Dangerous Trades

THE HISTORICAL, SOCIAL, AND LEGAL
ASPECTS OF INDUSTRIAL OCCUPATIONS
AS AFFECTING HEALTH, BY A NUMBER
OF EXPERTS

EDITED BY THOMAS OLIVER, M.A., M.D., F.R.C.P.

MEDICAL EXPERT ON THE WHITE LEAD, DANGEROUS TRADES, POTTERY, AND
LUCIFER MATCH COMMITTEES OF THE HOME OFFICE; PROFESSOR
OF PHYSIOLOGY, UNIVERSITY OF DURHAM; PHYSICIAN TO
THE ROYAL INFIRMARY, NEWCASTLE-UPON-TYNE

WITH ILLUSTRATIONS

LONDON

JOHN MURRAY, ALBEMARLE STREET

1902

The Right Hon. WILLIAM HENRY ASQUITH, K.C., M.P.

AND

The Right Hon. VISCOUNT RIDLEY

TO WHOM, AS HOME SECRETARIES, THE EDITOR IS IN A VERY SPECIAL
MANNER INDEBTED FOR THE MANY OPPORTUNITIES AFFORDED
HIM OF ACQUIRING THAT PRACTICAL KNOWLEDGE WHICH
HAS ENABLED HIM TO BRING TOGETHER THE
INFORMATION CONTAINED IN THE FOLLOWING
PAGES, THIS BOOK IS, WITH
GRATITUDE AND RESPECT,
DEDICATED

This is the first occasion on which, on the special lines indicated in this book, any adequate attempt has been made in this or any other country to deal with the conduct of trades and other occupations in respect to the dangers to life and health to which the workers are liable.

The subject is year by year engrossing more of the attention of the public, and this has been evinced in many ways, e.g., in the amount of space devoted by the Press to the subject of leadless-glaze in pottery, and to the manufacture of matches without phosphorus, etc.

The increasing interest displayed by the public in social affairs has led to a corresponding desire for accurate information as to the condition in which their fellow-men and women live and work. This volume is a response to a widely-expressed demand for a true and authoritative statement on this important subject—a subject which concerns thousands upon thousands of our fellow country-people.

The field covered by “Dangerous Trades and Occupation Diseases” is a very wide one, and, as there is no one person competent to deal adequately with the whole, it has been found desirable to engage the co-operation of experts on the various trades with which the volume treats.

In carrying out this scheme, an enormous amount of information which has hitherto been unrecorded or inaccessible has been brought into focus and made available for reference.

The language employed has been kept as free as possible from technicalities. It is confidently believed that this volume[viii] will be of considerable value, not only to medical men, whose practice brings them into contact with the working classes, to Certifying Factory Surgeons, Factory Inspectors, and employers of labour, but also to the educated public and to professional men interested in the hygienic side of industrial problems and in occupation diseases. It is hoped also that it will be of assistance to members of both Houses of Parliament.

Whilst congratulating myself on my good fortune in securing the assistance of many distinguished and able specialists, I take this opportunity of expressing my warmest thanks to Dr Whitelegge, Dr Morison Legge, Miss A. M. Anderson, and especially to Commander Hamilton Smith, R.N., of the Factory Department of the Home Office, for their help in various ways, and to all my contributors for their ready acquiescence and loyal support.

THOMAS OLIVER.

Newcastle-upon-Tyne,

March 1902.

CHAPTER I
INTRODUCTION

The commencement of the Twentieth Century finds us discussing problems and elaborating plans for the amelioration of the life of the people. The last few years have witnessed an unexampled awakening of the public to a sense of its responsibility in regard to conditions of labour and unhealthy trades. The question is not should men and women work, but how do particular trades affect individuals, physically and morally? Like human life itself, industrial occupation has been a passage from the simple to the complex, a process of evolution wherein each succeeding stage of industrial development has been attended by labour problems, social difficulties, and diseases particularly its own. An attempt has been made to include within this book special knowledge, and I have preferred that each contributor should express his or her own opinions unfettered by editorial requirements, since the object sought is not the promulgation of the views of a particular school, but enlightenment, so that the lot of our working classes may be improved, industrial hygiene promoted, and higher ideals if possible attained. Living in a democratic age, we hear much of the claims of the right to live, right to work, and the right of workers to a larger share of the produce of their labour. These are not the subjects dealt with in the following pages. There are certain side issues that deserve consideration, but which can only be mentioned here. Social advancement and commercial prosperity, while creating fresh desires, often increase the difficulty of satisfying natural wants. The growth of large towns and the concentration of people in the crowded homes of our great cities are limiting the amount of pure air necessary to the life of those collected there. Drinking water has to be brought from distant sources and at great expense. The removal of the waste or refuse[2] of human activity is often as difficult a problem as the conveyance of the necessaries of life. It is not, however, with such problems as these we are concerned, but rather with the conditions under which labour is carried on and its effect upon the people. Manual labour and handicrafts exercised for the purpose of gain were in a measure formerly controlled by family interests, subsequently by guilds, and to-day they are largely regulated by trade unions. By trade unions an attempt has been made, not only to sell labour in the highest market, but to artificially restrict output by objecting to the use of machinery, by requiring that machines shall run at a speed lower than their full capacity, by demanding one day’s holiday during the working week, claiming in many instances a uniform wage alike for the skilled and the less skilled workman, and a reduction of the working hours without a corresponding reduction of wages. Such methods in the long run cannot but be disadvantageous to the workers themselves, for they discourage industrial energy and enterprise, without which the wage-fund must inevitably fall. Instead of mutual co-operation there is an unnecessary conflict between labour and capital. The demands of organised labour already mentioned have called forth a marshalling of the forces of capital. Industrial competition concerns the sale of labour as well as that of products. Some persons maintain that in the bargaining that goes on capital has the advantage over labour. Without expressing an opinion upon this point, it is apparent that only organised capital is capable of holding its own against organised labour.

The change from the domestic system of industry to the modern methods of production by machinery and steam power forms what is known as the Industrial Revolution, and marks an important epoch in the history of the world. Within the last one hundred and thirty years the changes produced in the social and intellectual condition of the people have been enormous. Ever since the Industrial Revolution in our own country there has been gradually coming a greater demand for knowledge on the part of those workpeople who may subsequently acquire the control of industries and direct the manufacture of machinery. There has been created, if not immediately, certainly by degrees, a need both for general education throughout the country and a special education for those who wish to become leaders. On the one hand it has been felt desirable to counteract the cramping effects of machinery and to diminish the dwarfing influences of the division of labour upon the intellect of the workpeople by giving them the benefits of a wider education.[3] As knowledge has been gained by the artisan classes, their aspirations have naturally risen. With improved constitutional means for the redress of grievances there has been in many instances a gradual supplanting of methods that involve acts of violence and intimidation, which years ago disgraced our large industrial centres. Thus is it that while in the early decades of last century, shortly after the Industrial Revolution and before labour had become organised, factory legislation was promoted by the wealthier classes for the benefit of the workers, the latter at the present time, with their improved education and personal knowledge, can themselves bring to bear upon the legislature demands for reform that are deserving of careful consideration, especially when these are not extravagant and do not far exceed the limit of experience. Factory legislation, while it embodies the opinions of Members of Parliament who have studied labour problems theoretically, and of a few who have practical knowledge, is a State direction of our industries so far as relates to the safety, health, and moral condition of the people, and which embraces to-day, more than in any other epoch, the opinions of the workers themselves. The story of factory life in Britain, of the long hours of toil spent by children in the mills, and the physical suffering they endured, remains a blot upon the pages of British history. Britain was the pioneer of factory legislation—does she still lead the way? Her commercial supremacy, we are told, is questioned, and the position she has long held is being threatened by increasing competition. Despite this fact there is a disinclination on the part of British manufacturers to admit the necessity of learning anything from their Continental or American friends. Is our country, both as regards methods of production and factory legislation, abreast of the times and of other nations? Instead of manufacturers hugging themselves into a state of industrial lethargy which our insular position and national prejudices encourage, it would be well if they sent their sons and heads of departments abroad to see what other nations are doing.

Several things have prevented factory legislation being as far forward as it ought to be. In our country no Government, however strong, can hope to successfully introduce social legislation largely affecting personal interests until public opinion has been educated to the belief that the remedies proposed are really necessary. The facts likely to carry conviction can only be produced after years of careful study and investigation, consequently factory legislation has to some extent progressed[4] slowly. It is, however, fair to say that when certain trades’ organisations or representative bodies combine to secure amendments to Bills which, in their opinion, appear necessary, there is a tendency on both sides of the Houses of Parliament to drop party considerations, and to give facilities for well-considered legislation likely to benefit the community. At this stage of our inquiry it may therefore be not inopportune to refer to the Factory Act recently passed (August 1901), the framing of Special Rules, and the means of securing their observance.

In matters industrial the Home Secretary is not endowed with authority equal to that enjoyed by similar officials on the Continent. The arbitrary powers granted by foreign Governments for the regulation of factories do not commend themselves to English politicians, and this was borne in mind by the framers of the clauses in the Factory Act of 1891 relating to Special Rules and requirements, when each and every occupier could demand that a matter of difference between himself and the Secretary of State should be referred to arbitration. This system may be said to have answered fairly well when dealing with small trades, but certainly not in regard to extensive industries, such, for instance, as the manufacture of pottery. In this particular trade litigation has gone on for many years, and the questions at issue, at the time of writing, are not yet settled. The methods now proposed should not only secure fair-play to the manufacturer and the worker, but should obviate loss of time and unnecessary labour. Under the Act of 1891 the Secretary of State could not be held responsible to the House of Commons, or to the country, for the final word rested with an irresponsible arbitrator. Under the more recent provisions the ultimate decision will rest, as it undoubtedly should, with Parliament. Having certified that in his opinion any manufacture, machinery, process, or description of manual labour used in factories or workshops is dangerous, the Secretary of State may (subject to the provisions of the Act) make such regulations as appear to him reasonable and practicable. He must publish the proposals, with information as to where copies of the suggested regulations can be obtained, and the time within which objections may be made by, or on behalf of, the persons affected. He is bound to consider their objections, and may, if he thinks fit, amend the draft regulations, but where he does not amend or withdraw these draft regulations, he is required to direct an inquiry by a competent person, to be held in public, and the chief inspector, any[5] objector, or any other person affected, may appear either in person, by counsel, or solicitor or agent. The witnesses may be examined on oath. The proposed regulations may apply to all factories and workshops in which the manufacture, machinery, process, or description of labour certified to be dangerous is used, or to any specified class of factories or workshops. The regulations may provide for the exemption of any specified class of factories or workshops, either absolutely or subject to conditions. They may prohibit the employment, and modify or limit the period of employment, of all persons or any class of persons in any process certified to be dangerous. They may prohibit the use of any material or process, and modify or extend any special regulations for any class of factories and workshops contained in the Factory Acts. The regulations made under the new provisions shall not come into force until they have been laid for a period of six weeks before both Houses of Parliament. In the London Gazette must be published notice of the regulations made, and an announcement of the place where copies of these can be procured.

The right of arbitration conceded to manufacturers has been sometimes regarded as one of the means whereby the benefits of factory legislation have been diminished. No person considers it desirable for industrial liberty to be crippled by Acts of Parliament, or industrial progress checked by Home Office interference, and yet the dictates of humanity demand that no labour shall exceed the limits of endurance of the workers, and that all occupations shall be made as healthy as possible. The history of factory legislation is a record of attempts made to better the conditions of labour, improve the health of workers, and control the disposing power of employers over their workpeople. Those who blame State interference as the cause of the doubtful decline of our industrial supremacy, and who believe that it is checking enterprise, are not making a sufficiently serious attempt to grapple with the question by sifting all the facts carefully. It can be demonstrated that legislation has not paralysed but has improved trade as well as the conditions of labour.

At a meeting of the chemical industry in Glasgow, on 24th July 1901, Mr Joseph Wilson Swan remarked that “two causes are contributing to our loss as a nation in the chemical and metallurgical industries. One is the supplanting of old methods of manufacture by newer, e.g., the application of electricity. The electro-chemical and electro-metallurgical industries of the future[6] are grouping themselves around large water-power stations,—90 per cent. of the power thus used being obtained on the Continent from waterfalls. We have no such available water-power in Britain, but we possess instead an abundance of cheap coal. The other cause is the lack of scientific training, and the indifference of our leaders of industry to the results of scientific research. They are contented with the methods of production of a bygone age. Their plant is old.” It is circumstances such as these that explain, for example, the decay of the chemical industry on Tyneside, and its transference to other localities at home and abroad. As regards the causes that are threatening our industrial supremacy, apart from the serious attempts made by countries possessing the raw materials to complete the finished products on the spot, thus hitting hard our textile and iron industries, I would emphasise the higher technical education of the men who are heads of departments in factories abroad compared with those in similar positions at home. They are on the Continent a superior class of men. I am not for a moment contending that the German or French workman is, as a workman, superior to the average British artisan similarly employed. In many respects I think our own is the more capable man; but the foreigner is better directed, owing to the fact that the managers’ assistants and principal foremen have been highly instructed; several of them have had a University training, and they thus possess a theoretical as well as a practical knowledge of the particular industry. Besides, it is well known that in Germany at least, large firms employ men well trained in chemistry and physics to do nothing but research work, with the view of not only finding out new products, but of improving them and cheapening their manufacture. Industrial methods, in a word, are more scientifically studied on the Continent than at home, so that while such labour troubles as strikes, and the higher wages paid to English workmen, are to some extent responsible for the loss of some of our manufactures and their transference to the Continent, the cheapening of methods of production has not been without its influence. As international competition becomes keener, and our manufacturers endeavour to produce more cheaply by increasing the speed of their machinery, there will be imposed upon the workpeople greater tension during the hours of labour. Will this circumstance, also the rising rents of houses and the consequent overcrowding in our large towns, improve the physique of future workers? A study of the prospects[7] of the artisan classes is of necessity many-sided, since it must deal not only with the effect of work upon their health, but take into consideration the influence of their home life and surroundings. Our large industries, excluding mining, have scarcely existed long enough for us to realise to the full the physical changes they are inducing in the workpeople. Hitherto there has been no great difficulty in obtaining strongly-built men of good muscular development for hard manual labour. Many of these have been taken from rural districts. As these districts are becoming depopulated, they will cease to be the source of supply they have been in the past. It is not altogether idle to ask how far the second and third generations of the town-bred poorer working classes will possess the necessary physical powers for hard toil. Overcrowding and poverty are exercising a degenerating influence upon the rising generation; besides, industrial occupation as carried on in several of our large textile districts is preventing rather than encouraging development, especially when children are employed at too early an age. There is something in the air of such factories, it may be the excessive heat and moisture, or the animal products given off during perspiration and breathing, that interferes with the nutrition of the body and checks its growth.

Half-timers, fortunately, are becoming fewer and fewer. Experience has shown that they are not equal in physique to their classmates who are allowed to remain all day at school. When healthy country children have been taken into the factories of large towns, it has been found that their normal rate of growth has been checked, so that after two or three years’ work in the mills, they are observed to be of shorter stature than their former playmates left at home and allowed to rusticate. There is a limit to each person’s capability of doing work, and when this is passed, the results are harmful. We should not ask from any person more than his powers will enable him to accomplish. For mechanical as well as manual labour there is a determined number of hours beyond which the worker cannot proceed without physical suffering on his part, while industrially with each succeeding hour occupied there is a diminishing production. It is knowledge of this fact, apart from economic considerations, that is used as a lever by the working classes to obtain parliamentary sanction to limit still further the hours of labour. Our attention, for example, is directed to Australia, where, since 1856, the hours of toil have been reduced to eight per day with a satisfactory result. In the[8] coal mines, as well as in the factories of Sydney, the week’s work is forty-four hours. The eight-hours’ day has also been instituted in Tasmania, Victoria, and New South Wales. A few years ago an eight-hours’ day was conceded to the men employed in Woolwich Arsenal, and as this turned out to be satisfactory, the Admiralty, in July 1894, took a similar step. There are many writers who maintain that to a reasonable diminution in the number of hours devoted to work there corresponds a qualitative and quantitative increased production. There is a maximum beyond which production is not profitable. The produce of one particular period of the day cannot always be compared with that of another. While the reduction from twelve to ten hours’ labour may have been beneficial, and may even have improved production, it does not necessarily follow that a reduction from nine to eight would be followed by a corresponding result, and a reduction from eight to seven hours by one still better. On this and other points the facts detailed further on in this book by Mr A. P. Laurie, in his paper on Chemical Trades under the heading “Health of Chemical Workers, etc.,” will be found interesting. Too long hours are certainly a cause of accidents in factories. Experience alone can settle the question of the number of hours to be worked, and that number must clearly be not the same for every occupation. Common sense, too, must dictate the minimum limit of working hours. Men and women are conscious when their occupation exceeds their strength; but the demands of the machinery they tend are exacting, and so no difference is made between the strong and feeble workmen. A few years ago, Messrs Mather & Platt, iron manufacturers, Salford, reduced the number of hours worked in their factory from fifty-three to forty-eight per week without reducing the wages of the men, and this regulation is still, I believe, in force. Employers have frequently questioned the value of the work done by the men between 6 A.M. and 8 A.M. Mr Mather holds the opinion that the first two hours before breakfast are hardly worth the trouble and disarrangement which they cause alike to the employers and the workers. Not only are these two hours ineffective from a productive point of view, but their effect upon the physical and mental condition of the men is to diminish their vigour and spirits and their interest in what they are doing.

Coal mining is one of those industries from which an answer to this question of the effectiveness of work in the early morning hours might be expected, for the men work in two relays, a[9] “fore” and “aft” shift, and they change every fortnight. When working in the fore shift the miners enter the pit about 3 A.M., and when in the aft at 10 A.M., each working in the North of England about six and a half hours. Mr Ralph Young, Secretary to the Northumberland Miners’ Mutual Confident Association, informs me, in answer to questions addressed to him on this point, that the present method of working coal mines scarcely allows of a satisfactory reply being given as to whether more work is done during the fore or aft shift. There is a feeling among some of the miners themselves that they can do more work in the fore shift, i.e., between 3 A.M. and 10 A.M., but they attribute this circumstance not to the particular hour of the day in which work is carried on, but to the fact that the air in the coal mine is fresher and purer then than later on in the day. In other occupations it is equally difficult to get at the real facts of the case. To questions of a similar character addressed to twenty foremen and men working in a large iron and steel factory on Tyneside, I received the following answer—that more work is done in the hours 9 to 11 A.M. than 6 to 8 A.M., and that a man does more work after than before his breakfast. As regards the influence of day and night shift, they all agreed that less work was done on the night shift compared with the same number of hours of the day, but it is difficult to express this in terms of percentages. Some of the men stated that the amounts varied from 10 to 20 per cent. Against this, it is only right to mention that some of my Infirmary patients working in the same factory have told me that they believed after a time they did as much work on the night as on the day shift. It was entirely a matter of habit.

The Workmen’s Compensation Act, which was so strongly opposed by many employers on the supposed ground that it would ruin the industries of this country, has had apparently no effect in that direction. Although it has theoretically increased their financial liability, as a matter of fact many employers have been less out of pocket than formerly. The Act has cleared the industrial atmosphere, made employers more careful in their selection of workmen, more willing to safeguard machinery, and do all they reasonably can to prevent accidents. It pays them to do so.

Until July 1898, when the Workmen’s Compensation Act of the previous year came into force, in the case of all accidents coming under either the common law or the Employers’ Liability[10] Act 1880, the basis of the action was negligence or wrongful act on the part of the defendant, or of some person for whom the defendant was responsible. Since 1898 it matters little how the accident was caused, the employer is held liable by the Act of 1897. Certain trades only are included under the Act, e.g., railways, factories, docks, laundries, mines, buildings 30 feet high, and any building in which machinery is driven by mechanical power. So far as compensation for injury is concerned, the workman must be incapacitated for more than two weeks as the result of the injury before he can receive any benefit under the Act. After a fortnight a weekly payment is secured to him of one half of his weekly wages during his period of incapacity, or for six months, after which the employer can claim to have his liability redeemed by paying a lump sum fixed by agreement or arbitration. In the case of death the employer is liable to the extent of three years’ wages, or 156 times the average weekly earnings of the deceased workman during his period of employment, the amount to be not less than £150 and not more than £300.

When the Workmen’s Compensation Bill was introduced it was strongly opposed, as already stated, on the grounds that it would injure trade and ruin many employers. So far, events have not justified this suspicion, but have shown that these fears were more or less groundless. In providing compensation for injured workmen, Britain was only doing what other nations on the Continent, especially Germany, had already accomplished. It was thought at the time that the operation of the Workmen’s Compensation Act would very materially affect the output and price of coal as well as the wages of the miners. There is no clear evidence that it has increased the price of coal. The cost of compensation paid in Northumberland and Durham does not exceed one halfpenny per ton, while the cost under the Act for the United Kingdom is under three farthings per ton. This is a small sum compared with the threepence we were informed would be added to the price of each ton of coal. One way in which the Act might indirectly increase the price of coal would be by restraining timid capitalists from investing money in coal mining through fear of being ruined by some great accident or explosion; but this is a remote probability, and a contingency that could be met by insurance. Nor can it be shown that the Workmen’s Compensation Act has had any effect upon the miner’s wages. Theoretically the wages of miners should fall pro rata with the benefits received under the Act, but as the benefits will not be more[11] than 1½ per cent. of the wages, any readjustment would be small. It cannot be said that in coal mining the Act has had any noticeable effect one way or the other, so far as the number of accidents is concerned. For several years prior to 1898, owing to newer and more scientific methods, the number of accidents in coal mines had been diminishing. It would appear from the reports of Mr Hedley, H.M. Inspector of Mines for Northumberland, Cumberland, and North Durham, that during 1899 there were 84 lives lost, and in 1900 the number was 105, or a ratio of 1 death for every 784 persons employed, against 1 for every 924 in 1899; in 1898 the ratio was 1 in 1053, and for the five years 1893|97 the ratio was 1 in 895.[1]

Mr Ralph Young has abstracted from the annual reports of the Northumberland and Durham Miners’ Permanent Relief Fund the following facts, showing the number of fatal and non|fatal accidents, with the percentages of non|fatal accidents, spread over ten years in the North of England.

MINERS’ PERMANENT RELIEF FUND.

(a) Durham Strike, 90,000 members idle for 13 weeks.

The Workmen’s Compensation Act came into force in 1898, but it cannot be said, looking at the foregoing figures, that it has had any material influence upon the number of accidents in coal mines, nor, as was anticipated, has it so far displaced many of the older miners by younger men. There is a remarkable constancy in the number of pit accidents. I have tried to ascertain whether there is any decade in a miner’s life during which accidents are more numerous than another, but statistics do not support the supposition. There is a personal and age element that must not be[12] lost sight of, also one of fatigue. The older miners have experience and caution; the younger, if rash and less experienced, are more alert and can get out of danger quicker.

As bearing upon this part of our inquiry, the annual reports of the Chief Inspector of Factories give the following information:—

In reference to these figures Dr Whitelegge states that there has been an increase in the numbers of reported accidents since 1897, the year previous to the coming into effect of the Workmen’s Compensation Act. Many considerations other than the Workmen’s Compensation Act have to be taken into account, e.g., the better reporting of accidents, activity of trade, and classification of industries. From these figures of the Chief Inspector of Factories no definite conclusion can be drawn as to the influence of the Act in preventing accidents. As a contrast it should be mentioned that in some large factories where an “Accident Compensation Fund” previously existed under the Employer’s Liability Act, to which employers and employed contributed in the ratio of 2 to 1, and out of which all accidents were compensated, statistics show a remarkable falling off in the number of reported accidents under the Workmen’s Compensation Act. In some works these are now only one-third of what they were. This reduction is probably explained not by any change in the methods of production, nor by better safe-guarding of machinery, but by the fact that while previously all accidents, however trivial, were reported and compensated, accidents under the Act of 1897 must be of such severity as to prevent the individual following his employment for two weeks before he is entitled to compensation.

Although difficult to prove by actual statistics, there is a feeling that the Act has on the whole been beneficial alike to employer and workmen. It is this circumstance that has induced[13] some Members of Parliament to press for an extension of the Act so as to include a larger number of industries, and particularly those regarded as Dangerous Trades. One of the principal features of the Workmen’s Compensation Act is that it fixes the liability upon the employer, so that where an accident causes injury to health or the death of a working man the individual himself or his relatives receive compensation. If the circumstance solely of ill-health or of death caused through work, and not violence or the manner in which either of these has been induced, were made the principle that ought to underlie the operations of the Act of 1897, there would be found many persons who, taking effects alone into consideration, would recognise no difference between ill health the result of an accident in a factory, and ill health brought about by working at a particular trade known to be dangerous. Ought dangerous trades, therefore, to be brought within the scope of the Workmen’s Compensation Act? Many advocate their inclusion. The law recognises that trade shall be made as healthy as possible, and it takes steps to secure this, both by providing regulations and penalising those who transgress these regulations. Will it go further, and impose a burden upon the employer by making him compensate a workman injured in health when it can be shown that, even where all precautions have been taken, ill health has followed? Occupation ought to be the opportunity whereby an individual, in return for work done, should receive sufficient wages to enable him to live, and not, as it occasionally is when he is employed in a dangerous trade, the means whereby he becomes the subject of ill health at an early age, and is thrown as a burden upon the ratepayers for the remainder of his life. No high wages paid to men to undertake work in a dangerous trade, even if it were always the case that such were paid, can adequately compensate the affected workman for the loss of health caused by following a dangerous occupation. Many dangerous trades are far from being highly paid. The class of workpeople who are affected by these industries are usually very poor, their occupation is often interrupted, and they are not organised into Unions, so that they neither contribute to the funds of, nor do they receive benefits from, a Friendly Society. The Workmen’s Compensation Act makes accident the sole circumstance that enables an individual to receive compensation. As the Act stands at present it is clearly meant to distinguish between accident and disease. It is a disputable point, for example, how far a fatal disease like anthrax caught in a wool-combing factor is not as[14] much an accident beyond the control and expectation of the individual workman as the fatal burns caused by the sudden ignition of some spirit paint in a shipyard. A similar line of argument might be made to apply to other trades. The man who gets his arm broken by a piece of machinery in motion or by a barrel falling off a trolley in a colour factory receives a weekly allowance from his employers; but another man who becomes paralysed in both hands as a consequence of having filled the barrels with white lead in the same factory does not receive any part of his wages at all when off ill. It is said that the Act only recognises the fact of external injuries, but it goes beyond this, for a workman may die as a consequence of shock without any sign of external injury and yet his relatives receive compensation. It is the fact of personal and not external injury that underlies the Act. Is phosphorus necrosis, which is a purely personal malady, an accident? The Act answers—No.

There is considerable difficulty in defining what is meant by industrial disease. It would be well if we could have some clearer conception of what is implied both by “industrial disease” and “dangerous trades,” for there is scarcely any trade or occupation that is not attended by some risk or another. It is admitted that certain occupations involve exceptional risks. Theory cannot determine what these trades are, but experience and inquiry can. As an illustration, I might mention that of 22 trades suggested as dangerous, and given by the Home Secretary to the Dangerous Trades Committee to investigate, careful inquiry showed they could not all be included in this category.

In the case of an accident there is usually the history of a violent cause in operation, and there is the fact of an injury received. Yet even with accidents there are certain contributing factors, e.g., the length of the working day, the previous ill health of the workman, and his state of debility anterior to the accident. Old age, too, aggravates the harmful effects of an accident. It is accessories such as these that have made legislation difficult and tied the hands of Governments. The subject is one to which at home Mr H. J. Tennant, M.P., Sir Charles Dilke, Bart., M.P., Sir John Stirling Maxwell, Bart., M.P., Mr John Burns, M.P., and other members of the House of Commons have given considerable study, and to which among others on the Continent, Mr Arthur Verhægen, member of the Belgian Superior Council of Labour, drew the attention of members at the Congrès International des Accidents du Travail in Brussels in 1897.[15] Several writers have defined industrial disease. Dr Van der Borght says: “Industrial diseases are those maladies which arise as the result of the prolonged action of harmful influences in certain occupations, and which consequently and exclusively occur in persons working in these trades, or at least more frequently than in other persons in general.” Dr Glibert, Medical Inspector of Labour, Belgium, says: “Every disease recognised as particularly frequent in a profession ought to be considered as an industrial disease to the extent that it is clearly due to the risks in the trade.” By the term occupation or industrial disease we mean, briefly, disease the direct effects of a particular trade in which a person is engaged. In many instances there are also included maladies that are the result of pathological alterations of structure, indirectly induced by the occupation. Colic, for example, might be regarded as a direct effect of working in lead, and yet this is unaccompanied by structural alteration in the wall of the intestine; on the other hand, kidney disease in the file-cutter is very slowly developed, and although, as regards its production, there are other causes in operation than lead, still the kidney lesion is believed to be a remote or indirect consequence of plumbism. As artisans are liable to the ordinary ailments of humanity, it is necessary to carefully sift statements so as to eliminate all causes other than those related to the particular industry in question. To the production of occupation disease, several factors contribute. Even in the causation of such an indisputable malady as industrial lead poisoning, it is well to remember how important is the part played by individual idiosyncrasy, while in the badly ventilated state of one factory compared with another, the home life and surroundings of the workpeople, poverty, heredity, age, and sex are to be found conditions that favour its production, and are therefore not to be ignored. Usually it is a gradual deterioration of health that is produced. There is nothing of the nature of an acute illness in industrial disease comparable with an accident. The only occupation disease that approaches accident in the suddenness of its development is anthrax, and even here the prospects of recovery are influenced by the channel of invasion, the severity of the attack, the vital resistance and idiosyncrasy of the affected individual. Take another example: it is not always easy to draw a distinction between potters’ phthisis due to the inhalation of dust when at work, and a broncho-pneumonia which has become tuberculous, and yet potters’ consumption in[16] the early stages may be as much the result of the trade at which the person has worked as is the paralysis of the file-cutter.

In order to make an employer liable for an occupation disease there would have to be a stated limit as to the length of time an individual had worked in a particular factory, and as in some of the dangerous trades the workpeople change frequently from factory to factory, it would be difficult to prove under which employer the malady was caught. Carelessness on the part of the employed, through ignorance or intention, would also have to be disproved. In the case of workpeople who spend practically the whole of their life in one factory, say a white lead works, and who at the end of twenty or thirty years’ service find themselves the victims of an incurable form of plumbism, humanity and good feeling alike should indicate to the employer his obligation to the affected workmen. Yet even here the question might be raised, did the workman fully attend to all the regulations when in the factory as regards personal cleanliness, and were his habits, when not working, those of a temperate man? Mr Verhægen gives illustrations of the difficulty of exactly defining occupation disease. A workman becomes the driver of a public vehicle, and in the course of time, having developed rheumatism, he is obliged to give up work. To the individual thus crippled by rheumatism, is the employer financially liable? One can scarcely think so, for the simple reason that while exposure to inclement weather may be a cause of rheumatism, certain persons are by heredity predisposed to it, and would develop the malady irrespective of what their calling in life might be. Besides, are delicate men and imprudent drivers to be placed on the same footing as robust and careful men? Verhægen recognises the inexactitude, and states that if we would but limit the term occupation disease to conditions of ill health due to poisoning caused by coming into contact with certain chemical and other agents used in such industries as lucifer match making, colour grinding, etc., the difficulty would be materially lessened. It would still not always be easy to assign to one particular factory, especially when it was known that the workman had moved from place to place, the blame for having caused ill health. Even in cases of “phossy jaw,” in which it is generally admitted that exposure to the fumes of yellow phosphorus is its cause, there is yet some doubt as to whether the necrosis of bone is entirely due to this circumstance, or partly to it and the operation of micro-organisms. Take, too, the diseases of Italian miners and of the colliers of Belgium, particularly ankylostomiasis. Dr Kuborn[17] of Seraing, in discussing this question, maintains that the maladies special to mining have their origin very largely in the kind of life the men lead, their inattention to the rules of ordinary hygiene both in their home and person, excesses of various kinds, imperfect feeding and clothing, etc., causes to the influence of which want of education greatly contributes. In some industries there are inherent dangers, and yet with care these can be diminished if not removed. Ventilation of British coal pits, for example, has practically abolished pulmonary consumption in our miners. Experience shows that there is scarcely a dangerous trade from which, with extreme care and attention to regulations, the dangerous influences cannot be largely removed. There is no occupation so risky to life as the manufacture of the high explosives. I have had the opportunity of visiting the largest explosives works in the kingdom, and can bear testimony to the healthiness of the employment and its comparative safety owing to the careful training and discipline of the workers, scrupulous cleanliness and attention to the minutest details.

Occupation disease, it must be remembered, is not always easy of recognition. There is no difficulty in diagnosing a malady to be plumbism when there are double wrist drop and a history of exposure to the metal when at work; but where there is only complaint of abdominal pain and vomiting, the diagnosis cannot be always so clearly established, even in the presence of a well-marked blue line on the gums. Several cases have been recorded in the medical journals of acute abdominal pain occurring in painters, which had been regarded as lead colic; but when the patients died, the post-mortem examination showed that death was due to a small ulcer of the bowel or to inflammation limited to a particular portion of the intestine known as the appendix, which a surgical operation might have cured; while, on the other hand, workers exposed to lead and with similar symptoms have been operated upon by careful surgeons for appendicitis when the malady was lead colic. If this is the difficulty experienced by competent surgeons and careful medical observers, it shows us some of the pitfalls parliamentarians might easily drop into by including industrial diseases under the Workmen’s Compensation Act. Verhægen is of opinion that the matter would be more easily settled by accumulating a larger number of statistics of disease occurring in occupations; but this inquiry would have to be extended over a lengthened period, there would have to be some degree of uniformity in the conditions under which the people worked, there would also have to[18] be taken into consideration the hygienic conditions of the factories, the situation of these buildings, the number of hours worked per day, and the influences that would follow a prolonged strike of the workpeople, such as poverty. To be exact, too, the workpeople would have to be medically examined before entering upon the particular industry, and re-examined months afterwards so as to ascertain what effects, if any, the trade had produced. Some of the difficulty would be got over by limiting the definition of industrial disease to maladies that are the direct consequence of occupation, and in which as a result there is a well-ascertained lesion of the organism. Verhægen, as already mentioned, illustrated his argument by alluding to the driver of a public vehicle who in good health to commence with, and notwithstanding his obedience to the laws of prudence yet becomes rheumatic, and to another man who, under similar conditions as regards health and carefulness, undertakes work in either a lucifer match or a white lead factory, and suffers from phossy jaw or wrist drop. The malady is in either of the latter instances regarded as a disease of occupation, in the former it is not, the explanation of the difference being that as regards the first illustration rheumatism is not confined to the occupation of coach driving; also while it is admitted that out-of-door occupations expose the individual to all kinds of weather and predispose to rheumatism, the same out-of-door life led by other people is in them an explanation of the good health they enjoy. In the case of the match and white lead maker, had it not been for exposure to the fume of phosphorus or the inhalation of lead dust the workman would not have become the victim of phossy jaw or of wrist drop.

Although many workpeople in the factory incur the same risk, yet all do not equally suffer. Some men are more susceptible than others. It would be regarded as an interference with the liberty of the subject if an attempt were made to prevent people going to work in a factory. It is known, for example, that engravers are more liable to lose their eyesight at an earlier age than men engaged in outdoor occupations. Should a man with feeble sight be allowed to undertake this kind of work? On commencing his industrial career, unless he voluntarily seeks the advice of an oculist, who is to say to him nay? There cannot be, although it is accomplished in certain dangerous trades without much opposition, a medical examination of all persons undertaking work. The dangers of particular occupations ought, however, to be[19] pointed out to all applicants for work, after which these should state that they are prepared to accept certain risks. At present many workpeople incur risks without knowledge of the danger or of the means of preventing it. There are occupations that are not of themselves unhealthy, and yet owing to the strain which they impose upon the body, the weak spot of the organism, so to speak, is found out, and for this the occupation itself cannot altogether be held responsible. Take what is known as rupture or hernia, which occurs with greater frequency in persons whose work obliges them to be long upon their feet, and who are exposed to sudden strain, the lifting of heavy weights, etc. What is said of it applies equally to varicose veins in the legs. Both of these may be partly the result of the position assumed by the individual when at work or the strain he is exposed to, and yet it would scarcely be right to make the occupation responsible for an affection the result of an inherent weakness of the abdominal wall which allowed a portion of intestine to protrude, giving rise to rupture, or for an ill-nourished condition of the walls of the veins in the legs whereby the blood-vessels became distended and deformed. To secure compensation, the workman would have to establish that the hernia was solely the result of his work. Life is for all of us very much a game of chance, and we have to run ordinary risks. For a disease to be regarded as industrial, and capable, therefore, of being brought within the scope of the Workmen’s Compensation Act, it would have to be placed upon the same narrow limit as an accident. It would require to be shown that it was the sole result of the occupation, and that there had been produced a definite pathological lesion of the body. Adopting this view, the maladies that could be included in the category would be, among others, anthrax, poisoning by lead, mercury, phosphorus, and bisulphide of carbon; but with the exception of anthrax, in which the disease is often suddenly induced, and as rapidly runs to a fatal termination, there is not as a rule the same exactitude in the incidence of disease as is the case in accident. There might be little difficulty in including anthrax under the Act of 1897. The inclusion of some of the other dangerous trades would give rise to frequent litigation, but it would make employers more careful in the selection of their workpeople, and in the means adopted to prevent industrial poisoning. This latter fact is one of the objects aimed at by those who are in favour of an extension of the Workmen’s Compensation Act, not[20] omitting, where it can be clearly proved, the financial liability of the employer to compensate the affected workman. In the case of a fatal accident occurring in a factory, a post-mortem examination shows perhaps the body to be healthy, and therefore the accident to have been the sole cause of death, or there are certain signs of disease present which may have caused or hastened the fatal termination. In the latter instance the law takes no cognisance of the previous disease. It takes for granted that but for the accident the individual would have gone on following his occupation. In industrial poisoning, would a similar legal opinion be entertained? In acute lead poisoning, when the post-mortem examination and chemical analysis of the internal organs conclusively prove that death was due to lead, it might be a comparatively easy thing to fix the liability upon an employer; but the presence of signs of previous disease in the body, which probably contributed to the fatal termination of the illness, would make it extremely difficult to assign to each of the two circumstances its proper share in causing death.

It is facts such as these that doubtless led to the rejection by Parliament in 1897 of the proposal to extend the scope of the Workmen’s Compensation Bill so as to include industrial diseases, and place them on the same footing as accidents occurring at work. There is, however, a common sense view of the matter which should not be overlooked, and it is this. Where a person suffers in health, or loses his or her life through neglect of the employers to comply with the legal requirements of the Factory Acts, surely the employer under these circumstances ought to pay full compensation. In the case of accidents the question of neglect does not arise under the Act of 1897. The injured person is compensated, and that is the difference between the Employers’ Liability and the Workmen’s Compensation Act. The question that calls for an answer then is rather this: Where an employer has followed out to the full all the regulations required by the Home Office, and it is shown that he has done all that common sense and humanity dictate, and yet industrial poisoning has occurred, is the employer under these circumstances to be considered liable? In France, where the match industry is a State monopoly, the Government admitted its liability by paying to the workmen who suffered from the effects of phosphorus a stated indemnity. Bryant & May’s firm has always recognised its liability by paying a weekly allowance to the workpeople off ill through phosphorus necrosis. Other firms in other trades probably do the same. It is for the[21] public, therefore, to say whether humane deeds like these, which are purely voluntary in this country, should be made compulsory by an extension of the Workmen’s Compensation Act, or be simply dealt with through the medium of mutual trade insurance societies.[2]

Collectively, occupations may be likened to a huge organism. Industries are the functions that indicate the life and prosperity of a nation, and like the higher forms of life they have grown in process of time from simple beginnings to highly complicated combinations, the controlling and to some extent directing agent of which is parliamentary legislation, keeping pace with the inventiveness of man and human requirements. In many ways is the resemblance between the industrial and human organism demonstrated. No man can use unrestricted freedom with his own body. There is a physiological limit to which he must bow. An over-worked brain or group of muscles sooner or later tells its own tale, unbridled licence causes degeneration of the nervous system, and excess in wine or at table is checked by the diseases it produces. Perfection is what we ought to strive for, and this can only be obtained by submission to nature’s laws. So, too, in the industrial organism it is recognised that production should be kept within limits, reckless bargaining should be curtailed, that each man should put his very best into the work he is doing, and that there should be more sympathetic communication between employer and employed. Trades, like human beings, are influenced by their surroundings. They do not thrive well away from coal fields and centres of human activity. Competition or the struggle for existence is as keen in the world of industry as in that of biology, and there occurs the same weeding out in both. Thwarted by local conditions and hampered by scarcity of labour, overburdened by excessive taxation or ground rents, industries will languish in one place, while with fewer restrictions they will flourish in another. New trades are constantly developing, and new methods of manufacture keep replacing those that are old. Everything is tending towards improvement. Many circumstances are operating to direct the industrial evolution of to-day. Human wants and man’s inventiveness play their part so that those manufacturers alone of[22] their commercial confrères are successful who, recognising the spirit of the age, make an attempt to meet its demands.

