the liver, lungs, and heart, that bring life to a

premature close. According to Ogle, innkeepers and publicans have a

comparative mortality figure of 1521 as against 1000 of the general

population, an unenviable position, which is corroborated by the

statistics of the Scottish Amicable Insurance Society, which show

that dealers in intoxicating drinks have a mortality of 68 per cent.

in excess of the Actuaries’ or healthy Male Tables, and 49 per cent.

in excess of the English Life Tables. The mortality is 51 per cent.,

roughly speaking, above that for all males. In no other class of men,

as might be expected from the opportunities offered, is the mortality

from _alcoholism_ so high as in innkeepers and publicans. It is

from five to seven times higher than the average. The only occupation

that approximates to it from a mortality point of view is that of

cabmen. There is a belief that the mortality among publicans from

alcohol is diminishing, but Dr Tatham’s statistics for 1890–92, which

appeared in the _British Medical Journal_ for January 1898, do

not confirm this. Some barmen, it is true, are teetotallers, and many

are extremely temperate, but all are living under conditions of great

temptation. The dangerous nature of the occupation lies not so much

in the fact that barmen may get repeatedly drunk and run the risk

of delirium tremens, but in the opportunities that are offered of

continually nipping. It is the frequent nipping, begun early in the day

and continued through it, often without food and an increasing distaste

for it, that slowly undermines the physical and mental health of the

publicans, is the cause of the large number of suicides among them, and

of the large number of barmen that are carried off by cirrhosis of the

liver and kidney disease before they reach the age of forty.

Working brewers are also unhealthy. They have, according to Ogle, a

mortality figure of 1361 as against 1521 for publicans, but while they

present a lower mortality figure and greater freedom from alcoholism,

they have a higher mortality from heart and lung diseases, especially

consumption, a circumstance which is attributed to their greater

exposure to varying temperatures and to wet, their figures for phthisis

being 334 as against 295 for publicans. Brewers and their assistants

are more liable to accidents; these, like all alcoholic subjects, they

bear badly. Dr Tatham’s statistics are more recent than Ogle’s, and

they show that all occupations connected with the liquor traffic have

even a higher mortality rate than those furnished by previous decennial

reports. The figures are for brewers 1427, innkeepers and publicans

1642, and for inn and hotel servants, 1725. Taking 100 as representing

the mean mortality among all occupied males for each of the subjoined

causes of death, the comparative mortality figures for publicans,

innkeepers, and their servants are 723 from alcoholism, 600 from gout,

271 from diabetes, 644 from diseases of the liver, 210 from urinary

diseases, and 207 from suicide.

_Sewing-Machine Workers._

If seamstresses and tailors in days gone by suffered, in consequence

of plying the needle for many hours a day, from contracted fingers

and rheumatic swellings of the joints; and tailors, owing to their

cross-legged position when at work, from atrophy of the muscles of

the limbs, bandy-legs, and deformities of the chest, the introduction

of the sewing-machine about 1855, while removing these evils, was at

first believed to have introduced others of its own. To sit working a

sewing-machine, as thousands of anæmic women in this country are doing

six days in every week, is to aggravate the physical conditions upon

which their bloodlessness depends, to court neuralgia, and to encourage

lethargy of some of the eliminating organs, but beyond exaggerating

certain functional disorders, I do not think that to working the

sewing-machine can be traced any real organic disease. It has been

asserted that the vibration to which the spine is subjected is a cause

of spinal-cord disease, and of such a disorder as locomotor ataxia.

There is no truth in this statement. I know of no instances, nor is it

likely that the jolting of the spine could cause locomotor ataxia any

more than the movements of the knees induce disorders of the genital

organs and encourage immoral practices, which some medical men claimed

for the sewing-machine on its introduction. The one statement is just

as unfounded as the other. Working the sewing-machine too long may be

followed by muscular cramps, and even by loss of power in the limbs,

due to irritation of the flexor and extensor muscles of the legs. The

principal effects, however, are vague muscular pains in the limbs and

loins, and a sense of fatigue, but I question whether these pains are

more pronounced in sewing-machine workers than in shop girls and women

who are doing other kinds of work. It is a sedentary occupation, but

given a good constitution to start with, well-ventilated workrooms, and

not too prolonged hours of toil, coupled with such open air exercise

as a reasonable walk twice a day, between the home and the workroom,

provides, along with good wages to get sufficient food, it cannot be

said to be unhealthy. Women, recognising that the work is sedentary,

ought themselves to take the necessary means to keep the bowels open,

for obstinate constipation is not only a cause of anæmia, it ladens the

blood with impurities that induce headache, the too frequent recurrence

of which obliges the individual to give up her employment.

_Label-licking._

In thread mills young girls are often employed to put labels on the

bobbins. This they do by licking the labels, and as a consequence

children are known to have suffered from swollen submaxillary glands,

as reported in 1895 by Miss Anderson,[181] Principal Lady Inspector

of Factories. This unwholesome practice is not confined to thread

mills, it prevails in many industries in which small packets are

being labelled for sale. The work is generally given to young persons

and children. It is undertaken, therefore, at an age when growth is

active, and the system is in need of all its digestive juices. The

practice entails an enormous loss of saliva daily. Quite apart from

this circumstance weakening the digestive functions, there is always

the risk of the coloured labels containing, as Professor Thorpe’s[181]

analysis showed, copper and lead. Besides, there is the risk that the

adhesive part of the label owes its sticking properties not to gum,

but to substances of an animal nature, such as serum, to the presence

of which have been traced some minor forms of blood poisoning, and the

painful affection known as “stamp-lickers’ tongue.” As a consequence

ulcers in the mouth sometimes develop, and from these ulcers poisonous

material is absorbed and carried by the lymphatics to the glands

underneath the jaw, setting up an acute inflammation or adenitis.

Stamp-lickers’ tongue is an infective process which generally yields to

antiseptic treatment, such as a weak carbolic, boric, or hyposulphite

of soda mouth-wash. It is not so generally known as it ought to be,

that the licking of stamps may be followed by tubercular disease. The

following fact is therefore worthy of being more publicly recorded. Dr

Busquet,[182] a surgeon-major in the French army, and engaged in the

Bacteriological Laboratory attached to the military hospital at Dey,

in Algiers, received into the hospital a young soldier far advanced in

tubercular disease of the lungs. He was a collector of foreign stamps.

Unused stamps he generally fixed in his album by licking them. In

order to test some stamps, Dr Busquet bought three hundred for his

patient, many of which were for the purpose of exchange. These stamps

were placed in sterilised water. At the end of twenty-four hours,

Busquet inoculated guinea-pigs with the water. Of eight animals thus

treated all became tuberculous, and at the post-mortem examination

they showed various tubercular lesions in their internal organs.

School boys and girls form the larger number of philatelists, and as

they often wet the stamps with their tongue the danger incidental to

this practice is apparent. What has been said of foreign stamps may

not apply equally to label-licking, and yet labels are often lying

about in a factory exposed to the dusty atmosphere of the workroom in

which microbes of disease are known to abound. We cannot always be

sure too that the solution of gum was sterile to commence with, and

that it was spread upon the labels by healthy persons. There is no

wish to exaggerate the importance of microbes in causing disease; all

that is here insisted upon is that label-licking is an unhealthy and

an unpleasant occupation, one that can be better and just as cheaply

done by mechanical contrivances than by wasting children’s saliva.

That large quantities of saliva are used up in the process is shown by

the fact that half-timers will lick as many as forty to fifty gross of

labels in one day, and an adult woman as many as ninety gross. Where

factory owners have introduced the use of dampers, they have found that

by such artificial means the fixing of labels on bobbins can be just as

expeditiously performed.