Admitting that factory legislation has for the last century been gradually bringing into line industrial undertakings of all kinds, and that the Government has by enforcing regulations exercised a disciplining influence upon masters and men, it is only recently that it has taken up a strong and decided attitude in regard to the effects of particular trades upon health. Public health as a science is still in its infancy; it owes its origin mainly to the rush of people into the large towns. Its theories and facts have been brought by municipalities to bear upon the conditions of life in our homes and persons. Modern factory legislation, so far as industrial hygiene is concerned, is an extension of the ordinary laws of health to those workers who in many instances cannot frame rules of guidance for themselves. Law restricts as well as regulates individual freedom. The Public Health Acts have interfered with the liberty of the subject by insisting upon closing unhealthy dwellings, the removal of refuse, the notification of infectious diseases, and the compulsory removal from the home of members of a family who are suffering from some infectious malady, and by doing so have secured a larger measure of health for the community. Factory legislation similarly aims at improving the health of the workers.

Every man tries to get as much out of life as possible. Ideally he ought to contribute his best to it. A workman, while obtaining for his labour the largest wages possible, ought to put into his labour the best of his thought and energy so as to improve the character of the work he is engaged in. While the immediate object of labour is to obtain the wherewithal to live, the character of the work performed is unconsciously shaping the destiny of labour and building up through individuals the national reputation. The end of work is progress, and just as human life is perfected through suffering and experience, so is the industrial.

There are many ways by which the hygiene of trades may be promoted. The notification of industrial diseases to the Chief Inspector of Factories has, although it has only been in existence a very few years, already placed the Home Office in possession of facts and statistics which enable the Factory Department at once to realise when a particular industry is becoming prejudicial to the health of workers, and how it may be met. The good effects of notification are observed in the trades in which lead, mercury, and phosphorus are used. The power granted to the Home Secretary, which enables him to[23] schedule a trade as dangerous on sufficient information being given to him, is, so long as it is judiciously applied, a step in the right direction. It is desirable that accurate information should be obtained from all sources, from employers as well as employed, and from experts, chemical and medical. The formation of a consultative body or of an industrial council composed of the Home Secretary and members of the factory staff, employers, a few educated workmen, chemists, medical men, and electricians, for the purpose of discussing with the Home Secretary terms of Special Rules and prospective legislation has been recommended, and might be helpful. On the Continent such industrial councils exist, a description of which will be found in Miss Anderson’s paper on “Regulations of Injurious or Dangerous Occupations in Factories and Workshops in some of the Chief European Countries.” In Britain there might be some difficulty in including upon a permanent consultative body gentlemen capable of dealing with the numerous technical questions that constantly arise, but the difficulty would be no greater there than in France. Within the last few years the Home Secretary has, whether for direct advice or to serve upon committee, occasionally called in the assistance of recognised experts or authorities upon particular points under consideration. This system has worked well, and might with advantage be extended. Industrial hygiene, too, so far at any rate as dangerous trades are concerned, could be promoted by small International Committees meeting to improve the sanitation of labour rather than to discuss economic problems of production. By many it is believed that the cause of industrial hygiene would be furthered by the establishment of a Ministry of Labour. It seems an anomalous circumstance that a country like ours, whose reputation has been built upon commerce, should be without a department specially devoted to labour and labour problems. The Home Office has the necessary machinery and possesses all the information, but its jurisdiction covers too extensive a field. The Factory Department ought to form a separate and distinct branch of the Home Office to be directed by a Secretary or Under-Secretary of State. Year by year the work of the Department and its scope increase, and surely among the many Departments of the State there can be none of greater importance than that which watches over the millions of persons engaged in factories and workshops in the United Kingdom.

Thomas Oliver.

From the benevolent and learned Italian physician of the seventeenth century, in touch with every available source of information of his own and preceding ages, searching for mitigation of the diseases of workmen which he believes to be “incurable,” to the English State physician of the nineteenth century seeking to persuade men that the diseases must not be allowed even to arise, is indeed a long way. The way is long in all that concerns knowledge of the causes and treatment of disease, no less than in circumstances and organisation of industry. It is doubtful, however, whether the transformation of ideas in either is so great as in the general attitude of civilised society towards protection of labour and promotion of industrial[25] health. The change cannot be accounted for, completely, either by change in the methods and organisation of industry, or by increased knowledge, medical, economic, or social. Nor can the increased breadth of conception be attributed solely to that increased intensity and quantity of human suffering which inevitably accompanied concentration and growth of industry. In all ages there have been physical, moral, and economic evils which fell to the lot of the labourer, probably differing from time to time on the whole more in degree than in kind, and doubtless felt at each stage by the sufferers, and sometimes by onlookers, with an intensity which relatively was great, and which with adequate discernment of a remedy and the duty or expedience of applying it, would have led to legislative action.

In the great civilisations of antiquity, whether in the East, West, or in Europe generally, there was sufficient concentration of the forces of labour to produce the intensest forms of the maladies classed by Pliny as the “diseases of slaves.” Some of the most injurious processes known to us now are extremely ancient. To mention but a few: lead and quicksilver mining, the potters’ craft, and the textile processes of preparing and weaving asbestos and flax.

The long history, in another department of social ills, of legislation and organised guild efforts for protection of buyers from dishonest manufacture and dishonest trading in adulterated products, or again, of efforts to regulate supply of labour and to enforce honest service from workers, affords many illustrations of the action that could be taken in Middle Age and Renaissance Europe, where an evil was both recognised and also believed to be remediable. It is to be noted how few the indications are that the strivings after social improvement of handicraftsmen and labourers were in those times inspired by any clear vision of the physical safety and health of individuals as part of the well*-being to be sought. Illustrations might indeed be gathered from records of craft guilds and municipal organisations, of provisions and regulations that tended to results similar to those expressly aimed at by modern sanitary regulations. This is especially true of England, where the masses of manual workers came earlier than in other countries of Modern Europe to comparative physical comfort. We must, however, avoid the mistake of reading into past events, however interesting, ideas that are consciously at work in practical affairs only in our own times.

[26]

Of much later date are the first documents that I have been able to trace expressly dealing with the nature and results of industrial occupation in dangerous or injurious processes. These are in the Transactions of the Royal Society of England, and are of the theoretic and reflective character that is appropriate to their setting. Belonging to the same century as Ramazzini’s most human treatise (1670 and onwards), touching both manufacture and mining in Europe (e.g., manufacture of white lead, silvering of mirrors by mercury, lead mining, coal mining), they would take an important place in a general history of European thought and action on this question. The vivid descriptions by the Italian as well as by the English writers of the effects on the worker of lead,[3] of mercury,[4] of silk dust,[5] of explosions in mines,[6] give one a sense now of the kinship of past labour with present, and a clearer perception of the magnitude and the worth of the object that this generation has set itself—to remove such causes of suffering from the path of the labourer.

In those papers, however, we are still far from any practical preventive treatment of industrial diseases. My task in this paper is to trace out in England, that is in the foremost industrial community of recent times, the history of tentative, halting efforts, almost wholly within living memory, to engraft on the earlier legislative movements of the nineteenth century towards hygienic and moral reforms in industry, that special, applied regulation of injurious manufactures for which Sir Edwin Chadwick[7] and Sir John Simon were the earliest and most distinguished advocates. In this history itself, I think, is found the nearest attainable explanation of the wide difference between the general attitude of our day towards care of the health of the adult labourer[27] at his trade, and that of any previous age, when the diseases accompanying industry were the subject of scientific observation. In it is to be seen the gathering momentum which could so completely sweep away age-long modes of regarding the worker at his bench as merely a means to the ends of others than himself and his family, that the legislature and administration could at length treat the promotion of the physical security of each individual labourer as a worthy end for the State no less than the labourer. Lord Londonderry, when he railed in Parliament in 1848 against the “hypocritical humanity” which sought by protective legislation to save the lives and limbs of the miners of Great Britain, represented but a singularly extreme though not isolated survival of the older assumption of legislators that the health of the masses of people, as of individual labourers, might be left to take care of itself, if indeed it was worth thinking about at all. Even the learned and humane contributors in the seventeenth century to the Transactions of the Royal Society on dangers of mining and means of overcoming them, can tell without a thought of irony how a ventilating tube was first placed in a dangerous mine after an accident from fire-damp, resulting in the loss not only of men but of a “gentleman of quality.” There is indeed a long series of laws, extending back to before the time of Elizabeth, for the protection of the poorer wage-earner in making his contract so that he should not be cheated by extortionate charges or unfair payments in goods. The real contrast in the normal attitude of the centuries before our own towards the persons of workers is nevertheless well seen in Macaulay’s wondering notice of the fact that in the latter end of the seventeenth century it was possible for an eminent philanthropist to exult in the thought that in Norwich, the centre of the clothing trade, where “a little creature of six years old was thought fit for labour,” boys and girls of “very tender age created wealth exceeding what was necessary for their own subsistence by £12,000 a year.” Greater degradation than any shadowed there had to be achieved, in England at least, before the first legislative foundations could be laid, on which afterwards was to be engrafted the special trade legislation with which we are here concerned. Out of the desecration of child*-life and womanhood, underground and in factories and workshops, recorded in the Blue Books of the earlier part of last century, came the needed force for the beginnings of a State control in England of special conditions of health and security, which in some other European countries had been for long, at least in mines, partially[28] maintained through the operation of a more or less definite theory of State or Imperial ownership.[8]

Although I refer necessarily to the general sanitary and social protective measures, the development of which belongs to the great humanitarian movements of the first half of the Victorian age, I must at this point make it clear that I exclude here their history, so far as concerns purely the control of economic and moral abuses, which were not inherent in manufacturing and mining industry itself. We are not directly concerned with physical sufferings which, owing to the apathy of the community, in fact accompanied the earlier developments of the factory system, nor with the barbarities which culpable ignorance too long allowed to survive, from rougher and harder times, underground in mines. Our concern is with those material risks in any industry which, when reasonably good methods of working have been developed by the necessary help of law, remain as ordinary accompaniments of the occupation itself, either because of the nature of the substance used, or because of the appliances necessary to the processes carried on. Some special regard for classes of persons employed is also necessary in so far as they are specially affected by risks on account of tender years or physical constitution, but not because Parliament was first and foremost compelled by unnatural conditions to safeguard young workers and women, nor because the force of law remains, and, humanly speaking, will continually remain necessary in competitive manufacture to maintain for them good normal conditions.

We must remember that applied scientific protection of all workers against industrial injury was from the outset introduced step by step into two distinct sets of Acts of Parliament, the Mines Acts and the Factory Acts, both with primarily social aims, each acting and re-acting on the other throughout, both in Parliament and in the Department administering them. This compels study of the stages of development in those Acts, as distinct from the movements which produced them, in order to arrive at any comprehension of the nature of the now resulting form of control of injurious trades.

In a complete history of this subject a long section would be devoted to the development of the later-initiated law relating to[29] Public Health, to the origins of the two great Sanitary Commissions of 1843–5 and 1869–71 and their reports, and adequate recognition would be possible of one main cause of gradually quickened public and official understanding of the need of special precautions for health in injurious industries. This cause was the introduction into the service of the State, first as special commissioners, later as permanent officials, of scientific investigators and medical officers, whose work brought to light not merely new facts bearing upon industrial disease, but also new and broad ideas as to their origin and effects, and whose reports secured in some instances attention far beyond the boundaries of England. It is difficult for a modern Factory Inspector to realise all that is implied in the brief allusions of a former Chief Inspector, Mr Redgrave, in one of his annual reports, as late as 1868, to the fact that cleanliness, ventilation, and prevention of disease generally, in factories, were then regulated only so far as they were provided for at all in the “Sanitary Act,” and applied by local medical officers—where there were any—without effective central control or organisation. What it meant in loss of life and injury to the bread-winners of the masses of the nation was only too clearly set forth in the accumulated evidence in Dr Simon’s and Dr Greenhow’s reports to the Board of Health and to the Privy Council on the sanitary state of the people of England from 1858 onwards. The words I quote at the head of my paper indicate Sir John Simon’s idea of the magnitude of the evil at that time. In many passages he showed his view of the worthlessness of such general powers as then could be applied to the more general classes of evil.[9] In prolonged special investigations, guided by the danger signals of mortality statistics, he traced out the preventible[30] injuries going on steadily in half-regulated or wholly unregulated dangerous trades. “Certain industrial establishments,” he said, writing in 1862, “are subject to Government inspection, and some to a very limited extent are regulated by Act of Parliament.... Is there any sufficient reason why these precedents should not be followed in other industrial establishments.... There is abundant causation of premature death in mines which are neither coal mines nor ironstone mines,[10] and potters, grinders, carders, hacklers, not to mention hosts of other artisans, may, any of them, show the same claim as miners—the claim of grievous physical suffering—to have the special circumstances of their industry subjected to Government supervision.”[11] These observations were not based on vague description or casual inquiry into the circumstances of industry, but on systematic notes of conditions of employment in selected localities where mortality due to given diseases—for example, tubercular phthisis or irritative disease of the lung—was three, four, or even six times as high as in other parts of England. The evidence for this need of supervision by centrally directed specialists, working under a specialised legislation, had been already repeatedly touched on in Reports of Royal Commissioners primarily appointed to inquire into employment of children and women. Far more had to be later said and written before the first steps could be taken in some of these manufactures to remove causes of injury which, later, the Commissioners of 1878 referred to as a “public scandal,” and for which no basis of control existed until 1891.

What, then, are the first beginnings of special legislation; and how did the succeeding steps follow each other in the Factory and the Mines Acts respectively? First, it must be pointed out that whereas the particular kind of legislative weapon (the provision for “Special Rules”), which was destined to be forged for use against dangerous trades, was first planned in connection with regulation of mines, it reached its most elaborate form in connection with regulation of manufacturing industries, that is, in the earlier and more fully regulated industries, under the Factory Acts.

It is now almost incredible that one of the most dangerous of all groups of industry—mining—should have been free in[31] England from any form of protective legislation until 1842,[12] when women and girls were excluded from underground working, and that it was not until 1855 that any comparatively useful safeguards of health, life, and limb were prescribed by law. It is still more difficult to realise that before 1814 it was not customary to hold inquests on deaths of miners killed by accidents in mines. With the exception of regulations against truck, there was no provision except such as protected the colliery owner—and of that kind there were many—against injury to his property by miners.

Meanwhile the landmarks from the present standpoint in factory regulation had been the Acts of 1802 and 1833. The first, aiming only at the preservation in cotton mills of the “health and morals” of apprentices, further laid down that “visitors,” to be appointed by justices in every county for repression of contraventions, were empowered to “direct the adoption of such sanitary regulations as they might on advice think proper.” The Act of 1833,[13] regulating first the labour of children and young persons in textile factories generally, replaced those “visitors” of the Act of 1802 (who had seldom been appointed, and still more seldom had acted) by “inspectors” with similar powers of entry, and of calling to their aid expert advisers, but with additional powers: to administer oaths and to make such “rules, regulations, and orders” as were necessary for the execution of the Act, and to convict offenders and impose penalties under the Act, as if they were Justices of the Peace. In 1844 an Act applying similarly only to textile factories repealed these remarkable powers of Factory Inspectors to make rules, orders, and regulations, and to act as Justices of the Peace; at the same time it organised the Inspectorate, with institution of an office in London, on lines comparable to those of our own time. Certifying surgeons were then first provided primarily for the purpose of examining young workers under sixteen years of age as to their fitness for employment, and granting certificates of age and ordinary strength; but further also, for re-examination of such workers at the instance of an inspector where there was reason to believe that injury would be caused by continued[32] employment. The Acts were now extended to women, and for the first time special provisions for health and safety (as distinct from general provisions for cleanliness of the factory) began to make their appearance. Workers in wet spinning became entitled to sufficient means against being wetted and against unnecessary escape of steam into the room if young persons or children were employed there; but far more important were the new attempts to reduce accidents by providing for the safer use of machinery, inquiry into causes of accidents, and penal compensation to workers for accidents due to machinery remaining unfenced after notice from the inspector that it was “deemed to be dangerous.” These provisions embodied a few of the recommendations made in Special Reports of the Inspectors of Factories, presented to Parliament in 1841, and the recommendations of the Select Committee of the House of Commons presented in the same year; with them, however, was also introduced the principle of Arbitration on the objections raised by an occupier. The inspector might give notice of dangerous machinery to be fenced, but for fourteen days the right remained with the occupier to require the appointment of arbitrators “skilled in the construction of the kind of machinery” to which the notice referred. Each party, the occupier and the inspector, was then to nominate his arbitrator, and the two arbitrators were to proceed to examine the machinery “alleged to be dangerous” within fourteen days. If they could not agree, they were together to appoint as umpire a third arbitrator “possessing a similar knowledge of machinery.” When the ultimate decision supported the occupier’s objection, the inspector’s notice as to danger was annulled, and even if an accident thereafter occurred, penal compensation could not be obtained for an injured worker. Not until the Act of 1891 did this principle, later so greatly extended in application to matters of health as well as safety, cease to control the fencing of dangerous machinery (other than mill-gearing) in factories, and it still remains for all dangers in mines not expressly covered by any other provision. As regards this first introduction into the Factory Acts of penal compensation for preventible injuries, it appears to have been the outcome of a discussion by witnesses before the Royal Commission on Labour of Young Persons in Mines and Manufactures in 1841. This was the “trade charge or insurance payable by the branch of industry liable to the[33] accidents,” which has been at length secured to the worker only at the end of the nineteenth century by the Compensation Acts.

In the year in which these considerable steps had been taken in factory legislation (1844), the Mines Inspector under Lord Ashley’s Act published his first report. Even two years later women were still to be found in considerable numbers underground. Progress nevertheless was being yearly made—through the reports on safety and ventilation of special scientific commissioners (including Lyell, Faraday, Playfair), by the action of associations of miners, by spread of knowledge of the dangers of mining, and not least, by the recurrence of appalling accidents which ever increasingly shocked the public conscience—came the first tentative measure for general safety in coal mines—the Act of 1855[14] In 1854 the Select Committee on Accidents had reported, adopting among other recommendations a suggestion of the Inspectors for legislative extension of the practice of several colliery owners, of framing special safety rules for working in mines. The Act, in addition to specifying seven general rules binding on owners and agents of collieries for safety, relating to: (1) adequate ventilation to dilute and render harmless noxious gases; (2) fencing of disused shafts; (3) fencing of pumping pits when not at work; (4) secure lining of shafts; (5) proper means of signalling; (6) indicator and break for machine raising or lowering persons; (7) proper gauges and valve for steam boiler, provided for the framing and enforcement of special rules, to be submitted by owners for approval of the Secretary of State, at every colliery. These special rules, when established, were to have the force of law both for owners and miners, but were enforceable only by penalty in the case of owners, by penalty or imprisonment with or without hard labour (maximum three months) in the case of miners. This latter distinction occasioned considerable bitterness at the time, but the provision which was most generally criticised was the elaborate one for arbitration in case of objection on the part of the owner to any alteration or addition to special rules made by the Secretary of State. Within twenty-seven days the owner had power to nominate three or more “practical mining engineers or other competent persons of experience in the district,” not “interested in or employed in the management of ... the colliery,” and the Secretary of[34] State might appoint “one or more” such persons “to determine the matter in difference.” In case of the owner not exercising this power within the time specified, arbitration could be organised on lines very similar to those provided by the Factory Act of 1844, with the difference that in the case of special rules in mines one of the parties to the arbitration was the Secretary of State instead of the inspector. In the framing of special rules following on this Act, it was common for groups of collieries working under similar conditions to adopt one set of special rules, but sometimes individual owners drew up their own special rules, and occasionally attempted to introduce remarkably irrelevant matter, such as attendance at “Divine Service at least once on the Lord’s Day,” for the regulation of the conduct of miners.

Five years later the law relating to mines was extended, and in some ways strengthened, several disastrous accidents and explosions, entailing loss in the aggregate of thousands of lives, having in the meanwhile occurred. At several of the inquests strong evidence was given of incompetent management and neglect of rules in addition to disregard of inspectors’ suggestions for improvement of ventilation in the interests of safety; in one case the coroner’s jury returned a verdict of manslaughter against the manager, the overman, and the fireman of the colliery, though this was subsequently followed by acquittal at the assizes. The Act of 1860 touched on several new points, besides extending the law to include ironstone mines; wages and education sections were first introduced, but a demand for certificated managers of coal mines was not met until 1872. The chief advances in the direction of increased safety were, by extension of the general rules to include provision for places of refuge on engine planes, use of covers overhead in lowering or raising persons in every pit, fencing of fly-wheels of every engine, maintenance of boreholes to prevent inundations, by empowering an inspector to propose additional safeguards for dangers not covered by any rules (but in case of objection by the owner, the matter was to go to arbitration); by raising the age of those entrusted with charge of steam engines to eighteen years.

In the meantime the course of factory legislation continued to illustrate the strength of the original motive—rescue of young workers and women in textile factories from monstrously long hours and overwork—rather than intelligent and steady assimilation by the community of the evidence of need of special control[35] of drainage, ventilation, use of deleterious substances, and other matters affecting health in a large number of non-textile industries. Such evidence was first strikingly presented by the Report of the Commission on Mines and Manufactures, published in 1843, but later in greater detail as regards the injurious industries of lucifer match and pottery making in the Report of the Children’s Employment Commission of 1862. A long and fierce battle had to be waged over the form and degree of limitation of hours in textile works before the gradual extension of the principle of regulation could begin and proceed from trade to trade. It was in the Act of 1864, which added the largest number of these, including earthenware and lucifer match works, that the fruit of the labours of expert commissioners began to appear in explicitly sanitary measures, applicable to all classes of factories under the Acts.[15] In this Act we first find the idea of ventilation applied in order to render harmless “gases, dust, or other impurities generated in the course of manufacture that may be injurious to health.” And here we find the first fleeting attempt to introduce the “special rules” system from the Mines Acts, on the employers’ initiative, but without the arbitration clauses. Manufacturers were empowered to draw up special rules binding on workers, after approval by the Secretary of State, “for compelling the observance ... of the conditions necessary to ensure the required degree of cleanliness and ventilation, and to annex to any breach of such rules a penalty not exceeding one pound.” These powers were extended to many other trades, including indiarubber works, letterpress printing works, blast furnaces, and iron mills, by the Act of 1867, and were soon unfavourably reported on by inspectors, as throwing too heavy a burden on the workers, “the onus of being a principal under the Act,” to use Mr Baker’s words. In 1868 he reported that special rules were in force in most of the iron works in his district, which gave the employer “power over his workpeople who sub-employ in his works,” by holding them responsible for various sections of the Acts relating to employment of young persons; a purpose which we can now readily see to have been foreign to the general intention of such legislation. By the Act of 1871 penalties for breach of these rules were made recoverable by summary proceedings, but the provisions for framing such rules disappeared when the law was consolidated by the Act of 1878. The Workshop[36] Regulation Act of 1867, amended in 1870, practically completed the application of the general law to all workplaces in which manual labour was exercised for gain, in the making or finishing of articles or parts of articles for sale. The “Sanitary Act” of 1866 had provided for cleanliness, ventilation to remove injurious gases and dust, and for freedom from overcrowding in any workplace not under the operation of any of these Acts. The Factory Acts of 1864 and 1867 prohibited the taking of meals in certain workrooms where dangerous processes are carried on, e.g., lucifer match making, earthenware dipping, china scouring, glass-making (mixing, grinding, cutting, polishing), and the application of power to the extraction of injurious dusts was furthered by introduction of provision for a “fan or other mechanical means,” approved from time to time by the Secretary of State, in case of grinding, glazing, polishing on a wheel, or “any other process in which dust is generated or inhaled by the workmen to an injurious extent.” The Act of 1878, in consolidating all previous Factory and Workshop Acts, re-cast some special safety provisions (for example, those relating to prohibition of certain workrooms for meals), in such a form as to empower the Secretary of State to extend the prohibition to other industries, a power which was exercised in a considerable number of industries. Employment of young workers was also prohibited in certain dangerous processes, and power was taken to extend such prohibition. Nothing was done, however, at the time of this great measure—which was primarily for better administration of existing provisions, and was accompanied, on the recommendation of the Commissioners of 1875, by a thorough reorganisation and extension of the inspectorate—towards securing more detailed regulation of methods and conditions of working in dangerous trades, in spite of a recommendation to that effect by Mr Redgrave. The first decisive step in that direction was taken in 1883 in the case of one of the most deadly of lead industries, the manufacture of white lead, whose effects had been recorded for centuries, and in France had been the object of special inquiry followed by regulation early in the century under the direction of the Conseil de Salubrité. It is rather remarkable to read in a report of the Chief Inspector, 1882, that although “employment in dangerous occupations has on several occasions been brought under the notice of the legislature, until recently special attention has not been drawn to the manufacture of white lead.”[16] Now, however,[37] the evils pressed for remedy, and the “Mines Acts as to general precautions and special rules” were adopted as a “precedent” to be applied to white lead works.[17]

Before touching further on this new departure and tracing out its sequel, a brief reference must be made to the course of Mines legislation since 1860. While political conditions had been unfavourable to additional legislation for some time after the Act of that year, the conditions in the coal industry had been developing steadily, both as regards extent and methods of getting mineral on the one hand, and as regards association amongst miners on the other, in such a way as to make a complete law possible when it inevitably came. Scientific knowledge as to mechanical means of ventilation and other provisions for safety became at the same time incomparably wider spread. Greatly increased public discussion brought out far more clearly the objects and desires both of masters and men, and the determination of the latter to obtain certificated and competent management, extension of the system of “general” safety rules, improvement of the method of forming “special rules,” and increased inspection, had its effect in the consolidating and amending Act of 1872. The number of general rules was more than doubled, matters formerly left to the chances of special rules were permanently transferred to the general law, which now included compulsory use of safety lamps where needed, regulation of use of explosives in blasting, securing of roofs and sides, daily examination of the state of the mine, facilities for inspection by representatives of the miners. Special rules became more clearly defined as intended for the guidance, safety, and proper discipline of the miners at work, and they might only be transmitted for the Secretary of State’s approval after they had been posted in the mine for two weeks with a notice that objections to them might be sent by any person employed to the inspector of the district. Wilful neglect or contravention of any provision of a kind likely to endanger safety became punishable, in the case of employers as well as miners, by imprisonment with hard labour. The machinery of arbitration on any questions of safety under the Acts was made considerably clearer. In all these matters[18] the great advance[38] was by way of development of previous ideas. The entirely new departure lay in the six sections relating to daily control, and supervision of every mine by a manager holding a certificate of competency from the Secretary of State, after examination by a board of examiners appointed by the latter, power being retained to the Secretary of State to cause inquiry, if necessary, later into the competency of the holder of the certificate, cancellation or suspension of the certificate being possible in case of proved unfitness. There is little room for surprise that so great an advance in the law should have given widespread satisfaction to the miners, and that for a considerable time efforts of their associations were directed to securing vigorous enforcement rather than extension of the law. In the same year the question of health and safety in Metalliferous Mines[19] received its first treatment in a separate code (which remains in force to the present time), of similar scope to the Coal Mines Act. A Royal Commission had been appointed in 1862, and had reported in 1864. The great excess of mortality and sickness among metalliferous miners, “mainly attributable to the imperfect ventilation of the mines” and inhalation of gritty particles, to excessive physical exertion in climbing up and down ladders of great length, to the great changes of temperature, and exposure to wet, were brought out in the report and made the subject of recommendations. It was also shown that accidents were of frequent occurrence from falls from ladders, falls of the rock or stuff, carelessness in blasting, defective gear, and sudden irruptions of foul air and water. The method of regulation adopted for Metalliferous Mines, by general rules for safety, special rules for conduct and guidance of miners, and the requirements as to notice of accidents, coroners’ inquiries, fencing of abandoned mines, being similar to those for Coal Mines, details are unnecessary for the purpose of the present essay. In 1881 the Coal Mines Acts were strengthened in regard to the use of explosives underground, in 1886 the Secretary of State was empowered to direct a formal investigation of any explosion or accident and of its causes and circumstances to be held (a provision embodied by reference in the Factory Acts in 1895). In 1887 the Coal and Ironstone Mines Acts[39] were again consolidated with amendments strengthening the already existing provisions. By General Rule 4 more stringent provision for inspection of working parts of mines before commencing and during shifts, and the distinction between mines in which inflammable gas had been found within the preceding twelve months and those in which it had not, disappeared. By Rules 8, 9, 10, 11, construction and use of safety lamps became much more detailed and stringent than in the former Rule 7, which they replaced. By Rule 24 the age of competent male persons in charge of machinery for raising and lowering persons at the mine was raised to twenty-two. By Rule 34 provision of ambulances or stretchers with splints and bandages ready for immediate use at the mine became compulsory. Other main provisions of the Act strengthened were those relating to distance and height of communications between the two shafts required in mines; daily personal supervision of the mine by the certificated manager; notice of opening or abandoning seams. Arbitration on special rules and other matters was modified so that while the qualification of being a practical mining engineer was retained for the two representative arbitrators, the umpire, if any, is bound to be a county court judge, a police or stipendiary magistrate, a recorder of a borough, or a registrar of a county court.

Turning again to the Factory and Workshop Act of 1883, which forms the first distinct attempt to regulate a dangerous manufacturing industry, we find, in its unamended form, a remarkable parallel to the method of mines regulation, not merely in the requirement that every occupier of a white lead factory shall frame and submit for approval to the Secretary of State special rules[20] which have been affixed in the factory with a notice to the workers of their power to send objections to the Chief Inspector; but also in the prescribing of six general conditions for obtaining a certificate to carry on the dangerous industry. These include provision for ventilation of stoves and stacks, means of maintaining personal cleanliness, and proper room for meals. The special rules, however, were not in the original statute liable to any process of arbitration, merely to full consideration by the Secretary of State, who had power to make modifications after hearing the occupiers’ objections, if any, to his modifications.[40] This procedure was considerably modified when by the Act of 1891 provision was made for establishment of special rules in any industry (not being a domestic industry) certified by the Secretary of State to be dangerous or injurious to health, or dangerous to life or limb. Then the initiative in drafting the “special rules or requiring the adoption of such special measures as appear to the Chief Inspector to be reasonably practicable, and to meet the necessities of the case” was transferred from the occupier to the Factory Department, but a counterbalancing force was provided by addition of the arbitration clauses wherever the occupier persisted in objections to the proposed special rules, and the Secretary of State could not see the way to accepting modifications asked for by the occupier. At the same time the share of the worker in framing the rules, by his legal right to make objections before they were established, entirely disappeared. It was not until the Act of 1895 that this loss was imperfectly compensated, by a right to representation on the arbitration on conditions prescribed by the arbitrators which was then secured to workmen interested, or any class of them. In 1896, in the Mines Acts that privilege was superadded to the other. The general tenor of the Factory Act of 1891, following as it did on the important work of the House of Lords’ Committee on the Sweating System, and the Berlin International Conference, was one of development of sanitary organisation, particularly with regard to workshops, and of closer regulation of dangerous and injurious trades. It had been preceded in 1889 by an Act with special reference (like the Act of 1883) to a single class of factories, in this case the cotton cloth factories, in which excessive heat and humidity produced by artificial means seriously affected the health and comfort of operatives. The Act not only limited the temperature of workrooms and amount of moisture in the atmosphere, but also provided for tests and records of the same, and fixed a standard minimum volume of fresh air, 600 cubic feet, to be admitted in every hour for every person employed. Power was retained for the Secretary of State to modify by order the maximum limit of humidity of the atmosphere at any given temperature, and a short Act of two sections in 1897 extended this power to other measures for the protection of health recommended by a Departmental Committee appointed to inquire into the working of the Act of 1889. Without doubt, the most important measures adopted under this Act in 1898 were those tending to purify the air of workrooms by prescribing a CO[41] standard of ventilation (“during working hours in no part of the Cotton Cloth Factory shall the proportion of carbonic acid in the air be greater than nine volumes of carbonic acid to every ten thousand volumes of air”), and by prohibiting use of impure water for production of artificial humidity. One other point of historical interest in connection with the Act of 1889 must be touched on. It contained a general provision enabling an inspector, where he considered that dust was inhaled by the workers to an injurious extent, to serve a notice on the occupier of the factory to adopt mechanical or other means for its removal, but subjecting the notice in case of objection by the occupier to the same process of arbitration as the notice of fencing for dangerous machinery provided in the Act of 1844. In both cases the power of the employer to send the notice to arbitration was repealed by the Act of 1891, and, consequently, the ordinary procedure for the inspector to enforce such notices was by establishment of the evidence in support of his requirement in the ordinary courts. For the first time some provision was made in 1891 for means of escape in case of fire in factories and workshops. Certifying surgeons were now called upon to report annually as to the persons inspected and the results of inspection.

On the Act of 1891 followed a period of greatly increased administrative activity with the new powers to initiate detailed regulation for promotion of special hygiene in factory and workshop life. No fewer than sixteen trades, including the majority of those referred to in the reports of Royal Commissioners and special medical experts of the earlier and middle parts of the century, were certified, under sections, by the Secretary of State, as dangerous or injurious within four years of the passing of the Act.[21] The Act of 1895, extending greatly in several directions the sanitary control of industrial life, followed on this period of increased activity, after the Royal Commission on Labour had reported on the results of its wide survey of industrial conditions, after two important Departmental Committees had reported on lead and phosphorus industries, and after two successive annual reports had embodied reports and recommendations from the women inspectors who in 1893 were first added by the Home Office to the staff of factory inspectors. In the year in which this Act came into force, medical knowledge was established[42] as a guiding factor in the permanent administration of the Department. Probably no more important step towards control of use of poisonous substances in manufacture has been taken than that contained in the provision for reports to the Chief Inspector from every medical practitioner attending in certain cases of poisoning contracted in any factory or workshop. Complementary to this is an extension of the province of certifying surgeons; it included now not only examination of workers under sixteen, but also the duty of inquiry and report in certain cases of industrial disease and accident, and, under special rules, where required, periodical re-examination of workers. In the general provisions of the Act appear for the first time the questions of reasonable temperature, requirement of lavatories where poisonous substances are used, formerly only touched by special rules; it became possible by order of a court of summary jurisdiction to secure prohibition of use of dangerous structures or a dangerous machine until the necessary steps had been taken to remove the danger by the occupier of the factory or workshop. The field of factory regulation was extended by the inclusion of certain conditions of health and safety in “laundries,” and of general and special conditions of safety in every dock, wharf, quay, and warehouse. In the special rules it became possible for the Secretary of State, subject to the award of arbitrators if objection were raised, to introduce provisions prohibiting or limiting employment of any classes of persons in the industries scheduled as dangerous, a power which has been exercised in the case of white lead works (prohibition of women’s employment in the most dangerous processes), vulcanising of indiarubber by bisulphide of carbon (limitation of hours of adults), and lead smelting works (limit of spells in cleaning flues).

A few words must be said about the dangerous industry of quarrying in open quarries (as distinct from underground quarries under the Metalliferous Mines Act). These were nominally under the Factory Acts by section 93 of 1878, but it was not until special rules could be introduced under the Act of 1891 that any practical steps could be taken at all to enforce the particular measures of safety applicable to the conditions. These proved inadequate, and in 1894, on the recommendations of a Special Committee appointed in 1893 to inquire into the whole matter, a special Quarries Act was passed which, while retaining those provisions of the Factory Acts that were suitable, such as fencing and regulation of employment, applied also those provisions of the[43] Metalliferous Mines Acts which from the nature of the industry rendered them better adapted for control of its peculiar dangers; at the same time the administration passed to the Mines Department, and in a few years it was reported that special rules for safety had been established in over 2000 quarries with satisfactory results.

Much remains to be said of the methods of regulation of injurious and dangerous industries since 1896;[22] of the steps taken by inquiries and action of the permanent staff, with its increasingly expert character; of inquiries by Departmental Committees and by specially appointed advisers on scientific and technical aspects of processes; of endeavours, successful and unsuccessful, to frame and carry through special rules without resort to arbitration to meet the risks to the life and health of whole classes of workers; of the results of arbitration in two of the most injurious industries, manufacture of earthenware and china, and of lucifer matches, where white or yellow phosphorus is used. All this, however, belongs so much to current history and controversy that its true meaning and tendency can best be brought out later, and perhaps by a more detached observer. At the very time when the proofs of this sketch leave my hands, an important Bill is passing to report stage in the House of Commons from the Grand Committee on Trade, where opinion has been shown to be practically unanimous in regard to the substitution of a better method of establishing special rules for the precarious and clumsy method of arbitration; power has been taken to prohibit, limit, or control use of any material or process in industry; and, where fruitful extension has been made of the principle of legislating, for details in matters of health by means of departmental orders. Enough has, I trust, been said to illustrate the rise and growth in the last hundred years of the still new ideas of the claim of the industrial worker in a civilised country to reasonable, practical measures to secure his immunity from needless suffering, of the claim of the community that the profits of manufacture shall not be bought at the expense of the life and health of citizens, in whose individual well-being the true wealth of the community lies.

Adelaide M. Anderson.

In the historical sketch of the development in England of factory and workshop hygiene, I have endeavoured to indicate the groundwork on which special regulations for dangers arising out of the nature or the organisation of particular processes rest. Comprehension of the meaning of regulations for industrial health in other countries would be greatly increased for the student of this branch of comparative legislation and administration, if there were knowledge of the historical development of these institutions not only in one but in all the countries touched on. But then, equally so would there be gain in acquiring practical administrative experience in all those countries. Although both kinds of knowledge are not equally impracticable of attainment by one individual, the limits of space and time in such a chapter as this prohibit any attempt to enter on either field so far as details are concerned, and it is only possible to take the absolutely necessary step of entering a warning against over-estimation of the value of comparative surveys of systems of factory law and schemes of administration which are not followed by further research. With a view to such further research I trust that the slight survey attempted here may be of value.

While fully appreciating the need of supplementing study of the law relating to factory hygiene in any country by reference to the system of local government and the law relating to public health, I am compelled by the limits already touched on to concentrate attention on the one branch of law—factory legislation proper.

England stands in a special position, with its own qualities and own defects. Having entered long before most other European countries on the path of control of employment in factories owing to the earlier need of such regulation, and having admittedly also[45] led the way in the task of building up a complete and precise sanitary code for regulation of public health, England has shown in the later stages of the part of the work which touches industry too little interest in the later efforts, on different lines of other countries. This slowness is traceable in part to the same causes as those which have retarded in England the general study of comparative legislation and administration, of which foremost, no doubt, stands the necessity of developing on national lines our own safeguards, yet it seems probable that the country which in a singular degree stimulated European progress in Public Health by the justly famous “Report on the Sanitary Condition of the Labouring Population,” 1838, and its immediate fruits, has latterly retarded its own progress in industrial hygiene by too close an adherence to its own methods. However this may be, it is clear that whereas Continental thinkers have already begun to utter warnings as to the limits of the value of comparative study of labour legislation, we in England are still waiting for sufficient material and accurate information on which to base any comparisons at all. Even for those who have time to do little more than mould their opinions by reading the daily and weekly papers, still more for those who desire to devote more time to these subjects, it would be well if we had continually accessible, in convenient form, current documents which would enable us to estimate more exactly what we have to learn from other countries, and what are the ideas applied there which are capable of application here under different circumstances of social and administrative tradition and legislative groundwork.[23] And to understand any one branch of factory legislation, even the sanitary, engineering, and medical side of prevention of industrial diseases and accidents, knowledge must be acquired of other sides, the economic one of limitation of hours and times of work, and protection of workers in making their contract, no less than the social side of propriety of arrangements in the workplace, and direct or indirect protection of women, home life, and children’s training. The time has come, however, when there is a new readiness for the interchange of ideas between this country and others on the question of general provision for sanitation and special regulation for dangerous, unhealthy, and injurious occupations. As I have said elsewhere, “with the rise and development of new methods and even entire industries in new places, old and new dangers and diseases are[46] rapidly becoming clearer. The international interest in applying science at an equal pace to the development and to the sanitation of injurious industries is at once more equal and more urgent than in the indirectly hygienic questions of hours and holidays for industrial workers. At the same time the difficulties of regulation are far less prominently economic, legal or social, and more especially questions for treatment by expert scientific advisers.”

In order to estimate with an approach to accuracy the value of special measures adopted in other countries, it is necessary to obtain some idea of the ordinary scope of factory legislation, and of the degree in which the laws are made operative by methods of administration, and by sanctions attached to contraventions. The regulations for ordinary health and safety, which “at first blush” bear considerable resemblance to each other, are found on closer examination to have widely differing effectiveness, owing perhaps in one case to lack of precise definition or to special limitation of the class of workplaces covered; in another to the powers conferred both on local and on central authorities to sanction exceptions either to the Industrial Code, or orders made under it; in another to local variations in economic organisation of industries affected. For example, on the first point, more cases of disputed application of the code, which contains no definition of the term “factory,” have in Germany come before the courts than in England, and in Germany the special restrictions as regards hours and health for women and young workers apply only in “factories.” The various decisions, on particular instances, of the Supreme Court lay stress now on one feature, now on another, of what is understood as a factory, such as numbers employed, size of the building, subdivision of labour, active personal share of the employer in the processes. Application of mechanical power to manufacture by machinery generally brings a workplace under the scope of the factory regulations, but power is retained for the Federal Council to exempt even from this rule any special undertaking. The Austrian Industrial Code does define the term “factory,” but very much on the lines threshed out by the decisions of the German Reichsgericht. In both these countries there is much less control of conditions of labour in workshops than in factories, although Austria makes rather less distinction than Germany between the two. Whereas England distinguishes these two classes of workplace only by relegating general[47] sanitary control of the workshops to the local authority, not by differing requirements, France makes none of the distinction between factory and workshop which in one form or another is found in other European countries. In both these countries the general protection of the law covers alike factory and workshop employé; in Germany the Code has not gone further than to empower the Federal Council to extend the factory regulations, if cause should be found, to workshops. “Domestic workshops” are entirely exempt from regulation of labour in Germany and Austria. England stands alone in defining limits in domestic workshops for the labour of children and young persons, but hitherto has not taken the power of applying special sanitary regulation,[24] which both France and Belgium possess, for protection against dangerous or unhealthy occupations carried on in them. From even so brief a review of the classes of workplaces covered, it easily appears how in the past in some countries the domestic workshops in dangerous industries, e.g., lucifer match making (unknown except in factories in England), have furnished a disproportionate number of victims of industrial disease.