_Glass Manufacture: Glass-Blowing._

The manufacture of glass is a very old industry. The Egyptians made

glass more than 4000 years ago. Probably they learned the art from

the Phœnicians or Jews. When Rome was at its zenith the number of

Jewish glass-makers was so great that a special quarter of the city

was set apart for them. These men turned out beautiful works of art,

as the specimens in the Vatican and the British and French Museums

show. Glass is supposed to have been introduced into England in the

year 676 A.D., but the first glass works in London were not

established until 1557. Two centuries ago Lancashire led the way in

making plate glass. British sheet glass began to be made in Birmingham

in 1832. So far as plate glass for mirrors and windows is concerned

the British-made article is bad to beat. St Helens in Lancashire

is the home of the manufacture of this particular kind of glass,

which is composed of sand, soda salt, lime, felspar (quartz), and

occasionally red lead and black oxide of manganese. These when melted

together form a silicate, the sand supplying the silicic acid. Boric

can be substituted for silicic acid. These substances are all fused

together at an extremely high temperature in circular furnaces, with

several small openings through which the workmen, wearing blue-tinted

spectacles, can view the molten mass. Boys dip the end of a long hollow

iron tube into the lake of molten material and, removing a _blob_

on the end of the tube, take it to the men standing close by, who blow

down the iron tube and cause the glowing mass to become globular. They

fix and regulate the shape of the globe by occasionally rolling it on a

small iron table. As the mass at the end of the iron tube cools further

expansion of the glass by blowing becomes impossible, and so it becomes

necessary to again replace the unfinished product at the end of the

rod in the furnace. This is in time removed and again blown, restored

to the furnace and manipulated until a completely finished article is

evolved. This has still to undergo a process of annealing or toughening

so as to prevent it cracking or breaking readily. The process consists

in again exposing the glass to a high temperature, gradually raised

and just as gradually lowered. Frosted glass is made by forcing a jet

of sand under very great pressure upon particular parts of the glass.

Sheet glass, on the other hand, is formed from a large mass of molten

material adherent to the end of a blow-pipe, which, when it becomes

large enough, is swung round and round in the air until it becomes

oblong. It is then cut and the mass is allowed to fall flat. In order

to flatten it still more the sheet is put into an oven; when rendered

pliable by the heat it is removed and smoothed out by wood. In the

manufacture of plate glass no blowing is required. A pot of molten

glass is carried by a travelling crane to the casting-table, which is

made of smooth iron with an elevated rim. Upon this table the liquid is

poured. By means of rollers the workmen spread the layer out equally

until it is of uniform thickness. After cooling, the glass is annealed

in the manner already described. It is subsequently ground with sand

and water, and afterwards polished with emery or putty powder.

The risks to health incurred by makers of glass are mainly those due

to exposure to excessively high temperatures, _e.g._ bronchial

and pulmonary affections; many of the men die from phthisis. They

bear pneumonia badly owing to their intemperate habits. Dr Scheele,

in the _Berlin. Klinische Wochenschrift_, March 1900, has drawn

attention to what is known as “glass-blowers’ mouth.” Large swellings

like air-cushions can be seen and felt in some glass-blowers, extending

from the angle of the mouth to below the ears. The swellings look like

mumps. They involve the parotid gland only. They crepitate under the

finger, and by pressure can be made to disappear. It is only recently

that these swellings in the cheeks of glass-blowers have attracted

attention, and especially in France. The relaxation of the cheeks, the

_joues casées_ of French glass-blowers, is by some attributed to

a faulty method of blowing. From glass-blowers under my care in the

Newcastle Infirmary I have ascertained that the malady is not unknown

among the men in the works on Tyneside. Dr Scheele found that it was

present in only 2.5 per cent. of blowers, some of whom had worked for

years. In those who had thus suffered the duct that leads from the

interior of the mouth to the parotid gland had become dilated owing

to the repeated entrance of air into it under considerable pressure:

the mucous membrane of the inside of the cheek, too, showed thick pale

patches, _plaques opalines_, which Guinard regarded as the result

of the great pressure and straining the buccal mucous membrane was

exposed to during the act of blowing. Under ordinary forced expiration

the pressure inside the closed mouth is equivalent to from 6 to 9

millimetres of mercury, but in glassblowing it may rise to 90 and even

as high as 110 mm. In the course of an ordinary day a good workman will

blow as many as from 600 to 700 bottles.

In consequence of the strain experienced by glass-blowers other defects

are occasionally observed; one is deafness due to increased internal

pressure in the middle ear, and the other is a painless deformity of

the fingers (_main en crochet_) due to the manner in which the

blow-pipe is grasped.

[Illustration: FIG. 85.--Glass-blower when in normal

condition. (After Dr Scheele, Berlin. Klin. Wochen., 1900).]

[Illustration: FIG. 86.--A later photograph of

Glass-blower in Fig. 85, showing relaxed condition of Cheeks.

(After Dr Scheele).]

Glass-workers are exposed to other dangers. Dr Pröbsting,[183] an

oculist in Cologne, has found that in 12 per cent. of the factory

operatives in Ehrenfield who are upwards of forty years of age, the

crystalline lens of the eye becomes opaque. One of the most frequent

causes of this form of cataract is exposure to the intense heat on the

part of glass-makers, especially the workmen who remove the molten

material from the furnace. Owing to the manner in which they handle

their implements these men generally stand with the left side of their

face towards the furnace. It is generally the left eye that becomes the

seat of cataract. Meyhöfer believes that the excessive perspiration of

glass-makers plays an important part in producing this change in the

lens. A third cause may be the brilliant white light that dazzles

workers in glass, and which, by fatiguing the retina of the eye,

reflexly influences the lens. Mr Simeon Snell’s experience does not

quite corroborate that of Dr Pröbsting.[184]

A new method of making hollow glass ware, _e.g._ tumblers, etc.,

has lately been introduced. The blowing is no longer done by men

exhaling air from their lungs, but by driving in compressed air by

means of machinery. One machine managed by four men and seven boys can

turn out 500 tumblers in an hour, or 5000 in a day, whereas the same

number of operatives working under old methods can only throw off 40

tumblers in an hour. In large glass factories the work often goes on

night and day in double shifts, particularly on the Continent. The

use of compressed air in glassblowing is very desirable, for by its

use many of the ill effects consequent upon the present methods of

blowing would soon disappear. The more frequent wearing of blue-tinted

spectacles by the workmen, too, would tend to lessen the frequency of

cataract.

_Glazed Ware Poisonous from other Causes than Lead.--Cyanide of

Potassium._

The United States Consul at Mayence, in December 1900, uttered a

word of warning to purchasers of silvered glass and porcelain,

which is deserving of notice. In order to apply the silver by the

galvano-caustic method in use, the ware has to be dipped in a bath

highly charged with cyanide of potassium. However carefully treated,

the surface is never perfectly smooth, but conceals innumerable fine

cracks. The cyanide lies in the minute fissures and cannot be removed

during manufacture. As a consequence both the use and the handling of

the ware may be followed by poisonous effects. Cyanide of potassium

contains the well-known poison, prussic acid. Owing to the danger to

health incurred by the workmen and the public, some large firms have

abandoned the manufacture of goods by this process, but the ware is

still exported from Frankfort, Stuttgart, and Berlin. Attempts are

being made to devise non-poisonous methods of plating these goods.

_Coal-heaving, Coal-trimming, and Chimney-sweeping._

Men employed in the first two of the above occupations are much exposed

to the weather and to dust given off during the tipping of coal, while

in the case of chimney-cleaning the sweep is exposed to the effects

of soot that has been formed during the combustion of coal. The men

who perform the rough, heavy labour on quays and staithes, loading and

unloading ships with coal, or who fill sacks with the fuel, are called

coal-heavers, while the men who are in the holds of vessels, shovelling

and distributing the coal therein, are known as coal-trimmers. Usually

the men are well developed and of good physique, but as a class they

are extremely intemperate. On Tyneside they earn good wages, but a

large part of them goes in drink. Owing to the many delays to which

steamers are exposed the work of these men is rather irregular, a

circumstance which does not conduce to steady habits. Beyond the risk

of accidents, and the hard and exposed nature of the calling of the

coal-heaver, there is nothing that is particularly dangerous in it,

if the men themselves are careful. The trimmers when in the further

recesses of the holds of vessels work in a dusty atmosphere, but the

dust readily escapes. On coming out of the holds they often bring up

a black spit, but this is mostly pigmented mucus from the bronchi.

Phthisis and pulmonary disease carry off a large percentage of

coal-heavers and trimmers. It must be admitted that neglect of common

colds, and the indifference to health created by intemperate habits,

are to a large extent responsible for these maladies.

_Chimney sweeps_ form pretty well a social class by themselves.

Their occupation cannot be regarded as a healthy one. To pulmonary,

cardiac, and kidney diseases sweeps are particularly liable. Soot has

a peculiarly irritating effect on the skin. It induces eczema, and

is apt to cause inflammation of the eyelids, hence the “blear” eye

exhibited by many sweeps. Occasionally the soot enters the skin, and

is transported by the cells along the lymphatic vessels to distant

parts of the body. A short while ago the question was raised in the

pages of the _Lancet_, Do coal miners suffer from cancer? In a

paper which I read at the Sanitary Congress in Newcastle-on-Tyne five

years ago, I showed, from statistics of admissions into the Newcastle

and Sunderland Infirmaries and the Durham County Hospital, that coal

miners were anything but exempted from cancer. It is interesting to

note, too, that while coal dust when inhaled is followed only by an

inflammatory reaction in the pulmonary tissue surrounding the entangled

particles of dust, coal when burnt undergoes some peculiar chemical

change, whereby soot has conferred upon it properties of a specially

irritating nature, for only thus can we explain the prevalence of

cancer in chimney sweeps, a disease with which hospital surgeons at

home, particularly in London, have been long familiar. Taking Dr

Ogle’s statistics of the deaths of 242 chimney sweeps, 49 were due to

malignant disease. Expressed in other words, Ogle found that while

among all males in England and Wales between twenty-five and sixty-five

years of age the proportion of deaths from malignant disease was in

the ratio of 36 per 1000 deaths from all causes, it was in sweeps 202.