While the first question necessarily is, what are the workplaces covered by the regulations? the second and equally important is, what is the system of inspection? In most countries, as in England, the institution of a special inspectorate has followed, not accompanied, the enactment of measures of protection, even though in some countries the idea of sanitary regulation has preceded limitation of hours for women and minors. In Belgium, Holland, and Sweden the institution dates from 1888–9; in Switzerland, and some of the German States, beginning with Prussia, it dates from 1878; in Austria, from about 1887; France, from 1874; Denmark, 1873. About 1892 to 1893 both France and Belgium undertook the reorganisation of their inspectorate, which corresponds to the thorough reconstruction that in England followed the Royal Commission on Factory Legislation in 1876.

In several of these countries, all of which had originally to some extent looked to the far earlier example and experience of England in enforcement of the law, the important step was taken, considerably in advance of England, of bringing into the factory service medical, engineering, and chemical expert[48] knowledge. No doubt in England, the delay in this matter is directly traceable to the character stamped on the institution by the educational, moral, and social origin of our Factory Acts, and to the very recent beginnings of development (1883–1891) of a special basis of factory hygiene. The delay in England was probably further increased by the introduction (referred to in my historical sketch) of tentative investigations of industrial diseases under the ægis of an entirely separate Government Department, concerned with local government and administration of the law relating to public health. This delay as compared with Germany was, however, more than compensated, when the Act of 1891 had introduced special means of control of injurious trades, by the centralised, organised character of the English inspectorate. Although the German Federal Council can make regulations for injurious industries throughout the Empire which over-ride special state or local rules, still each state has hitherto appointed its own inspectors, and when appointed these inspectors in order to enforce the rules must ordinarily report infringements to the local police authority, who may or may not always take action. Thus in Germany uniformity of administration in such matters outside the boundary of any state, so far as it depends on centralised supervision, can hardly be looked for. Much more closely knit is the Austrian inspectorate, with its chief inspector, who has some expert advisers on his staff, and power himself to take part in final decisions on cases brought up, on appeal, to the industrial authority of third and final instance at the Ministry of the Interior. Only in Austria, so far as I know, is it obligatory in fixing a penalty for a contravention to take into account both the amount of advantage the offender might expect from the infringement and the amount of harm that the worker may suffer. The latter consideration would be weightiest in questions of health and safety, and since the fines have to be paid into local provident funds for workers, would correspond to the penal compensation in case of injury through neglect to fence machinery possible under English law. Medical and chemical reports are less prominent in the Austrian inspectorate than the German, and it has been distinctly laid down that the inspectors are not so much engineering and sanitary experts as a special institution for the protection of labour; since 1876 the supervision of dangerous and unhealthy industries has been one of the functions of the provincial authorities for public health. Although in France the inspectorate has been organised on lines, so far as[49] territorial divisions are concerned, similar to those in England, i.e., with district and superintending inspectors, it is without a chief inspector, and works under the general supervision of a commission (Commission supérieure du Travail dans l’Industrie). This system has been declared by one of the oldest superintending or divisional inspectors to work most unsatisfactorily in the matter of control of dangerous industries where the great need is that the circumstances not of a locality, but the country as a whole, should be considered by a chief having under his directions both expert officials and an organised staff. The special expert character of the central Belgian inspectorate is determined by the fact that the earliest inspectors were appointed (1889) under the law relating to sanitation and safety in dangerous or unhealthy industries, and not under the law limiting hours of labour for women and children. The latter were first appointed in 1891, and the whole service organised as one in 1895. Of the Scandinavian countries Denmark has had the most definitely constituted inspectorate, but here the central authority has hitherto been divided (as it was before 1876 in England) between two principal inspectors. This is now altered. An Act which came into force on 1st January 1902, not only amends and strengthens the law relating to factories, but also centralises the control by providing for a single chief or director with two expert secretaries, one trained in economic questions, the other in technical questions. Of the remaining European countries Hungary possesses an organised and centralised inspectorate of the English type. In Russia control of the methods of inspectors is by a system of Provincial Boards under the supreme supervision of the Chief Factory and Mining Board, presided over by the Minister of Finance, who places some of the principal inspectors on the Board.

I may turn from the field of application of the laws and methods of organising inspection to the methods of securing general sanitary conditions and security in workplaces. England stands alone in both delegating certain sanitary powers to local authorities, and at the same time retaining power to the Government inspectors to intervene in these matters in case of default of the local authority, and yet we have nothing quite comparable to the powers of health authorities in Belgium, Germany, and Austria, to lay down in certificates of authorisation for large numbers of workplaces, conditions aimed at securing the health of the workers as well as the public health. In some cases, particularly in Belgium, this power extends[50] beyond the trades here classed as noxious or offensive, and includes amongst many trades recognised as injurious to workers even laundries, one of the last of the great manual industries to be regulated in this country. Quite early in the nineteenth century we find laundries appearing in French lists of noxious or offensive trades under two classes, (a) as requiring authorisation for establishment near dwellings, (b) as requiring internal supervision on account of decomposing soap and water. In Germany and Austria, lists of trades subject to preliminary authorisation are shorter than in Belgium, but there is nothing in other countries equivalent to the absolute duty placed upon German local authorities, apart from all initiative of numerous Government inspectors, to visit every industrial establishment where protected persons are employed at least once in six months, in order to apply the provisions of the industrial code in all matters relating to safety, sanitation, and propriety of arrangements. Further, we have in England nothing comparable to the powers of the separate State Authorities in Germany to call in the advice of the Accident Assurance Associations under the Accident Insurance Laws in order to restrict hours of labour in dangerous occupations, or to carry into effect the general requirements of the Code relating to safety and health. In general, in comparing special rules against dangers in industry as between England and Germany, due weight must be given to the consideration that for many years in Germany there has been insurance for workers both against accident and sickness; also it must be remembered that the Civil Code lays a positive obligation on every master to secure for his servants arrangements for health, safety, and morality in their employment such as are also required in the Industrial Code. We are, moreover, in Austria and Germany reviewing countries in which traces of the old guild organisation of industry survive both in law and fact, and the industrial codes, while defining the duties of employers to workers, expressly require obedience and fidelity from the worker to his employer. Discipline thus is a far easier matter in a German than an English workplace, a factor of very considerable importance in regulation of dangerous trades.

It would not be difficult to demonstrate in tabular form that England and Germany stand easily first among the European countries in respect of detailed attempts to regulate unhealthy industries by special Government rules, but it must suffice[51] presently to set forth the trades so regulated in these two, while touching on some of the salient features of special rules in other countries. First, however, it must be indicated how the various countries stand to each other in such general matters as ventilation and lighting of workrooms, temperature, provision of meal rooms, cloak rooms, lavatories, drinking water, arrangements for sanitary accommodation, reporting and prevention of accidents.

As regards ventilation, until the Bill of 1901 to amend the Factory Acts was introduced by the Government, England stood almost alone in requiring removal of air from workrooms only so far as injurious dust, gases, and vapours arose from the manufacturing process. The laws of Germany, Austria, and Belgium recognised much earlier the need of ample ventilation in a workroom, quite apart from the special question of removal of poisonous or injurious products of manufacture, although for those too sufficient provision had been made. In Belgium, general ventilation of workrooms was one of the special conditions of authorisation of unhealthy trades under a decree of 1886, but in 1894 it was particularly laid down for all workshops that means of securing renewal of the air equal to at least 30 cubic metres per hour per worker should be provided, and that where unhealthy processes were carried on, the removal should be equal to 60 cubic metres. “The inlets for fresh air and outlets for vitiated air shall be so placed as to cause no inconvenience to workers.” On this followed the further provisions for exhaust ventilation for steam, gases, and dust. A French decree of the same year is rather less exacting in the matter of general ventilation, but more precise as to the measures necessary for removing or preventing injurious dusts, gases, and steam. In Austria and Germany, in addition to the general proviso that workrooms are to be maintained in such a condition as to secure the health of workers, both general ventilation and special provision for removing dust and fumes are required. These requirements are of much earlier date than the French and German decrees referred to. General ventilation and removal of dust from workrooms are required in Hungary by the law of 1893, and will be in Denmark by the law to come into force in 1902.

As regards lighting of workrooms, a condition of health almost as important as ventilation, several of the more important industrial countries have provisions, although England has hitherto left the matter untouched. Germany by section 128, and Austria by section 74, of their respective industrial codes recognise sufficient[52] light as an essential condition of health in factories. In France provision is made for proper lighting of workrooms and also of passages, staircases, and other accessory parts of factories and workshops. In Belgium and Denmark lighting has hitherto been required as a measure of safety, not of health. On the other hand, the important sanitary question of temperature is more carefully provided for by the general law now in England than in the codes of other countries.

Suitable dining-rooms, which can only be required in dangerous industries under special rules in England, may by the German code be ordered wherever it seems desirable by the local authority, who may also require that they shall be heated in cold weather. In France, although it is laid down that all workrooms must be cleared, and the air entirely renewed during meal hours, the law is silent as regards provision of meal rooms; consequently, as in certain cases in England, inspectors report difficulties in enforcing the evacuation of workrooms during meal hours. It is frankly admitted in the latest annual report that the law has hitherto only been strictly applied where the nature of the manufacturing process makes the restriction essential for protection of the health of the worker: mostly in trades classed in this country as injurious. The Belgian law does not in this matter go quite so far as the French, the restriction applying only to rooms in which poisonous substances are handled. Suitable lavatories, cloakrooms, and drinking water are required in all factories and workshops in France by the decree of 1894, a requirement going far beyond those of other countries, for example Germany, where provision of lavatories and cloakrooms depend on their being required by the nature of the work, and where a detailed order must be made to that effect by the police authority for specified classes of workplaces. As in the case of meals in workrooms, it appears from the official reports that in France the provision of washing appliances is enforced only in chemical works, workplaces where poisonous substances are handled, rag-sorting shops, tobacco factories, and a few other classes of workplace, where the nature of the work makes it important that such protection should be given.

The French and the Belgian laws are as yet the only ones which attempt to define precisely a standard, independent of local conditions, for sufficient and suitable sanitary conveniences. The German code makes a general requirement as to sufficiency and suitability, having regard to number and sex of workers, and[53] leaves details to police regulation. In Belgium the number must be one convenience at least for every twenty-five workers, in France for every fifty workers, and in neither country may there be direct communication with workrooms. It is clearly stated in inspectors’ reports that in France the conditions in sanitary respects are far from being fully enforced, although the general limit of one in fifty is not infringed. These two countries again have general provision for the very important matters of drainage of floors and frequent cleansing of workrooms, and prompt removal from them of organic matter. “The floor shall be cleansed, thoroughly, at least once a day before or after the period of employment,” in the French decree of 1893, is a provision which appears to be well enforced and is applicable to all industries. The inspectors are specially instructed to draw attention to the hygienic value of a cleansing which takes place before the entry of workers. The sanitary value of such a practice, whether in dusty, poisonous, or ordinary workshops, cannot possibly be overrated.

Glancing for a moment at general regulations to protect women and young workers, as distinct from adult workers, two points only can be touched on, protection of young workers against overstrain, and women from accidents and from too early employment after childbirth. The brevity of this article makes it impossible to compare in detail the limits of age for child labour in the different countries, but some special safeguards under the French law cannot be passed by: (a) careful detailed regulation of the weights that may be pushed, lifted, carried by girls and boys under eighteen years of age; (b) prohibition of employment of girls under sixteen at machines driven by treadles; (c) prohibition of employment of young workers in a large number of processes scheduled as unhealthy; (d) cleaning of machinery in motion is prohibited not only for young workers but also for women. The German Industrial Code especially insists on the peculiar responsibility of employers to take every possible step to protect young workers from risks of all kinds.

The limitations as regards employment of women after childbirth may be briefly summarised as follows:—

Belgium.—“Women must not be employed in industry within four weeks after childbirth” (sect. 5 of Law of 5th December 1889).

Switzerland.—“A total absence from employment in factories of women during eight weeks before and after childirth must be observed, and on their return to work proof must be tendered of an absence since birth of the child of at least six weeks” (section[54] 15 of the Federal Law of 23rd March 1877). An order of the Federal Council, 1897, indicates a further abstinence from employment before confinement (the length of time unspecified) in certain dangerous occupations, e.g., in processes in which fumes of white phosphorus are produced; or in manipulation of lead or lead products; or where mercury or sulphuric acid are used; in dry cleaning works; in indiarubber works; any processes involving lifting or carrying heavy weights, or risk of violent shocks. As the limit of the period is undefined, and means of enforcing the prohibition unspecified, it is difficult to see how the regulation does more than outline an excellent theoretical protection.

Holland.—“Women must not be employed in factories or workshops within four weeks after childbirth” (Law of 5th May 1889).

Denmark.—“Women must not be employed within four weeks of childbirth except on production of a medical certificate showing that the mother’s employment will not be injurious to herself or the child” (Law of 1st July 1901).

Germany.—The Industrial Code contains the same absolute prohibition of employment during four weeks as the Dutch law, but extends it to six weeks if a medical certificate cannot be produced approving employment at the end of four weeks.

Austria.—The Industrial Code lays down the same prohibition as the Dutch law.

Spain, by a law of 13th March 1900, prohibits employment of women within three weeks of childbirth, but lays a further obligation on employers to allow one hour at least in the ordinary period of employment (for which there must be no deduction from wages) to nursing mothers to nurse their infants. This hour may be divided into two separate absences of half-an-hour, and may be fixed at pleasure by the mother, whose only obligation is to notify the times she chooses to the overlooker.

Turning to accidents and their prevention in factory and workshop employment, it is probable that only in Germany and Austria, through the operation of the long-established insurance laws, is there anything approaching the completeness of information with regard to occurrence and causes of accidents secured in England by the duty of reporting so precisely defined in the Factory Acts. On the other hand, through the operation of the same insurance laws, the fencing and other precautions against occurrence of accidents, necessarily tend to be far completer than in any country where this motive has only recently arisen (as in[55] France and England). It is indeed expressly stated in the last annual report of the French inspectors, that the statistics of accidents are very far from indicating the real state of affairs, and that it cannot be known until the law of employers’ liability for accidents, of 1898, has come fully into operation. Possibly to the admittedly ineffectual control by Government in France of the causes and prevention of accidents is due the formation and steady growth of Employers’ Associations with the object of reducing industrial accidents by careful fencing and organisation of work. Details as to methods adopted in the various countries for guarding machinery and reducing risk of accidents would be too elaborate and technical for this article. So far as the various laws, distinguished from administrative regulation, are concerned, none contain so complete a series of provisions as the English Factory Acts, though Belgian and French decrees contain some excellent safeguards. In Germany, as can be readily verified by reference to any volume of Government inspectors’ reports, much of the detailed work of enforcing use of safeguards is done by the Trade Accident Associations, often acting in co-operation with the State inspectors. Not only are rules relating to safeguards—for example, the elaborate ones in aerated water works—drawn up by the Trade Associations, but they are enforceable by penalty both on employers and employed after they have been duly authorised by the Imperial Insurance Office. Employers neglecting the rules may be condemned to pay double their ordinary contribution to the Trade Association, and the fines imposed on workers are payable to the Sick Insurance Fund.

Turning now to governmental regulation of specially unhealthy or injurious occupations by more closely applied and more easily amended rules than are possible in a general code, I must revert again to the observation made above, that only in England and Germany can a clear comparison be made of “special rules”; this applies both to the method of formulating such rules, and to the number and variety of trades so regulated. Other countries have in their general factory law powers to make somewhat similar regulation, but have relied in a greater degree on control of injurious occupations by local authorities concerned with the law relating to public health, or have endeavoured, especially in France, to lay down in a single administrative decree general requirements as to exhaust ventilation for dust and fumes, washing appliances, meal-rooms, etc., which would be likely to cover the special risks in many industries.[56] In Belgium, where special rules for safety of workers in dangerous industries (such as manufacture of lucifer matches by means of white or yellow phosphorus) have been drawn up, both in pursuance of the general law regulating factories (1889) and of the laws relating to noxious industries, under control of local authorities, there is an increasing tendency for sanitary regulation of workplaces to pass into the control of the central factory inspectors.[25] There we find in the decree of 1894, relating to general precautions in unhealthy industries, very similar provisions to those in the French decree of the same year; but the Belgian decree is declared in its preamble to be a codification of the conditions liable to be attached to certificates of authorisation by the local authorities, whereas in the French decree we clearly find the first step in an attempt to apply the general law of 1893, relating to hygiene in factories and workshops. An exceedingly interesting commentary on the incomplete and unsatisfactory effect of this latter method is found in the summary to the annual report of the French inspectors for 1899. I gave a translation of the terms of the decree in my annual report for 1894 to the Chief Inspector of Factories, and need not repeat them here. The difficulties since complained of in France are twofold—(a) judicial, as to interpretation in the courts of some of the exceedingly vague terms employed, (b) technical, owing to the inappropriateness in some of the industries of rules which are admirable in others. There is a growing demand, likely to be met after completion of current investigations in various unhealthy industries, for more detailed and precise rules, applicable to special processes or to classes or allied groups of industries. Such special rules were clearly originally intended to be the outcome of the law on hygiene, 1893, but in only one case, the manufacture of emerald or Schweinfurth green, have special rules binding both on employers and workers been applied (decree of 29th June 1895) to the peculiar risks of the processes. “Does that mean,” says the official report of 1900, “that it is only in this branch of manufacture that the need for special protection of workers against the injurious effects of the processes has appeared? No. The Government have had under consideration a certain number of draft rules for application to particular industries ... for example, industries[57] in which lead and lead compounds, mercury, arsenic, or arsenious acid, and varnishes with an alcoholic base are used.” In the meantime the result of their considerations has been that draft rules for electric accumulator works, vulcanisation of india rubber, laundries (against danger from infectious diseases), horn and woollen factories, handling of foreign hides and skins, were referred to the Committee of Public Hygiene, for an opinion to guide the Minister of Commerce and Industry before he finally issues the decrees, embodying the rules. It appeared, however, that the statutory powers of this Committee do not go beyond the framing of recommendations applicable to industries in general, and the Minister of Commerce and Industry appointed, therefore, in December 1900 a special Dangerous Trades Committee, composed of nine members, under the Presidency of M. le Docteur Napias, Member of the Académie de Médecine. The aim in selecting the members of the Committee was to secure the technical and scientific knowledge necessary for preparation of special rules suitable to particular classes of industry, processes, or modes of working. In addition to expert members such as M. Bouquet, M. Fontaine, and Professors of Chemistry, Economics, and Representatives of Employers and Employed, four other members may be appointed for the special technical considerations belonging to each trade or class of work to be regulated.

As regards poisonous processes, in all but the deadliest, where the frequency and severity of illness (as, e.g., amongst white lead workers) long ago led to inquiry followed by special local precautions, inquiry must be greatly handicapped in France, as it has been in Germany, by the lack of complete statistics of industrial poisoning such as have been secured in England. In no other country has the step been taken of laying both on the occupier of a factory or workshop and on every medical practitioner the duty of reporting to a chief inspector of factories, or the central authority, individual cases of industrial poisoning. The lack of information would possibly have been earlier felt in all its seriousness in both France and Germany had there been the centralised responsibility that followed the appointment of a single chief inspector in England. Although in France the attention of the Minister of Commerce and Industry has been repeatedly drawn to the effects of lead poisoning in potteries, and special precautions are recognised as necessary, it is difficult, as Dr Oliver pointed out in his report of 1899 to the Home Secretary,[58] “to estimate the amount of lead poisoning that occurs in the potteries in France,” owing to the incompleteness of statistics. In Germany, where considerable information can be obtained in some districts, through the records kept under the Sickness Insurance Laws, the incompleteness and uncertain character of the information supplied is the subject of frequent report by the factory inspectors. In the Potsdam district, where there are innumerable glazed-tile stove factories, great service was done by the action of a sick fund doctor, who reported that in the dipping department nearly every worker suffered, more or less, from lead poisoning. Energetic precautionary measures were taken by the local authority, and great improvement in health of workers was soon reported by the doctor. In other districts, on the other hand, comments are frequent from the inspectors on the lack of effective assistance from sick funds and their doctors in tracing the origin of industrial diseases.

In spite of this defectiveness in statistics of industrial disease, it is with the German Imperial Regulations (Orders of the Federal Council made in pursuance of section 120 of the Industrial Code) that the English method of regulating dangerous trades can be best compared.[26] Some years before it was possible in England under section 8 of the Factory Act of 1891 to schedule as dangerous or injurious any process, machinery, or particular description of manual labour in a factory or workshop, the Federal Council of the German Empire, or the central authority in any one of the Federal States, was empowered to draw up special rules to guard against risks of injury to life, health or limbs of workers, and to limit hours of adults as well as of minors. Such rules, bearing date 1888 and 1889, are still in force. This power was strengthened by an amendment in 1891 to the Industrial Code, applying to protected persons, which empowered the Federal Council to forbid entirely the employment of women or young workers, or to make it dependent on very stringent conditions in occupations dangerous to health or morality. At no time has there been under the German Code a power reserved to employers, similar to that in force in the English law until 1901, of compelling such objections as they can sustain to proposed rules to be settled by arbitration. It has been repeatedly remarked by competent observers that special hygiene in German factories, particularly chemical factories, has far surpassed[59] the standards obtaining until recently in England. This is not surprising when the greater facilities in Germany for giving effect by administrative measures to expert recommendations are remembered; but the readiness of workers to submit to regulations, to which I have referred already, is certainly a factor of importance. It is remarkable that, in spite of the difference, more or less stringent special rules have been established in twenty-four classes of unhealthy industries in England, as compared with fifteen similar sets of rules in Germany; it must be observed that in some of the latter more than one class of works is included, as, for example, in the special rules of January 1899, which cover both horsehair spinneries and brushmaking works.

It is of interest to compare as follows the classes of industries included, and the date of the regulations:—

SPECIAL RULES FOR INJURIOUS OCCUPATIONS.

England.

Germany.

[60]

It must not, however, be forgotten that some dangers for which no apparent provision is made in the list of German rules are to some extent covered by other means—for example, mercurial poisoning among thermometer makers by rules of the Accident Insurance Associations, or earthenware works by regulations of local authorities or by action of separate State authorities.

On first comparison of the two sets of special rules in detail, it would appear that whereas white lead works, earthenware works, and indiarubber works, are far more stringently regulated in England than in Germany, other industries, for example, electric accumulator works, letterpress printing works, are subject to closer control than any here. In the German rules for electric accumulator works we find prohibition of employment of women and girls, limitation of hours for men, detailed conditions as to construction and cleansing of premises and floors, in addition to the more common regulations for baths, lavatories, medical examination, sick registers; whereas in the English rules there are only provisions for baths, lavatories, respirators, and gloves, no restrictions on employment beyond the ordinary factory limits, and no medical examination. It must be noted that the enforcement of these rules does not rest solely in the hands of the Government inspector, and that before action is possible, the matter must be referred to the local police authority, whose powers in Germany, however, are considerable. The special rules for letterpress printing works are so interesting and typical that I append a translation herewith for comparison with similar English regulations. It seems clear that some of the rules are directed as much against propagation of tubercular disease as against risks of lead poisoning.

In closing this brief survey, reference must not be omitted to the experiment that has been made in three European countries—Switzerland, Holland, and Belgium—of limiting in a single instance (in the interests of the health of workers) the use of a poisonous material in industry. I refer to the use of white phosphorus in the manufacture of lucifer matches. In Switzerland and Holland the use of the material in this industry has been prohibited; in Belgium its use has been limited to a maximum of 8 per cent. in the paste.

Adelaide M. Anderson.

[61]

Appendix to Chapter III.

Order of the Federal Council of July 31, 1897, regulating Letterpress Printing Works and Type Foundries in pursuance of section 120e of the Industrial Code.

“Quot manus atteruntur ut unus niteat articulus.”—Pliny.

Natural History, Book II., chap. lxiii.

He who attempts to deal with the future of industrial legislation is confronted at the outset by two obstacles. The one is inherent in most endeavours which relate to prospective law-making. The barque which sets forth into the sea of futurity should, if its voyage is to terminate in the safe anchorage of a fair haven, steer clear of those currents which only too easily carry it upon the shoals and quicksands of controversial politics. Once launched, it is scarcely possible to avoid stranding upon the sterile shore of party. And even a successful cruise must bring it perilously near the Scylla and Charybdis of government and opposition. The effort of this chapter will be to steer as even a course as possible between these opposing forces.

The second difficulty is more of a particular than general nature: particular to the subject under consideration. A study of what has gone before, especially of the historical chapter preceding this, must force the conclusion that what has up to now been achieved seems to have been more the result of accident, or of some extraneous agitating forces, than of any carefully considered or preconceived plan. How piecemeal the work has been, and how intricate a fabric! Upon what lines can so patchy a structure be developed? Upon what principle applicable to the whole code can our industrial legislation, already a congeries of partially connected details, proceed?

Students of the British Constitution will be tempted to draw an analogy from their favourite example; and indeed there is much at first sight in common between the histories of the Factory Acts and the British Constitution. The structure of each is compounded[64] of small accretions, contributed by what seemed the necessity of the moment. But in the one case, in spite of the seemingly haphazard nature of the work, judged by the manner in which it has been performed, the British Constitution is firmly established upon a solid foundation, the independent blocks have fitted well into their time-assigned places, and have become welded together into a sound, cohesive whole in the process Mr Walter Bagehot has admirably called “the cake of custom.” How far has this been the case with the Factory Acts? Certain warring elements have gradually become adjusted; incongruous items have in certain cases been made to harmonise. The best example of this is to be found in the Consolidating Act of 1878, by which many inconsistencies were corrected. But even this admirable piece of work left the door open to the recreation of the incongruities and anomalies. In many cases the loopholes have been but too freely utilised, and exemptions and exceptions have been widely extended. These have largely tended to weaken the law and to create confusion.

This want of homogeneity in the base work suggests problems of procedure difficult of solution. In view of the danger that any weighty superstructure would threaten foundations thus composed, it might be urged that our first care should be to remodel the foundations that the base may be secure. Such a course would involve the inevitable risk of disturbing what is already firmly rooted, and the true answer is that only a few reforms in the foundation work are required. These reforms, successfully executed, would produce a basis upon which the most elaborate fabric might rest secure.

A glance at the general nature of the work, which has been ably described, reveals the fundamental doctrine that protection is necessary, protection of the wage earner against cruelty or harsh treatment, against fraud, against accident, against poisoning, even against himself. There is a small and rapidly diminishing school of thinkers, who hold that any protective law is wrong unless it be applied equally to men and women. But as men and women are not equally subject to the same risks and dangers, it is idle to argue that they can be treated in the same way. Those who are sceptical of the value of protective law would do well to remember that it was during the heyday of the Manchester School, when freedom of action, and of trade, and non-interference generally were at the zenith of their popularity, that some of the earliest Factory Acts were passed[65] into law. If the necessity for the regulation of the labour of women and children was recognised at a time when such restrictions were eminently repugnant to the public mind, that necessity must have been great indeed. Is it suggested by the opponents of protective measures, that although such a necessity did exist in the past it has been dealt with and no longer exists? The facts go to show that the need continues, and even increases, with the volume of trade.

Statistics make it abundantly clear that there is much sickness and mortality engendered by industrial occupations, and that a large proportion of this is preventable. The method of prevention is the subject which has to be considered, and before doing so, it is desirable for a moment to refer to the historical chapter preceding this. There it is shown that there is a multitude of injunctions laid upon manufacturers in the form of rules known as “special rules.” The imposition of these rules is limited to such trades as are certified by the Secretary of State to be dangerous or injurious. The rules are all imposed with one end in view, the safety of the worker, and though they deal with an infinity of matters, the cleanliness of the operative is one of the objects most commonly designed. To effect this many forms of words have been drafted and are at present in use. In these varying forms the duty of providing and maintaining the means for cleanliness is laid upon the manufacturer, and the duty of availing himself of those means is laid upon the operative. Not only does this injunction vary in form in different trades, but different codes embracing different standards are found in separate factories in the same trade. It will be asked how did this come about? How could a sane legislature or an administration outside Bedlam permit one law for the good employer and another for the less sensitive in conscience, though more sensitive in pocket? How could such a system creep into any code of law? As a matter of fact, it is the creation of that hysterical fear of compulsion, that nervous concern for the liberty of the subject, which has carried its mischievous influence into many spheres of activity. The plea that the employers’ grievances should be heard has gradually developed into an argument that each employer should be allowed to object, and objecting, he has eventually, by a process called “arbitration,” been enabled to procure a law to his own liking.

[66]

It is scarcely necessary to demonstrate the great inconvenience and injustice which arise from such a system. Two men carry on the same trade; two standards of efficiency are demanded by the law. One manufacturer is required to set up and keep in good repair an apparatus, which is as nearly perfect as human ingenuity can devise. The other, perhaps sceptical of the advantages of such an apparatus, or more often for the sole reason that he objects to the cost and trouble of erecting it, is permitted to provide something less efficient. This system, happily described as “the creation of industrial Alsatians,” is open to five obvious objections: (1) As between the two employers it is a substantial injustice; (2) it is not less unjust to the operative, compelled in his need to accept worse conditions than his comrade; (3) it puts a premium upon resistance, in that the objecting employer is rewarded; (4) it imperils the dignity of the law; and lastly, (5) it embarrasses those who administer it.

The situation then demands redress. How can this best be effected? Two reforms, one already indicated, suggest themselves as most ripe for decision. The first is the consolidation of the special rules and the direct enactment of such of them as are common to all or many of the dangerous trades. Of this class consideration has already been given to washing appliances. Such other matters as the provision of a dining-room, the prohibition of taking meals in dusty workplaces, the provision and maintenance of mechanical apparatus for withdrawing fumes, gases, or dust, the prohibition of certain classes of persons from working in certain places and processes, might each and all be embodied in the general Acts with specific reference to particular industries. And indeed they do find a place in the general Acts, but owing sometimes to capriciousness of reference and sometimes to vagueness in form, their inclusion has failed to effect that simplicity and uniformity in the law which is so much to be desired. By such a consolidation the multiplication of codes of special rules would be avoided, and even in some cases their elimination would be secured. But not only so: an immense gain would result from the uniformity which could be achieved. If the sporadic and capricious incidence of these obligations could be abolished, the gain would be indeed enormous.

Not less simple is the reform which is called for in the employer’s power of objection and the system of arbitration. The working of the existing system has long been condemned. Nobody[67] in the House of Commons is found to defend it; and yet, like other friendless doctrines, such as that of “common employment” in the law of Employers’ Liability, it has lived into the twentieth century. Last year an attempt was made to alter the law. Although this attempt would have been a step in advance of the present situation, it was so slight a step that it was not greeted with enthusiasm by those for whose benefit it was intended. The proposal was to substitute a system of reference for that of arbitration. Some advantages were claimed for this proposal in that uniformity would be secured. But the uniformity would have been at the expense of a thorough and stringent code of rules, which might have been acceptable to some of the employers. The referee’s court would have inevitably toned the rules down to suit the objectors. Evil as is the existing system, no alteration would be a gain which, while it purchased uniformity at such a cost and amended the procedure to so trifling an extent, postponed a radical and effective change to the Greek Kalends.

Full inquiry into the alleged dangers of a trade and full hearing of the manufacturers’ case are carefully designed by the present system. This design might well be satisfied, these effects be yet retained, and without revolutionary change additional advantages be secured; the advantages of a decision of the Secretary of State, unjeopardised either by arbitration or by reference, given after consultation not only with employers but with workpeople, and subject only to the control of Parliament. Legal provision should be made for full inquiry (such as it is now the practice to make by departmental committees) into the special conditions of the trade alleged to be dangerous; if, on the conclusion of the inquiry, regulation by Special Rules be recommended, and the Secretary of State certify the trade to be dangerous, he should issue to the manufacturers, and by public notice in the factories or workshops to the workpeople, a copy of the rules he proposes to make. The manufacturers and workpeople should be entitled to make objection in writing to the rules, or any of them, within one month of the receipt of such notice. Then the Secretary of State, in consultation with the Chief Inspector of Factories and the recommenders of the rules, should consider any objections so made, and the rules as drawn up after such consideration should be laid on the Table of both Houses for forty days, and have the force of law if during that period no objection to them be raised. It might often be desirable that the rules should be considered individually by Parliament, and provision for such consideration should be made.[68] Under this scheme the clumsiness and delay now inevitable would be averted, and with proper safeguards for his interest being retained the manufacturers’ power of rejection would be transferred to Parliament.

Other reforms in the regulation of dangerous trades demand mention. It is true of most poisonous substances in use in dangerous trades that adults whose constitution is fairly established can resist their danger more easily than can young persons. This is especially true of lead, whose insidious character has often been dwelt upon by scientists and statesmen; the inevitableness of its action is now recognised, and wherever risk of poisoning by this agency is established, there are to be found regulations and restrictions of a more or less effective nature. But it is also true of other substances, the absorption of which is injurious, and in all cases where much dust is generated, as in the manufacture of flax or hemp, or in trades where steam is given off in considerable volume, the labour of persons of immature years should be prohibited. This would be one reform.

Again, there are other trades in which the degree of danger is peculiarly influenced by the continuity of the exposure to it. Such, for example, is the use of inflammable paints, where continuous employment during the normal period of five hours inflicts injury appreciably in excess of that caused by exposure of the same duration but broken in its continuity. Shortened spells of work were recommended by the Dangerous Trades Committee in the indiarubber trade, where carbon bisulphide is used, and in the painting of ships with inflammable paints. The special rules applying to indiarubber works embodied this recommendation, and there should be no great difficulty in extending the principle to other trades where it is obvious that the danger of employment is increased by long periods of exposure to these deleterious influences. Such trades as bronzing in lithographic works, in wallpaper, and in paper-staining works would greatly benefit by such a provision.

Another reform was recommended by the Dangerous Trades Committee, which made its final report in 1899. All officials who have had occasion and opportunity to investigate the subject are convinced that many deaths occur which are primarily due to some industrial occupation, but are never so classified or reported. Diseases of occupation are so numerous and varied in character, and liable to disclose themselves in such diverse symptoms, that the initial cause of illness is often lost sight of, or still oftener never discovered. It consequently arises that the statistics of illness and death from[69] industrial causes are most imperfect. Any improvement in the manner of obtaining such statistics and eventually of striking at the causa causans would be valuable. All cases of death where the person has worked in a certified dangerous trade, or in a trade to which any of the consolidated special rules are applicable, within a prescribed period before death, should be reported to the coroner, who would, if he thought fit, conduct an inquiry into the circumstances of the case.

No chapter dealing with the future government of dangerous trades would be complete without an appeal for drastic and thorough measures. Loose wording in the rules, or, still worse, small omissions, may involve mischief out of all proportion to their apparent significance or to the value of the compromise effected. Numerous instances of the injury caused by the admission of small concessions to protesting manufacturers could be given. Possibly none is more striking than that of the bottling of aerated waters. Conducted under proper conditions there is no reason why the operatives should be subject to any but unimportant and minor casualties, but conducted as it often is, grave accidents occur with a persistent and alarming regularity. Many cases of persons losing their eyesight, and even cases of death, from injuries received by the bursting of bottles could be quoted. The rules as originally outlined by the Dangerous Trades Committee contained provisions for the protection of all persons engaged in the labelling of bottles, but in the rules as finally issued to and accepted by the manufacturers, persons engaged in labelling bottles standing in cases were exempted from the safeguards. From this simple omission, many accidents and much suffering have resulted. One is tempted to ask how, in the first place, this apparently small precaution was omitted, and when its importance was discovered, why the defect was not remedied. The answer to the first question is probably that the manufacturers demurred as to its necessity, upon which for the sake of peace and economy of time and temper their view was adopted. This is but a surmise. The explanation of the subsequent inaction requires no surmise. After the danger had been established, Sir Matthew White Ridley, in answer to a question upon the occurrence of one of these accidents, said in the House of Commons:—“I have not the power at pleasure to make or alter special rules. They must be settled either by arrangement with the employers or by arbitration, and in the present case I cannot regard the occurrence of a single accident,[70] much as I regret it, as sufficient reason for re-opening a question which has just been settled, after long and difficult negotiations.” From this answer the importance of thoroughness in translating the recommendations of committees into special rules becomes obvious.

Nor is it sufficient to hope that by persuasion or agreement with employers rules suggested by the Factory Department or the Secretary of State will be effectually carried out. In some cases they may be, in others they will not. The same unfortunate results proceed from such a course as are to be traced to the existing system of arbitration. It has been shown how that system is unjust both to employers and workpeople, how it encourages the careless and irresponsible employer, how it derogates from the dignity of the law and embarrasses its administrators. This is true of persuasion.

As in human nature there is every gradation of sensitiveness of conscience, so must there be in the factory, if reliance be placed on the forces of moral suasion alone, a corresponding gradation of conditions from excellence and thoroughness to indifference and neglect. Uniformity in these matters is an urgent necessity; and uniformity is incompatible with the substitution of persuasion for compulsory powers.

Let thoroughness, then, be the watchword of those whose prerogative it is to frame these protective measures. Let the loopholes for escape from the provisions of the rules be closed up; let the channels for contracting out of just obligations be carefully dammed; and do not let small pretexts of irksomeness, or the employer’s scepticism, or the manager’s contempt, or the workpeople’s want of care, weigh in the balance for a moment against the health, the well-being, and the lives of masses of working men and women.

For a strong Government and a humane House of Commons, the few reforms indicated would be but a light undertaking. They would put no undue strain upon the executive or the legislature; and they would, directly and indirectly, prevent a large amount of suffering, now patiently borne by a lowly and an inarticulate portion of the community. If simplicity, uniformity, and thoroughness be established in the government of the trades which carry grave risk to those engaged in them, the national conscience will be relieved of an oppressive burden, sometimes perhaps but dimly realised, but always real, and assuredly its removal will enhance the security and confidence with which this generation entrusts to its heirs the great destinies of our race.

[71]

Note.—The year 1901 has witnessed the efforts of the Government and the House of Commons to amend and consolidate the law relating to Factories and Workshops. In this effort, so far as dangerous trades are concerned, certain changes have been effected. There is a prohibition of eating meals in factories and workshops where lead, arsenic, or other poisonous substance is so used as to cause dust or fumes. Power, too, is granted to the Secretary of State to prohibit, limit, or control the use of any material or process; but although he had not this power before, he could practically exercise it under section 28 of the Act of 1895. Electrical generating works, and those railways which connect factories with each other and the main lines, are now brought within the law for certain purposes; and dangerous trades conducted in domestic factories or workshops can now be regulated.

But the most important alteration is that which transfers the responsibility for the special rules from an arbitrator or umpire to the Secretary of State. Under the new law the Secretary of State may frame regulations, and if they are not accepted, modified, or withdrawn, he must (unless the objection to them is withdrawn, or is, in his opinion, frivolous) order a public inquiry to be held by “a competent person.” The Chief Inspector, and any person affected by the draft rules, may appear at the inquiry either in person or by counsel, solicitor, or agent. This inquiry will take the place of the present arbitration, and the person holding the inquiry has, unlike the arbitrator or umpire, no power of adjudication. He will report to the Secretary of State, who is not bound to adopt his recommendations. The responsibility for the rules will rest with the Secretary of State, subject only to the control of Parliament (the rules will lie on the table for forty days), and in this lies the main advance effected. This advance may, however, prove more theoretical than practical, for it is unlikely that the Secretary of State will reject the advice of the person whom he has specially selected to advise him. The Government insisted on retaining the competent person, in spite of the contention of the reformers that reliance should be placed in the Committee of Inquiry, in whose minds all the circumstances and evidence taken would still be fresh, and in the Secretary of State’s permanent official advisers.

After full credit has been given for the transference of the final responsibility, the question arises: Are the two main defects of the present system remedied? Can uniformity be said to have been achieved, when we find that the new regulations “may provide for the exemption of any specified class of factories or workshops either[72] absolutely or subject to conditions”? And is it satisfactory that we should have still with us, in the form of the “competent person,” in one of the most important advisory positions in the State, “the man in the street,” “the irresponsible outsider” so properly described by Mr Ritchie in his introductory speech on 28th March 1901?

H. J. Tennant.

I

“What is not good for the bee-hive cannot be good for the bee.” A better appreciation of this truth and there had been less cause for this chapter. But in so grave a degree is a demonstrated danger to the race tolerated in the pursuit of an imagined profit to the individual, that it cannot be impertinent to recall the general truth and to point its specific application.

That there is danger to the race in the engagement in factory life of the mothers of young children, should be beyond challenge: always danger to the child, often danger to the mother; and sacrifice of infant life, failure of infant promise follow, have followed, and must follow, as surely as leaves fall to frost. Statistics abound, but for the most part they have received their lot of Bluebook burial; and the purpose of this article is, in the main, to rescue from the obscurity of the past its array of facts and its store of warnings. Upon the statistical evidence of the present there is less need to dwell. Dr Reid, in his admirable chapter, has dealt fully with the striking results of an inquiry conducted by him as Medical Officer to the Staffordshire County Council; and an inquiry instituted throughout England, upon similar lines, by the Parliamentary Bills Committee of the British Medical Association, supported, Dr Reid tells us, “in a remarkable way the conclusions drawn from the Staffordshire figures.” These are the Staffordshire figures:—

Deaths of Children under 1 year in Three Classes of Artisan Towns in Staffordshire per 1000 births.