Reference may here be made to the opinions expressed by Dr Tatham in

this book, _vide_ “Dust-Producing Occupations,” upon the mortality

of sweeps from cancer. His statistics, which are more recent than

Ogle’s, indicate that the mortality from different forms of cancer

amounts to 156, compared with 44, the figure for occupied males in

the aggregate. Chimney sweeps have a liability to cancer eight times

greater than other persons. The disease tends to locate itself in the

scrotum more than in other organs. To this subject Mr Henry T. Butlin,

F.R.C.S., Surgeon to St Bartholomew’s Hospital, has given considerable

attention, and has embodied his experience in a series of lectures

delivered at the Royal College of Surgeons.[185] There is a widespread

opinion that chimney sweeps’ cancer is seldom met with in any other

part of the civilised world than in Great Britain; also, that during

recent years, in this country, it is becoming rarer. Statistics show

that it occurs very infrequently on the Continent. Many French hospital

surgeons say they have never seen a case of cancer of the scrotum in a

chimney sweep. In Vienna during eleven years, 1874 to 1884 inclusive,

only one case of scrotal cancer was reported, and in that instance the

patient was not a chimney sweep. During the years 1878 to 1885 not one

case occurred in the large town hospitals of Berlin, and yet in four

of the large London hospitals in one year, 1884, there were five cases

of chimney sweeps’ cancer admitted; during 1881, into a similar number

of Metropolitan hospitals there were received four patients suffering

from this affection. It is sometimes stated that cancer in chimney

sweeps has practically disappeared in Britain. This is not so. As Dr

Tatham has shown in his article on “Dust-Producing Occupations,” there

has been within the last twenty years a considerable decrease in the

mortality of sweeps from this cause; but that it still claims annually

a large number of victims in this trade is, unfortunately, too true.

During a recent period of twenty years, there were admitted into St

Bartholomew’s Hospital alone 39 cases of cancer of the scrotum, and

of these patients 29 were chimney sweeps. So far, then, as London is

concerned, there are every year in its hospitals one or two cases of

chimney sweeps’ cancer in the wards. In Newcastle it is only rarely met

with.

There is a theory that the supposed decline of sweeps’ cancer is due to

the prohibition of “climbing boys,” to the use of machinery, cleaner

habits of sweeps, and the abolition of passing soot through sieves for

agricultural purposes. That the disease we are alluding to is cancer

there is no doubt. It often commences in the form of a wart or warts

on the scrotum, and as these are very frequently followed by cancer,

what is called the “soot wart” becomes the “soot cancer.” These warts

may exist for years. In many instances they never take on malignant

action at all. The warts are liable to be rubbed and irritated by

the dirty clothes of the sweep and by soot, and in consequence they

become larger and ulcerate, the ulceration extending superficially

along the skin or penetrating deeper into the testicle. The glands in

the groin become enlarged at first from irritation, but ultimately

they assume the malignant characters of the original ulcer. Under any

circumstance, even when the disease is far advanced, death comes but

slowly; emaciation does not progress rapidly, strength is gradually

lost, and the general health is undermined by the profuse and sickening

discharges from the open sores. On post-mortem examination of the

body secondary disease, as might be expected, is frequently found in

the peritoneal cavity, liver, and lungs. On microscopical examination

of the scrotal ulcer the appearances presented are those met with in

epithelioma or squamous cell cancer.

[Illustration: FIG. 87.--German Sweep’s Costume.

(Reproduced with permission of Mr H. T. Butlin, F.R.C.S.)]

[Illustration: FIG. 88.--Belgian Sweep’s Costume.

(Reproduced with permission of Mr H. T. Butlin, F.R.C.S.)]

Although the dirty clothes of chimney sweeps and their want of personal

cleanliness have been regarded as causes of the cancer, there is a

feeling that the real cause resides in the soot itself, for there are

many trades that are as dirty as chimney sweeping, and yet the men

engaged therein do not suffer from scrotal cancer. Gardeners, who have

been in the habit of using soot for the protection of plants from slugs

(see paper by Mr D’Arcy Power, page 237), are known to have developed

cancer in the hand. How soot causes cancer it is difficult to say.

By some pathologists the sulphurous acid present in soot is blamed,

by others, the ammonia compounds. The parasitic causation of cancer

is still only a theory and requires confirmation. At any rate there

is no proof of the existence in soot of a cancerous element. Soot

when repeatedly applied to the skin causes it to become thickened, or

harsh and dry, and just to the extent that it is capable of altering

the structure of the skin, so may it predispose to cancer. The

disease is most rife in chimney sweeps between the ages of forty-five

and fifty. Whether the soot from one particular kind of coal has a

greater influence compared with another it is not easy to say. The coal

that is used for heating dwellings is of four kinds: (1) anthracite

or smokeless coal; (2) hard coal or stone coal; (3) brown coal; (4)

coke, wood, peat, and charcoal are also used. There is very little soot

formed during the burning of anthracite. In England the fireplaces

are open, but on the Continent stoves for heating purposes are more

in evidence. At home there is a much larger quantity of hard or

stone coal burnt in the dwellings than on the Continent, and to this

fact has been attributed the greater freedom of chimney sweeps from

cancer across the Channel. Butlin made extensive inquiries into the

question of chimney sweeps’ cancer abroad, and elicited a good deal

of information as to the personal habits of the men who follow this

particular calling. In Belgium, for example, sweeps are in the habit of

washing themselves to the waist daily, and of washing the whole body

from head to foot once or twice a week. The chimney sweeps of Hanover

wear special kinds of clothes, and after each day’s work they wash

themselves with soap and warm water. In the North German towns several

of the sweeps have baths fitted up in their own houses, and where this

is not the case the fraternity own a bath-house, fitted up with all

the necessary requirements, and to which the sweeps pay a daily visit.

They also wear special garments, and a handkerchief over their mouth.

Swiss chimney sweeps take a bath every evening. In some of the towns

of France the precautions taken in regard to preventing the contact

of soot with the body are not so good. It was found, however, that in

Amiens, Lille, Rouen, etc., the sweeps wore blouses, and that they

washed themselves thoroughly all over once a week. In Paris, sweeps’

cancer is practically unknown. Chimney-sweeping in Paris is relegated

to companies known as _fumistes_ (stove makers, menders, etc.).

One establishment employs 100 men; these men dress in a linen blouse

or jacket buttoned in front, trousers made from the same material,

a coarse shirt and boots. After a day’s work the men take off their

clothes in the workshop, wash, and on reaching home wash themselves

again. Their working clothes are washed once a week.

“Climbing boys” are still employed by sweeps on the Continent for

cleaning chimneys. It is several decades since they were prohibited in

Britain. In the north of Germany, boys from seven to fourteen years of

age are employed for this purpose, and in Belgium Mr Butlin found that

even still younger boys were engaged to do the work.

Workers in tar and paraffin are also liable to cancer of the scrotum,

and men employed in the production of anthracene, which is the last

product of the distillation of gas-coal tar, are specially prone

to suffer from warts and skin eruptions. Distillers of benzine

and creosote suffer in a similar but slighter degree from warts.

Tillmanns[186] of Leipzig, who made an inquiry into the health

conditions of the men employed in the tar manufactories, stone coal tar

distilleries, pine soot, or lampblack factories in Saxony, Hanover, and

Holland, etc., states that “in lampblack factories, and in stone coal

tar factories cancer of the skin and severe dermatitis do not appear to

have been hitherto observed, as in the workers in the brown coal tar

and paraffin industries.”

Having reviewed this subject at considerable length, I reproduce the

conclusions that Butlin arrived at--(1) That it is possible to prepare

the skin for the occurrence of cancer by the constant or repeated

application to it of certain substances during a period of years; (2)

that the nocuous substances in this relation of which we have the most

information are hard or stone coal soot, brown coal tar, and crude

paraffin; (3) that there is evidence to cast grave suspicion on certain

other substances, such as stone coal tar, but that those are far less

to be feared.