[74]

At all moments they are figures to command concern, at this moment they compel alarm. On the one hand is the infant death*-rate steadily rising, on the other the birth-rate steadily falling;[28] and to the rising death-rate maternal neglect gives impetus, while the State inattentively takes note. But though statistical speech is eloquent of death, it says nothing of withering injury to life; nothing of injury to the mother who, herself affected in health, produces less fitting children; nothing of those children who escape death to endure life, crippled in body and in mind, drugged and starved in infancy, neglected in childhood. What dare we ask of their womanhood and their manhood? What service of citizenship have we any right to demand, any reason to expect? We must seek our answer from within our reformatories and our asylums, from our hospitals, our workhouses, and our prisons. For the feeble in body and dwarfed in mind there is no room in the struggle for industrial supremacy. Their drifting place is among criminals, in the lowest ranks of industry, or in the homes of charity.

Every deadly industry has its octogenarian; and so, too, under this system there are those who escape, or escape at least its greatest evils of physical and mental disability. For the girl-children full escape seems impossible. Victims in their ignorance of home, they become vehicles to perpetuate the system; without knowledge of the sacred, the helpful, even the elementary elements of home life, they in their turn, in their own married life, seek mill employment as did their mothers before them. It is, in fact, the only occupation they know. Baking, washing, sewing, are dead arts; and in these children of mothers, “to a grievous extent denaturalised towards their offspring,”[29] the deepest forces of nature seem asleep. So from generation to generation the service of the mother to her child is entrusted to a stranger, whose introduction as substitute housewife, substitute mother is not without its cost. The net gain is sometimes in money a few shillings: in influence and training there is always loss; even in money sometimes loss. In evidence given to the Royal Labour Commission, a Yorkshire employer quotes a case “in which the woman drew 10s. a-week in wages, and paid 12s. a-week for the care of her home.”[30] The case may indeed be exceptional, but an abundance of other cases may be found where the actual gain in money is but slight. The companion to this picture of the mother in the factory[75] and the paid stranger in the home, is that of the mother drudge who, neglecting her duty to her children, placing it perhaps in pathetically inadequate child hands, yet tries to fulfil it to her home. She may have worked in the factory from six in the morning to six or eight in the evening; but worker in the factory, she is worker too in the home. For her the day is never done, and through her youth of unending labour she is hastening to old age. There are advocates of such freedom to labour who can be convinced of hardship to the mother, who yet claim benefit for the child. Better far, they urge, the mother’s laboured addition to the family fund than scanty meals; home care and influence are necessary enough, but without bread what are they?

To this argument the answer comes from homes bread-starved during the cotton famine in Lancashire, during the great depression of trade in Coventry, and during the siege of Paris. “During the Lancashire cotton famine, while privation increased the actual death-rate, the infant death-rate was greatly lessened owing to mothers being compelled to suckle their infants. During the siege of Paris also, while the general mortality was doubled, the infant mortality fell 40 per cent. from similar causes.”[31] And, writing of the effect in Coventry of the prostration of trade in 1861, the Registrar-General says:—“The care of the mothers of Coventry has, it would seem, counteracted some of the effects of privation, so that neglect of their homes by mothers at work in factories is apparently more fatal than starvation.”

In the comparative figures given by the Registrar-General for the ten years (1859–68), the reduced infant mortality during the three cotton famine years (1862–64) is strikingly shown.

Deaths of Infants under 1 year of age per 1000 Births in Lancashire, and in the whole of England and Wales, 1859–68.

[76]

The Registrar of Little Bolton held that the decrease of deaths was mainly due to a greater amount of domestic superintendence, and other registrars united in similar conclusions. The slight rise in 1863 and 1864 was apparently due to the prevalence of smallpox, scarlatina, typhus, and measles, caused by overcrowding in workhouses and bad sanitary conditions.

Comparison between privation and maternal care on the one hand, and good cheer and maternal neglect on the other, to the advantage of the meaner diet and the greater care must, as the Registrar-General admits, be within limits. Under the stress of absolute starvation, no mother could provide nourishment for her child. But the obviousness of the limitation cannot diminish the significance of facts, and evidence, official evidence of convincing weight and appealing eloquence is, if we look for it, at our hand. It is easy to realise in its light, why the mother, even though poorly fed herself, is a better mother than the mother who earns a certain keep-money for her child.

Sir John Simon,[32] writing in 1897 of the inquiries conducted between 1859 and 1872 by the Medical Department of the Privy Council, of which he was Medical Officer, says of one:—“In addition to showing on a very large scale those sanitary wrongs of certain sorts of industry, we had also shown as an industrial influence of very wide operation, that in proportion as adult women were taking part in factory labour or in agriculture, the mortality of their infants rapidly increased; that in various registration districts, which had such employment in them, the district death-rate of infants under one year of age had been from two and a quarter to three times as high as in our standard districts; and that in some of the districts more than a few of the infants were dying of ill-treatment which was almost murderous.” Considering the subject in greater detail, in his fourth report to the Privy Council, he recalls the report[33] made to the General Board of Health in 1858, in which he drew attention to the fact that in different districts of England there were enormous differences of infantile mortality: “Such differences, that children in some districts die at perhaps four or five times the rate of children in other districts.” These wide differences of death-rate he attributed “to the varying prevalence of two local causes:—first, to differences of degree in common sanitary defects of residence; ... and secondly, to occupational differences among the[77] inhabitants; there being certain large towns where women are greatly engaged in branches of industry away from home; where, consequently, the home is ill kept; where the children are little looked after; and where infants who should be at the breast are improperly fed or starved, or have their cries of hunger and distress quieted by those various fatal opiates which are in such request at the centres of our manufacturing industry.” An inquiry was conducted by Dr Greenhow into the second of these influences, and commenting upon his report, Sir John Simon says: “It gives a very sad picture of suffering and demoralisation, caused by the present circumstances of female employment in factories. It corroborates very exactly the opinion above expressed as to the probable causes of the high mortality of infants in places of female factory occupation. And it shows that, while the infants perish under the neglect and mismanagement which their mothers’ occupation implies, the mothers become to a grievous extent denaturalised towards their offspring.”

The following quotations, Sir John Simon continues, tell the main facts of the case:—“Factory women soon return to labour after their confinement. The longest time mentioned as the average period of their absence from work in consequence of child-bearing was five or six weeks; many women among the highest class of operatives in Birmingham acknowledged to having generally returned to work at the expiration of a month.[34]... Mothers employed in factories are, save during the dinner-hours, absent from home all day long, and the care of their infants during their absence is entrusted either to young children, to hired nurse-girls, sometimes not more than eight or ten years of age, or perhaps more commonly to elderly women, who eke out a livelihood by taking infants to nurse. Young girls, aged seven or eight years, are frequently removed from school for the purpose of taking charge of younger children while the mother is absent at work, and are sometimes said to return, on the death of the child, evidently rather pleased that this event has released them from their toil.... Pap, made of bread and water, and sweetened with sugar or treacle, is the sort of nourishment usually given during the mother’s absence, even to infants of a very tender age; and in several instances, little children not more than six or seven years old were seen preparing and feeding babies with this food, which in such cases consisted only of lumps of bread floating in sweetened water.... Illness[78] is the natural consequence of this unnatural mode of feeding infants.... Children who are healthy at birth rapidly dwindle under this system of mismanagement, fall into bad health, and become uneasy, restless, and fractious. To remedy the illness caused by mismanagement various domestic medicines are administered, more particularly some kind of opiate such as Godfrey’s cordial or laudanum. Wine, gin, peppermint, and other stimulants are often given, for the purpose, as alleged, of relieving flatulence, the actual effect being, however, rather to stupify the child. The quantity of opiates sold for the purpose of being administered to infants in some of the manufacturing towns is very large.... Indeed, there seems to be no doubt that the habitual administering of opiates to infants must be included among the causes of a high infantile mortality in certain manufacturing towns, not only on account of an overdose being given, but also because infants kept in a state of continual narcotism will be thereby rendered disinclined for food, and be but imperfectly nourished.... Parents who thus entrust the management of their children so largely to strangers become more or less careless and indifferent about them, and as many of these children die, the mothers become familiarised with the fact, and speak of the deaths of their children with a degree of nonchalance rarely met with among women who devote themselves mainly to the care of their offspring.... Abundant proof of the large mortality among the children of female factory operatives was obtained during the inquiry. An operative of the better class in Birmingham reported that he collects money for the expenses attendant on the deaths of children among the workers in a factory where 150 women were employed, and that he believed ten out of every twelve children born to the married women in this factory died within a few months after birth. Many married women were questioned, as opportunity served, in the several factories visited regarding their families, the number of children they had borne, the number that survived, and the manner in which they were brought up. The evidence of these women tallied exactly with that of other persons.... It was frequently found that two-thirds or three-fourths of the children borne to these women had died in infancy.” In his report, which appears in the Appendix,[35] Dr Greenhow continues: “And on the other hand, it was remarkable how, in other instances, the majority of the children were reared when the mothers did not[79] work in factories, or discontinued doing so whilst nursing, or when the infant’s supplementary food consisted partly or chiefly of milk.” In the same report Dr Greenhow states that “all the medical men who gave evidence on the subject of the present inquiry, besides several clergymen, ladies who are accustomed to visit the poorer classes at their dwellings, scripture readers, relieving officers, and other persons who have paid attention to the subject, unhesitatingly expressed an opinion that the system under which the mothers of young children are employed at factories and workshops away from home is a fruitful cause of infantile sickness and mortality.”

Among the most interesting figures in the report are those which relate to the sale of Godfrey’s cordial. It appears that in Coventry alone at least 12,000 doses weekly were administered, and “even a larger quantity of opiate, in proportion to the population, is said to be sold in Nottingham than in Coventry.” In conclusion, Dr Greenhow reports: “The results of the inquiry may be stated as follows:—

“1st. The infantile death-rate bears no definite relation to the general death-rate, but their comparative proportions to each other vary in different districts.

“2nd. The infantile death-rate bears the largest proportion to the general death-rate in districts where the infantile population is specially exposed to unwholesome influences, as in Coventry, Nottingham, and other manufacturing towns.

“3rd. The unwholesome influences to which infants are exposed in the manufacturing towns comprised in the present inquiry may be attributed mainly to the industrial employment of the married women, which leads them to consign the tendance of their infants at a very early age to young children or strangers.

“4th. That infants thus deprived of the mother’s care are habitually fed on diet ill adapted to their digestive powers, and are very frequently drugged with opiates, in order to allay the fractiousness arising from the illness induced by improper food.

“5th. That infants in manufacturing towns where women are much engaged in factory labour are likewise exposed to other causes of sickness, proceeding from the ignorance or carelessness of the mothers or nurses, such as deficiency of exercise, and exposure to inclement weather.”

There is constant reference in public inquiries to the excessive use of opiates. Mr Ernest Hart, giving evidence in 1871 before the Select Committee on the Protection of Infant Life, says:—

[80]

“... We wish also to take measures to prevent the habitual drugging of children in those day-nurseries. You will get evidence easily from the manufacturing districts that opiates are sold by gallons by druggists there. The sale of opiates for that purpose forms a very large part of the trade of many of the druggists in those districts.” Later, Dr Lyon Playfair (afterwards Lord Playfair), a member of the same Committee, in examining a witness, refers to “the evidence of three druggists in Deansgate, who state that they supply 1260 families per week with opiates,” and to the experience of “Mr Ransome, a distinguished surgeon who lived in Manchester, ... that out of the children who attended his dispensary, about one-half he found to be drugged with opiates.”

Mr Curgenven, another surgeon witness before the Committee, speaking of the high death-rate among insured children, says:—

“... They know that if they put their children out with their neighbours, as it is said, to be nursed, brought up by hand, while they are at work in the factories, there is very great chance that they will die, and therefore they calculate that the sum which they receive from the burial club will more than cover the expense of the burial. And the deaths amongst the children of the operatives in the manufacturing towns amount to about 40 to 56 per cent., because they are left by their mothers at an early age, when they are only a few weeks old, and are placed in the hands of women to be brought up. They are drugged frequently with Godfrey’s cordial and other opiates to keep them quiet. They are fed upon bread and water with very little milk, so that they are half-starved. The consequence is that more than half of them die.”

And again:—“... The infantile mortality has decreased so far as the mothers were enabled to remain at home to nurse their children. It is only when they are employed in the factories, away from their homes, leaving their children to be brought up by hand by their kind neighbours, that they die.”

Turning to another inquiry, we find Mr Foulkes, a certifying surgeon, giving evidence before the Factory and Workshops Acts Commission of 1875, and pleading for a prohibition upon the return of mothers to their employment within six months of their confinement. “... Many of the women are at work within a month after they are confined; the result is that the child is left at home, and it is invariably fed upon the same thing, bread, water, and sugar, and the children dwindle away, and that has a great[81] deal to do with the infant mortality of the place. What is done with the children in this district generally when the mothers are at work? They are often left with the other children; there is no provision made, and they are very badly treated and sadly neglected....”

Before the same Commission, Mr Baker, first a surgeon in practice at Leeds and then joint chief of the Factory Department with Mr Redgrave, gives it as his experience that “very considerable mischief arises with women going to work, not only to the mother, but also to the child.” He is then asked by the Chairman Sir James Fergusson: “We may take it for granted that it is not theoretically desirable that women should go to daily work immediately after confinement, leaving the child all day to somebody else; but, practically speaking, do you think from your experience of this matter, that if Parliament interfered with it, it could be enforced with uniformity and without hardship?” And his answer is: “Yes, I think it might. I think that by the visitation of certifying surgeons it might be enforced decently, and delicately, and sufficiently, so as to make it very useful.”

One more reference to Sir John Simon shall almost close this array of quotations from buried reports. In this last instance the inquiry was conducted in agricultural districts:—

“The discovery that an enormous infantile mortality was prevailing in several purely agricultural districts, suggested at first sight that perhaps in these districts some third[36] sort of destructive influence was at work. The result of this new inquiry, however, has been to show that the monstrous infantine death-rate of the examined agricultural districts depends only on the fact that there has been introduced into those districts the influence which has already been recognised as enormously fatal to the infants of manufacturing populations—the influence of the employment of adult women. ‘The opinions’ (says Dr Hunter) ‘of about seventy medical practitioners, with those of other gentlemen acquainted with the condition of the poor, were obtained. With wonderful accord, the cause of the mortality was traced by nearly all these well-qualified witnesses to the bringing of the land under tillage—that is, to the cause which has banished malaria and has substituted a fertile though unsightly garden for the winter marshes and summer pastures of fifty or a hundred years ago. It was generally thought that the infants no longer received any injury from soil,[82] climate, or malarious influences, but that a more fatal enemy had been introduced by the employment of the mothers in the field.’ On this agricultural employment of women there follow identically the same results as have already been traced to result from the employment of women in manufacture.”

This, then, is the finding of skilled inquirers, the teaching of half a century’s statistics: that, for the child, the employment of the mother in the field is “a more fatal enemy” than malaria; and her employment in the factory, “apparently more fatal than starvation.” And what is our answering record of effort? A pathetic capacity for inquiry. Not certainly because we lack facts, or because the need for action has passed; for, on the contrary, it becomes cumulatively more acute. In Dundee, for example, in 1881, 19.4 per cent. of married women were employed in its mills and factories; in 1891, 24 per cent. were so employed, and the infantile death-rate rises accordingly. In the following table, prepared by Dr Templeman, Dundee’s able medical officer of health, this death-rate can be seen for a period of twenty-eight years:—

First among the causes Dr Templeman puts “Industrial Conditions:” first, too, this recognition should be in the conscience of the parent, in the conscience of the employer, in the conscience of the State. Of all who are responsible, the State has least acknowledged the responsibility. The examples may be rare, it is true, of parents who make sacrifices themselves that their homes and children may have benefit, but yet there are examples. The efforts of employers of labour may, too, be rare, but still they are appreciable, notably in Yorkshire; more frequent are the efforts of philanthropy: there is one effort by the State;[37] not to save the life of the child, for that admittedly it does not do, one effort, barely calculable in its result, to protect the health of the mother.

All credit to those who, singly as employers, or collectively as philanthropists, have endeavoured to save life and preserve efficiency for the nation. But such effort of necessity is ineffective. It can never be complete, and the abstention of a few mill owners in a[83] district is sufficient to annul the effort of the majority. The helplessness of such a position was so strongly felt by one mill owner in Yorkshire, that his rule prohibiting the employment of married women was abandoned: “Other mills being open to married women, the rule failed to serve the purpose for which it had been designed—that of keeping the women at home.”[38]

The attempt of philanthropy to establish day nurseries, discouraging as it has been, would even in apparent success serve but as a prop to an evil system, as an anæsthetic to the manufacturer’s conscience. It can but alleviate, it cannot cure; and its condemnation many years ago, for the involved exposure of the infant to unsuitable hours and inclement weather, holds equal force to-day. Better than the drug-nursery, but bad in itself, for the most excellently managed crèche might well provoke the situation described by Dr Greenhow, in Coventry[39]:—“Women being obliged to attend at the factory at an early hour are always hurried in the morning, and may be seen on their way to the mills, hastening along the street with their children only half dressed, carrying the remainder of their clothes, and their food for the day, to be left with the person who has charge of the child during its mother’s absence; and this ofttimes on a cold winter’s morning in the midst of sleet or snow.”

Widows without children of earning age may, as part of their burden, be forced to imperil the welfare of their infants in one direction while they seek it in another. And here philanthropy has just scope, for, save in exceptional cases, the crèche is the only practicable form of aid to the mother. Better, then, this care of her infant than its abandonment to a child, itself a candidate for the nursery, or to the elderly woman who confesses unfitness for all other employments. But this is the smallest section of the whole. In its widest aspect it is not a question for the make-shift, though devoted, benevolence of philanthropy; it is a problem for the State in its responsibility to the nation. What are the terrors that lie in its handling? The dread of a barrier raised before the freedom of employment: the fear that the prohibition of employment within say six, or even three, months after childbirth might embarrass a large class in its endeavour to earn a living. But the freedom to labour is no sacred right when its exercise involves injury to others; it is not even so held when it[84] clearly threatens injury to ourselves. The worker in a dangerous trade is suspended from employment on the verdict of the certifying surgeon during such period as he considers to be necessary: in certain departments in a white-lead factory the employment of women and girls is altogether prohibited. There is therefore no inviolate right. Is there in this case necessity? What is the motive-power which drives the mothers of young children into factories? Commonly, ignorance of home duties, and the consequent unattractiveness of the home; the companionship of factory life, where the companionship of children has no meaning; often, fashion; least often, true poverty. There is poverty in Glasgow and in Paisley, as in Dundee, but its cure is not felt to lie in the employment of mothers. The father accepts the obligation of breadwinner; he is ashamed that his wife should work outside his home. “If a Glasgow lad wearies o’ work, he must marry a Dundee lassie.” There poverty conjures excuse, and a man is not ashamed to claim his wife before her time in the hospital is over, that she may come out and earn his bread. Exceptional, it must be hoped, are such cases, but at least the system which breeds them is not, and what some towns claim as a necessity, others will not tolerate, in their rejection disproving the need.

Within the space of this chapter it has been impossible to consider arguments to which place would otherwise have properly been given. It is left only to suggest a comparison of the possible evils which lie in action, and the certain evils which have come of inaction. The principle of regulation is already accepted in our laws, and in the laws of other countries, as Miss Anderson’s deeply-interesting chapter shows; it but needs extension to render it effective. The State holds the scales: difficulties on the one side, not light it is true; but on the other, forces weighted already with accomplished evil, charged with greater evil to come: on the one side, the fancied interests of the individual; on the other, the deepest interests of the nation. “It cannot be too distinctly recognised,” says Sir John Simon, “that a high local mortality of children must almost necessarily denote a high local prevalence of those causes which determine the degeneration of the race.”

May Tennant.

II

Although a steady decline has taken place in the general mortality of the country coincident with, and, no doubt, in the[85] main, consequent upon sanitary progress, it cannot be said that the infant mortality has diminished in like proportion, and among the many factors which contribute to the maintenance of a lamentably high death-rate among infants, not the least important is improper feeding, the result of ignorance on the part of mothers. If by some means the simple fact could be brought home to mothers that milk, and preferably human milk, is the only permissible diet for infants, the natural instincts of motherhood would prevail in the majority of cases, and thousands of otherwise healthy infants who do not now survive the first few months of life would reach an age when greater license in diet is permissible, and the chances of living are immensely greater. But, in a humanitarian sense, the saving of life which would thus be effected is of small moment when compared with the mitigation of the pain and misery which infants now have to suffer, and which has to be borne, not only by those whom death ultimately relieves, but by the still larger number who manage to survive the ordeal, and who thus have to suffer for a longer period.

From inquiries made some years ago, Dr Hope of Liverpool came to the conclusion that among the artisan classes in that town upwards of 50 per cent. of infants during the first three months of life are entirely breast-fed, 35 per cent. are reared on other food in addition to breast-milk, and 15 per cent. are entirely artificially fed. Analysing upon this basis a large number of deaths from diarrhœa, he found that for every death attributed to that cause among entirely breast-fed infants under three months’ old, 15 occurred among the mixed class, and that for every death which occurred among the breast-fed and mixed class combined, 22 occurred among the entirely artificially fed class. He also found that among infants aged from three to six months, for every death from diarrhœa among the partially breast-fed, 6 occurred among the entirely artificially fed class. Other observers who have devoted attention to this matter bear out Dr Hope’s conclusions, and it is a well-known fact that in countries where artificial feeding of infants is largely practised, the mortality is very high compared with other countries where natural feeding prevails.

Now the practice as regards the feeding of infants varies in different districts according to circumstances which will presently be referred to, and no one can dispute the fact that, other things being equal, infants reared for the first few months entirely on breast-milk have a far better chance of survival than either of the other two classes. No doubt this is very largely due to the gross[86] ignorance which prevails, especially among the artisan classes, as to the only permissible substitutes for breast-milk; but we must deal with circumstances as we find them, and, up to the present at any rate, our efforts to bring about a better order of things have proved unavailing. When we ultimately succeed, as we must do, in getting the teaching of elementary hygiene introduced as a compulsory subject in all elementary schools, the more rational feeding of future generations of infants must follow as a natural consequence, and then, even if the proportion of breast-fed infants is not increased, the difference in the death-rates among the different classes (entirely breast-fed, partially breast-fed, and entirely artificially fed) will be greatly lessened, for the artificial food administered will more nearly approach nature’s requirements.

From what has been said, it follows that if from any cause the proportion of entirely artificially fed infants in a district were abnormally large, in the absence of any counteracting influences the infantile death-rate of the district would compare unfavourably with that of other districts in which circumstances did not prevail which disturbed what may be called the normal grouping of the children according to the methods of feeding. If, for example, taking Dr Hope’s figures, instead of 15 per cent. only of the infants under three months being entirely artificially fed, the number, from disturbing causes, more nearly approached say 85 per cent., the remaining 15 per cent. only being either partly or entirely breast-fed, it would certainly be surprising if the effect were not apparent in a greatly-increased mortality among infants.

Some twelve years ago, when, in my capacity as County Medical Officer, I first had occasion, among other duties, to inquire into the mortality returns of the various districts in Staffordshire, I was greatly impressed by a very marked dissimilarity in the infant mortality of the two groups of populous artisan towns, one in the north and the other in the south of the county, a dissimilarity which I subsequently found could not be accounted for by any apparent difference in the sanitary surroundings of the northern and southern towns. In view of the fact, however, that, generally speaking, the trades carried on in the southern group of towns did not afford much employment for women, whereas in the northern group the conditions in this respect were different, it occurred to me that in this was to be found the explanation of the high infant mortality of the northern compared with the southern towns. In order to test the accuracy of this conclusion, with the help of the District Medical Officers of Health, and from information obtained[87] from manufacturers regarding the proportion of married women workers, I classified the purely artisan towns in the county into three groups, and obtained the infant mortality figures for previous years, in order to allow of more reliable conclusions being drawn. Since then I have continued to record the figures according to the same plan annually, and I have now records covering a period of 20 years, and relating to artisan towns only, with a mean total population of about 529,000. One may fairly claim, allowing that the home conditions in the towns in question, in other respects, apart from the proportion of artificially-fed infants, are practically identical, that records from such a large population and for so long a period may legitimately be used for our purpose from a statistical point of view, provided care is exercised in the classification of the towns in accordance with the number of young married women workers employed away from home, and who are thus prevented from suckling their children.

In the classification of the towns it was found impossible to arrive at the actual number of married women workers, but one was able to divide them into three groups, as follows:—

(1) Many Married Women Workers. (2) A good number of Married Women Workers. (3) Practically no Married Women Workers.

Adopting this classification, the figures of infant mortality in the different groups of towns are set forth in the following table:—

Deaths in Children under One Year per Thousand Births in Three Classes of Artisan Towns in Staffordshire.

The figures speak for themselves, and it will be noticed that while there has been a general increase in the infant death-rate, practically the same relative proportion has been maintained between the three groups of towns.

As the outcome of a paper I read before the Public Health Section of the British Medical Association, at the Annual Meeting held at Nottingham in 1892, the question was taken up by the Parliamentary Bills Committee, with a view to securing some legislative remedy, and an inquiry was instituted throughout England on similar lines to the Staffordshire inquiry. Returns[88] were thus obtained from a large number of artisan towns, and these returns bore out in a remarkable way the conclusions drawn from the Staffordshire figures.

It appears, then, to be a fact that the State is permitting a practice to be followed which is directly responsible for the deaths of thousands of infants annually. Deliberate cruelty on the part of parents is a punishable offence, and in a strict sense starvation comes within this category; it does not seem to matter, however, what sort of food is provided, so long as, theoretically, some provision is made for the care of the infant during the absence of the mother. Possibly, in many cases, owing to ignorance and other causes, the infant might not receive any better care at home, but there, at least, the natural food would be available, and in the majority of instances it would be given. It is true we cannot legislate as to how mothers shall feed their infants, but surely it is not too much to ask that the legislature shall not allow any deliberate disregard of parental responsibilities.

The law at present does provide some amount of protection, by making it illegal for a mother to return to work under one month after the birth of her child; but although this restriction is valuable from the point of view of the mother’s health, it can hardly benefit the child, for, if factory work is to be engaged in after a month’s interval only, it is not likely that the mother will commence suckling her child. The period of restriction should undoubtedly be extended, and the shortest serviceable time is probably three months. The probability is that if such an extension of time limit were enforced the mother would suckle her child until she returned to work, and thus the most precarious period in the life of the child would be tided over, and its chances of survival would be considerably increased.

In many cases the wife—it may be from choice, or because of improvident habits on the part of the husband—goes to work, while at the same time the husband is earning ample wages. In Lancashire it is common for a man to receive 25s. a week while his wife earns from 15s. to 20s., and in Staffordshire, when the potting trade is ordinarily prosperous, the weekly wages of a man and his wife amount to 30s. and 12s. respectively. These figures represent a fair average, but many of the men workers receive much higher wages.

In seeking for a solution of the question, we may learn something from other countries. In Switzerland, for example, a period of absence from work of eight weeks is enforced on mothers, the[89] time to be counted from two weeks before confinement; and in Germany, by a process of compulsory assurance, the working woman, while prevented from working owing to childbirth, receives a sum equal to half her ordinary daily wages. In the former case the period, for reasons already given, is not long enough, and the latter expedient could hardly be made applicable to economic conditions in this country. However, a way out of the difficulty ought to be found, and it would seem that it should be sought for in the direction of State control.

George Reid.

The half-time system is dying. The age of the full-timer in the mill or factory is being steadily raised. But as long as poverty exists children must feel the pinch of it. They must help also to bear the burdens of their parents, and share their anxieties and cares. One would be very wrong, however, in supposing that the most anxious and harassed parents and children are to be found at the bottom of the social ladder. At the bottom of the social ladder will be found little care and much movement—a tourbillon of change—marriages, accidents, tragedies, crimes, all succeeding each other pell-mell, and obliterating one another. The parents and the children of the slums are occupied, not with thoughts of to-morrow, but with thoughts of to-day. Here, for example, is a large Board School in a slum district of a big northern city. It is difficult for the head teacher to keep the register, for large numbers of children are always flowing through the school like a shoal of mackerel on a tide. Families arrive, and encamp in the fair ground close by, or find shelter in the poor lodging houses of the neighbourhood. The children attend school for a short time, pick up a smattering of the three R’s., and then disappear. There are of course regular residents, and the children of such people are much better attenders. But they have this in common with their migratory neighbours, that their lives are varied by exciting and gruesome events, which they do not take to heart too seriously. A certain unfortunate mother of ten loses several of her children in succession. Then suddenly her husband, who is a drunkard, falls down some steps and is killed. There is a tragic gathering of friends at the house on the eve of the funeral. A few months later the widow marries again. But the second husband turns out to be a scamp. She leaves him and takes refuge with a married daughter. The children change homes, take the ups and downs of their rocky life, and attend school pretty regularly. Some children are[91] deserted, and go into neighbours’ homes. The strong ties of kinship are dispensed with; and other ties, equally strong, for the hour at least, take their place.

Apart from the family drama, the children have their own struggles and adventures. They have to help to earn the living. In some families a child is the breadwinner. In many, children are important co-helpers with the parents. How does a child earn money? In provincial towns, also in London, the newspaper offices are responsible for a great deal of out-of-door child labour. A crowd of boys rush every afternoon to the “offices.” Some of these children are already employers of labour. They engage a smaller or less lucky comrade to deliver some of the papers, and pay him twopence or threepence, according to his success. They—the small employers—may earn 6s. per week and even more at times. Besides the newsboys there are the errand boys, and those who help shopkeepers. These form a large contingent of the children’s army of labour. And so, alas! do the vagrant sellers of chips, flowers, etc., who have to cultivate the beggar’s as well as the vendor’s art. At a Conference in April 1900 between the School Board and Board of Guardians of Bradford, a return was presented showing that 91 children—84 of whom were of school age—were found begging and hawking in the streets in the course of three evenings of December 1899.

The domestic toilers in such a district as that which we are now considering would be mainly nurses. Little cooking and less washing is done in some of the homes. There are no regular meals, no regular duties, and the elder children are useful therefore mainly in taking charge of the younger ones, or earning pence in the street. Taking their roving habits into account, it is strange to learn that such children suffer from lack of proper exercise. Yet such is the case. About a year ago Dr Kerr, the medical adviser of the Bradford School Board, made an examination of the children attending a school situated in an “insanitary area.” He found that nearly all the children were ill-nourished. And this ill-nutrition was not simply the result of insufficient food. “Lack of exercise,” he writes, “has a very large share in it. And the exercise required is not careful gymnastics, but coarse work, such as running round the playground.”

There are many kinds of physical exercise, just as there are many kinds of food, and one order of exercise does not take the place of another. Moreover, the same kinds of movements,[92] executed under different conditions, have quite different effects. This is the important fact which is lost sight of by those who declare that the child can rest from the labours of the school by engaging in the labours of the mill. It is ignored also, or forgotten, by those rural educationists who believe that six hours of weeding or potato-picking mean the same thing for a child as six hours of free play. But the fact remains that work does not take the place of play, not even when that work is very easy, and involves walking or running. Here in this school of the slum, “careful gymnastics” are not required. And we may safely add that running about the streets, and the carrying of milk-cans and babies, are not required. For the children have had a good deal of this kind of physical exercise, and are suffering, nevertheless, from defective circulation and want of muscular tone. Only movements that imply the removal of tension from the nervous system are required. There is no real substitute for such free, natural movements in any factory, schoolroom, nor even we may add in any gymnasium in the world.

Let us turn from those whom we may call the “casuals” of the child-labour world, to the State-recognised little toilers who work in factories or mills. These form still a large contingent of the child-labour world, numbering as they do over a hundred thousand children, one-third of whom work in Lancashire cotton-mills. A goodly proportion, too, work in Yorkshire, the seat of the woollen and worsted trades. The rate of decline of the half-time system among factory and non-factory child-workers may be seen from the following figures, compiled in Bradford.

Number of half-time cases in Bradford in each year for the past twelve years:—

[93]

The half-time system is dying fast in some towns, more slowly in others—but it is passing away even in Lancashire. No one appears to be more indifferent than the masters. It is not even fair to say that the masters are indifferent, for many of them have tried to hasten the end. And yet forty or fifty years ago the masters, as a class (there were, of course, honourable exceptions) opposed the raising of the age. Even ten years ago some masters showed concern when it was proposed to raise the age of half-timers to eleven. “Younger children,” they said, “have special aptitudes which the elder ones have lost.” The wails of regret came usually from masters who could remember long bye-gone days. “Ah!” they cried, letting their thoughts drift back into the dim past, “when the children came to us very young, say at five or six years old, a great deal was possible that has since become quite impossible! It is of no use to speak of that now.” No, it is of no use to speak of it, since the age had been raised, and raised again. And with every rise the commercial value of the child in the labour world has diminished. And now you may hear a manager say, “The child who comes at twelve years old is more dexterous than the one who comes at thirteen,” but the masters are evidently of opinion that so far as they are concerned the matter is no longer worthy of discussion. That the children come a year earlier or later makes little difference when the minimum age is raised to twelve.

The masters’ claim that the younger children had special aptitude, undoubtedly rests not upon fiction but upon fact. Every physiologist knows that the various sensory centres of the brain are plastic in early childhood, and that this period of plasticity is very short. It begins to wane already in the seventh year. Previous to this age, however, every human being is in a peculiarly receptive and responsive state. So that, during the first six or seven years “a great many things,” as the silk manufacturers said, “are possible.” For example, the sense of touch may be developed within very narrow limits, and complex and specialised movements may be learned so well that they become automatic. This can be done. It can be done only at great cost. (Probably the employers did not know the actual cost.) It implies the atrophy of many cells, the impoverishment of the whole life. It is a kind of psychic mutilation. But it can be done, and it has to be done quickly, since the spring tide of opportunity soon wanes. Alas! for the old adage, “It is never too late to mend.” The mending, and making, and altering time is over for a great many people at the[94] age of eight, and of this employers were well aware, thanks to their opportunities for observation and experiment. So as the age of the half-timer was raised the masters’ interest in him declined, and the latter-day champion of the half-time system stepped forward in the person of the half-timer’s own father,—his father, not his widowed mother. For the “poor widow,” who looms so large in the consciousness of controversialists on the half-time question, is seen and known wonderfully little in the school attendance rooms, where applications for half-time are considered. The applicants belong very largely to the better class of working people. Mechanics, engineers, railwaymen, overlookers, and, now and again, a mill operative. Of course these various trades represent a great variety of wages. Some applicants earn but £1 per week, or even less, and out of this support a large family. But many earn from 30s. to £2 or £3 per week. Indeed, men with £4 and upwards per week coming in have been known to apply, though these are exceptional cases. It is certain that the average working-man champion of child-labour to-day is not a thriftless, irresponsible person. He is, very often, a man with money in the bank, with ambitions and views of his own, also with a will of his own, and a strong Trades organisation behind him, through which he can express that will. Neither is he a person lacking in parental susceptibility and ambition. It is almost impossible to overrate the influence which custom has on sentient beings. The caterpillars of the Bombyx Hesperus feed in a state of nature on the leaves of the café diable. Yet Darwin found that certain caterpillars of the Bombyx family, having been reared on another variety, refused to touch the leaves of café diable. They preferred to die of hunger. Thus caterpillars can become, in a sense, unnatural. Kindhearted people, too, may follow a course of conduct with their own offspring which appears monstrous to the stranger. In certain districts where child-labour is a tradition and custom, the very idea of associating it with inhumanity does not occur to the people. “Why, they mun be all clean off their heads,” cried a Yorkshireman, who had been hearing of poor parents who sent their sons to school till they were fifteen or sixteen years old. He had gone to “t’ miln” at seven, and it seemed to him that all “workin’ foaks” children should do the same.

It is not then to the parent you must go in order to learn what the effect of half-time is on the young. Nor need you turn with very confident hopes to the statistician. It is, indeed, a little discouraging[95] to reflect how little the statistician can help us in establishing the most obvious ill effects of child-labour. The effect of half-time exemption a little while ago was to filter off a number of mentally sharp children who passed their standards rapidly and were ready to go to work at eleven. These bright children were a continual stumbling-block to the statistician. For example, it was proposed to test the vision of the half-timers and other children with a view to finding out the effect of the mill life on this important sense. Now the stupidest boys and girls are those who have most defective visual acuity. They are also the deafest.[40] And the bright children who went to the mill at eleven, are, of course, the children gifted with the keenest senses. By the time these bright young half-timers had got to full time, the duller ones came on as half-timers, and by their transference appeared to increase the percentage of defective vision with age in half-timers and diminish it among the non-half-timers. Thus defective vision apparently increased with the age of half-timers, only because those kept back by defective brain or eyes alone were half-timers at the age of twelve. This is but one example of the great difficulty of collecting reliable evidence to establish even the most reasonable assumption.

But it is hardly an “assumption” that children suffer in England through half-time labour, and unregulated toil out of school hours. You cannot put tired eyes, pallid cheeks, and languid little limbs into statistics, and yet when you see them they are more convincing than figures. And in many schools you can receive this kind of evidence. The younger children who work out of school hours have undoubtedly the worst time of it. They come to school looking dull and heavy-eyed. Some are irritable and restless, others so languid that they appear almost oblivious of everything around them. “It seems as if they haven’t the force to work through the school day,” said a young master in a school of very poor children. “They may be bright enough children, but they haven’t the strength to show it.”

The factory half-timers are doubtless more fortunate than the younger casuals; for the former have arrived at an age when many of the critical turnings of child life have been passed. And yet the child of twelve no sooner enters a mill than the teacher[96] begins to see a deplorable change in him. He loses interest in his school work, his manners become rougher. Manners are forms of mental expression, so the teacher may presage from this fact alone a certain decline of brain power. But there are many other indications of decline. The other day a teacher showed me the copy-books of children who had been at the mill for one week, and allowed me to compare these with the work done by the same children while they were whole-day scholars. As full-day scholars they all did creditable work. Their sums were correct, their writing good, and books were kept perfectly clean. Yet in the course of one week the progress of months seemed to be cancelled: for the half-timers’ sums were all marked with a “W.” The writing was careless, the pages soiled and blotted. The children had changed and their work had changed. Their achievements had slipped from their grasp as a waggon slips back when driver and horse are arrested suddenly on a steep hill.

Indeed, though the factory child suffers less in some ways than the “casual,” he appears to be under certain great disadvantages from which the latter is exempt. Ask any master of an elementary school and he will tell you that the characteristic of the factory child is dulness. The casual is not dull. Not at all, he is glad to talk to-you about his “business,” and the chances of his work-a-day life in the street. Not so the young factory hand. After the first fortnight in the mill he is a disillusioned person. He does not want to talk about his work or his prospects. He loses interest not only in others but in himself.

What is the secret of this subtle change? Why does the factory boy of twelve become so torpid? It is because in the mill growth and development are arrested. At the age of twelve a boy or girl is still a child, not an adult. It is true he has passed already through certain stages of growth, but the whole period of growth and development has not come to an end. His sensory organs are as acute, rather more acute, indeed, than a full-grown man’s, and yet in the matter of sight and hearing he is inferior. It is through psychic development that the full harvest of the sensory and motor powers is reaped. This is why, at the age of twelve, if growth is to continue, the boy or girl should enter an atmosphere of varied mental interests and activities. The richer the forces of human life the more intricate will be the means by which they can be put into operation. The mill does not provide an atmosphere in which the new order of human development due at this hour can take place. “Still the mill-child is not always dull,”[97] you will say, “sometimes he is very noisy.” Yes, at “loosing time” the mill-yard and streets ring with loud talk and laughter. But the noise itself proves the same thing as the torpor of the mill child. In the jostling and shouting of the youth or mill girl the scientist sees not a vice but a reaction. In the desire for alcohol, the feverish love of betting and gambling, we behold the revolt of nascent human powers. These human powers, so varied and so subtle, are dammed up all day long, without possibility of exercise or escape. So the wild torrent of life surges free at last round the mill-gates, and escapes in the voice and glance of the excited lads who learn to love gambling and betting to the despair of good people. “A weak or insensible limb is certain of rough usage,” said Donaldson, for, obeying a natural instinct, its owner will insist on having a sensation through it. If the whole nature is dwarfed or blunted, only violent pleasures can be appreciated.

It is said that the poor “have no room to live”; what is even as serious—they have no time to grow. As long as such is the case we may be sure that, despite all the efforts of educationists and philanthropists, there will be a great many undeveloped persons. Meantime the scientist advances, taking account of all, and stating all fearlessly. Year by year the processes of growth and development become clearer, and the conditions of human progress more defined. And although we cannot at once remove even the more obvious causes of arrested development and weakness, yet it must be evident to all that the future belongs to the nations who permit and enable their children to come to full human stature.

Margaret M’Millan.

There is perhaps no section of industrial life regarding which so much misconception prevails as out-work, or, as it is popularly called, home-work.

To many persons the name home-work is synonymous with the idyllic term cottage industries, and this again calls up the picture of the model villager in the model village. The clean and tidy widow, so dear to the heart of the philanthropist and of the district visitor, is the favourite type. She dwells in an ivy-clad cottage surrounded by all the accessories of highly picturesque poverty, the kettle sings on her well-burnished hob, and geraniums bloom perennially on her window sill.

How does this picture compare with the grim realities of home-work in our city slums? We shall see from the cases which I quote further on, and which have been revealed by the investigations of the Scottish Council for Women’s Trades, and the Women’s Industrial Council of London.