In order to prevent the occurrence of this malady in chimney sweeps,

the individual should have his skin protected as far as possible

against contact with the soot, and he ought to have a warm bath daily

after his work. In the special clothing worn by Dutch, Belgian, and

German sweeps, and in their practice of covering the mouth with a

handkerchief, may possibly lie one explanation of their freedom from

the disease compared with English sweeps, while in the use of the daily

bath there assuredly lies protection.

* * * * *

Acts of Parliament relating to the Employment of Boys in the Sweeping

of Chimneys in England:--

_George III._, 28, _chap._ 48 (1788).--To compel the

masters to provide proper clothes for the climbing boys and to

cause the boys to be washed and cleaned from the soot and dirt

at least once a week. Also that the boys shall attend public

worship on the Lord’s Day, on which day they are not to wear

their sweeping clothes. The masters are not permitted to take

more than six apprentices at one time, and no apprentice of less

than eight years of age.

_William IV._, 4 and 5, _chap._ 34–35 (1834).--The age of the

apprentices is not to be less than ten years.

_Victoria_, 3 and 4, _chap._ 85 (1840).--To provide that from

and after July 1, 1842, no sweep under the age of twenty-one

years shall climb a chimney, and that no apprentice of less than

sixteen years shall be taken.

_Manufacture and Use of Emery Wheels._

Emery wheels are used for grinding steel goods, knife and fork

smoothing, etc. A large proportion of the wheels run in this country

are imported from the Continent and from America, but many are

made at home. When serving on the Dangerous Trades Committee I had

the opportunity of inspecting their manufacture in Manchester and

elsewhere. The Departmental Committee was invited to report upon emery

wheels,[187] less on account of danger to health in their manufacture

than their breakage when running at great speed, and of their

splinters, which are hurled with great force, dealing sad havoc in a

crowded factory. The wheels are made from crushed emery stone. Emery

rock,[188] which is imported from Smyrna or from the Island of Naxos,

is an anhydrous oxide of aluminium with a large percentage of flint,

silica, and iron. In Canada a similar kind of wheel is made from a

stone called corundum, which, while quite as hard as emery, is also an

oxide of aluminium. The rock in either instance is crushed by means of

heavy rollers into a very fine powder, which is sifted and then blown

by a fan into a dust chamber, where it is collected. A considerable

amount of dust is generated at this particular stage, but as the

processes are conducted in encased machinery there is little or no risk

to the workmen who superintend the crushing of the rock. Nor did it

appear to me that any risk to health was incurred by the men who built

up the emery wheels. These are made of crushed emery rock, with such

binding substances as shellac, indiarubber, oil, sulphur, and silicate

of soda, all pressed together in a mould under great hydraulic power.

Into some of the wheels brass wire webbing is inserted, so that in the

event of one of them breaking when running there would be less chance

of the whole wheel sundering.

The danger commences during the running of emery wheels, a circumstance

that can be readily imagined when it is known that a small wheel of 3

inches in diameter will often make as many as 7400 revolutions in a

minute, and a large one, 3 feet in diameter, 600.

The Departmental Committee recommended that guards should be used in

connection with the running of emery and corundum wheels. These should

cover as much of the wheel as possible without interfering with the

operations of the workman. During grinding a considerable amount of

dust is given off. A suction pipe and fan should therefore be provided

to draw the dust away from the face of the workman. Mr Archibald

Newlands, H.M. Inspector of Factories, has invented a guard which not

only protects the workmen from portions of broken emery wheel, should

such an accident happen, but is so arranged as to aspirate and remove

by suction the dust that is generated. In addition to the mineral and

metallic dust that is given off during the operation of grinding,

sparks are sometimes thrown off which might injure the eyes of the

workman, hence the necessity for powerful suction.

THOMAS OLIVER.

CHAPTER LX

OCCUPATION DISEASES DUE TO EXCESSIVELY REPEATED

MUSCULAR ACTIONS.

_Fatigue Neuroses: Scriveners’ Spasm, or Writers’ Palsy._

Under the head of occupation or fatigue neuroses it is customary to

include affections characterised by spasm or paralysis of the muscles

which prevent the individual performing certain muscular actions, by

means of which he has hitherto earned his livelihood. The affection is

met with in various occupations, usually, but not always, in those in

which delicate movements--as, for example, those of the fingers--are

required; hence as writing is one of the commonest of this class of

occupations, it occurs as writers’ palsy. Accompanying the spasm or

sudden contraction of the muscles that takes place, there is frequently

pain, but there may be pain without spasm. Gowers, in his _Diseases

of the Nervous System_, speaks of a motor and a sensory, or a

spasmodic and neuralgic, form of scriveners’ palsy. Seventy years ago

the affection was first described by Sir Charles Bell. The infirmity

affects males oftener than females, and the weakness shows itself

mostly between twenty and thirty years of age. While the repeated

muscular movements required in writing become through fatigue the cause

of the loss of power, there are other circumstances in operation,

notably the inheritance of a weak nervous system, family worries, and

financial difficulties. Excessive use of tobacco and intemperance in

alcohol also favour its development. Since over-use of the muscles

is a cause of the palsy, the malady naturally occurs in those people

who earn their living by writing, _e.g._ clerks, copying-clerks

particularly, and it would seem to be caused less by the amount than

by the manner of writing. Steel pens have been blamed for causing

scriveners’ palsy, because they have to be grasped more firmly and

adjusted more exactly than quills. Doubtless the malady has become

more general since their introduction, but the disease was previously

not unknown in persons who only used quills. Besides, the number of

people who are employed as clerks is greater now than formerly, and the

conditions of life have materially altered. Quick writers do not suffer

so much as slow and laborious toilers of the pen, owing to the greater

range of their muscular movements. Sharp-pointed pens are more liable

to cause paralysis than stub-pointed, because they have to be held more

tightly, and require more and finer muscular adjustments.

Once the malady is established, it is when any muscular effort is

made that the defect is observed. An individual, for example, may

feel nothing wrong with his hand until he begins to write, and then

the muscles that control the movements of the fingers are thrown into

a state of involuntary spasm, or there is pain which prevents him

writing. I have at present under my care a schoolmaster whose right

arm is perfectly still, and its muscular movements normal, until he

attempts to write. In the middle of writing a word the fingers will

be unexpectedly thrown into a state of spasm, so that the pen is more

firmly gripped than before, and yet he is unable to lift the pen off,

or move it further on the paper. He has no difficulty in writing on

the blackboard owing to the wider range of muscular movements of the

elbow and shoulder. In scriveners’ cramp there may be, in addition to

spasm and pain, violent tremor, or there may be what is still rarer,

actual paralysis. When the muscles during the act of writing are thrown

suddenly into a state of spasm, the individual is conscious that he

is grasping the pen too tightly, but he cannot help it. Any voluntary

attempt to relax his hold of the pen makes no difference so far as his

ability to finish the writing is concerned. The act is accomplished

slowly: the letters and figures which he makes are irregular, while

the handwriting resembles that which is attempted by a person riding

in a jolting carriage or on the railway. The power of writing may

be lost gradually or quickly. The presence of spasm either prevents

the individual writing at all, or if the spasm is intermittent and

accompanied by tremor, the handwriting is jerky and rather illegible.

It is the attitude assumed by the muscles in the act of writing that

induces tremor, for where no effort is made there are no tremulous

movements. It is an interesting fact too, as showing how the affection

is limited to a distinct group of muscles concerned in a particular

act, that while a person who is the subject of scriveners’ palsy

cannot write, he may be able to paint quite well or even to print

various letters and words. The grasp of the affected hand is usually

unimpaired, or there is just the slightest loss of power. In grasping

the affected hand in scriveners’ spasm, I have noticed that if there is

prolonged contraction of the muscles concerned in grasping, the act is

sufficient to bring on tremor. The muscles of the fingers seem to be

incapable of sustaining any effort without being thrown into a state of

spasm or tremor. If there is any atrophy or loss of muscle substance

it is generally slight. Usually there is very little alteration in

the response of the nerves and muscles to electrical stimulation. In

some persons it is increased, in others it is diminished. The patients

complain of the arm and hand feeling tired, and of a general sense of

languor and fatigue to which they have hitherto been strangers. They

are easily fatigued and retire to rest early, for they feel the need

of repose, and are conscious of the benefit that comes from it. Their

general health remains on the whole good. They are, however, apt to

suffer in consequence if they are unable to take their accustomed

out-of-door exercise, and there is a degree of mental depression that

comes from the disablement caused by their infirmity. The individual

feels that he cannot earn his living as he used to, and so he worries.

It is not that he is overcome by pain, although in some instances this

is acute and of a severe neuralgic character, especially in the muscles

of the thumb, the finger, and the forearm. It is mental anxiety that

drags him down.

There are others working in a mine beside the coal-getters. Among