The reason why the popular conception of home-work has lagged so far behind actual fact is, that this is practically the No Man’s Land of the industrial world. Here treads not the foot of the labour agitator, for the home-workers are composed largely of “casuals”—dreary phantoms, who come and go, whence and whither no man can tell, and no organising secretary of any trade union, however enterprising, would waste time or effort in inducing them to join its ranks. Each worker is a sort of industrial Ishmael, working only for his or her own hand.

Nor has the home-worker been much better off in respect of Government protection. For while the factory and workshop hand has had the conditions of her work regulated by law, the home-worker has been treated as a step-child by the State, and has been left outside the protecting pale of the Factory Acts.

Apart from the points of starvation wages and excessive[99] hours, one of the main facts brought out by recent investigations into home-work is the grave danger to the health of both the worker and the community at large arising from the making of garments, etc., in disease-infected and otherwise insanitary houses, and public opinion has been gradually ripening to the conclusion that legal regulation of some kind is necessary as a protection to public health. Further, it is beginning to be recognised that the application to out-work of the laws that regulate labour in the factory is a perfectly reasonable and logical extension, as out-work, in the modern expression of it, is practically an extension of factory work, or it may be more properly described as its back-wash. Out-workers are employed mainly on the surplusage of the factory orders—the unskilled, poorly paid work that the workshop hand rejects, or that the pressure of a big order prevents her wholly overtaking. The low degree of skill required for the most part, and the consequent low earnings, have their inevitable result in placing this section of the industry in the hands of the very class of workers whose conditions most need supervision and control.

Previous to the passing of the Factory and Workshop Act of 1891, some agitation with respect to the conditions of home-work had begun to make itself felt, and in recognition of this a provision was made in that Act giving the Secretary of State power to require employers to keep lists of all the out-workers they employed. These lists were to be open to the inspection of the Factory Inspector and the Sanitary Inspector. This was carried a step further by the Act of 1895, in which it was decreed that copies of these lists should be sent twice a year to the Factory Inspector. But while the latter may visit the homes of the out-workers, he has no power to remedy any defects he may find there; all he can do is to report insanitary conditions to the Local Sanitary Authority; except, of course, in the case of out-workers who employ others to help them, and whose premises thus become a workshop within the meaning of the Factory and Workshop Acts, and are accordingly subject to their provisions. But these after all form a comparatively limited class; consequently the great majority of out-workers are left entirely outside the scope of these Acts.

The following cases will convey some idea of the actual conditions under which out-work is carried on:—

1. Is the wife of a labourer, who is sick and in the infirmary; works from twelve to sixteen hours per day finishing trousers;[100] is paid 4½d. and 5d. per pair; earns 2s. per day; supplies thread and twist, which cost about 8d. per week; works in a very untidy, dirty kitchen. Has no time to clean up except once a week. Children carry the work to the workshop.

2. Is a widow living alone; finishes trousers; is paid 2¼d. and 2½d. per pair; earns 9½d. per day of nine and ten hours, and provides thread, which costs about 9½d. a week. Her earnings are supplemented by 2s. 6d. a week from the parish.

3. Married woman, husband out of work; finishes shirts; is paid 2½d. per dozen, and earns about 7½d. per day of eighteen hours; supplies thread, which costs about 8d. per week. When work is brisk she can earn 4s. 8d. a week by getting up at three and four in the morning.

4. Is the wife of a bricklayer; she works eight to nine hours a day making matchboxes; is paid 2¼d. per gross, and earns about 1s. 4d. a day. A girl of eight out of school hours helps the mother, who has to supply paste and hemp, which costs about 6d. a week.

5. Is the wife of a porter; works ten to twelve hours a day making matchboxes; earns 1s. 3¾d. per day, and her little boy, who is four years old, helps her by folding the paper after it is pasted over the cardboard.

6. Is a married woman; makes bead trimming; is paid ¾d. to 1¼d. per yard, and earns from 1s. to 1s. 6d. per day, working twelve to fifteen hours. Little boy of eight helps out of school hours.

7. Two girls work at fur-pulling eleven hours a day, and earn about 8s. 6d. per week each. Three girls sleep in workroom in one filthy bed. Elder girl said her chest was bad, but she was accustomed to this.

8. Is the wife of a labourer in irregular employment; finishes shirts, and works from 5 A.M. to 11 P.M.; is paid 2½d. to 5d. per dozen; pays about 1d. out of every 1s. earned for thread. The highest wage she ever earned was 4s. 10d. a week, “working late and early.” The eldest girl does the housework. House in filthy condition; work piled upon the floor.

9. Two single women living together, the daughters of a city missionary deceased; work about ten hours a day finishing children’s shirts and making pinafores, and earn from 4s. to 6s. per week each. On the day visited, one had worked seven hours and had made 7d. Her wages-book for ten consecutive weeks showed 2s. 4d., 4s. 4d., 5s. 8d. (week and half),[101] 7s. ½d., 3s. 1½d., 3s., 2s. 3d., 3s. 9d., 3s. 1d., and 5s. House, attic room, beautifully clean, rent 8s. per month.

10. Is the wife of a labourer irregularly employed; has three young children; “makes shirts throughout and finishes them,” earns 5s. to 6s. per week, working twelve to fourteen hours per day. She pays 1s. 6d. per week for machine, and 4d. per six dozen for thread. Occupies house of two rooms, very dirty and almost destitute of furniture.

11. Is a widow; lives in one-roomed house, which is very dirty; “finishes” woollen shirts; is paid from 2½d. to 6d. per dozen, according to the amount of work put upon the garments. Her average earnings are from 5s. to 6s. per week. Two children were lying ill in the room, and were covered up with the shirts on which the mother was employed; she could not tell what was the matter.

12. Is the wife of a surfaceman earning 16s. a week; makes aprons, pinafores, and chemises, and earns about 5s. per week. She is in delicate health; has had eight children, only one of whom now survives.

And so on, through this dreary tale “of poverty, hunger, and dirt.”

The evidence collected in respect to out-work by expert investigators in these and other cases seems to prove conclusively that it is usually accompanied by very low wages, inordinately long and irregular hours, and distressingly insanitary conditions. With the matter of wages British legislators have not yet seen fit to deal directly, and it is obvious that any regulation of hours for work carried on by workers in their own homes would be extremely difficult to enforce. What remains is the sanitary condition of the house and of the worker. And there is the double ground for interference here, in that the making of clothing and other articles for public use in insanitary dwellings is not only a danger to the workers themselves, but also to the public generally.

How does the law on this point at present stand? Perhaps the most important legislation we have had dealing with out-work is to be found in sections 5 and 6 of the Factory Act of 1895, which contain the following provisions:—

I have no doubt sub-section 1 of section 5 might have gone a long way to improve the sanitary conditions under which out-workers are employed, and reduce the danger to the public, had it not been for the restriction imposed by sub-section 3, which makes it practically inoperative.

Notwithstanding the many overcrowded and insanitary districts in our large cities, I am not aware that a single area has been specified to which the section should apply. The reason for this will probably be found in the difficulty to prove the existence of “special risks of injury or danger to the health of the persons employed and of the district.” And in any case the month’s notice to be given would simply mean that by a system of removing—which would be nothing unusual with the class of workers concerned—the purpose of the Act could be successfully evaded.

It would seem to be the desire of the legislature to place all responsibility for compliance with the law upon the employer, or the person giving out the work, but it stops short at providing him with the means of ascertaining whether the law is being complied with.

The limited space at my disposal will not allow me to deal[103] with the many economic issues involved in the question of out-work. I can only make a brief reference to its possible effect on wages.

Many of the more intelligent workers in the factories and workshops speak very strongly against it on the ground that the long and irregular hours tend surely, if indirectly, to lower wages, and workshop hands in some cases, even where the total earnings were very low, have on principle refrained from taking work home to finish after the workshop hours, through fear of thus producing an artificial standard of wages. Out-workers are often used as a lever for reducing rates of wages. They are not restricted by any law to a specified number of hours per day as in factories, and they are often found working from early morning till late at night. With the help of some other members of the family, a fair wage may be earned, in consequence of which the employer is inclined to make comparisons which show the factory hands at a disadvantage. Subsequently rates are reduced for everybody.

It may be interesting to note that a large number of out-workers met with during these inquiries were in receipt of parochial relief, although they were working full time for their employers. Attention has been directed to this subject from time to time in the official reports of the Factory Department, and various suggestions have been put forward as to the best methods for the efficient regulation of home-work; but sooner or later the Government will be obliged to deal with this question, and as the matter will therefore be in the hands of the Home Office it would be unwise of me to anticipate the manner in which they might treat the subject.

A. Ballantyne.

There is a limit to man’s power of doing work. This varies in different individuals. In an ordinary way work is conducive to health, and even under abnormal circumstances work is often the main factor that tends to prolong life. Mental not less than physical occupation has been known to raise men and women above worries that otherwise would have crushed them and lifted them above the depressing influences of an incurable malady. In itself work is a good thing. It is when we come to consider the effects of overwork and fatigue in an age when all is hurry and excitement, when every one is pressed, and work is undertaken under such unhealthy conditions as exist in some overheated, overcrowded, and ill-ventilated factories, that one of the worst sides of excessive toil is seen. In order to understand more fully the evils of overwork and fatigue, physical and mental, let us learn something of the physiological conditions under which muscular work is performed.

We are frequently reminded that the human body resembles a steam-engine. From the circulation within the body of the absorbed products obtained from digested food are evolved those chemical and mechanical forces which direct all work, physical and mental. The human body differs from the steam-engine in being able to transform some of the food products into living tissue, whereby during work it calls upon its stored-up energy and loses weight. Human life can only be supported by oxygen and the ingestion of foods of vegetable or animal origin. In the internal laboratory of the human body chemical changes are continually taking place, resulting in the formation of such waste products as carbonic acid, water, and urea. These have to be removed by the lungs, the kidneys, and skin. A pure atmosphere, healthy surroundings, and an adequate supply of water and proper food, are therefore required in order to introduce into the system the ordinary necessaries of life. Health can only be[105] maintained by a normal functional activity of the emunctories, whereby waste products are eliminated.

All organs when in a state of greater functional activity than usual draw to them, by a kind of automatic arrangement of the nervous system, a larger supply of blood. The demand upon the muscles of the labourer is met by an increased flow of blood at the time, therefore, when most required, and when changes within his muscular system are most active. In a similar fashion, a quickening of the cerebral circulation occurs during the processes of thinking and mental attention. We are, however, at this particular part of our inquiry concerned rather with that large army of workers, men, women, and young persons, who are either day or weekly wage earners, whose life is one of hard toil, and who in reaching home of an evening are frequently tired out with the day’s labour. Work while physiologically making for health may, if pushed too far so as to induce fatigue, ultimately unfit the individual for his allotted task.

By means of an instrument known as the ergograph, physiologists can estimate the amount of muscular work done. We can thus learn something of the laws of muscular activity and of fatigue in man. Work is only done by muscle when it is contracting. By means of the ergograph we can register the character, the frequency, and rhythm of these contractions, and estimate the weight of a load lifted, or the amount of work accomplished, in a given time. In addition to the physical work accomplished, heat is also generated within the muscle, and certain waste products are formed which escape by the veins and lymphatics. A healthy fresh muscle responds practically at once to an electrical stimulus, but when it has been over stimulated so that the individual muscular contractions follow each other too rapidly, the tissue becomes fatigued and no longer responds to the induction shocks. The ergograph shows us the manner in which we become fatigued. Professor Mosso, of Turin University, found that the instrument registers very much the same results in the same people over a period of years, allowing for certain minor modifications depending upon the conditions of the organism, the state of health at the time, diet, sleep, and the amount of intellectual fatigue present at the moment. We are all familiar with the influence of volition upon muscular contraction. By a strong effort of will we can force our jaded muscles still to accomplish work, but in doing so we often add to the muscular tiredness a sense of brain fatigue as well. There[106] is a marked difference in the character and amount of work done by muscles that have been gradually trained compared with that done by those not so prepared. Professor Aducco found that at the end of a month, after having practised a few hours daily with the ergograph, he could perform twice the amount of muscular work than he could at the commencement. A moderate amount of work, physical and mental, is attended by a feeling of pleasurable satisfaction. It is when work is carried too far, and when a man’s daily labour becomes too hard, or makes lengthened and unusual demands upon his strength, that there is experienced a sense of extreme weariness and fatigue. When a muscle has become fatigued its irritability is lessened. It no longer contracts with the same vigour, less energy is set free, and the muscle relaxes and regains its original form less quickly. Under any circumstances energy is only liberated at the expense of the nutriment stored up within the muscle and the oxygen absorbed from the blood. A process akin to oxidation takes place within the muscle during its contraction whereby waste products are formed that act as poisons to the muscle protoplasm. Muscle is only capable of doing work so long as energy holding explosive compounds are formed within it and the waste products are excreted.

What, then, causes fatigue? Since during muscular contraction oxygen is absorbed, and carbonic acid and other waste materials are formed, fatigue might in the first instance be considered as dependent upon processes of a chemical nature, and be due to the non-removal of the harmful substances formed by muscle when doing work. That fatigue is largely the result of this is shown by passing some simple saline solution through the blood-vessels of a limb removed from a recently killed animal, and where the muscles of the limb have been thrown into a state of fatigue by excessive stimulation. As the liquid percolates through the muscles and washes out the waste products, fatigue disappears, and the muscular contractions on stimulation become again as vigorous as they were before. Over-use of muscles obliges us to breathe more frequently. By increased frequency of respiration the temperature of the body is lowered owing to evaporation of water from the interior of the lungs. Add to this the cooling influence of the air inspired, for it is of lower temperature than that within the lung. Respiration too is the medium through which we throw off the excess of carbonic acid from the blood. As long ago as 1845, Helmholtz, a German physiologist, demonstrated that when a muscle is in a state of repose it contains very few substances that are soluble in alcohol.[107] For the sake of comparison we shall name this amount 1. In fatigued muscle the quantity of these soluble substances rises to 1.3. Healthy muscle in repose has an alkaline chemical reaction, fatigued muscle is acid. Some of the substances formed during muscular contraction possess distinctly poisonous properties and are toxic to the individual himself. While fatigue is induced by local conditions in the muscles, the sense of tiredness which we experience is the result of general rather than local causes. During the course of a long walk, or a day’s hard toil, the muscles are constantly forming waste products which it is the function of the internal organs to throw out of the system. It is not deprivation of food, for example, that is the cause of fatigue, although it may be contributory. The real cause is the circulation in the blood of fatigue products. These act upon the nerve-endings in muscle and paralyse them, and they also act upon certain portions of our brain, and create the sense of fatigue. Ranke made an aqueous extract of fatigued but otherwise healthy muscle, and taking the poisonous substances he injected them into a living muscle that had been removed from a recently killed animal, with the result that its power of doing work at once diminished. Were it not for the watchful activity of our emunctory organs, e.g., the liver, kidneys, skin, and bowels, the human body would soon be poisoned by the toxic substances formed within the system. The sensation of fatigue is due to the temporary retention of these harmful substances. The blood of a fatigued animal is more poisonous than that of a healthy one which has been in a state of quietude for some time previously. When some of this blood is injected into a healthy animal, it induces the phenomena of fatigue. If, for example, the blood of a fatigued dog is injected into a healthy one, the receiving dog will shortly afterwards show signs of fatigue, creep into a corner and go to sleep. The effect of hard work upon the blood is also shown in a diminution of its hæmoglobin or colouring matter. When we are mentally tired, it would seem as if the sensation of fatigue was located in or depended upon certain conditions of particular portions of our brain, for if we change the subject of meditation or take up some game that requires even a great amount of thought, e.g., chess, the sensation of tiredness often disappears. It is difficult to prove whether brain or muscular work is the more fatiguing. It depends upon the training, the occupation, and constitution of the individual. The personal element is a factor in fatigue that cannot be ignored. Prima facie, owing to[108] nerve tissue being the more highly organised, this circumstance suggests that the brain would be the more easily fatigued. Against that must be placed the fact that the muscles form a much larger portion of the body by weight than the nervous system, and consequently within them must be formed a much larger amount of poisonous waste material. Some people we know are more easily tired than others, both mentally and physically. There is for each person apparently a definite rate of muscular contraction essential to the amount of work accomplished in a given time. If this is true for the muscular, it is none the less so for the nervous system. People who have inherited a weak nervous system become readily exhausted, even with very little work, and they recuperate slowly. They are said to suffer from neurasthenia, or nerve weakness. In addition to muscular work being accompanied by the production of toxic substances, it should be remembered that the individual is perhaps standing all day at work in a heated factory, and as a consequence of the fatigue the circulation becomes languid, and his feet swell. Muscle can after all do only a limited amount of work, and in order to recover from fatigue there must be a period of repose or relaxation. This raises the question of the number of hours per day a man should work, also the length of the break for the mid-day meal. On the Continent the mid-day break is in some factories longer than it is in this country, but the work is carried on further into the evening. It is admitted that in iron works and factories, where the hours of labour have been unusually long, say ten and eleven hours, the work done in the latter part of the day is not so good as that done in the forenoon, and managers say that where the experiment has been tried, the men have turned out in eight hours an amount of work equal to what was previously done in nine. The problem can only be solved by experience. It is right to mention that fatigue does not always, or necessarily, depend upon the amount of work done. A good deal depends on the state of the body at the time. We know that good work can never be done by a tired brain or fatigued muscles, and that the amount of work accomplished is always greater where the limit of exhaustion has never been reached. If we are tired and feel that we have to make a fresh spurt to accomplish something, the end, it is true, may be gained, but it is by using up a certain amount of reserve force stored away in our muscles, and by making an additional demand upon our nervous system. The physical fact of muscular fatigue has its psychical[109] counterpart in the sensation of tiredness. When muscular work is light and of short duration there may be only a sense of weight, but if the labour has been hard there may be a sensation of actual pain which continues for a time. Intellectual work when carried on too long and without sufficient recreation, interferes with the innervation of the heart and blood-vessels. In cerebral fatigue there are often languor, or its opposite restlessness; the pulse may be small and excitable; the head hot, the feet cold, and there may be noises complained of in the head. The nervous control of the blood-vessels is destroyed, so that while the extremities are cold and their blood-vessels small and contracted, those of the brain may be dilated and overfilled. Protracted brain work is followed by irritability of temper, by inability to concentrate the attention and to reason out problems. It becomes an effort to think. There is headache, for the brain is, in a similar manner to the muscles, affected by the circulation through it of waste products. These at first, like alcohol, may stimulate and excite the brain, but they end by paralysing it. It is an interesting fact that while the brain is particularly sensitive to the action upon it of poisonous substances and of an altered circulation, as seen, e.g., in bilious headache, the headache of kidney disease, plumbism, etc., the surface of the brain is insensitive to touch, as is demonstrated in cases of injury to the skull where the brain is protruding. The brain can be gently touched without any sensation being experienced; if there is any at all, it is certainly not one of pain; any effects that follow are the result of pressure. While insensitive to a great extent to touch, the surface of the brain will respond to an electrical stimulus. Levy (British Medical Journal, 13th September 1900), after stimulating the motor areas of an animal’s brain by electricity, found that fatigue was rapidly induced, and when this occurred, that the brain failed to respond to fresh stimulation until after a period of rest. When interruptedly stimulated, so that there are periods of rest, the brain does not become readily fatigued, but is rendered capable of expending a greater amount of energy.

Hodge (Journal of Morphology, 1892) has studied the effects of work upon nerve structures. He found after prolonged electrical stimulation of spinal nerves certain structural alterations in the cells of the ganglion on their posterior root. When the nerves were over-stimulated the cells became shrunken, their protoplasm crenated and vacuolated. The amount of shrinkage was proportional[110] to the length of stimulation, e.g., if it was continued for—

1 hour	there was	22 per cent.		Shrinkage in volume of the nuclei of the stimulated cells.
2.5 hours	„	21 „
5 „	„	24 „
10 „	„	44 „

Hodge’s experiments demonstrate that there is a relation between the amount of structural change in nerves and the length of time during which the stimulus has been applied. The influence of rest in restoring the cells to their normal size was equally apparent. In order to determine how far these changes were really dependent upon work, Hodge examined the nerve-cells of birds and bees after a day’s work and after a night’s rest. At the beginning of the day, when the animal had rested over night, the nerve-cells were found to be large and turgid, and with prominent nuclei, but after a day’s work, the contents of the cells were vacuolated and shrunken, and their nuclei altered in shape.

Dr Guido Guerrini (Lancet, 21st October 1899, and 10th November 1900) confirms the statement just made, that as a result of fatigue the nerve centres exhibit certain alterations of structure. Beyond being more vascular than usual, a fatigued brain does not exhibit anything special to the naked eye. Guerrini caused dogs to run a certain mileage every day, but it was not until they had covered a distance varying from 22 to 61 miles that they appeared fatigued. On examining their brain microscopically, he found the lymphatic spaces around the cells distended, the chromatin network of the brain-cells changed, and the pigment disintegrated, while the protoplasm exhibited numerous vacuoles, the outline of the nucleus was irregular, and its contents vacuolated. These changes were always proportional to the amount of fatigue undergone by the animal, and were most pronounced in those parts of the brain known as the motor areas, i.e., those which innervate the muscles. The cause of these alterations of structure in nerve-cells in fatigue is the circulation in the blood of waste products formed during work. The presence of this waste material in the blood not only creates a sense of fatigue, but so alters the structure of nerve-cells that they require a lengthened period of repose before they become quite recuperated. Additional changes were found by Guerrini in the liver and kidneys. On examining these organs in fatigued dogs, he found that there were changes in the cells of the convoluted tubules of the kidney, and in the loops of Henle. The cells were observed to be larger and more brittle than in[111] health, so that they readily disintegrated and filled the tubules with débris, in the midst of which the liberated nuclei could be seen. The liver cells too were found to be enlarged, and the seat of cloudy swelling, which is always one of the earliest indications of pathological change occurring in cell protoplasm.

In considering the question of work and fatigue, there are in addition certain other factors that cannot be ignored, for example: (1) the social conditions in operation upon the individual at birth, and during his upbringing; (2) habits such as the use of alcohol; (3) the atmosphere in which his work is carried on; and (4) the nature of his employment, and the number of hours per day spent at it.

Roughly speaking, the working classes may be divided into artisans, the majority of whom make good wages, are well housed, well clad, and well fed; and into labourers, who do unskilled work, whose occupation is irregular, and who, when out of work, are not well fed.

To some even of the regularly employed labouring classes, when the family is large and the wages small, or where work is interrupted on account of recurrent ill-health, life is a hardship, and the children are occasionally more or less deprived of their proper food; while in the case of the textile industries where women are employed in the factories, the infants, bereft of maternal attention and proper nutriment, necessarily suffer. The children born in the alleys of our large towns cannot, as they grow to manhood, be possessed of that well-developed bodily frame required to fit them for undertaking hard muscular work. The offspring of parents, both of whom work in textile or jute factories, are inferior in size and general physique to children born under healthy surroundings and under more normal conditions. When these grow up and enter the factory as half-timers, their rate of growth lags far behind that of children of their own age who still remain at school. The trend of civilisation is for hard manual labour to be more and more replaced by machinery in all industries. By some social economists, however, as we shall see later on, this is not always regarded as an unmixed benefit. When a child commences work and earns a weekly wage he is to that extent more able to procure the additional food his growing frame requires. From this point of view the object is good; and if only the physical labour is gradually undertaken, is not too long, and is tempered to the strength of the juvenile worker, the training, like the muscular exercises alluded to in the earlier part of this paper, may be beneficial than otherwise. It is not always thus, however,[112] with children who go into factories. Children brought from the country, and with good physique to start with, will be found after two years’ work in a mill in a large town to exhibit a smaller rate of growth than those who engage in outdoor work. The children of the poorer classes commence life at a great disadvantage compared with those of the well-to-do. There is more sickness, and the death-rate among them is higher, owing very largely to bad feeding, exposure, and neglect. Pagliani found as a consequence of women continuing to do hard muscular work when enceinte, and commencing their industrial duties again too soon after their confinement, even though giving their infants the breast, that the children were of shorter stature and of feebler force than those not similarly treated. A fairly reliable test of the effect of severe manual labour upon children in Continental countries is seen in the large number of conscripts rejected from military service on account of some physical disqualification. In no place perhaps more than in Sicily are the harmful effects of fatigue and exhaustion on young people so apparent. An excessive proportion of the conscripts who had been in their earlier years engaged in carrying heavy baskets of sulphur out of the mines near Catania are found to be physically feeble, ill-developed, and unfit for military service. Is a similar condition of things, although to a minor degree, not taking place in our own country? The standard of height and of chest measurement required of recruits is not rising but falling. The improper feeding, bad housing, imperfect clothing, and absence of pure air in the home, which are the lot of an increasing number of the poorer working classes, are not the conditions that favour the development of such healthy labouring people as are required to enable us as an industrial community to compete with other nations, perhaps more favourably circumstanced. The point is, whether in this respect other nations do not come under the same ban as ourselves.

After work there must be relaxation, in order that an opportunity may be given for the muscles to recuperate, and for waste products to be removed. For working men, physical rest and recreation, sleeping in good air amid healthy surroundings, are desiderata, and yet how few there be who find these. With the toil of the day over, home reached and supper finished, there is little in the immediate dingy surroundings that is attractive, and so the working men saunter out to the nearest street corner to converse with their comrades, or adjourn to a public-house, where[113] in an overheated bar and ill-ventilated rooms the remaining hours of the evening are spent. Nor is the married working woman much better off, so far as rest is concerned, for after her day’s work in the factory she attempts to overtake, often unaided, her neglected maternal and domestic duties. It is desirable that healthy recreation for our working classes should be provided to a greater extent than it is. In this matter employers could do a great deal. The proper housing of the working classes is even a greater need. How can the poorer working men have good health, good morals, and be long lived, when they do not have in their homes and surroundings those conditions that enable them, during periods of relaxation, to sleep well, and to eliminate by their lungs and skin the waste materials formed during toil. After all, we are each of us, physically and mentally, very much what the circumstances of life make us. Personal, not less than national character, is partly moulded by external surroundings.

The habits of the poorer working classes, too, as regards alcohol are not without their bearing upon this important question. It is a subject, therefore, upon which there should be some definite expression of opinion, especially since both at home and abroad there is a belief that alcohol is a necessity for the working classes. This matter has been recently brought to the front in France by the socialist leader, M. Fournière, in an address delivered to working men, the gist of whose argument is, that alcohol is a hydrocarbon, capable of supplying during combustion within the body the necessary elements for muscular work, and that therefore it is a food. Among foods of the hydrocarbon type Fournière places alcohol in the first rank. He maintains that the insufficient food of the workman imposes upon him the necessity for alcohol; his hard work creates a desire for it. Alcoholism as a social infirmity is therefore regarded as a direct consequence of the excessive demands made upon the muscular system by present-day labour. This is dangerous teaching to working men, and cannot be allowed to pass unchallenged. The insufficient food of the working man is in many instances the result of his small wages and uncertainty of employment, but it is a monstrous evil for any political leader to recommend him to spend more of his wages upon drink. Money purchases less alcohol than food; besides, what is spent upon alcohol is consumed by the individual himself, leaving less of the wages, therefore, to be spent on food for his wife and family. It is pandering to selfishness, and the teaching tends to encourage the idea that what a man produces by his labour he has a sole right[114] to spend upon himself, leaving to Society the care of those who are naturally his own. But quite apart from this side of the question, what is the teaching of physiology?[41] It can be shown that the administration of alcohol in more than moderate doses is followed by a diminution of muscular energy, which fresh doses of the stimulant do not readily compensate; that to the period of excitement there succeeds one of depression, so that in a given time the amount of work accomplished under alcohol is less than that done without it. I think I may safely say that no literary man ever did his best work under the influence of alcohol. In moderate quantities alcohol stimulates the brain for a brief period, and quickens the flow of ideas, but this is followed by a reaction of depression. In a paper read before the Académie des Sciences, January 1901, M. A. Chauveau detailed the results of his experiments upon alcohol and muscular work. He set himself this problem: how far a man who works and whose blood is saturated with alcohol obtains from the combustion of alcohol the energy necessary for the functional activity of his muscles? In order to estimate this he measured the “respiratory quotient,” that is to say, the relation existing between the volume of carbonic acid excreted and the amount of oxygen absorbed. His conclusions are drawn mostly from dogs. In an ordinary way meat and sugar were administered to these animals, and subsequently for 84 grammes of sugar 48 of alcohol were substituted. Under the normal feeding the mean respiratory quotient was 0.963, but during the period of the administration of alcohol it only reached 0.922. Chauveau proved by this and other means that alcohol is not utilised as potential energy either for the execution of physiological functions acting together in a state of repose or for muscular work during states of activity. In substituting alcohol for sugar he found in a given time—(1) a diminution of muscular work; (2) loss of body weight, and (3) increased expenditure of energy relative to the amount of work accomplished. We are familiar with the fact of the large quantities of stout consumed by the London dock labourers, who, either as the result of experience or imagination, have come to look upon malt liquor as a necessity and as a food. Without denying the fact of stout in small quantities when taken with food supplementing, through its hydrocarbons and the sugar[115] it contains, muscular energy, it can only to a limited extent contribute to those combustion processes from which the muscular system derives the necessary energy for its functional activity. Reverting for the moment to Chauveau’s experiments, it was found that during the period of normal feeding a dog ran a distance of 23.924 kilometres every day in two hours, and that its weight increased 1.245 kilos.; but during an equal length of time when it was taking alcohol instead of sugar, the distance coursed in the two hours daily was only 18.666 kilometres, and its weight fell 115 grammes. It is true that we cannot apply in toto the results of this experiment to man, but they are not without their meaning. Sugar is a well recognised muscle food. The experiment shows us that in dogs, when alcohol is substituted for sugar, the result is not to the advantage of the individual. There is a diminution in the amount of work done. More than this, alcohol tends, and the more impure it is the greater the tendency, to load the blood with harmful substances, and to induce pathological changes in such of the eliminating organs of the body as the liver and kidneys. Even admitting that it may contribute to the production of muscular energy, it imposes upon these organs a greater burden than a proportional quantity of food, and thus it happens that as a consequence of the circulation within the body of the toxic substances formed in muscle during work and of those derived from alcohol, also the fact that alcohol checks the power of the liver and kidneys to throw off the toxic material circulating in the blood, there are induced at an early age in working men who are intemperate, pathological changes in the liver, kidneys, and nervous system, structural alterations which play a very large part in the causation of the high death-rate of the poorer working classes.

In considering the question of fatigue of working people we must not overlook the nature of their employment, the rooms in which the labour is carried on, and the number of hours daily spent in work. When the air in a factory is close, and is not renewed frequently enough, there is an impediment to the escape of carbonic acid from the lungs, and when the air is overheated and moist, the natural cooling of the body through respiration cannot occur. Labour carried on under these conditions entails an additional tax upon the strength of the workers and burdens their system with impurities. We live in an age that creates, because there is a demand for, labour-saving machinery. The introduction of steam has revolutionised industry. Manufacturers keep increasing their production and throwing goods in larger quantity[116] and at lower price upon the market. Machinery acts with unerring uniformity. At times so simple is its mechanism that a child can almost guide it, yet how exacting are its demands. While machinery has in some senses lightened the burden of human toil, it has not diminished fatigue in man. All through the hours of work in a factory the hum of the wheels never ceases. Requiring constant attention, to stop the machinery running is to lose money, and so men and women are obliged to wrestle with the forces of steam and mechanical ingenuity. While the machinery pursues its relentless course and is insensitive to fatigue, human beings are conscious, especially towards the end of the day, that the competition is unequal, for their muscles are becoming tired and their brains jaded. In many factories the system of double shifts allows the work to be carried on by night as well as by day. It is not urged that where double shifts of men are employed and the work conducted in well-ventilated factories, the shifts alternating every fortnight (night being the ordained period for man’s rest) with no Sunday labour and Saturday afternoons off, that the double shift system is necessarily prejudicial to health. But what shall we say of double shifts that practically never know of any interruption? A short while ago I visited a large iron works on the Continent where steel rails were being made. By means of a day and night shift the work went on continuously. On the occasion of my second visit to the works at eleven o’clock at night I met with a strange sight. The men were working almost naked; they were only wearing loose, coarse cotton garments like shortened nightdresses, and even in these they were bathed in perspiration. As they flitted about in the darkness, lit up by the lurid glare of the furnaces, they looked more like demons than men. For nearly seven years had the furnaces been going almost without cessation. From the first day of one year to the commencement of that following, Sunday, Saturday, and Christmas Day, the men had worked their particular shift, never knowing what twenty-four hours’ respite from labour was unless when off ill. The company pensioned the men when they were too ill or too old to work, and gave them a house with a small garden and pasturage for a cow; but what availed these when the best years of the workmen’s lives had flown and the enfeebling influences of old age had fallen upon them? The men were old at the age of forty, and many of them were broken down in health. It is the continuous demands made by machinery that are so trying, there being no time left for relaxation. Presentday[117] factory labour is too much a competition of sensitive human nerve and muscle against insensitive iron, and yet, apart from an appropriate shortening of the hours of labour, it is difficult to see how this can be remedied. The greater the number of hours machinery runs per day the larger is the output for the manufacturer, but the feebler are the human limbs that guide it. To the machine time is nothing; to the human being, each hour that passes beyond a well-defined limit means increasing fatigue and exhaustion. There are some social economists, Marx among others, who maintain that while machinery has diminished the price of products it has made the lot of the worker worse, since by disregarding human strength it has introduced into factories a larger number of women, thereby reducing wages and diminishing the number of men required; so that, while there has followed a diminution in the number of hours of employment, the tension when at work is greater, and the output larger, thus resulting in more work being done. Machinery, too, by obliging man to do and to keep at one particular detail of work, is reducing him to a mere unit, and causing him to be ignorant of the other processes of manufacture, and to be less and less the handy man of an age now all but past. It remains to be seen how far this enforced relegation of man’s labour to the production of one particular product is for his own ultimate good and that of Society.

There is, it seems to me, too great a tendency even on the part of working men themselves to insist upon uniformity in regard to the number of hours they shall be employed. This is seen in the attempt to nationalise an eight hours’ day for coal-miners, when it is known that in Northumberland and Durham they do not work eight hours from bank to bank. There are local and social conditions that cannot be ignored, and before which the leaders of working men must bow. As regards dangerous trades, it goes without saying that the number of hours spent daily in a factory should be fewer than in healthy trades or in outdoor occupations; and a similar remark applies to those industries in which the work is hard and makes severe demands upon the muscular system of the labourers. It was surely never meant that work should be other than invigorating to man, and educive of all that is best within him. Healthy persons, therefore, should work to keep healthy; those who do not work, miss one of the greatest charms of life and stimuli to health. Fatigue is not due to work but to overwork, and excess of every kind is injurious.

Thomas Oliver.

Having undertaken, at the invitation of the editor of the present work, to contribute a section on the mortality of occupations, I think it just to him and to my readers to premise that inasmuch as the results of the forthcoming census cannot possibly be available for a considerable time to come, the statistical data on which I shall have to base my present observations must inevitably be those which were collected some years ago for the purposes of the second volume of my previous work.[42] And, seeing that those data were to a large extent exhausted in the preparation of the work referred to, it follows that I can offer comparatively little that is actually new in the remarks which I am now about to submit. The best that I can hope to accomplish is to select from the mass of statistical matter that was compiled for my larger work such particulars as may seem appropriate for the present article, adding from time to time such explanatory comments as a careful review of my previous book may show to be desirable.

Before entering on a discussion of the special subject with which the present essay is concerned, it may be well to offer a few preliminary remarks on the variations of mortality in general, as affected by conditions other than those of occupation, and in different parts of the country.

In a paper read before the Royal Society in 1859, my distinguished predecessor, Dr Farr, produced evidence to show that in sixty-three of the registration areas of England and Wales, which he designated “Healthy Districts,” the death-rate in 1845–50 did not exceed 17 per 1000 persons living. Improvement in the health conditions of England and Wales has now made it practicable to establish a higher standard for healthy districts: for whereas in 1845–50 less than 6 per cent. of the total population[119] lived in localities where the death-rate was 17 per 1000, we are now able to state that in the years 1881–90 not less than 25 per cent. of the people lived in districts where the death-rate ruled below 17 per 1000, including a proportion of 4.5 per cent. in districts where the death-rate did not reach 15 per 1000. At the same period the general death-rate of England and Wales was 19 per 1000 living: about one-fourth part of the English population experienced a death-rate of from 12 to 16 per 1000, one-half were subject to death-rates ranging from 16 to 22 per 1000, whilst one-fourth part of the population experienced death-rates varying from 22 to as many as 36 per 1000 living, or more than double the rate obtaining in the healthy districts. It is not of course suggested that these enormous differences of mortality are to be accounted for exclusively by circumstances of locality, or even by circumstances of occupation and locality combined. The true causes of excessive local mortality are for the most part well known to the sanitary authorities who are responsible for the health and well-being of the communities among whom such unfavourable conditions prevail; in any case, these causes cannot be specially discussed here.

The foregoing remarks, with respect to fluctuations in general mortality, may have little obvious bearing on the subject in hand, namely, the mortality of occupations. But I adduce them in order to assist in explaining what will be further emphasised later on, i.e., the fact that even in the same industry the workers in various places experience wide differences in their mortality—differences which can only be accounted for on the theory that conditions of environment determine, to a greater degree than is usually believed, whether the mortality of a given industry shall be favourable or the reverse.

In connection with each of the last four census enumerations, and with the aid of the death registers for the several intercensal periods, attempts have been made to ascertain the influence of occupation on the health and vitality of the people. The results have been published in successive “Decennial Supplements,” and to these works reference must be made on points of detail. The earlier investigations of Dr Farr, which were based on the census populations and the deaths in 1861 and 1871, were limited to the mortality from all causes incidental to men engaged in certain well-defined occupations—account[120] being taken only incidentally of the diseases to which that mortality was due. This omission, however, was supplied by Dr Ogle in the third Decennial Supplement, which dealt with occupational mortality in 1880–2. On that occasion Dr Ogle undertook the laborious task of abstracting and analysing large numbers of deaths in combination with ages, causes, and occupations, and thus succeeded in preparing the valuable series of tables concerning “causes of death in different occupations” which illustrate his work.

For the last decennial supplement I am myself responsible. In Part II. of that work the calculations were based on the population, as enumerated at the census of 1891, and the deaths registered in the three years 1890–2. Details of age, occupation, and cause of death, with respect to every male over fifteen years of age who had died during these three years, were abstracted from the registers and entered on separate slips of paper: these slips, more than half a million in number, were then examined by specially selected clerks, who had been employed in classifying occupations for the census reports, and each slip was distinctively marked with the heading under which the occupation should fall.

In the course of the work it speedily became apparent that the mortality of men employed in the several occupations is seriously affected by the surroundings in which they work, and, as before mentioned, these surroundings vary considerably, even for the same occupation, in different parts of the country. In order to ascertain, if possible, the extent to which the mortality of certain occupations was modified by these conditions, the following plan was pursued: the slips belonging severally to London, and to certain groups of districts the populations of which are mainly engaged either in industrial, in agricultural, or in mining pursuits, were counted separately from those belonging to the remaining parts of England and Wales, and the mortality of the same occupations was ascertained in each of these areas.

The group of Industrial Districts was constituted as follows—The county of Lancaster was selected as the seat of the cotton industry; the towns of Huddersfield, Halifax, and Bradford, as that of the woollen industry; Wolverhampton, Birmingham, Leeds, and Sheffield, as that of the iron and steel industry; and Leicester as concerned in the manufacture of boots and hosiery.

The Agricultural Group contained all those counties of England[121] and Wales in which at least one-third of the occupied males over ten years of age were returned at the census as farmers and farm labourers; to these were added parts of counties in which, after exclusion of some of their principal towns, a like proportion of the population was found to consist of farmers and their labourers. In order to avoid possible confusion, as between different grades of labourers, it may be mentioned that all those who were described simply as “labourers” in these agricultural districts have been reckoned here as “farm labourers.” For comparison of the mortality among coal miners in different parts of the country, separate statistics for this industry were compiled for the following six local areas: (1) Durham and Northumberland, (2) Lancashire, (3) The West Riding of Yorkshire, (4) Derbyshire and Northamptonshire, (5) Staffordshire, and (6) Monmouthshire with South Wales.

The extracts from the death-register were limited, for the purpose of my Decennial Supplement, to facts concerning males aged fifteen years and upwards. Hitherto no attempt has been made to deal with the occupational mortality of females. The uncertainty attaching to the statement of occupations in the case of females has been urged as a reason against such an attempt. Much importance has also been held to attach to the fact that only 38 per cent. of the women aged between fifteen and sixty-five years were returned at the census as following any definite occupation, whereas 94 per cent. of the men at the same ages were so returned. Having regard, however, to the vastly increased attention which is now devoted to female industries, especially those which are carried on under the control of the Factory Acts, it is much to be desired that the mortality of the more important of these industries, at any rate, should be subjected to careful statistical investigation at the earliest possible opportunity.

The choice of an occupation by a labouring man is not always, nor is it mainly, determined by personal caprice. It is matter of common observation, that in industries of the more laborious type, such as those of railway navvy, engine fitter, boiler maker, blacksmith, etc., only men in the prime of life, or of more than average physique, are to be found. The operatives in these industries are selected men, quite as much so as are soldiers or sailors, but the process of selection is a different one. They can continue their arduous toil only so long as their bodily strength remains at its best: and when, from sickness or from advancing[122] age this gives way, they are forced to relinquish their labour. They then either turn to some employment which makes less exacting demands on their energy, or else fall out of the ranks of definite employment entirely, and descend to the sad lot of those who are described as of no settled occupation. It follows, therefore, that the men in actual work in the laborious occupations above mentioned enjoy a special advantage over the workers in less arduous trades; and their mortality, although high in spite of that advantage, appears far lower than it would do if every individual could be traced from the time of his entry on the occupation to the end of life. But what of the men who, after trial of a laborious calling, perhaps for the best years of their lives, are forced by ill-health or other infirmity to relinquish it? Very many of these will be found struggling to eke out a living either as cab-drivers, omnibus guards, or messengers, and being for the most part broken down in health as well as careworn and ill-nourished, they must further increase the already high apparent mortality of these workers. Failing this, they will go to swell the ranks of the classes indefinitely known as costermongers, dock labourers, street sellers, hawkers, and general labourers, or less fortunate still, they will drift into the yet lower grade of the unoccupied, whose terrible mortality I shall shortly have to describe.

The mortality prevailing in a given industry from time to time can only be regarded as, at best, a rough measure of the healthfulness of that industry. The reason for this will be explained presently. It is, however, beyond question that when the public mind becomes sufficiently appreciative of the economic value of human life, and of the wastefulness of ill-health, to demand a registration of sickness corresponding with that which is now in force with regard to mortality, we shall be in a position to measure with a near approach to accuracy the amount of damage done by the several industries to the health and vitality of the workers, although it may not be practicable to suggest in all cases a remedy for the waste and the suffering so caused.

Meantime it is desirable to indicate briefly some of the chief reasons which detract from the value of mortality statistics as criteria of the healthfulness of occupations. And first with regard to the data concerning the living in the various industries. It might seem at first sight a simple matter to sort out the units of an industrial community[123] according to their occupations as stated in the census schedules: but even a superficial study of the experience of those responsible for the conduct of past censuses will show that even this initial process is, in reality, a highly complex and difficult one.

The number of names of more or less distinct avocations in England is enormous; at the last census it was about 12,000, but at the present time it is probably far greater than this. The vast additions that have accrued to our nomenclature of occupations is due in a great measure to the circumstance that new branches of industry have sprung up amongst us in recent years, and that with advancing times, old trade processes have undergone more and more minute subdivision. Nevertheless a large number of more or less obsolete names are still of necessity retained in the list of occupations, for the guidance of the abstractors, although many of those in current use are scarcely more than ephemeral nick-names, which are of but rare occurrence in the schedules.

In recent years the industries of the English people have come to be very minutely subdivided, each group of workers in the several subdivisions being known by a special name; and what is worse, the same name frequently indicates one thing in the north of England, and another thing in the south. Nay, more, it frequently happens that these arbitrary names give no clue whatever to the character of the industry to which they are assigned. Perhaps the most serious and perplexing difficulty met with in connection with classification is the fact that very frequently one and the same name is used to indicate totally dissimilar occupations. Thus, for example, the term joiner in some places is used to designate a carpenter, but in others it means a maker of lace. By clothier is sometimes meant a cloth-maker, in others it stands for a dealer in clothes. By jobber is understood in some cases merely an artisan, whilst in others it takes a more definite meaning in connection with the exchange of money (stockjobber). A drummer is either a soldier or a blacksmith’s striker. A miller is either a dealer in corn or a stone mason. An engineer may be either a maker or a driver of machinery. A placer may be either a potter or an iron manufacturer. In the above-mentioned cases the confusion is only between two occupations, but there are other instances far more numerous and much more troublesome, in which one particular name is used in common for a similar process in a considerable[124] number of different trades. For instance, there are spinners, weavers, warpers, winders, etc., alike in cotton, silk, wool, and flax factories, and when an operative is returned under one or other of these names, without further distinction, it is impossible to decide to which of the several manufactures he ought to be assigned. Nor is the worker necessarily to be blamed for this; for he, failing to see the importance of precision, and perhaps ignorant of the use in other industries of a designation similar to his own, not unnaturally returns himself under some such familiar heading, without further question. Nevertheless it will readily be understood that the existence in the returns of such indefinite headings as “miner,” “labourer,” “artisan,” makes it difficult to estimate the precise number of workers in any industry, if, indeed, it does not in certain cases seriously reduce the value of such estimates. Fortunately, however, the numbers of workers thus vaguely returned at the census are small when compared with the enormously greater aggregates of those employed in the more important industries, and whose exact occupations are definitely known: so that, with respect to these principal industries, at any rate, the numbers can be ascertained with sufficient accuracy for practical purposes.

Thus far a few of the difficulties and possible errors connected with the returns of the living in the several industries having been considered, we now come to speak of the other factor of relative mortality, viz., the deaths occurring in the several occupations, and their classification according to age and probable cause. The difficulties encountered in relation to estimates of population have already been shown to be considerable; and yet they are not only fewer in number, but also less serious than those we shall now have to notice. The vagueness with which occupations are too often stated in the schedules has already been referred to, but unfortunately even greater vagueness is discoverable in the death returns. In proof of this the large group of men, some six hundred thousand in number, who are designated “agricultural labourers,” may be taken as a case in point. In the census returns of the living these men are doubtless correctly described, but in the death registers they are in many cases entered simply as “labourers,” without qualification of any kind. Consequently there is danger lest these men, who for the most part are remarkably healthy, sober, and well-conducted, should be confused with “general labourers,” a sadly unhealthy, degenerate set[125] of men, whose occupation is uncertain, who live from hand to mouth, and whose mortality is nearly double that of agricultural labourers. Coal miners, again, are a class of workers who are likely to be differently entered in the census returns on the one hand, and in the death registers on the other. In consequence of the very commendable efforts which are made to secure accurate returns of the living at each census, it is probable that for the most part miners are classified accurately according to the mineral in which they work, but in the death registers coal miners and iron miners, tin miners and copper miners, are alike in many cases classed simply as “miners,” without further distinction, and thus much uncertainty results as to the exact class of workers to which a particular death should be assigned.

In his Decennial Supplement for the period 1871–80, Dr Ogle dealt with this subject very thoroughly; and inasmuch as his opinion is deserving of great weight, I make no apology for quoting here the following extract from that work. Speaking of the difficulties which occasion flaws in the calculations of occupational mortality, he says:—“There are many trades and occupations which require a considerable standard of muscular strength and vigour to be maintained by those who follow them; such occupations, for instance, as those of a blacksmith, of a miner, and the like; and so soon as from any cause the health and strength of a man fall below this standard, he must of necessity give up the occupation, and either take to some lighter form of labour, or, if his health be too much impaired for this, retire altogether from work. And even in those industries where no excessive amount of muscular strength is required, there must nevertheless be always a certain time beyond which continuance in the business becomes an impossibility. The weaker individuals, and those whose health is failing them, are thus being drafted out of each industrial occupation, and especially out of those which require much vigour; and the consequence is that the death-rates in these latter occupations are unfairly lowered, as compared with the death-rate in occupations of an easier character, and still more, as compared with the death-rates among those persons who are returned as having no occupation at all. A very considerable proportion of those who are forced to give up harder labour take to odd jobs of a more or less indefinite character, and are returned both in the census schedule and eventually in the death registers as general labourers, as messengers, or as costermongers, street sellers, etc.; and thus it comes about that the death-rates of[126] general labourers, of messengers, and of street sellers ... appear to be of appalling magnitude, as also do those of persons returned as of no occupation. Under these headings, however, are comprised the broken-down and the crippled, who have fallen out of the ranks from all the various industries, as well as those who have been throughout life debarred, by natural infirmities or other causes, from following any definite occupation. Another very serious flaw in these death-rates, when taken as measures of the relative healthiness of different industries, is due to the fact that these several industries do not start on equal terms as regards the vitality of those who follow them. A weakling will hardly adopt the trade of a blacksmith, a miner, or a railway navvy, but will preferentially take to some lighter occupation, such as that of a tailor, a weaver, or a shopman. This defect in the death-rate gives an unfair advantage to such industries as demand much strength or activity in those that follow them. Such industries are in fact carried on by a body of comparatively picked men; stronger in the beginning, and maintained at a high level by the continual drafting out of those whose strength falls below the mark.”

In comparing the mortality of occupations at different and perhaps remote periods of time, it is important to ascertain whether any epidemic or pandemic diseases have been seriously prevalent among the general population during either of the periods compared; for in that case considerable allowance will have to be made for this fact, if anything like accuracy of result is aimed at. Thus, for example, in any comparison that may be instituted between the mortality of 1891 and that of 1881, it is necessary to take into account the far-reaching effects of the influenza epidemic which exceptionally and with great severity prevailed throughout the more recent period. It is unquestionable that the fatality of diseases not only of the respiratory but of the nervous and circulatory systems also was seriously increased by this complication, and that the value of any comparison between the mortality statistics of the two periods has been considerably diminished as a consequence.

The foregoing are a few of the more important defects which are unavoidably present in the data from which comparative statistics of occupational mortality are prepared. They are serious and far-reaching. In using such statistics as a means of distinguishing between different industries with respect to their healthfulness, it is necessary to recognise the existence[127] of these defects, and to make suitable allowances for them. Nevertheless when this has been done, it is beyond question that the rates of mortality furnish reliable measures of the healthfulness of different occupations, especially of those in which the number of workers is sufficient to furnish trustworthy rates, and the period of investigation is adequate for the purpose.

Dr Farr has indicated the period of life between the twenty-fifth and the sixty-fifth year as that in which “the influence of profession is most felt.” Dr Ogle, in his Decennial Supplement to the 45th Report, adopted the same view, supporting it by the argument, that in the earlier periods the effect of occupation is not as yet fully developed: and that the last age period (sixty-five and upwards) is that which is more especially affected by the retirement from the industry of such men as have become too weakly to follow it. My own inquiries having tended to confirm these opinions, I have retained in my recent work the same interval, namely, that of the forty years between the twenty-sixth and sixty-sixth birthdays, as marking the period of life during which the effects of occupation are most conspicuous. In the majority of industries this is generally held to be the term of years which most accurately corresponds with the period of man’s greatest capacity for effective labour. There are, however, several occupations in which this is not so. Instances may readily be adduced of occupations in which the actual task of bread-winning both begins and ends at an earlier age than it does in most other industries; so that it would be impossible to specify any limit of age which should apply equally well to all occupations in this respect. Inasmuch, however, as it is necessary for our present purpose to select some one interval for general adoption, the age twenty-five to sixty-five is that which has been adopted as the “main working period of life” in the following pages.

The mortality of any given occupation is influenced very decidedly by “the age and sex distribution” of the workers. The examples following will show how great is this influence: the figures indicate the rates of mortality in each thousand males living in groups of ages: (1) among men in general, (2) among farmers as a class (see table on next page).

From this table it will be seen that the mortality of farmers is below that of males in general at every age-group, and that from the first stage of life to the last it averages from 50 to 60 per cent. of the mortality of males generally. If, however, the total deaths of farmers above fifteen years be calculated on the total[128] number of farmers living above fifteen years, and without further distinction of age, the mortality of farmers would be represented

by a rate of 19.58 per 1000, or 0.84 per 1000 above that of males in the aggregate. It therefore appears that although farmers do not die so fast as other men at each of the age-groups here specified, nevertheless farmers in the aggregate, i.e., without distinction of age, die faster than other men. This apparent contradiction will, however, be explained when the differences in age constitution are taken into account between farmers on the one hand and males in the aggregate on the other. Reference to the census report will show that there are nearly three-fourths as many farmers above sixty-five years old, when the mortality is 88 per 1000, as there are at ages between twenty-five and fifty-five, when it is only 4½ per 1000: whilst among the male population generally the number living at ages above sixty-five years, when the mortality exceeds 103 per 1000, is less than one-third of the number between twenty-five and thirty-five, when it does not exceed 8 per 1000. From the foregoing example, then, which is by no means a solitary one, it is clear that crude rates of mortality, i.e., rates computed without reference to age differences of population, are untrustworthy as a means of comparing one occupation with another on the score either of health or of longevity.

In dealing with the occupational mortality of 1880–2, Dr Ogle adopted the plan of “deaths in standard population,” which fairly represents the mortality of a given occupation as compared with the general mortality. The same plan has been followed (mutatis mutandis) in the present work. It may be thus explained. The standard population here used is the number of men between the ages of twenty-five and sixty-five years in the population of England and Wales, amongst whom 1000 deaths would occur in a single year; the population in 1891 and the deaths in 1890–2 being taken as the basis. The[129] comparative mortality figure, therefore, is the number of deaths that would occur in a year, according to the death-rates ascertained for a given occupation among 61,215 men of standard age constitution: it represents very fairly the mortality in the given occupation as compared with that among males generally.

Out of 61,215 men aged from twenty-five to sixty-five at the census of 1891 there were enumerated:—

In order to ascertain the number of deaths that would occur among 61,215 men engaged in a particular industry, all that is necessary is to apply to these four totals the corresponding rates of mortality occurring in that industry: the resulting sum of deaths will be the comparative mortality figure for that industry; and if the calculated deaths in each of the four age-groups be distributed proportionally according to the causes of death in such age-group, the parts of the comparative mortality figure that are due to the several causes will be obtained. By means of the tables which follow in the letterpress, and which have been prepared according to this principle, the mortality of men engaged in the stated occupations may be studied. I now proceed to illustrate, by means of a particular example, the manner in which dissimilar rates may be used for the purpose of comparing the mortality of men engaged in different occupations. In my larger work it was shown that in the three years 1890–2 there occurred among gardeners and nurserymen, between the ages before mentioned, 3462 deaths out of 339,225 years of life. If the age constitution among gardeners had been the same as that among the general English male population, the mortality of 61,215 males taken (1) from among the general male population, and (2) from among gardeners, would stand as follows:—

[130]

The true ratio of mortality among gardeners to that among the general male population is thus seen to be 553 to 1000, and this may be expressed by designating 553 the “comparative mortality figure” for gardeners.

Unhealthy Trades.—A simple and rational classification was that of the late Dr Guy, the accomplished physician of King’s College Hospital, by which occupations were divided into (1) indoor, and (2) outdoor. It is matter of common knowledge, at least among medical men, that outdoor occupations are, for the most part, more healthful than indoor; which is tantamount to the statement that a life of labour in the open air, in spite of the danger of exposure to inclement weather, is more conducive to health and longevity than is indoor labour, with its ordinary (though by no means necessary) concomitants of foul air, sedentary habits, and want of exercise.

Having ventured to estimate, with the sole assistance of mortality statistics, the amount of damage to health, as well as of waste of life, which is encountered by workmen of different grades, as a result of their employment, it is of course necessary, in limine, to determine the maladies whose inordinate fatality is to be regarded as evidence that mischief has resulted from any particular trade process. The organs which are affected, not only earliest, but also most seriously, by dusty air and by air which is organically impure, are the lungs: and we naturally look to these organs as being those which will probably exhibit the chief indications of injury. Here, however, we are met by an initial difficulty. Unfortunately, the returns of death, as registered, do not in all cases furnish the means of discriminating between the various kinds of ailment. For example, medical experience shows that under circumstances frequently existing, especially amongst the poor, it is difficult to distinguish accurately between one form of lung disease and another, and there is reason to believe that a considerable number of deaths actually caused by simple inflammatory diseases of the lungs and air passages are erroneously returned in the registers, and consequently in the classified tables, as due to tubercular phthisis. In remote parts of the country, where the populations are for the most part ill-provided with medical attendance, it is the fashion to attribute to what is locally termed “consumption” or “decline,” all cases of illness that are accompanied by cough, expectoration, or shortness of breath. It must, however, be remembered that deaths are not in all cases certified as to[131] cause by medical men: many of them are attested by coroners, and a certain proportion are registered without certificate of any kind. This is exceptionally the case in certain parts of Wales, where the mortality ascribed to phthisis is very high, and where the proportion of persons who die without medical attendance is likewise excessive.

Having regard to the tendency which not infrequently exists to confuse tubercular with non-tubercular affections of the lungs, it is probable that the most reliable evidence derivable from the registers as to the evil effects, on the one hand of irritating atmospheric dust, and on the other of organically contaminated air, will be attained by the adoption of the late Dr Headlam Greenhow’s plan, which was to include the deaths from phthisis under the same heading with those of the respiratory system. This plan has accordingly been adopted here, and in the following tables the order of occupations has been determined by their combined mortality from these diseases. The mortality figures, however, from phthisis as well as those from other lung diseases are separately shown in the tables.

In my larger work on occupational mortality the varying incidence of phthisis and of respiratory diseases among certain classes of workers, in different localities, was treated of in considerable detail. I must here revert somewhat briefly to this subject, in order to explain what follows at a later stage. In the work referred to I showed that among occupied males as a class between the ages of twenty-five and sixty-five the mortality figure from respiratory diseases exceeds that from phthisis by about one-fifth part: among unoccupied males, on the contrary, the mortality from phthisis greatly exceeds that from respiratory diseases. The main causes of this difference are probably: (1) that occupied males who are attacked by phthisis are especially prone to drift into the unoccupied class; and (2) that certain portions of the unoccupied class—the insane, for example—suffer a very high mortality from phthisis. The normally prevailing excess of mortality from respiratory diseases over that from phthisis does not obtain among occupied males in all parts of the country. In the industrial districts that excess is very clearly marked, but London and the agricultural districts are exceptions to the rule, their mortality from phthisis being greater than that from respiratory diseases. In London the mortality from respiratory diseases is high, but that attributed to phthisis is higher still; in the agricultural districts, on the other hand, the mortality ascribed[132] to phthisis is low, but that ascribed to respiratory diseases is still lower. Turning to the separate groups of occupations, it appears that about one-third part of these groups, containing about the same proportion of the occupied male population at ages above fifteen years, differ from occupied males generally, in this respect, that they encounter higher mortality from phthisis than they do from respiratory diseases. This third part of the occupational groups may be arranged in two sections: the first section comprising those occupations which deviate from the general rule because of a special tendency among the workers to succumb to phthisis; the second section comprising those occupations which deviate from the rule for the reason that the workers enjoy unusual immunity from death by respiratory diseases.

The above remarks must be understood to apply only to such occupations as depart from the rule, which is that the mortality from respiratory diseases exceeds that from phthisis. Among the occupations which conform to this rule, there are some in which either impure or dust-laden air is one of the conditions of[133] working; and there are others in which either alcoholic excess or exposure to weather is accompanied by enormous mortality from respiratory diseases. On the other hand, there are also included some occupations in which the workers experience low mortality from respiratory diseases, and still lower mortality from phthisis.

With respect to the standard by which the healthfulness of the several industries is to be determined, only a few words are necessary. The standard should be a high, but for obvious reasons it should be an attainable one, and the men composing it should be of a class not widely different from that of those with whom they are placed in comparison. The men engaged in agricultural pursuits form a group numbering more than a million, and consisting of farmers, graziers, gardeners, and farm labourers. They are for the most part a hard-working and healthy body of men, who spend the greater part of their time in the open air of the country: they may therefore be considered typical of that section of the population which suffers injury in the least degree from the inhalation either of dust-laden air or of air contaminated by organic effluvia. For these reasons agriculturists have been chosen as the class with which the occupations now to be specified shall be compared, so as to render appreciable the serious waste of life which is still experienced by the workers in certain selected occupations.

That the constant inhalation of dust as a necessary condition of daily labour results sooner or later in the appearance of grave and characteristic lesions which lead to premature breakdown and death among the workers, is matter of common medical experience. Through the instrumentality of the Factory Department the conditions of labour in these industries have recently been greatly improved: this has been achieved by the general introduction of ventilating fans and of other expedients for preventing the inhalation of irritating particles by the operatives. Nevertheless the returns of mortality still show that several of these occupations produce a terrible amount of suffering and disablement, whilst they unquestionably shorten the lives of those who follow them.

In the subjoined table will be found a list of those industries in which the labourers suffer exceptionally from the presence of dusty particles or other irritating matters in the air of the apartments in which their work is carried on. In this table the mortality of the several dust-producing occupations is contrasted with that of agriculturists, who have been shown to suffer from the effects of dust to a less degree than any other workers. It is not asserted or believed that the whole of the difference between the respiratory mortality of certain unhealthy trades and that of this more favoured class is to be accounted for by dust irritation alone. There are almost certainly present other contributory factors also, the effects of which it would be difficult to show separately: nevertheless, there is no doubt that an atmosphere constantly charged with mechanical impurities of this kind is the main cause of the excessive mortality indicated in the table.

The aggregate death-rate from tubercular phthisis and diseases of the respiratory system is shown in this table, as also are the figures relating to each affection separately. Columns 3 and 4 give the combined mortality from these diseases among the[135] several classes of workers in comparison with that of agriculturists. In the fourth column the mortality of the latter is taken as 100 and that of the other workers is shown proportionally to that figure.

Comparative Mortality from Specified Causes in certain Dusty Occupations.

It thus appears that there are 22 industries in each of which the mortality from tubercular phthisis and respiratory diseases together is more than double that of agriculturists; and further, that these 22 occupations include 8 (giving employment to more than 100,000 men) in which the total mortality from these diseases ranges from three times to as much as four and a half times that of the agricultural class.

Potter, Earthenware, China Manufacture.—“The earthenware manufacture is one of the unhealthiest trades in the country. At the age of joining it is low: but the mortality after the age of[136] thirty-five approaches double the average: it is excessively high; it exceeds the mortality of publicans. What can be done to save the men dying so fast in the potteries and engaged in one of our most useful manufactures?” Thus wrote Dr Farr in 1871, with regard to the pottery manufacture of that day. And Dr Ogle, writing ten years later, confirmed this statement, adding that the mortality of these workers at all ages from twenty-five to sixty-five had increased since 1871. He further stated that at that time (namely, in 1881) their comparative mortality figure was no less than 1742, which was only exceeded by the figures for costermongers, Cornish miners, and inn and hotel servants. In the three-year period 1890–92 things had only slightly improved: the mortality in this occupation from all causes remaining almost unchanged; and although phthisis claimed fewer victims than in 1881, lead poisoning had become more than twice as fatal since the previous record, and diseases of the circulatory and urinary systems had seriously increased in fatality. The excessive mortality of these workers is mainly due to phthisis and diseases of the lungs and heart. Of their entire mortality figure (1706) from all causes, not less than 1001 is contributed by phthisis and other diseases of the lungs. The mortality of potters from bronchitis is more than four times as high, and that from other respiratory diseases is three times as high as the mortality of occupied males in the aggregate.

Potters succumb to non-tubercular disease of the lungs much more rapidly than they do to tubercular phthisis; and it is certain that much of the so-called potters’ phthisis ought properly to be termed cirrhosis of the lung. Deaths from this affection should never be included under the head of phthisis, which term is now restricted, by universal consent, to the tubercular malady of that name.

The mortality figure of potters from lead poisoning is 17, and comes next to that of plumbers, as fourth highest in the list of industries liable to plumbism. The mortality figures, due to diseases of the nervous and urinary systems, in these two occupations, exceed the standard for occupied males by 54 and 50 per cent. respectively.

The term “potter” is a very comprehensive one, and is ordinarily understood to mean any workman employed in a pottery. But Dr Arlidge, the author of the best essay of modern times on the ailments of this class of workers, has shown how widely the operations in pottery manufacture differ from one another in[137] their effect upon health. Speaking of the manufacture of earthenware generally he says: “This manufacture stands foremost among those wherein the employment is distinctly chargeable with the production of disease; and the principal materials to which its unenviable character is due are the clays and the flint used in it. However, these minerals are not the only agents that render the fictile trade one so highly injurious to health, for lead also is largely used for glazing and colour-making, and is a frequent cause of plumbism among the artisans. Again, it is a manufacture having many departments, between several of which no common characters can be said to exist. This holds good of the two principal departments, viz., (1) the making of the articles from potter’s clay; and (2) their ornamentation by painting and gilding. They are often spoken of as the “clay” and the “finishing” departments. It is with the former that we are in the first instance concerned, because in it the production of dust ... is pre-eminently the cause of disease.”[43]

Cutlers, Scissors-makers.—The mortality among cutlers is enormous; at all ages it is very high, but at ages beyond thirty-five years it exceeds the standard among occupied males generally by from 64 to 72 per cent. The comparative mortality figure for cutlers at ages from twenty-five to sixty-five years is 1516, which is higher than the average of other occupations by 59 per cent. Cutlers, although in this respect they have an advantage over potters, are nevertheless among the occupations which suffer excessively from “pulmonary” disease. Their mortality figure for phthisis is 382, and for respiratory diseases is 518, against 106 and 115 respectively, the figures for agriculturists. Taking these diseases together, cutlers sustain a mortality in excess of that of other occupations by 122 per cent. It has been shown by Dr Headlam Greenhow and others that the great mortality among cutlers and grinders arises from the irritation caused by the mechanical particles produced during the process of manufacture, and received into the lungs with the air of respiration.

Cutlers suffer slightly from lead poisoning; their mortality from this cause being represented by 3. The occurrence of lead poisoning among cutlers is a novel feature in the mortality returns for 1890–92, Dr Ogle having found no deaths from that cause in the sample of these workers examined by him in preparing his supplement for 1881. In the mortality figures for diseases of the urinary system there is, among cutlers, an excess of 37 per cent.[138] as compared with the standard among occupied males. From diseases of the nervous system the excess of mortality among these workers is 11 per cent. Taking together the mortality ascribed to alcoholism and to liver disease as a rough measure of the mischief caused by intemperance, there is a slight excess among these workers as compared with the standard.

Since the previous record the mortality among cutlers has increased; and this not only at the higher ages, as appears to have been the rule in most other occupations, but also among men under forty-five years of age. Their mortality attributed directly to alcoholism, which had been much below the average in 1881, has risen above the average in 1891, but there has been no corresponding increase under the head of liver diseases. Since the former period the mortality of cutlers from heart disease has increased by 58 per cent., from lung diseases other than phthisis by 38 per cent., and from tubercular phthisis by 9 per cent.

File-cutters.—Judged by their general death-rate, file-cutters are the least healthy men included in our list of occupations, with the exception of publicans (in certain districts) and of dock labourers—their comparative figure being 1810, or three times as high as that of agriculturists. As compared with the standard mortality of occupied males, that of file-cutters is in excess by not less than 90 per cent. At each of the age-groups of the working period of life the mortality among file-cutters is appalling, and this is especially the case at ages above thirty-five years, when the death-rate exceeds the average by from 93 to 110 per cent.

As with cutlers, so with file-cutters—their great mortality appears to depend on the irritation caused by particles of stone or of metal which find their way into the air passages with the respired air. Dr Headlam Greenhow, writing so long ago as 1858, stated that file-cutters owe their enormous mortality from lead poisoning to the circumstance that the files are cut on blocks of lead: their mortality figure for plumbism, in 1890–2, was no less than 75!

Diseases of the urinary system cause a mortality among file-cutters which is above the average by 154 per cent., and diseases of the nervous system a mortality in excess by 159 per cent.

Intemperance does not seem to be especially rife among file-cutters, but they are addicted to suicide in about double the normal proportion.

The comparative mortality figure of file-cutters has increased considerably since 1871: the increase being relatively greatest[139] since 1881. At the age-group 45–65 the increase in the death-rate has been steady throughout the entire period of twenty years, but at ages under forty-five, although between 1871 and 1881 there had been a fall in the death-rate, this has been followed since the latter year by a rise of considerably greater amount.

The mortality from tubercular phthisis, which had been 407 in 1881, has still further increased to 414 in 1891. According to recent experience, file-cutters die from diseases of the circulatory and respiratory systems even more rapidly than they did in 1881.

Glassmakers.—The making, blowing, and engraving of glass occupies a prominent place among unhealthy trades, for several reasons. In the first place, the workers are exposed to extreme variations of temperature—in some processes, that of glassblowing especially, the operatives are constantly exposed to the intense heat of the furnace, as well as to that which radiates from the pots of molten glass which they are engaged in blowing. The intense heat and profuse sweating naturally induce painful thirst, which the workmen evidently allay by excessive drinking: this is shown by the fact that their mortality from alcoholism and from nervous disorders is nearly double that experienced by operatives in other trades. In the next place, glass-makers are subject to plumbism, their mortality figure attributed to this cause being no less than 12, or sixth highest in the list of industries subject to this complaint. According to Dr Arlidge, who has contributed much valuable information on this subject, it is in the cutting and engraving of glass that the operatives are exposed to contact with lead. In these processes “putty powder,” which is a compound of lead and tin, is constantly used, and as the men are careless as to ventilation and cleanliness, often taking their food with unwashed hands, it is easy to understand how lead finds its way into the system.

The comparative mortality figure for glass-makers is 1487, and is, therefore, in excess of the average by 56 per cent. Phthisis and diseases of the respiratory system are especially fatal to workmen in this industry, and they suffer more severely than other occupied males from diseases of the circulatory, digestive, and urinary systems, as well as from cancer. Since 1881 the mortality of glass-workers has increased considerably, and this is true of the younger as well as the older workers in this industry.

Copper-workers.—As the number of operatives engaged in the[140] working of copper is small (scarcely exceeding 8000), only general remarks can be made concerning their health.

At all ages the mortality of copper-workers exceeds that of other occupations; their comparative mortality figure is 1381; it is therefore considerably above that of metal-workers generally, and is also above the standard for occupied males in the aggregate by 45 per cent. That copper-smelting is an injurious occupation is proved by the pallid, sickly appearance of the workers. It has been noticed by Dr Arlidge, as a result of personal experience, that the hair of copper-smelters (especially where this was originally fair or white) becomes much discoloured; but this discoloration is caused, not by absorption of the metal, but simply by adhesion of copper particles to the hair. Nevertheless, he thinks that cupreous salts do eventually find their way into the circulation, and when this is the case the characteristic symptoms of colic, vomiting, and purging with extreme prostration are produced. A greenish or purplish red line is also noticed in the gums, in the same position as that which is occupied by the blue line in cases of lead poisoning. The operations of filing, turning, and polishing of copper are especially injurious to the workmen, and like other dust-inhaling processes, lead to fatal results by interference with the respiratory functions—lung diseases being much more common among these operatives than the average, whilst their mortality from pulmonary phthisis is in excess by 59 per cent. Copper-workers die much more rapidly than other operatives from diseases of the circulatory, digestive, and urinary systems, their mortality from all these forms of disease being greatly in excess of the average among workers in metals generally.

Iron and Steel Workers.—At the census of 1891, more than 200,000 workers in iron and steel, above the age of fifteen years, were enumerated, but the number had decreased since the preceding census by 2 per cent. The labour of iron and steel working is heavy and exhausting. The operatives, whether at the blast furnaces or at the rolling mills, whether puddlers or moulders, are exposed to intense heat, as well as to great vicissitudes of weather, for most of their work is done in the open air, or at any rate in outdoor sheds unprotected from cold and draughts. The men are for the most part sturdy and of powerful build: the arduous nature of their occupation making it impossible for any but the most vigorous to follow it. In spite of these natural advantages, however, statistics show that iron and steel workers are by no means so healthy and long-lived as they ought to be.

[141]

The death-rates of these operatives are higher than the corresponding rates among occupied males generally, and also higher than the rates of other metal workers, at all stages of life up to sixty-five years. They have a comparative mortality figure of 1301, which is higher than that of occupied males, as a standard, by 37 per cent. Iron-workers suffer more severely than do other occupied males from influenza and from diseases of the nervous, circulatory, respiratory, digestive, and urinary systems; their mortality figure from diseases of the lungs being more than double the standard figure, and that from phthisis also greatly exceeding the average.

Since 1881 there has been a considerable increase in the mortality of iron and steel workers: the increase has affected both divisions of the working period of life, but has been far the greatest among men over the age of forty-five years.

Zinc-workers.—The number of men engaged in this industry is small, although it has increased by 50 per cent. within the last decennium. Nevertheless, the vital statistics of zinc-workers are important, as showing excessive mortality from all the diseases enumerated in the table on page 135. The evidence is conflicting as to the evolution of noxious matter during the process of extracting zinc from the ore; but the workmen are exposed to great heat, and to the inhalation of irritating particles, in consequence of which they are said to suffer exceptionally from digestive and respiratory troubles. Zinc is coming more and more into use in the process of galvanising sheet-iron, so as to protect it from rust; and in this operation the workmen are exposed to the fumes of sal-ammoniac and to other substances which are said to produce a form of nervous derangement that is apparently peculiar to this process.

Zinc-workers are subject to a mortality considerably above the average. Their comparative mortality figure is 1198, and at ages beyond middle life they die more rapidly than occupied males generally. Their mortality from respiratory diseases and pulmonary consumption together is more than double the standard figure, and they die faster than the average from diseases of the circulatory system.

Lead-workers.—The occupation of lead-working is pursued by but very few in this country; only about 2000 men above the age of fifteen years having been thus returned at the census of 1891, and even this number is rapidly decreasing. But the injurious effects of lead-working are by no means limited to the[142] operatives designated lead-workers in the census returns. In the list of one hundred occupations prepared for my larger work on occupational mortality, not fewer than thirteen were selected as showing unmistakable evidence of plumbism. These occupations are as follows (the figures represent the comparative mortality figures from lead poisoning in the several trades)—

The above occupations are arranged in order according to their mortality from lead poisoning, as shown in the tables. A little consideration, however, will show that these figures represent but very imperfectly the relative damage sustained by the several operatives as a result of their occupations. If, for the sake of example, we compare the mortality figure of lead-workers with that of potters, it would appear, by the table, that the former workers die from plumbism more than twelve times as rapidly as do the latter. But, on closer examination, we find that whilst the whole body of lead-workers are constantly in contact with lead as a necessary condition of labour, not more than a twelfth part of the potters are so circumstanced. It is the dippers and the glost-placers among potters who are the chief, if not the only, serious sufferers from lead poisoning; but as these workers are not distinguished in the census returns from other potters, their deaths are distributed over the whole class of potters, and thus a false impression is conveyed as to the amount of mischief done by absorption of lead, in those branches of the industry where the workers are actually exposed to contact with this metal. Again, when the figures for painters and glaziers are compared with the figure for file-cutters, a great disparity becomes evident; the file-cutters suffering apparently more than four times as severely from plumbism as do the painters and glaziers. But on inquiry, we find that whilst, on the one hand, file-cutters handle lead continuously in the course of their work, on the other hand, painters and glaziers are by no means so constantly exposed to this danger—much of their time being spent on labour which does not involve contact with lead, or inhalation of particles or fumes of that metal. If the death-rates[143] attending those processes in the occupation of potters and of painters which are continuously subject to lead poisoning could be separately ascertained, there is no reason to doubt that they would show results quite as unsatisfactory as those experienced by lead-workers.

Although lead-working is known to be a very unhealthy trade, it is evidently impossible to deduce from the vital statistics of only 2000 workers more than very general conclusions. Speaking generally, however, the mortality returns warrant the statement that, in the main working period of life, these operatives sustain a mortality which is about 90 per cent. above that of other workers, on the average. Their comparative mortality figure from all causes is no less than 1783, and is therefore nearly three times that of agriculturists. Of the total deaths occurring among lead-workers, one-third are from “pulmonary disease,” i.e., from tubercular phthisis and diseases of the respiratory system taken together, and one-eighth are from lead poisoning. As compared with the standard for occupied males, the mortality among lead-workers is excessive from diseases of the urinary, nervous, circulatory, and digestive systems, in addition to the causes above specified.

Stone-Quarriers.—The aggregate of men above the age of fifteen years returned under this heading, at the last census, amounted to nearly 50,000, but the numbers had decreased by about 3 per cent. since the previous enumeration. The comparative mortality figure of quarrymen is 1176, which, as compared with the figure for occupied males, is in excess by 25 per cent. At all stages in the working period of life the death-rate of these labourers exceeds that of other occupations in the aggregate. As stone-quarrying is an outdoor industry, and consequently the workers are not exposed to the unhealthy conditions of sedentary work, the vital statistics of this class should obviously be compared with those of agriculturists, rather than with those of males of all occupations. So compared, we find that stone-quarriers experience a mortality from all causes which is little short of double the standard figure. From respiratory diseases and also from tubercular phthisis, their mortality is at least two and a half times as high as the standard, and from diseases of the circulatory system they die faster than agriculturists by 50 per cent. At ages between twenty-five and forty-five years the mortality of stone-quarriers has fluctuated considerably during the last twenty years; but at ages from forty-five to sixty-five[144] it has steadily increased throughout that period. Since 1881 the increase has been principally under the head of pulmonary and circulatory diseases. During the same interval the mortality of quarriers from phthisis and also from digestive diseases, as well as that from alcoholism and from diseases of the liver, has decreased considerably, and so likewise has their liability to fatal accident.

Brass-workers.—At the 1891 census there were enumerated 33,000 persons over fifteen years of age under the head of brass-workers, braziers, etc., the number having increased since the previous enumeration by little short of one-third.

If death returns alone be relied on, there is little in the mortality of brass-workers that does not apply equally to other allied industries; but from the investigations of Dr Headlam Greenhow in 1858, and more recently those of Dr Simon and Dr Hogben of Birmingham, we learn that brass-workers suffer very seriously from ailments which are not experienced by the workers in copper or in zinc, the chief metals of which brass is an alloy. The disease to which these workers are exceptionally subject is known locally as “brassfounders’ ague,” which, according to Greenhow and some other authorities, is caused by the inhalation of oxide of zinc, whilst others of equal repute attribute it to copper poisoning. That brass-workers are exposed to conditions inimical to health is fully recognised by employers and employed alike, who agree in describing the trade as a most unhealthy one. Dr R. Simon (in a thesis for his degree at Cambridge) says that brass-workers rarely attain old age, and that formerly provident sick societies either altogether refused to enrol them in their lists, or accepted them as members at greatly increased rates. The workers who deal with molten metal—the founders, the mixers, and the casters—are those who are exceptionally liable to “ague.” The “mixers,” who bring together the two metals, suffer most severely. The copper is first molten, and the zinc is then added to it. When the metals come into contact the zinc deflagrates, and some of it, combining with oxygen, flies off in dense white clouds of oxide of zinc. This, of course, is of necessity inhaled by the operatives who, experiencing discomfort from the process, tightness of the chest, and other respiratory troubles, attempt to avoid it by covering the mouth and nostrils with a handkerchief.

Although, as has been previously stated, the deaths registered afford little evidence of the exceptional unhealthiness of brass-workers as compared with the workers in other metals, nevertheless[145] we find that they sustain a mortality from “phthisis” which is in excess of that of “occupied males” by 50 per cent., whilst they die more rapidly than the average from diseases of the nervous, urinary, and respiratory systems. Brass-workers as a class are, like copper-makers, pallid, ill-nourished, and unhealthy-looking: they suffer from anæmia, dyspepsia, constipation, colic, and other digestive troubles. Happily, however, these symptoms do not permanently injure their health, for on changing their occupation, as they commonly do, for a less unhealthy one, the above symptoms rapidly subside, and their usual health is soon restored.

Gunsmiths.—The only remaining metal-workers in the list whose mortality exceeds the average for the class are the gunsmiths. Their comparative mortality figure is 1228, and is exactly 100 in excess of that of metal workers in the aggregate. Gunsmiths die faster than the average of metal-workers at ages from twenty-five to forty-five, but less rapidly both before and after that period of life.

On reference to the extended tables in my larger work, it will be found that gunsmiths die from alcoholism about two and a half times as fast as do other workers in metal. Most of the processes in which gunsmiths engage are of an unhealthy nature, and the workers are exposed to the harmful effects of metallic and flinty dusts which set up in the lungs very similar disorders to those which have been noticed in connection with the Sheffield “grinding” trades. This industry demands expert workmanship and high finish, especially in the later processes, and involves a great deal of filing and polishing of metal, and these operations are frequently carried on in workshops which are ill-ventilated and otherwise unsuited for the purpose. As a consequence, the mortality of gunsmiths from phthisis (much of which is probably fibroid) stands at 324 against 206, the figure for metal-workers generally, and 185, the standard figure for all occupied males. From other diseases of the respiratory system and from diseases of the heart, gunsmiths sustain a mortality which exceeds the standard for occupied males by 47, and by 21 per cent., respectively. During the last twenty years, and especially during the more recent half of that period, the mortality of gunsmiths has increased considerably, and this is true whether we consider their mortality during the earlier or during the later half of the main working period of life.

Chimney Sweeps, Soot Merchants.—Recent statistics agree[146] with those of earlier records in attributing to this industry a very unsatisfactory position in the scale of health. Compared with those of other occupations, the death-rates of chimney sweeps are excessive at all ages below the sixty-fifth year. Their comparative mortality figure amounts to 1311, and is therefore higher than the standard by more than one-third part.

Chimney sweeps are, by the nature of their calling, much exposed to the inhalation of particles of soot and of other irritating matters which seriously affect the respiratory functions. They die more rapidly than the average from pulmonary tuberculosis, and from other diseases of the lungs, as well as from diseases of the heart and urinary organs. Their mortality from suicide is also more than double the average, and their figure for intemperance is more than four and a half times that of occupied males generally. But it is in regard to their extreme liability to malignant disease that chimney sweeps are deserving of special consideration. Their mortality from different forms of cancer amounts to 156 as compared with 44, the figure for occupied males in the aggregate. In the list on p. 135 there is no other occupation in which the ravages of cancer at all approach those to which chimney sweeps are subject. Of the 512 deaths from all causes among chimney sweeps, as many as 61, or about 1 in 8, were from cancer, and 18 of the 61 were returned as from chimney sweeps’ cancer. Of these 61 deaths 3 were ascribed to sarcoma, and the rest to carcinoma or other forms of malignant disease. In the course of the last twenty years the mortality of these workers has decreased considerably. Between 1871 and 1881 their mortality figure, modified for purposes of comparison, had fallen by 11 per cent., the fall in the death-rate having been common to both divisions of the main working period of life, but much greater at ages under than at ages over forty-five years. In the interval between the two last censuses, on the contrary, the fall has been greater at ages above forty-five years. Although chimney sweeps still die from cancer in enormous over-proportion, there has happily been a great abatement in their fatality from this disease since the previous record. In 1880–82 the mortality figure had been 290, whilst in 1890–92 the figure, modified to allow of comparison, was 157, showing a reduction of nearly half within that interval.

Textile workers.—In the accompanying list there still remain several dust-producing occupations in which the mortality from[147] pulmonary diseases is in excess of the average, notwithstanding that the workers are not exposed to the action of metallic irritants. Of these there are four which may be taken to represent the textile trades—viz., the manufacture of cotton, wool, rope, and carpets—in all of which the mortality figure from respiratory diseases is not only vastly in excess of the figure for agriculturists, but is also considerably above that of other occupied males. Among textile workers, cotton operatives (especially those of Lancashire) are the most unhealthy. Their mortality figure from all causes is higher than that of occupied males generally, by from 20 to 23[A] per cent., whilst from diseases of the respiratory system exclusive of phthisis, their mortality is in excess by proportions varying from 53 to 65[44] per cent. The workers in cotton mills suffer severely from the presence, in the air, of “fluff” and “flue” that escapes from the cotton, especially in the preparation of the yarn. The amount of this and the degree of irritation to which it gives rise when inspired, varies with the quality of the material used; inferior and brittle cotton, being more liable to breakage in the course of manufacture, gives off more dust than do the finer kinds, and requires for its successful working a warmer and moister air. The workers in the lower-class cottons therefore suffer more seriously in health, and require more perfect arrangements for ventilation than do those who deal with materials of higher quality. Cotton spinners have to work all the year round in a very warm and humid atmosphere, and accordingly suffer from debility and exhaustion caused by profuse sweating. The temperature and moisture of the sheds are maintained at a high standard both night and day, in order to prevent brittleness in the cotton fibres, and as a consequence the operatives become peculiarly sensitive to chills, brought about, perhaps, by injudicious exposure to draughts. From personal experience in Manchester, for a period of twenty-five years, I can testify that these workers are exceptionally liable to acute rheumatism, and this statement may be confirmed by reference to the mortality tables in my larger work, which show that the mortality of cotton spinners from this disease exceeds the average by not less than 70 per cent. The operation of “sizing,” preparatory to the weaving of cotton, introduces a new element of danger. The size contains, in addition to flour or farina, a very[148] large proportion of china clay, which finds its way into the air passages, and there produces its well-known mischief. It is pleasant to record that cotton operatives do not add to the evils of their occupation by undue recourse to alcohol: their mortality from intemperance being below the average by 23 per cent.

Wool, Worsted Manufacturers.—Wool-workers suffer much less severely from their occupation than do cotton operatives. In the weaving of woollen materials, a lower and drier temperature is required than in the case of cotton-weaving, and the mischief caused by “sizing” with china clay and other irritants has no place in woollen manufacture. Nevertheless, in certain of the processes, especially where inferior foreign wools are manufactured, a good deal of dust is disengaged, and this produces its ill-effect on the lungs of the workers. It is also in connection with dirty or blood-stained foreign wools that the majority of cases of anthrax or wool-sorters’ disease have been observed from time to time, which have been the subject of inquiry in past years by the Medical Department of the Local Government Board.

It is worthy of notice that wool-sorters are even more careless as regards exposure to cold and draughts than are even cotton workers, and their mortality from rheumatic fever is much higher, being double that experienced by agriculturists as a class. Wool-workers have a comparative mortality figure from all causes, which is somewhat above the average for occupied males generally, but is below that of other textile trades. Workers in wool appear to be remarkably free from intemperance, their mortality figure being less than one-fourth of the average. From diseases of the digestive system other than the liver, wool-workers die half as fast again as do occupied males generally, whilst from diseases of the nervous, respiratory, and urinary systems, as well as from cancer, the mortality of these workers is from 10 to 22 per cent. in excess of that standard.

Other Workers in Dusty Trades.—The accompanying list includes a few industries, the workers in which have not yet been alluded to as regards their health: such as the rope-makers, carpet-makers, coopers, bricklayers, bakers, etc. These industries, although not remarkable for the production of other serious forms of illness, have this feature in common, that being essentially dust-producing processes, they one and all induce among the workers excessive suffering from pulmonary affections. Although the mortality of these workers from phthisis and other[149] lung diseases is considerably below that of metal-workers, nevertheless it is in every case inordinately high, exceeding the mortality of agriculturists by proportions varying from 77 to 120 per cent.

EFFECTS OF BREATHING FOUL AIR.

In my larger work on occupational mortality, detailed vital statistics are given respecting those workers whose occupation is not in itself necessarily unhealthy, but who are the victims of unwholesome conditions of labour, either self-inflicted, or else caused by the ignorance or the parsimony of persons in authority. The evils here alluded to are the result partly of the accumulation of respiratory and other impurities in the air breathed, from neglect of suitable methods of ventilation, and partly of the cramped posture adopted in certain cases (notably by tailors and shoemakers) in their sedentary indoor labour. Considerations of space preclude the insertion here of a complete list of these occupations; but in the following table a selection has been made of those industries in which the workers are liable, in the greatest degree, to damage from the inhalation of foul air in the course of their employment. For each of these occupations the figures indicating the mortality from phthisis and from diseases of the respiratory and circulatory systems are separately shown, and in another column the combined mortality of the several occupations from the first two of these forms of disease is compared with that of agriculturists, the latter being taken as 100. The occupations have been arranged in the descending order of their mortality from tubercular phthisis and respiratory diseases together.

Comparative Mortality from several causes in certain unhealthy occupations.

[150]

From this table it will be seen that, roughly speaking, the combined mortality from phthisis and respiratory diseases varies from twice to two and a half times that of agriculturists. It may further be stated (although the figures are not given in the table) that the workers in four of the above-mentioned occupations die from these diseases alone more rapidly than farmers in the agricultural districts die from all causes put together. Contrary to the experience of two-thirds of the occupied male population of England and Wales, tubercular phthisis is more fatal than are diseases of the respiratory organs other than phthisis, to all the workers in the table, except agriculturists.

Bookbinders, Printers.—Writing in 1881 of the sanitary condition of these workers, Dr Ogle speaks of both of them in common as “carrying on their industries under notoriously unhealthy conditions, in ill-ventilated rooms, and in an atmosphere unduly heated by engines, stoves, and flaring gas-lights.” The decline in the death-rates, as compared with the earlier records, he attributes to the improvements effected by the Factory Inspectors since these trades came under their supervision. Further on he writes, with respect to their mortality: “Excepting costermongers ... and those industries in which the workman is exposed to the inhalation of dusts, such as file-makers, potters, and Cornish miners, there is no industry in the table in which the mortality from phthisis approaches to that of printers.” “As for bookbinders,” he writes, “so far as can be judged from the 77 deaths of which the causes are recorded, in this industry also the high mortality is due to phthisis, for of the 77 deaths no less than 30 were caused by this disease.”[45]

In both of these trades the conditions of work have still further improved under the supervision of H.M. Factory Inspectors since the above was written. Taking bookbinders first—The returns show that their death-rates are still considerably above those of agriculturists, and, indeed, above those of other occupied males at most of the ages in the working period of life, their comparative mortality figure being above the firstnamed standard by 76 per cent. Bookbinders still die very rapidly from pulmonary consumption, their mortality figure from that disease being no less than 325, or more than three times as high as that of agriculturists. Their mortality from cancer and from diseases of the respiratory, circulatory, and urinary[151] systems also shows excess. Bookbinders are more addicted to suicide than are agriculturists, in the proportion of 26 to 10. Ever since 1871 the mortality of bookbinders has steadily decreased, and there has been a fall in the death-rates at ages under as well as above the forty-fifth year.

Printers experience a death-rate at the various age-groups which is above the standard at all the age-groups dealt with in the table. Their mortality figure is 1096, as against 953 for all occupied males, and 602 for agriculturists. Like bookbinders, printers die very rapidly from phthisis, and probably for a similar reason—namely, because of the excessively unhealthy conditions under which their work is carried on—their mortality from diseases of the respiratory organs other than phthisis is, however, below the average, but from diseases of the nervous, circulatory, digestive, and urinary systems it is above the average. Printers suffer only about one-third as much from fatal accident as do other workers, but they are somewhat more addicted to suicide. Their mortality figure from lead poisoning is represented by 3. In the course of the last twenty years the mortality of printers from all causes together has decreased considerably. Both the age divisions in the main work time of life have shared in the fall, but in unequal proportions. As compared with that of 1881, the mortality of these workers from alcoholism in 1891 has fully trebled, and that from suicide has more than doubled. The most important decrease occurs in the case of phthisis, the mortality from which has fallen, since 1891, by one-sixth part of the former rate.

Musicians.—The mortality of the class of men who, by a euphemism, are styled “musicians,” is very high. At all ages in the working period of life it greatly exceeds that of agriculturists, and also exceeds that of the working population in the aggregate. Their comparative mortality figure amounts to 1214, or more than double the figure for agriculturists, and is about one-third part in excess of that of occupied males generally. Compared with both these standards, musicians die more rapidly from alcoholism and from diseases of the liver. Their mortality figure from phthisis is enormous, amounting to not less than 322, or fully three times that of agriculturists, and almost double that of male workers in the aggregate.

In addition to the above, musicians sustain very heavy mortality from diseases of the nervous, circulatory, digestive, and urinary systems, and their mortality figure from suicide is 23, as[152] compared with 10 for agriculturists and 14 for other occupied males. From these statistics it is certain that many of those who are included in this class are sadly addicted to intemperance, whilst others suffer from want of the bare necessaries of life. “It must be remembered,” writes Dr Ogle in 1881, with reference to the mortality of this class, “that under this heading are comprised all sorts and conditions of men, and that a large portion of them are organ-grinders, ballad-singers, and street musicians generally, many of whom are of intemperate habits, and exposed by their mode of life to cold and want, while no few have merely taken to the occupation as a refuge, after their health has broken down in more regular occupations.”

Within the last twenty years the mortality of musicians has declined very considerably, both at the earlier and at the later ages. Their comparative mortality figure in 1891 was lower than it had been in 1871 by more than one-fifth part: nevertheless, their vital statistics still continue to be very unsatisfactory, and their nomadic habits are a serious hindrance to improvement.

Hatters.—As compared with agriculturists, the mortality of hatters is enormously greater at all stages of the working period of life, and their comparative mortality figure from all causes is in excess of that standard by 84 per cent. At ages under thirty-five years, hatters experience a death-rate which barely exceeds the average among occupied males, but at each subsequent age-group their mortality is greatly in excess. As far as we know there is little in the employment of hat-makers which of necessity acts prejudicially to their health. Their work, however, like that of too many other trades, is frequently carried on in overcrowded and ill-ventilated apartments, and the men suffer accordingly. Thus we find from the tables that hatters die from tubercular phthisis about three times as rapidly as do agriculturists, and that their mortality from this complaint considerably exceeds the average in other occupations. Hatters appear to be much addicted to intemperance, their mortality figure from alcoholism, and also from liver disease, showing serious excess. Their mortality from suicide stands at 28, as compared with 10 for agriculturists and 14 for other occupied males. Among hatters under the age of forty-five years there has been a decline in mortality within the last twenty years, but at ages from forty-five to sixty-five there has been but little change.

Hairdressers.—The mortality of hairdressers is higher than[153] that of other occupied males at each of the age-groups of the working period; it is, consequently, greatly in excess of that of agriculturists. Their mortality figure from all causes at ages twenty-five to sixty-five is 1099, and, therefore, exceeds that of the standard last mentioned by 82 per cent. The life of a hair-dresser is for the most part a town, or at least a village, life; the work being carried on indoors for long hours together, in an atmosphere heated and polluted by gas. In addition to this, the occupation is a dusty one, and the men are exposed to the effects of particles of hair and other irritants which find their way into the lungs. Their mortality figure from alcoholism, liver diseases, and gout, as well as from pulmonary tuberculosis, shows serious excess; it therefore appears that hairdressers, as was the case in 1881 also, are still excessively addicted to intemperance. They fall victims to suicide almost as rapidly as do even the least fortunate workers included in the list of occupations. Hairdressers experienced almost the same rate of general mortality at the census periods of 1871 and 1881, but since the latter year there has been a fall in their mortality to the extent of about one-seventh part.

Tailors.—The occupation of tailors is a typically sedentary one. The men work for the most part in overcrowded, ill-ventilated, and overheated rooms, and consequently suffer in general physique and appearance, as well as in health. In recent years the introduction of machinery, whilst in some respects an advantage, has produced its counterbalancing ill-effects by rendering it possible for any man or woman who can work a sewing machine to take the place of the regularly skilled tailor, and thus to depreciate the market value of his labour. In consequence of this the tailor and his family are only too frequently reduced to great poverty, if not to a state approaching starvation. The mortality of tailors at the several age-groups does not greatly differ from that of other occupied males. Tailors die more rapidly than agriculturists at ages between twenty-five and sixty-five, but at ages below and above these limits their mortality does not greatly exceed this standard.

Although in past times tailors have been considered an intemperate class, the figures for 1890–92 lend little support to that opinion. Their mortality figure from alcoholism as well as from liver disease scarcely differs from that of occupied males generally, although, of course, it considerably exceeds the low figure of agriculturists.

[154]

The mortality of tailors from tubercular phthisis is greatly in excess of that of other occupied males, and is more than two and a half times as high as the mortality of agriculturists; it is also worth mention that they die more rapidly than other workers from diseases of the nervous system. On the other hand their mortality from influenza and from diseases of the respiratory organs, and of the heart, is in each case below the average. During the last twenty years there has been a notable increase in the mortality of tailors at ages from forty-five to sixty-five years, and an equally notable decrease at ages from twenty-five to forty-five. Although the mortality directly ascribed to alcoholism is now slightly higher than it was in 1881, nevertheless the mortality from diseases of the liver and other digestive organs has undergone a more than equivalent reduction, so that the total mischief caused by intemperance has probably decreased since 1881. The mortality of tailors from gout as well as from phthisis, and from diseases of the nervous system, has fallen since the same year.

Drapers, Manchester Warehousemen.—The large body of men included under this heading appear to enjoy but poor health, when allowance is made for the fact that the greater part of them are under twenty-five years of age. Drapers and Manchester warehousemen, who are here grouped together because of the similarity of their occupation and mode of life, are credited with a mortality which is higher than that of any other occupation save one in the category of shopkeepers. Their comparative mortality figure from all causes is 1014, which, as compared with that of agriculturists, is in excess by 68 per cent. Even when compared with the low standard of “occupied males,” drapers are subject to a mortality which is considerably above the average. Confinement in close, ill-ventilated shops for very long hours together, and an almost exclusively indoor life, is the unlucky fate of these workers. They are exposed to the heat and fumes of gas and cotton “fluff” and dust which escapes from the bales of goods in process of sale, and their health suffers accordingly. Their death-rate from tubercular phthisis exceeds that of other occupations by not less than 41 per cent., and is more than two and a half times as high as that of agriculturists; but the fact previously mentioned, that drapers’ assistants are for the most part youths or young men, may account to some extent for their exceptional liability to this scourge. Drapers die faster than the average from influenza, rheumatic fever, and diabetes, as well as from alcoholism, diseases of the liver and nervous system, and from suicide. During the main working[155] period of life, the mortality of drapers has decreased somewhat since the earliest record. In the first twenty years of this period, i.e., from twenty-five to forty-five years of age, their death-rate has fallen considerably since 1871; whilst at ages from forty-five to sixty-five years, although it had fallen between 1871 and 1881, it has since returned to its former level. Since 1881 the mortality of drapers from all causes has increased by 18 per cent. Between 1881 and 1891 their mortality from phthisis remained stationary, whilst that from other lung disease and heart disease showed a considerable increase. Their mortality from suicide has increased threefold since 1881, and that from alcoholism has increased by nearly two-thirds.

Shoemakers.—Although the contrary is generally held to be the fact, shoemakers are shown by the figures now at our disposal to enjoy a degree of health which is at least equal to that of the average working man.

As the occupation of shoemaking is an indoor one, involving sedentary labour for many hours together, in closely confined and ill-ventilated apartments, the workers suffer inordinately from those ailments which are commonly associated with such environment. Up to the thirty-fifth year of age shoemakers die faster than other occupied males, but more slowly at later ages. Compared with agriculturists the mortality of shoemakers at all ages is in excess by 53 per cent.

Shoemakers die much less rapidly than the average from lung diseases (except phthisis) as well as from accident, and their mortality from intemperance is remarkably low. Cancer and pulmonary consumption, however, play sad havoc among shoemakers, their mortality from the first-mentioned disease being in excess of the average by 14 per cent., and from the last-mentioned, by 38 per cent. Throughout the three decennia, commencing with 1861, the mortality of shoemakers above the age of forty-five years has steadily increased, whilst below that age it has steadily decreased; the balance showing a slight increase in the total mortality figure. Under the head of alcoholism their mortality has increased since the earlier record, although that from liver disease has decreased. Shoemakers die as rapidly as ever from pulmonary consumption, and more rapidly than ever from diseases of the lungs and heart. Their mortality from diseases of the nervous system has, however, shown a decided improvement, and they are at the present time less addicted to suicide than was formerly the case.

[156]

THE MINING INDUSTRY.

At the census of 1891 more than half a million men above the age of fifteen years were returned as miners, their number having increased since the previous census by more than a fourth part. As the proportion is still probably increasing, we may safely calculate that at the present time one in every 17 males between the ages of twenty-five and sixty-five years is a miner. In round numbers it may be stated that of the 524,000 miners in England and Wales, 482,000 work in coal, 18,000 in ironstone, 9000 in tin, 6000 in lead, 2000 in other minerals, and 1000 in copper; whilst the remaining 6000 are classed under the head of “mine service.” With a few noteworthy exceptions, miners are not, as a whole, an unhealthy body of men, but from the nature of their employment they are necessarily more exposed than are other workers to certain forms of violent death. The various groups of miners, however, have, of course, this feature in common, that most of their time, for a great part of their life, is spent underground. Accordingly their work is carried on under conditions of heat, moisture, etc., which are exceptionally artificial, and for this reason it is desirable that their mortality should be studied with especial care. The following table shows the death-rates of miners at several ages, compared with the corresponding rates of occupied males. The figures in each column represent proportions of the standard figure, the latter taken in each case at 100.

The table shows that at ages from fifteen to twenty, and from twenty to twenty-five, as well as at both the age-groups above fifty-five[157] years, miners in the aggregate die more rapidly than do other occupied males, whilst at intervening ages they die less rapidly. Miners, however, are a picked class of men in a more especial sense than are the toilers in most other industries. Their labour is so arduous that those only who possess exceptional physical endurance are able to continue it, and this may account for the fact that when they are barely past the prime of life many of them become enfeebled, and subject to a mortality which is considerably in excess of that incidental to other occupations.

On attempting to trace the causes of mortality in the various groups of miners, and to compare those industries, in this respect, with one another and with other occupations, it readily appears that a large, though very inconstant, proportion of the total mortality is contributed by “accident.” It is accordingly desirable to isolate this factor, so that we may arrive at a fair judgment as to the loss of life by disease alone occurring amongst these workers in their several fields of labour. This has been done in the following table, where the comparative mortality of the various groups of miners is given (a) from all causes except accident, (b) from certain prevalent diseases, (c) from accident or violence, and (d) from disease and accident together.

This table shows that miners, as a class, are a temperate body of men; their mortality directly attributed to alcoholism being less than one-third, and that from liver disease being only two-thirds,[158] of that of occupied males generally. In this respect they scarcely differ from farm labourers; their mortality from alcoholism is the same, and that from liver disease is only slightly higher.

Miners, as a class, suffer less than other occupied males from phthisis, as well as from cancer and diabetes, their mortality from the first-mentioned disease being below the average by 41 per cent., from the second by 16 per cent., and from the last by 29 per cent. Among miners, diseases of the nervous, circulatory, and urinary systems are less fatal than the average, but, with few exceptions, respiratory diseases are more fatal.

Coal Miners.—As a class, colliers compare favourably with men in most other occupations on the score of health. During the first thirty years of the main working period of life their mortality is substantially lower than is the mortality in other industries, although at ages under twenty and over fifty-five they die faster than the average.

The excessive mortality of colliers under twenty years of age may be accounted for by the fact that from 40 to 50 per cent. of the total deaths are due to violence, caused by the waggons and “tubs” in which coals are conveyed from the underground workings to the shafts. This form of accident falls mainly to the lot of the younger and less experienced colliers who are employed in “tramming” and “hurrying” the coals. When their mortality from accident is deducted, the residual death-rate of colliers under twenty years of age does not greatly differ from the average.

The comparative mortality figure of colliers, without distinction of age, from all causes including accidents, averages 925; but whilst on the one hand it does not exceed 727 among the colliers of Derbyshire and Nottingham, and 774 among those of Durham and Northumberland, on the other hand it ranges upwards to 1069 among colliers in Lancashire and 1145 in Monmouthshire and South Wales.

It is not easy to explain why it is that colliers in the several coalfields, working as they do in the same material, and spending an equal portion of the day underground, should differ so widely from one another in their mortality. For example, on reference to the accompanying table we see, with regard to miners under twenty years of age, that whilst on the one hand, among colliers in the counties of Derby and Nottingham, and also in Stafford, the mortality is lower than among “occupied males” by 7 and 5 per cent. respectively; on the other hand, among colliers in Durham[159] and Northumberland, the mortality exceeds that standard by 54 per cent., in Lancashire by 63 per cent., and in Monmouthshire and South Wales by not less than 127 per cent. Again, in the counties of Derby and Nottingham colliers between their fifty-fifth and sixty-fifth years die less rapidly than the average by 4 per cent., but colliers of the same age in Staffordshire die more rapidly than the average by 35 per cent., and in Lancashire and Monmouthshire more rapidly by 40 per cent.

Various theories have been advanced to account for the great disparity just alluded to in the local death-rates among colliers. In the first place, we know that coal-pits differ greatly in geological character, in depth, in the grittiness or dustiness of the rock which has to be worked in order to get at the coal, in the amount and composition of gas present, in the quantity of water permeating the strata, in the thickness of the coal seams, in the temperature of the workings; and last, but most important, in the perfection or otherwise of the ventilation of the coal-pit. Again, it is known that the habits and consequently the health and comfort of coal miners vary extremely according as the colliery is situate in a country district, or, as is frequently the case especially in the Lancashire coalfields, in what is practically an urban district, perhaps bordering on a large town. These variations in the circumstances of life are certainly sufficient to account for wide differences in the health and longevity of coal miners.

Aged colliers, wherever they are employed, sustain a mortality which is considerably in excess of the standard; yet even among them the mortality varies greatly with locality. For whereas in the counties of Derby and Nottingham the mortality of colliers aged sixty-five years and upwards exceeds that of occupied males by 18 per cent., the excess amounts to 50 per cent. in Lancashire, 52 per cent. in Durham and Northumberland, and 80 per cent. in Staffordshire.

In the list of principal causes of death amongst colliers there are two diseases which have been the subject of exceptional comment, both in this country and abroad—namely, pulmonary phthisis on the one hand, and ordinary inflammatory diseases of the lung on the other. Almost all writers on the subject, whether in recent or in earlier years, agree in attributing to colliers an unusually low mortality from tubercular, and a correspondingly high mortality from non-tubercular, disease of the lungs. The accompanying table, which gives statistics for the years 1890–92, confirms the general opinion. Thus, taking coal miners in the aggregate[160] we find that their mortality ascribed to phthisis is only about half of that to which other occupied males are subject, whilst their mortality from respiratory diseases exceeds the same standard by 21 per cent. If we take farm labourers as a standard by which the mortality of colliers should be judged, we find that whilst colliers suffer from fatal phthisis in the proportion of 97 as against 115 for farm labourers, colliers die rather more than twice as rapidly from diseases of the respiratory system other than phthisis. Although, as has already been stated, colliers as a class enjoy special immunity from pulmonary phthisis, nevertheless the disease prevails amongst them very unequally. The highest mortality figures from phthisis among colliers are 123 in the West Riding of Yorkshire and 107 in Monmouthshire, whilst the figures do not exceed 83 in Staffordshire and 69 in Derbyshire. In no English county does the mortality of colliers from phthisis even approach 185, which is the figure for occupied males in the aggregate.

In the West Riding of Yorkshire the mortality of colliers from phthisis has increased since 1881 by one-fifth part; but in other counties it has decreased by proportions in some cases as high as one-third of its former amount. Non-tubercular diseases of the lungs are excessively fatal to the colliers of Monmouthshire and South Wales, and still more so to those of Lancashire, where the mortality from these diseases is 76 per cent. above that of occupied males generally, and is more than double of what it is among the colliers of Northumberland, Durham, Derby, and Nottingham. These diseases have very considerably increased in fatality since 1881 in all the coalfields of England: the increase being equal to two-thirds of the former amount among the colliers of Lancashire, and to more than one-half among those of the West Riding of Yorkshire. Colliers nowhere appear to readily fall victims to intemperance. In Derby and Nottingham, as well as in Staffordshire, the colliers are especially free from that vice, their mortality from alcoholism being only half the low figure for colliers generally. Even in Monmouthshire and South Wales, where the figure for alcoholism is the highest, only 7 of the colliers die of this disease for every 13 that die from it in other occupations. Since 1881 the mortality due to intemperance has slightly increased among the coal miners of Lancashire, but has decreased in all other counties respecting which comparison is possible.

Ironstone mining.—This is one of the industries that are declining in this country. Miners of ironstone numbered barely[161] 18,000 at the last census, and were fewer by nearly one-third part than at the census of 1881. More than half of these workers are to be found in the counties of Cumberland and York, and about an eighth part more are scattered over the counties of Stafford and Northampton. Speaking generally, iron-workers are a healthy body of men. They experience rates of mortality which are lower than those of “occupied males” at all periods of life between twenty years and sixty-five, and also lower than the rates for coal miners at the same ages. Both ironstone miners and colliers, however, suffer a much higher mortality than other workers at ages under twenty and over fifty-five years; the reason for this has not as yet been satisfactorily explained. It has been shown by Dr Ogle and other writers that the vital statistics of ironstone miners bear a general resemblance to those of coal miners. Recent investigations confirm this statement thus far, that in both cases the mortality from tubercular phthisis and from all other diseases except those of the respiratory system are below the average, and even this reservation does not apply to the statistics of 1890–2. Their comparative mortality figure from all causes is 774, and therefore considerably below that of coal miners in the aggregate. From disease alone (excluding accident) their mortality is slightly higher than that of colliers in Northumberland and Durham, but they suffer somewhat less severely from accident. Ironstone miners are a temperate body of men, their mortality figure from alcoholism being practically the same as that of colliers.

The extended tables of causes of death in my larger work show that ironstone miners suffer more severely than the average from influenza and from accident, but that under all other headings their mortality is below that of other occupations.

As compared with miners generally, the only diseases which show an excess among these workers are influenza, cancer, diseases of the liver, and suicide. Since 1881, the mortality of ironstone miners has decreased; but, as in the case of many other occupations, the improvement is limited to the lower ages, the rate having slightly increased at ages above forty-five years. Since 1881 the mortality of ironstone miners from alcoholism has decreased by more than half. There has also been a substantial decrease in their mortality from pulmonary consumption, and a slight decrease in that from other diseases of the lungs and air passages. Diseases of the nervous, circulatory, digestive, and urinary systems are, however, more fatal than formerly amongst these workers, and they are now more addicted than they were to suicide.

[162]

Copper Miners.—The number of men engaged in this industry is so small that it is scarcely safe to express an opinion as to their healthiness or otherwise, especially when, as in the present case, the period covered by the statistics does not exceed three years. At the last census scarcely more than 1000 copper miners above fifteen years were enumerated, their number having dwindled to less than a third part of what it had been at the preceding census.

If one may hazard an opinion from so small a number of deaths, it would appear that copper miners are an unhealthy body of men: their comparative mortality figure is 1230, or 295 above that of miners in the aggregate. Pulmonary consumption and other lung diseases appear to be very destructive to these workers, and the survivors certainly do wisely in endeavouring to find a healthier field for their labour by emigrating to other and more prosperous regions. At the next census it is probable that the copper-mining industry in England will have practically ceased to exist.

Tin Miners.—This is another unhealthy occupation; it is limited almost exclusively to the counties of Devon and Cornwall. The miners of tin at the last census numbered rather fewer than 10,000, and as the deaths in the course of three years did not exceed 336 in all, no very detailed observations on their mortality would be profitable. In consequence of the very general emigration of tin miners in recent years to South Africa and elsewhere, the age constitution of tin miners as a class has become exceedingly abnormal. Adults in the prime of life having left their homes in search of more profitable work abroad, the tin miners who are left at home are the least robust and healthy of their tribe, and this fact has a considerable effect on their mortality. Reference to the table on page 156 shows that tin miners sustain rates of mortality which are excessive at all ages. Their comparative mortality figure is 1409, or nearly half as high again as the average. Tin miners die two and three-quarter times as fast from phthisis, and one and three-quarter times as fast from other lung diseases as do occupied males generally; their mortality from cancer and from diseases of the nervous and urinary systems is also in excess of the average.

MORTALITY OF UNOCCUPIED AND OCCUPIED MEN.

In my previous work on occupational mortality, the death-rates of unoccupied men were compared, in considerable detail,[163] with those of men following various occupations, in different parts of the country. A brief summary of what was then advanced at much greater length may fitly close the present section.

At the census of 1891 the number of unoccupied males living between the ages of twenty-five and sixty-five years was returned as 208,857. Of these, 35 per cent. were classed as “retired from business,” 6 per cent. as pensioners, and 23 per cent. as “living on their own means,” whilst 21 per cent. were referred to the class of “unoccupied persons,” including an unknown proportion of paupers and prisoners. Careful investigation of the facts leads to the surmise that somewhere between one-third and one-half of the unoccupied males, as above defined, experience a mortality which probably does not exceed that of occupied males at the same ages. If this be so, it follows that the mortality of the remaining two-thirds, or one-half, as the case may be, must greatly exceed even the high rates of unoccupied males in the aggregate. In the following table the rates of unoccupied males are contrasted with those of occupied males at the several stages of life.

The comparative mortality figures of occupied and of unoccupied males between twenty-five and sixty-five years of age are 953 and 2215 respectively. In other words, the number of males of definite age constitution, within these limits, that would give 1000 deaths among the general population, and 679 deaths in the healthy districts, would give 953 deaths among occupied, and 2215 among unoccupied, males. The comparative mortality figure of unoccupied males, therefore, exceeds that of occupied males by 132 per cent. The following table shows the chief causes of death that go to make up the comparative[164] mortality figures for occupied males and unoccupied males respectively.

It thus appears that nearly two-thirds of the enormous excess in the mortality of unoccupied as compared with occupied men is due either to diseases of the nervous system, or to phthisis. The heavy mortality from both these diseases would appear to partly depend on the circumstance that the unoccupied class includes a large proportion of insane persons who are exceptionally prone to phthisis. Among other causes of death, diseases of the heart account for 114, and influenza (with respiratory diseases) accounts for 96 of the excess in the mortality figure of unoccupied men.

The mortality attributed to cancer is double, and that attributed to intemperance and liver disease, to diseases of the urinary system, and to suicide, is about double as heavy among the unoccupied as it is among the occupied class. The excess of mortality from accident among unoccupied males possibly results from the addition to their ranks of men who, having been permanently disabled whilst at work, drift into the unoccupied class, and finally die from their injuries.

At the census of 1891 London contained 1,230,010 occupied males aged fifteen years and upwards, while the industrial districts contained 1,833,295, and the agricultural districts contained 1,246,156 at the same ages. More than half of the occupied males in England and Wales are therefore included in these three sections of the population.

The mortality of occupied males exhibits very wide variations in different parts of the country. These variations are exemplified[165] severally by London, by the group of districts representing Industrial England, and by the areas representing Agricultural England.

At each of the seven age-groups, between fifteen and sixty-five years, the highest death-rates occur in the industrial, and the lowest in the agricultural, districts, London occupying an intermediate position.

The comparative mortality figure among occupied males, at ages from twenty-five to sixty-five years, is 1147 in London, 1248 in the industrial districts, and 687 in the agricultural districts; these figures being respectively 20 per cent. above, 31 per cent. above, and 28 per cent. below, the figure for all occupied males.

Phthisis and respiratory diseases are more fatal than any other causes of death to occupied males, both in London and in the industrial districts. In London these two headings contributed almost equally to the mortality figure. The industrial districts, on the other hand, show less mortality than does London from phthisis, but the difference is more than made up by the heavy death-roll from respiratory diseases. In the agricultural districts the mortality figure for phthisis is less than half of that of London, and the figure for respiratory diseases is still lower. After due correction for age constitution, these two classes of disease in the aggregate cause 48 per cent. of the total mortality among occupied males in London, 47 per cent. in the industrial districts, and 36 per cent. in the agricultural districts, against 43 per cent. for all occupied males within the same age limits.

John Tatham.

The soldier is liable, like other members of the community, to various diseases due to his occupation and surroundings, although at the present day the hygienic conditions of barracks and military duties are so carefully supervised that he is, when on home service, placed under much more favourable circumstances than men of his own class in civil life. It is, therefore, somewhat disappointing to find that under these circumstances, knowing soldiers to be more or less picked men, they are not, judging from tables of mortality, more healthy than their civilian brethren of the same age. It is a matter of common observation that the army ages a man quickly; the old soldier of a regiment, who is looked upon more or less as a privileged individual, and generally given some sort of employment which relieves him from “sentry go” and the more arduous duties of his profession, is seldom over forty years of age, and ought to be therefore at his best; but partly from the monotony of his existence, and partly from excessive smoking, drinking, and night duty, the private of twenty years’ service is, as a rule, a worn-out machine, his mental faculties blunted, and his body, if not the seat of actual disease, aged and almost useless. These effects are still more marked when a man, as is generally the case, has spent a great part of his service abroad, for to the effects of hot climates and the diseases incidental thereto must be added, in a greatly enhanced degree, the enforced ennui and idleness which are the bane of the soldier’s existence in all stations in times of peace, and especially in the tropics. We all know how much more likely we are to rust out than wear out, and the enforced idleness which the soldier, especially in the infantry, has to encounter, leads to sluggishness of the functions of the body, while in many, drunkenness, increased smoking and debauchery, exercise an injurious influence upon health, apart altogether from the actual diseases to which[167] they may give rise. An old soldier, for these reasons, can seldom eat his rations, and his system seems to be in that receptive condition that he readily falls a victim to epidemic disease prevalent in the neighbourhood, and this the more owing to his tendency to haunt the lowest and most insanitary parts of the town near which he may be quartered. This is seen more particularly abroad, where the native quarters are in marked contrast to the clean and sanitary military cantonments, so that medical officers have come to regard it as almost certain that the soldiers will soon suffer when an epidemic breaks out among the civil population. Statistics prove that the longer soldiers serve, the greater is the proportional mortality among them.

After these preliminary remarks we will proceed to discuss the peculiar health conditions under which soldiers exist, and their effects as regards their duties, habits, surroundings, and dress: firstly, at home; secondly, abroad, with special reference to hot climates, both dry and damp, and the diseases from which they suffer in such climates; thirdly, the special dangers to health incidental to active service.

The peculiar conditions of military as contrasted with civil life are that the soldier must perforce (in most cases) remain unmarried, that his daily wants are all provided for by the State, so that his pay, though small, is practically all pocket money, which may, if he is so inclined, be all spent on drink and debauchery; that his personal liberty is a good deal restricted, tending to irritability and low spirits in many temperaments; that he has no privacy, living as he does in rooms common to him and many others; that he has to dress in clothes in which hygienic principles are sometimes overruled by the necessity for ornamentation and smartness; and that his duties frequently entail great exposure to varieties of temperature and loss of sleep.

As regards the first of these points, it is known from statistics that married men, as a rule, live longer than the unmarried, apart altogether from the dangers of venereal diseases. This is not difficult to understand, seeing that the married man has more solid comforts, and is not tempted to spend his evenings abroad, also that he has that incentive to steady work and moderation in all things which the celibate has not. Again, the average soldier has undoubtedly more pocket money than the average civilian of his class; he has no incentive to save; he is tempted by numerous[168] companions of both sexes to excess of all kinds, and spends most of his evenings abroad, consuming more drink and tobacco than is good for him. Vanity and desire to be smart frequently cause him to dress in garments much too thin for the state of the weather. Discipline has, no doubt, a very depressing effect upon the health of some men. Restraint and the petty tyranny of superiors exercise a bad effect upon their spirits, causing loss of sleep, and often leading to drinking. In spite of the great improvement in the treatment of the men which has been effected in our army in recent years, suicides are still too common, though not nearly so frequent as formerly, or as they are in other armies.

As regards the herding together of men in barrack rooms, this is an evil which is almost unavoidable without great increase of expense, but if it could be altered it would certainly make the army more attractive to the better class of men. Formerly there was great overcrowding and consequent sickness, but at the present day, in almost all barracks, each man has at least 600 cubic feet of space, a larger amount than men of that class usually enjoy in civil life. Before the need for fresh air was so fully recognised as it is now, there was great mortality in the army from chest complaints, especially from consumption, as also in the navy; but now the regulations are very strict, the number of men to be accommodated in each room, so as to give each his 600 cubic feet, is painted on the barrack-room doors, and any overcrowding, beyond the regulated numbers, must be reported upon and explained by the officers, regimental and medical. The public are now, generally speaking, fully alive to the need for fresh air and ventilation, but disregard of the necessity is still a very fertile cause of disease in civil life, especially when to lack of fresh air is added the fact that such air as there is is laden with dust or other solid matter, as in mines or workshops. In former years the large amount of lung disease in the army and navy was in exact proportion to the amount of overcrowding, but now the soldier and the sailor do not suffer more from these diseases than do the civil population. In the first ten years of the late Queen’s reign, the deaths from lung diseases in the army per 1000 of strength were at the rate of 7.82, but in 1898 there were only 2.5 cases per 1000 admitted to hospital, of whom a very small proportion died, the majority being invalided or cured. Apropos of this I need only remark that the latest plan of treating consumptives is to keep them day and night in the open air. Cold fresh air is no longer so much dreaded as formerly. That it is not the cause of[169] consumption can be abundantly proved from army statistics. From these statistics one may learn how, in the old days of overcrowding, pulmonary consumption was much more prevalent among the troops serving in the delightful climate of the West Indies than in England, or in Canada, owing to the scandalous manner in which the barracks in those islands used to be kept overfilled. Now, except when yellow fever appears and carries off the men, the West Indian station is the healthiest quarter of the British army, not excepting even the home stations.

As regards the dress of the soldier, there was formerly in the army a good deal of disease of the heart and great blood-vessels. This was undoubtedly caused by restriction to the circulation from tight clothing, and from the pressure on the chest of the straps which supported the knapsack and accoutrements. At the present day the tendency is to do away with everything tight: the stock has disappeared, the tunic is made to fit more loosely, and the weight to be carried is so arranged that there is no pressure on the chest. The dress for hard work is made of light material, serge or drill, allowing free transpiration from the skin, and even the stick-up collar of the tunic is being done away with, at all events for the campaigning dress, and is being replaced by a turned-down collar, as may be noticed in pictures of officers on active service in South Africa. One wonders that any men survived the active service in India in the old days of the tightly-fitting, thick cloth clothes, insufficient head-dress, and straps supporting the knapsack and ammunition pouches crossing over the chest. The fighting at the Alma was in full-dress uniform, and there is no doubt that there was a great deal of unnecessary suffering and mortality from this cause. Instinct and common sense alike urge against doing hard work and long marches in tight clothes, which overstrain the heart. We still hear every now and then of serious consequences, both in England and on the Continent, from holding fatiguing field days in hot weather. Doubtless we must attribute part of the trouble to excessive smoking and drinking. “Soldier’s irritable heart” is attributed to the uniform and to men having to stand for long periods in a constrained attitude; but I am disposed to blame beer and tobacco for part of the mischief: tobacco especially, I believe to be a cause of heart trouble among soldiers, though many authorities doubt it, seeing that Continental soldiers smoke more than ours do and suffer less. Our men, however, as a rule, smoke and chew much stronger tobacco than other people; they indulge in it in the early[170] morning on an empty stomach, and at all other times, and I have known a man who was anxious to be invalided out of the army produce the most marked cardiac symptoms by the surreptitious use of strong cake tobacco. The men of the navy, who have always had a looser and more workmanlike dress than the army men, do not suffer to the same extent from heart troubles. Such complaints are more prevalent in that corps of the army which has the hardest work and the tightest clothes, viz., the Artillery. With more rational ideas prevailing at the present time, the amount of heart complaint has diminished, and there is now proportionally only one-third the amount which existed about the time of the Indian Mutiny. In making this statement we must, however, bear in mind that our soldiers are younger than the men of those days, and in such the effects of these diseases are less likely to manifest themselves. However, there is no doubt that not only in respect of cardiac, but of all other maladies, the army is much healthier than it used to be since reforms in dress and the general treatment of the soldier have been instituted. Old medical officers say that they never see the same class of diseases they used to. Walks round military burial-grounds, especially abroad, tell terrible tales of mortality among troops in former years. In the “Happy Valley” in Hong Kong may be seen a monument erected to over 500 men of one regiment who perished there from disease.

Of the duties of the soldier that have a prejudicial effect upon his health, the most injurious is night guard. The medical authorities are charged to make representations to the authorities whenever in their opinion the turn of men for this duty is becoming so frequent as to be liable to cause illness. To the civilian mind it may seem a trifle that each man should come on guard not oftener than say once in five days, but when we consider the long hours of monotonous standing or walking about in the cold and darkness, perhaps too in rain, which this duty entails, one can understand how this prematurely ages the soldier, and can sympathise with the latter’s ambition to get a billet which gives him all his nights “in bed.” This is altogether apart from the great risks of inflammation of the lungs or rheumatic fever caught in this way, especially as the intervals of “sentry go” are, in the winter, usually spent in a superheated guardroom, from which the soldier passes to his cold and solitary vigil. I have known among cavalry in cold weather an immense amount of sickness caused by the men, after getting very hot while grooming their horses in the[171] hot stables, leading them out to water in their shirt sleeves. Either from lack of time, desire to save their clothes, carelessness or reluctance to appear “molly coddles,” the neglect to put on their jackets frequently resulted in attacks of pneumonia, quinsy, etc., etc., which the distribution of woollen jerseys subsequently did much to prevent. Those who imagine that soldiers lead a lazy life little realise how hard a young cavalry or horse artillery soldier has to work before he becomes master of his craft. What with learning to use his weapons, his drill, riding and the care of his horse, clothes, and accoutrements, the recruit, if not well fed and cared for, is very prone to break down under hardships.

To turn now to causes of sickness among soldiers abroad. This is so largely a consideration of the whole question of the effect of hot climates on the European constitution, that I can only briefly treat of it here. The first points to note are that, owing to the impossibility of the troops working in the sun, and to the provision of native servants to do many of the things which the soldier does himself at home, the men have much more spare time; the climate causes a great craving for drink, and the great activity of the skin renders the system more liable to sudden chills. It is a curious and remarkable fact that whereas most severe illnesses at home are due to chest troubles, the abdomen is that part of the body which suffers most severely in the tropics; hence it has been well said that tropical disease generally “hits below the belt.”

Let us consider first the conditions of life in a hot, dry climate, such as Egypt and India in the warm weather, and next, in a moist climate like Ceylon or the West Coast of Africa. The great difference between Egypt and India is in that in the former the nights are comparatively cool owing to the rapid radiation of heat from the sand as soon as the sun goes down in the cloudless sky, while in Northern India in hot weather, the nights are almost as hot as the days. Only those who have had experience can realise the power of the sun in those climates; to go out into the sunlight without a hat, even for a few minutes, is to be struck down, or to get a splitting headache for the remainder of the day; the skin is burned, and the lips cracked by the hot wind, so that even when driving at midnight one turns away his face as from the open door of a furnace; while to sleep, except under a constantly waving punkah, is almost an impossibility for most Europeans. Bungalows are kept closed up to exclude the[172] hot wind except at one or two windows, where it is allowed to enter through grass mats kept constantly saturated with water. The air is only changed by throwing the house open for an hour or so at dead of night, after which all openings are again closed so as to bottle up, as it were, a supply of comparatively cool air before sunrise. Hence exercise in the open air is an impossibility except before sunrise and after sunset. In the military stations in India soldiers can be seen sitting all night about the cantonments, unable to sleep in their beds on account of the heat of the barrack bungalows, which, like all buildings, retain the heat of the sun far into the night. When we think of the effect of such a life on the private soldiers, without a taste for reading or other resources within themselves, can we wonder that their health suffers, and their spirits become depressed, or that the raging thirst such heat engenders should lead to drinking? If the temptation to indulge in alcohol be yielded to, the liver, already in an irritable condition from the heat, and from the digestion of a diet of meat much too heating for the climate, soon becomes congested, or even suppurates; or the nerve centres which control the temperature of the body, already over-worked, break down completely, and heat apoplexy supervenes. It is a remarkable fact that a temperate man rarely suffers from heat apoplexy, for the body in health can adapt itself to enormously high temperatures. On the other hand, I have been much struck by the distress caused by the heat among beer-drinking soldiers, compared with the immunity experienced by the more temperate officer, doing the same work on a march. The measures to mitigate the effects of such a climate are to get as much exercise as possible during the comparatively cool hours of the morning and evening, and to be as much in the open air as possible at night; to have a diet as cooling as possible—fruit, vegetables, fish, etc. (all of which are unfortunately very difficult to procure at that season), and to try to interest the men with books, lectures, and indoor occupations, such as woodcarving, bootmaking, etc. Also to let them have plenty of temperance drinks—tea, lemon juice, etc., etc. Sleeping in the open air is the pleasantest at these times, but unfortunately sudden storms are apt to arise in the night which cause annoying breaks in one’s rest, and again one has to retire indoors at break of day, just when the air is coolest and sleep most refreshing. The alternative is to sleep under a punkah indoors, but the punkah-pulling in soldiers’ barracks is frequently most unsatisfactory, and the broken rest from the heat and mosquitoes is a[173] serious cause of deterioration of health in the soldier. To the educated officer with books, and perhaps music and painting to while away the long, hot hours, the life in the hot weather is not unpleasant, dinner is not taken till perhaps 9 P.M., and social intercourse passes the time till long past midnight, then a few hours of sleep in the coolest time of the twenty-four hours, supplemented by a siesta in the daytime. All open-air work is over by 9 A.M. The more closely the life of the soldier is made to resemble that of his officers, the better will be his health. A word of warning is necessary about the swimming-bath, which, though it gives the most delightful form of exercise, is somewhat dangerous, for the bath being generally under cover, the water is much colder than the outer air, and lengthened immersion is very apt to cause liver and other internal congestions, the commencement of grave tropical disease.

Contrast with the above description that of a moist, hot climate. The air, instead of being hot and dry, is ladened with moisture, the slightest exertion causes profuse perspiration, which renders all the garments damp and clinging; the moisture of the atmosphere renders evaporation from the body and consequent lowering of the temperature much slower; there is experienced a total lack of energy, but as there is no hot wind, the houses can be kept open all day long; there are frequent showers, and vegetation is abundant, and affords plenty of shade for those who care to remain out-of-doors all day. There is not, therefore, in a climate like this the same amount of confinement indoors, but the constant heat and perspiration are very enervating, and soon lead to marked pallor in Europeans. The great danger in such a climate is from the damp clothing; the skin being so active is full of blood, and a sudden cooling from sitting in a draught in damp clothes drives the blood to the internal organs, causing congestion of the liver and spleen, dysentery, etc. To avoid this it is most important always to wear flannel next the skin and to change after exercise. By doing this the risks of such a climate are much mitigated. In two years in Ceylon I never had a day’s illness, and the good health of the army in the Ashanti expedition of 1895–96 must in a great measure be attributed to making the men carry a dry shirt on the march, into which they changed at once on arriving at the halting place. The most important disease of those climates is malaria, due to a minute organism in the blood, now proved to be generally communicated by the bites of[174] mosquitoes. The obvious preventatives are to avoid being bitten by mosquitoes, to destroy the breeding places of these insects by draining the pools in which their larvæ develop, to avoid going out at night, when these insects are most active, and to keep them off by mosquito curtains. Smearing the exposed parts of the body with carbolic oil will repel these pests. There is no reason why soldiers in tropical barracks should not be supplied with mosquito curtains, when it is not hot enough to demand the use of punkahs, which also keep off the insects; and I have no doubt this will be done in all feverish stations as the result of recent teaching.

In sleeping under a punkah, and in fact at all times in the tropics, where the individual retires to bed bathed in perspiration, one of the best means of avoiding chill of the abdominal organs is to wear a long silk scarf (kummerbund) or a flannel “cholera belt” round the body.

One of the older theories about malaria was that it was due to some miasma arising from the ground, and especially from ground which had been recently disturbed. However erroneous this idea may be in theory, in practice many instances are on record of its apparent truth. I can never forget the results of sending men to a so-called sanitorium which had been made in the far East by levelling the top of a mountain and building barracks thereon. Almost every man who went got an attack of malarial fever, and this is in accordance with the experience and superstition of the Chinese. They say that the “Fung Shui,” or genius loci, of a place is a dragon who lives in the ground, and if you disturb the soil you irritate him, with the result that he avenges himself by spreading fever among his aggressors. Therefore the soil about barracks and encampments should be disturbed as little as possible, and all shallow pools of water should be drained or treated with a small quantity of paraffin oil to kill the larvæ of mosquitoes.

Other scourges of the tropics which cause sickness and mortality among our soldiers are liver disease and dysentery (generally due to chill as above described); and those diseases due to contaminated water, e.g., enteric or typhoid fever, cholera, and some forms of dysentery. This is so large a subject that I cannot say more on it than to indicate that the germs of the disease may, while almost invariably matured in water, be taken into the system with milk, water, or food, and the best precautions are rigid prevention of adulteration of the milk (to be[175] secured, if necessary, by having the cows milked before a responsible European), boiling suspected drinking water, and the most perfect cleanliness in the preparation of all food. Notwithstanding the greatest care and expenditure in obtaining the best water for our large Indian stations, enteric fever seems rather to increase than diminish, but that is due, I fear, to the carelessness of the soldiers in drinking from contaminated sources in the bazaars, or in their walks abroad. The well-water of India and the native made aerated waters are almost invariably open to suspicion, and ordinary filters are, I fear, only a delusion and a snare. I am acquainted with at least one terrible outbreak of cholera distinctly traced to the use of filters. The bacterial filters of Berkfeld and Pasteur-Chamberland are reliable, but are so difficult to work and keep in order that it is much better to trust to boiling the water. In a tropical climate, when soldiers on the march acquire an intense thirst, it is practically impossible to make them wait till water can be boiled and cooled before quenching their thirst, and we have had recently a terrible example of the effects of foul drinking water in the outbreak of enteric fever among our troops in South Africa. My own practice in India when out shooting was to carry boiled water or cold tea, but to slake my thirst as much as possible by sucking a lemon or lime, a practice which most travellers and (generally) soldiers also could follow with advantage. Another use of these fruits is to squeeze a little of the juice into water which is not above suspicion, as it is known that acids kill the germs of cholera, and also possibly of enteric fever. I may add that limes are very abundant and cheap in most tropical climates, and could generally be served out to the troops.

I have already stated that heat apoplexy is most likely to attack those addicted to alcoholic excess, and is not likely to be prevalent among temperate men in the airy dwellings of Europeans in the tropics; but any great overcrowding, such as occurred in the Black Hole of Calcutta, would be likely to cause fearful mortality. Great and sustained exertion in the hot sun of Egypt or India might cause heat apoplexy or sunstroke in the most temperate. It is marvellous, however, what an amount of exercise temperate men can take when “pig-sticking,” for instance, in the hottest weather in India, with impunity.

The Europeans in India, who live in roomy and clean dwellings, suffer remarkably little from the plague, which is now[176] threatening our shores, but has so far not obtained a foothold owing to rigid sanitary precautions.

A very troublesome complaint among soldiers in the tropics is “Dhobie itch,” a form of ringworm locating itself under the arms and between the legs, where the skin is always moist from perspiration. In one regiment I had charge of, about 75 per cent. of the men had it, causing a considerable amount of suffering and inefficiency. The disease is spread by inoculation from dirty clothes, or such as have been washed in impure water, and the best preventative is the use of clean and frequently changed underwear.

By the adoption of the measures above indicated it is possible for Europeans to enjoy good health in the tropics, but in war it is impossible to observe many of these precautions. It is well known that in all climates the ravages of disease are infinitely more fatal than the weapons of the enemy. The existence of hostilities, with the hard work and privations thereby entailed, usually puts all health considerations into the background. In the Crimean war three times as many of our men died of sickness as at the hands of the Russians, and the proportion will be found even greater in the present war in South Africa, in spite of the deadly accuracy of modern weapons and of the fact that the theatre of operations is one of the most salubrious regions in the world. And it is not difficult to understand why this should be so when we reflect upon what active service means—the prolonged and intense exertion, the loss of rest, deficiency of food, which at the best is coarse, unpalatable, and badly cooked—in a word, starvation; the bad water, the fouling of the camping grounds by the excreta of thousands of men and animals, the heat by day and the cold by night, the clothes alternately saturated by perspiration and frozen by the bitter night wind, also the clothes becoming dirty and infested by vermin owing to their wearers being unable to change them for weeks. In the stress of campaigning men have become ill from want of time and opportunity to secure the daily evacuation of the bowels, which is so necessary to health. These are a few of the conditions incidental to active service, and when we reflect it is not difficult to understand that not only are there many diseases induced by campaigning proper, but that if a man have one weak point about him, such hardships are bound to find it out. We have only to glance at the casualty lists published in the newspapers every morning, to see how various are the causes of death among our men at the[177] front. So well is this recognised that every man is medically examined before going on active service, and all with any defect of constitution are rejected. Here I may incidentally remark that the prevention of venereal diseases in the army is a matter of national importance, for the men who are thereby unfitted to endure the privation of a campaign are many, and all reasonable measures for the prevention of such diseases should therefore have the support of patriotic people.

It is well known that excessive fatigue alone will cause a feverish condition of the body, leading to weakness and loss of appetite, and when that is induced the body is in a favourable condition for the reception of the germs of specific diseases. Service conditions obviously predispose to such diseases as pneumonia, rheumatism, quinsy, frost-bite, etc., etc., and in hot countries to heat apoplexy and sunstroke.

The commonest specific diseases of campaigns are dysentery, enteric fever, cholera, and malarial fevers. Dysentery has always been the great scourge of armies in the field in almost all climates, and the causes may be briefly summed up as bad food, bad air, bad water, and chills. The unwholesome food may cause disease in two ways: owing to its coarseness and being badly cooked, it may give rise to inflammation and irritation of the bowels, or it may be deficient in those still imperfectly understood constituents which are necessary to prevent scurvy. It is unnecessary to dilate further on the food question, the points of which are obvious, but as regards scorbutic dysentery I may say that it is very liable to appear among soldiers in the field, and our authorities endeavour to ward it off by giving, whenever possible, rations of fruit, vegetables, jam, and lime juice. As regards bad air, the condition of camping-grounds whereon large numbers of men and animals have lived even for a few days must be seen to be realised, and when to that is added the stench of dead bodies of men, horses, and cattle, as on a battlefield, it can be easily understood how frequently the air which men have to breathe on active service must be such as to give rise to bowel complaints. Again, in some countries where our troops have to operate, such as in the West African jungles, the air reeks with the smell of decaying vegetation in the stagnant depths of the primeval forest, and such air is most unwholesome.

Bad water is the principal cause of dysentery, but whether a man can acquire true dysentery thus, unless the water has been fouled by the discharges of a previous case of the disease, is[178] not quite certain. Generally, such fouling is not difficult to establish. The drinking of water in which are immersed the rotting carcases of men and animals, and other nameless abominations—such water as our soldiers drunk at Paardeberg—is, as might naturally be expected, likely to cause diarrhœa running into dysentery, especially when all the other causes of that disease exist also. Chill I hold to be an exceedingly common cause of dysentery, having contracted the disease myself from that cause alone after leaving the tropics. It is most important to avoid sudden cooling of the surface of the abdomen by changing into dry flannels immediately on halting, and keeping that region warm, especially at night, by a thick woollen or silk covering. Unfortunately such precautions are generally impracticable on active service.

Enteric or typhoid fever has only been recognised as a distinct disease apart from typhus fever since the researches of Sir Wm. Jenner in the late Queen’s reign, and therefore, whether it used formerly to be as great a scourge in the past as it is now, it is impossible to say. At the present day it is without doubt by far the most fatal disease to which our soldiers are liable either in peace or war, and experience in Egypt, India, and South Africa, where it seems to become more and more fatal in spite of all that science can do to check it, almost causes us to despair.

Protective inoculation on the same principle as vaccination is the latest plan, tried extensively in South Africa, but the reports to hand so far do not show that it has had any marked success as a preventative, though it is hoped that it will prove to mitigate the severity of the attack. The disease is most prevalent and fatal among young men, which is a strong argument against the employment of very young soldiers; but on the other hand many middle-aged men, whose deaths the country is even now deploring, have lately succumbed. There is little doubt that in England and other temperate climates this disease is almost invariably due to bad water, but in India and other very dry climates, where it has continued to spread in spite of the most rigid precautions, the opinion is gaining ground that the germs may often be spread by the wind carrying them about into food and drink from the dry excreta of previous sufferers, deposited on the ground. Flies also are suspected of bringing about the same effect. Even in India and South Africa, however, it is remarkable how often epidemics are associated with contaminated water—for instance, Paardeberg and Bloemfontein (where the enemy cut off the regular water[179] supply), and when one has had experience of the way in which the ground is fouled by the natives of Africa and India, there is little wonder that the water supply suffers. It seems certain that people can drink sewage contaminated water with comparative impunity, but the germs of enteric once admitted into the water, an epidemic is almost certain. The Hindoos always wash their buttocks after defecation, and hence generally perform that act near water, and in the hills in India often when I have been tempted to drink from an apparently pure mountain stream, I have noticed, just in time, the evidence of this disgusting practice. Again natives generally build their huts near a water supply, and hence nearly every rivulet is contaminated. In a hot country it is therefore most difficult to prevent men quenching their raging thirst with obviously polluted water. The Boers are reported to be very filthy in their habits, and as enteric fever is rife among them, it is not difficult for us to understand how so many of our men have contracted the disease in such a thirsty land, where I am informed even doctors, well aware of the risks, could not resist the temptation of drinking the dirty water by the roadside. The only safeguard with suspicious water is to boil it; filters only give a false sense of security, but wells can be purified with Condy’s fluid and acids, and of course rain water, if carefully collected and stored, or a stream, if guarded from its source, may be trusted, as also wells sunk at the time by the Royal Engineers. Many observers think that enteric fever may be caused by excessive fatigue and exposure to the sun, with absorption of poisons from the bowels, especially if they are overloaded with decomposing excreta due to constipation from heat, hard work, unwholesome food, and want of time and opportunity to secure a regular evacuation. In the navy, where condensed water is largely used for drinking purposes, enteric fever is rare, except when contracted ashore; but as soldiers cannot, as a rule, be supplied with condensed water, we must rely on the above precautions as regards water, cleanliness in the preparation of food, care in the disposal of excreta (and it is important to remember that enteric urine is as dangerous as stools), and constant supervision of natives and camp followers.

Cholera is like enteric fever, generally a water-borne disease, and much the same remarks apply to both. On active service, tea, coffee, and cocoa should be drunk in preference to water, as far as time and the supply of fuel will allow, and all drinking water should, if possible, be boiled. When green cocoanuts can[180] be procured each will furnish nearly a pint of deliciously cool and perfectly wholesome “milk.”

I have said enough to show what a vital point the water question is on active service, how the health of an army in the field is largely dependent upon obtaining pure drinking water; and while all officers, regimental and medical, must never weary in their endeavours to secure such a supply, the men themselves ought to be instructed and exhorted to exercise the necessary vigilance and self-restraint, and, if necessary, punished when they fail to do so.

Malaria is always a great danger to soldiers on active service, not only in tropical regions, but also at times in our own latitudes, as was seen in the Walcheren Expedition. Though our theories as to the cause of the disease have lately been altered by the discovery as to the agency of mosquitoes in disseminating it, the old rules of not disturbing the ground, sleeping on raised platforms (as was done in the Ashanti Expedition of 1895–96), avoiding the neighbourhood of marshes and jungly ravines, preventing chill by changing into dry flannels on halting, never starting off in the morning without a cup of cocoa or something of that kind, and taking a daily dose of quinine, should on account of their proved utility still be followed. To keep off mosquitoes in the absence of curtains and punkahs, the face and other exposed parts of the body should be smeared with carbolic oil.

Sunstroke and heat apoplexy are causes of mortality on active service, and even at home in hot weather we have had lamentable results from overworking our soldiers in improper clothing and head-dresses. The obvious precautions are, the avoidance of overcrowding and overloading the men, the wearing of a suitable head-dress, loose porous clothing, the provision of plenty of non-alcoholic drinks, and marching in as open order as possible, so as to give every man enough fresh air. The greatest precaution of all, viz., avoidance of work in the sun, cannot, of course, be generally adopted on active service.

Sore and tender feet cause a great deal of inefficiency on active service, though our army boots are generally very good, with plenty of room and low heels, but a less rigid sole would be an improvement. The socks should be woollen and not too thin or loose, the feet should be kept clean and well soaped immediately before putting on the sock, and blisters should be carefully treated.

Many of the above suggestions may appear incapable of being[181] carried out in the stress and hurry of active service, but, of course, anything which will prevent disease contrives “a double debt to pay”; it keeps the men in the fighting ranks, and prevents their becoming not only useless but a burden and trouble to their healthy comrades. Every soldier is said to cost the country about £150 before he can be placed in the field as efficient, therefore sickness entails very heavy pecuniary loss to the country, and all reasonable precautions will ever receive the earnest attention and support of capable leaders. In fact, without due regard to many of them it would be impossible in some countries for white men to remain in the field at all, and the Ashanti Expeditions of 1873 and 1895 have well been called “doctors’ wars.”

In conclusion, if my remarks have given rise to the impression that the soldier is a drunken or unreliable creature, such is far from my intention. He only presents, and that in a degree mitigated by discipline and respect for authority, the faults of his class. My experience of the average working man, which is large, is that the majority cannot refrain from drinking so long as they have money in their pockets, regardless of the consequences to themselves and their families, and that to offer a man drink is their ordinary way of showing kindness and good-fellowship; while their general want of self-restraint is very disappointing, considering the educational advantages they have enjoyed compared with their fathers.

J. R. Dodd.

Although from time to time there have been energetic workers in the cause of marine sanitation, there is probably no other department in which the great advances in hygiene have produced so little good result.

It must be conceded at the outset that the seamen’s lot is by no means an enviable one, and that his sanitary environment falls considerably short of modern requirements. Legislation is slow, and the lack of knowledge by the public of the requirements of the Mercantile Marine is no doubt in great measure responsible for this. At a first glance it might naturally be supposed that a life at sea was a healthy one; living in fresh air, and removed from the unhealthy conditions of large towns, it might be expected that the general health of seamen would bear favourable comparison with the corresponding class of the community on shore. But there is another side to this picture. In the first place there is practically always local overcrowding on board ship, and in dealing with this question the hands of port sanitary authorities and their officers are tied by the Shipping Acts. By the Merchant Shipping Act, the minimum space allowed per head is only 72 cubic feet, and in this space a man has not only to sleep, but to feed and live when not engaged on duty. It has been contended that inasmuch as one-half of the crew is always at work, the forecastle provides double this amount of space. But this is entirely a fallacy, for while half the men are always off duty, there is practically continuous occupation, and therefore no opportunity of opening doors, skylights, and other ventilators, to admit of free perflation. Another serious difficulty to contend with is the presence of moisture. Nearly all forecastles are badly ventilated, and the greatly increased use of steel and iron in modern vessels leads to the condensation of moisture, or “sweating” due to change of temperature. It is no uncommon thing to find the[183] bunks and bedding in the crew’s quarters saturated with water from this cause.

While it can scarcely be stated that any special diseases are associated with the sailor’s calling, there are undoubtedly many which are caused by the conditions under which he performs his duty. His work is intermittent, consequently his intervals of rest, broken by sudden and severe exertion, throw undue and violent strain upon the circulatory and respiratory organs. In steam vessels the changes of climate are rapid, and their influence trying to the system. In spite of all the improved methods of storing and preserving food for long periods, there is still much to be desired both in the actual dietary of the sailor, and still more in the rough and inefficient manner in which it is cooked for him. The loss of life from drowning and other accidents connected with casualties to the vessel is large. Again, the habits of the seaman must be taken into account. From the mere fact of his being for long periods confined on shipboard, without any amusements except those provided by his fellows, it is perhaps not surprising that on arrival in port he should give way to full indulgence in pleasure. Unfortunately, moreover, the parts of sea towns frequented by sailors are generally the lowest, and the temptations of the worst kind. This explains the frequency of alcoholism and venereal disease among our Mercantile Marine, and in addition the tendency to contract the diseases to be met with in such localities.

The principal diseases to which seamen are liable are:—

There is unfortunately no reliable record of sickness in the Mercantile Marine.

The returns of the Board of Trade show the mortality rate from all causes in 1898–99 to have been 9.60 per 1000 in the[184] Merchant Service, while the corresponding rate in the Royal Navy was, for the year 1899, 4.91 per 1000, or practically one-half.

The returns of the Mercantile Marine show that of the 9.6 per 1000, 7.4 were from injury, and 2.2 from disease; the 4.91 per 1000 of the Royal Navy being made up of 3.56 from disease, and 1.35 from injury.

The following table shows the disease and accident mortality incidence in sailing-vessels as compared with steam-vessels.

1. Diseases due to Employment.—The violent exertions called for at times of emergency fully account for the frequency of heart disease, especially of cardiac hypertrophy, and also of hernia, while the occurrence of aneurism may be assigned to the same cause, though doubtless greatly aided by the influence of syphilis. With the large increase in size of sailing-vessels and the consequent introduction of labour-saving appliances, this class of disease is showing a decided tendency to decrease.

Injuries are more common on sailing-vessels than on steam-ships, owing to the greater amount of work aloft, and the more laborious efforts involved in working the sails.

The “heat stroke” of stokers requires special notice. It is far more common in vessels of the Merchant Service than in those of the Royal Navy. Stokeholds in the navy are better ventilated, and forced draught, if necessary, tends to a freer supply of air. The “fireman’s frenzy” appears to be caused by the continued high temperature, coupled with insufficient ventilation, and often associated with alcoholism. Much can be done to diminish heat stroke by due attention to the ventilation of stokeholds and confined spaces in connection with them. The utmost advantage should be taken of the up-draught caused by the heat of the furnaces to remove foul and vitiated air. Men engaged in this class of work should be freely supplied with oatmeal water, as this is the most wholesome method of replacing the large[185] quantities of fluid lost by perspiration. The same class of men are, moreover, specially liable to diseases of the eye caused by the glare of the furnaces, and the constant irritation produced by particles of coal and dust.

2. Diseases caused by the Habits of Seamen.—Of these the two most common are alcoholism and the various forms of venereal disease. The irregularity of a sailor’s life, especially in these days of rapid transport, sufficiently explain without justifying his failings. A man whose home life is interrupted by voyages across the sea, who is thrown upon his own resources in foreign ports, and who is from the nature of his calling almost of necessity confined to the shipping quarters (invariably the lowest) of the towns he reaches, is not unlikely to seek for amusement where it is most easily obtained, and wine, women, and music occupy a considerable part of his spare time under such circumstances. Much has been done by the Board of Trade and voluntary associations to protect the sailor, by taking care of his money when first paid off (when the temptation to squander it is strongest), and enabling him to draw it at his own home, by arranging for his being sent by rail to his destination, by protecting him from “crimps” and unauthorised agents, and by providing Sailors’ Homes, where he can live at a reasonable cost, without being plundered by unscrupulous persons, but there is still much to be desired in this direction.

3. Diseases of Climate.—To a great extent these can scarcely be avoided. Seamen suffer much from tropical diseases. No doubt their careless habits and unwillingness to take reasonable precautions in unhealthy climates are in some measure responsible for this. Simple rules for the preservation of health, greater care in dieting, and, above all, limitation of indulgence in alcohol, would be of undoubted value, and a recent suggestion to afford information on such subjects to seamen through the medium of Sailors’ Institutes and Homes would doubtless lead to good results. Diarrhœa, so common a disease in hot climates, is mainly caused by the ingestion of improper articles of food and drink. Seamen do not realise the importance of the source and purity of drinking water. One common cause of this disease is the carriage of water in casks and tanks on deck, or in places where it is easily affected by the temperature of the sun. Any simple arrangement for reducing by evaporation or other method the temperature of the water supply has considerable effect in this direction. Dysentery, so far as prevention is concerned, can be guarded against in the[186] same manner as diarrhœa—water, however, being the main agent in causation. Cholera, yellow fever, and plague call for no special comment. Where these diseases are known to exist, shipmasters should be careful to warn their crews as to the danger, and explain how best to avoid them. Men should be kept on board as much as possible during the stay of the vessel in an infected port, and especially should they be required to return at night. A careful watch should be kept for any suspicious sickness, and medical advice sought at an early stage of any illness. The sanitary condition of the vessel itself must be the special care of the master. Malaria, now known to be due to a specific organism, conveyed by means of the bite of a species of mosquito, is much under the control of the master of a vessel, who should prevent his crew from remaining on shore in a malarial country during the night, or in the evening, when special danger exists.

4. Diseases due to Insanitary Conditions and Environment form a long and important series. These are essentially the diseases which can be controlled, if not altogether prevented.

Rheumatism and its allies are mainly due to cold and exposure, and still more to the difficulty of obtaining dry clothing on board ship, and the constantly wet condition of bedding, etc., from the sweating of iron vessels. These causes can be avoided. The condensation can be prevented by the universal use of sheathing over iron decks and of a non-conducting lining over and around bunks, the proper provision of heating stoves, and the free ventilation of forecastles. There is further no reason (especially in steam-vessels) for not providing facilities for dry clothing, and preventing it being taken into the sleeping bunks. These two precautions, together with the free use of woollen underclothing, would tend to greatly reduce the “sailors’ curse,” rheumatism. Lung diseases are very common, and are caused chiefly by the close aggregation of men in confined and ill-ventilated quarters. The difficulty of the system of watches prevents the proper airing of a forecastle, and men coming off duty enter an atmosphere already fouled and polluted by those who have previously occupied it. The cubic space per head should be largely augmented. The Royal Commission on Labour has recommended that 120 cubic feet should be the minimum, and bearing in mind the special difficulties, this would seem to be a moderate figure. The present 72 cubic feet is ridiculously inadequate, and only remains the legal minimum by reason of the proverbial ignorant conservatism of the sailor.

[187]

Scurvy happily, under ordinary circumstances, is almost unknown in its acute form. During the last twenty years our ideas as to its causation have undergone considerable change, and it is no longer possible to assert that the one essential for its production is the use of salt meat, and the absence of vegetable food. In one of the recent Arctic expeditions, owing to the loss of all the stores, the crew lived for more than twelve months exclusively on fresh meat, and no symptoms of scurvy made their appearance. There is little doubt that the condition of the blood producing the symptoms we call scurvy is caused by the ingestion of food in an incipient stage of decomposition, although a free supply of natural vegetable acids will tend to delay its appearance. Slight manifestations of scurvy are still common among sailors, and there is one point of great practical importance in connection with this. More care is required in the examination of tinned meats, the date of packing should in all cases be stamped or indelibly marked upon the tin, and those tins that are found on examination to be in any degree defective, should be destroyed under official supervision, and not be allowed to pass into the hands of unscrupulous dealers.

Beriberi is a common disease among certain natives on board ship. The disease has the habit of remaining dormant in a vessel, also of recurring from time to time when conditions for its development are favourable. Though it has been ascribed at different times to malarial influences, to a deficiency of nitrogenous food, and to a definite microbe, these explanations have failed to satisfy all the requirements of the conditions under which it appears. Manson believes that it is due to a toxine, produced by a saprophyte living outside the body, and that as the soil or ship becomes infected, man is poisoned therefrom. It occurs invariably on board ship in connection with moist, overcrowded, and heated forecastles, where ventilation is deficient, and may therefore in this sense be said to be a disease caused by want of sanitation. Further, as favouring this view is the fact that patients removed to hygienic surroundings, and properly fed, rapidly recover. To prevent beriberi all that is necessary is to keep a vessel clean and dry; to see that there is no accumulation of bilge water or foul matter under the flooring of the crew’s quarters, and that these are properly ventilated and not overcrowded.[46]

Enteric fever is undoubtedly the most common disease to which seamen are liable. Thus in the port of London, out of 791 cases of[188] infectious disease occurring on board ship from 1895 to June 1900, no fewer than 290 were enteric fever. The figures are as follows:—

The large proportion during 1900 is due to the number of cases brought from South Africa.

The causes of the large number of cases of enteric fever are three:—

1. The congregation of seamen in the unhealthy quarters of foreign ports.

2. Want of care in the selection of sources of water supply.

3. Improper methods of carriage and storage of water.

Most of the infected or dangerous sources of water supply are known, and great benefit would result if consuls and other representatives of this country abroad were instructed to warn shipmasters of the special danger. Water should always be stored on board ship in galvanised iron water tanks, which should be carried in such places that they can be easily reached for cleaning purposes. They should be provided with large manholes so situated that where possible natural light can penetrate to the bottom of the tanks when the covers are removed. They should be periodically emptied, cleaned, and coated with a cement wash.

Lastly must be mentioned the digestive troubles so common in seamen. The insufficient and monotonous dietary is of itself sufficient to cause this, and when one further considers the unsatisfactory way in which such food is ofttimes cooked, it will be at once seen how serious a matter this may become. There is no compulsory diet scale, nor theoretically is it wise that there should be. It is felt that if such were laid down by law it would speedily become a minimum beyond which the owner or master would not care to go. The Merchant Shipping Act requires that[189] a diet scale shall be produced when men are engaged, and shall form an essential part of the contract, any departure from which shall constitute a breach of the agreement on the part of the employer. Several improvements on the old scale (still usually in vogue) have been made, but in practice these are scarcely ever adopted. In the present day there are far better opportunities for giving men fresh meat and vegetables, while the use of preserved foods should obviate to a large extent the necessity for salt meat. It can be clearly shown that a reasonable dietary can be provided at a less cost than the antiquated one generally in use, while the advantages from the improved health of the crews and the consequent increased discipline and work are beyond dispute. But even if the dietary be good, the cooking is generally bad. Here legislation is needed. At the present time the master and certain other officers of a ship are required to hold certificates, granted after training and examination, and it is equally necessary that in the case of the cook, some definite standard of knowledge of the work he undertakes should be required before appointment. In the majority of cases a man is rated as “cook” because he so describes himself, or has acted in a similar capacity before. There is no difficulty in organising a system of instruction and examination for ships’ cooks in large centres, and the result of such would be to the advantage of shipowners as regards economy of food, as well as increased efficiency on the part of their crews. This work has already been initiated in several ports, notably London, Liverpool, North Shields, and Glasgow, but the question still demands the most careful attention.

Much ill-health and disease would be avoided if more care were exercised in the selection of men for the Mercantile Marine. The Merchant Shipping Act (sect. 10) provides for the medical inspection of seamen if required, but as a matter of fact, this provision is practically a dead letter, and men are allowed to “sign on” without any inquiry as to their physical fitness for their occupation.

W. Collingridge.

There is not much to be said respecting the nature of the injuries sustained by those at work on railways. The occupation cannot be described as unhealthy. A very large proportion of the work is done in the open air, and the normal lives of the men appear in every way up to the average.

The accidents that occur are mainly what would be called surgical. A large proportion consists of crushed hands and fingers. Instead, therefore, of entering into details respecting the character of these injuries and the manner in which they are received, it will be more useful to give a short account of the progress of legislation in respect to accidents upon railways.

The Mines and Factories Acts had their origin in the desire to preserve children from overwork and bodily injury. The protection thus accorded was gradually extended to women. The next stage was the inclusion of men in many of the factory provisions, and finally the Acts which had originally been intended only for the protection of health began to be timidly and cautiously extended to other and wider objects. But the movement for the prevention of accidents on railways commenced by aiming at the safety of passengers, and it was only in the last year of the nineteenth century that railway servants were included in the category of protected trades. Limits of space prevent my attempting to trace the movement in detail, nor indeed is it necessary. I shall therefore only mention certain epochs which have marked its progress.

As most people are aware, the railway movement began about the year 1830, the year Huskisson was killed, and proceeded until in 1840, there were nearly 1000 miles of railways in the United Kingdom. But about this time the importance of railways became so recognised that in 1840 they were placed under Government supervision. In 1841 a Bill was brought[191] into Parliament to give the Board of Trade powers to issue regulations for the prevention of accidents upon railways, and referred to a Special Committee, presided over by Lord Seymour, and with Sir Robert Peel, Sir James Graham, and others as members.

The arguments for and against the proposal were exactly the same as they have always been upon the subject of State interference in matters of trade. On the one hand, the Board of Trade Inspector-General, Sir Frederick Smith, contended that the power was necessary. The railway companies said that by interfering with the responsibility of railway officials more harm than good would be done. Those who are acquainted with the general trend of public opinion upon factory questions in those days will not be surprised to learn that the proposal was considered likely to “disturb the amicable spirit which then existed between the Board of Trade and the railway companies,” and “to engender on the part of the railway companies a desire of concealment and feelings of jealousy which would not otherwise arise.” The Committee therefore limited its recommendations to empowering the Board of Trade to suggest improvements. These recommendations were carried into effect by an Act known as Lord Seymour’s Act, which provided for the appointment of inspectors of railways, the reporting of accidents, and the punishment of engine-drivers, guards, porters, or other servants of the company who were guilty of negligence. It was urged against the railway companies that expense was no object where life was concerned; to which Mr Brunel, the celebrated engineer, retorted on behalf of the railway companies by asking why the Government did not have a large force of men on the Serpentine when it was frozen, to prevent accidents to skaters. He submitted that in considering the question of safety it might be considered as a question of cost also. On the other hand, it is interesting to note that George Stephenson considered it would be advantageous that the Board of Trade should have power to make regulations. Coming from such a man, himself a large railway proprietor, the opinion is of great weight.

The next time the question came before Parliament was in 1857, during Lord Derby’s administration, when the matter was referred to a Select Committee. The Committee was against interference with railway companies, except as regards the times of trains, with respect to which they thought that the public[192] should have some means of obtaining prompt and cheap redress in the recovery of penalties in every case of want of punctuality. They also made a few minor recommendations. The subject was again discussed by a Royal Commission appointed in 1865. But the times were not ripe for the adoption of State interference. The laissez faire system was in full force, and the Committee recommended that the railway companies should not be interfered with. Meantime the management of the railway companies seems steadily to have deteriorated. The year 1872 was a year of considerable commercial activity, marked by a great rise in the price of coal, and by an increase in the number of railway accidents. In those days it was estimated that several railway accidents to trains took place every week, sometimes as many as four were reported on a single morning. In fact, as stated in the Annual Register for 11th September 1872, “Railway accidents are now becoming of such frequent occurrence that, unless a number of people are killed or seriously injured, no notice is taken of them.” The number of accidents to individuals was also very great. In that year no less than 1145 persons were reported killed, and 3038 were injured. Some of the accidents, too, were of an appalling character. At Wigan in August 1873 a portion of a railway carriage, with a lady in it, was hurled over a wall and through the slated roof of a foundry. The rest of the carriage was smashed to pieces.

In order to secure more precise returns of accidents by checking those made by the railway companies, it was provided in the Railways Regulation Act of 1873 that coroners should make returns to the Secretary of State of all deaths occurring on railways.

The public feeling which these accidents excited led to the appointment of another Royal Commission in 1874, during Mr Disraeli’s administration. It was presided over by the Duke of Buckingham. The Committee sat for three years and heard evidence at great length. They ended by recommending that the Board of Trade should have power to make requirements as to siding and station accommodation, and as to defects in rolling stock, permanent way, and works. They declined to recommend that general powers should be given to the Board of Trade to make general changes calculated to secure the safety of the railway servants, but they thought that servants ought to receive compensation for injuries in all cases of negligence of the companies’ officials, but not for the negligence of their fellow-servants.

[193]

In the evidence that was given it seems to have been admitted that overwork was not universal or even general on railway lines, but a good many remarkable instances of overwork were adduced. Thus Captain Tyler, a Board of Trade Inspecting Officer, gave evidence that at Wakefield in 1864, a man had been regularly on duty as a signalman 25 hours a day every third week, and 37 hours every thirteenth week. The man had made this arrangement in order to get extra time off duty; and in another case, in 1874, a signalman had actually averaged 17 hours work a day regularly.

Nearly all the witnesses complained of the couplings as a fruitful source of danger. Captain Tyler recommended automatic couplings as then used in America.

The next Act of importance regarding accidents upon railways was that passed in 1889, when Sir Michael Hicks-Beach was President of the Board of Trade. The principal objects of the Act were to secure the adoption of the block system of running trains, to cause points and signals to be interlocked, and to enforce the use of an improved brake. The principal object of the Bill was to promote the safety of passengers; there was a clause dealing with automatic couplings, but the clause was ultimately withdrawn from the Act.

During all these years, however, repeated recommendations were made by the Board of Trade officials to the railway companies to adopt various means of saving life. The companies were not obdurate or unreasonable; in particular instances and small points they repeatedly gave way and adopted suggestions. But in the main they declined to introduce automatic couplings, or other life-saving appliances on a large scale. Their refusal was based chiefly on the ground of expense; but they also defended their action on the ground that the proposed appliances were not suitable or practicable, and that if adopted they would not produce beneficial results.

Before narrating the next steps which were made in the direction of securing safety when Mr Ritchie became President of the Board of Trade, it will be of use to examine in outline the condition of railway service as regards accidents, and the means by which the number of deaths and other injuries is ascertained. Reports of accidents on railways exist from the year 1848 onwards; but in forms which render them very difficult to compare with accidents in more recent times. It was not until the passing of the Regulation of Railways Act of 1871 that the reporting of[194] accidents was placed on its present footing. By section 6 of that Act it was provided that accidents should be reported to the Board of Trade, in such form and with such particulars as the Board of Trade should prescribe. In earlier years the reporting of accidents was not very systematically done, and in 1872 the inspector reported that “accidents to servants do not appear in many cases to have been reported by certain of the railway companies; and their numbers would, if the whole truth could be ascertained, be very considerably increased.” Moreover, no uniform standard of injury was prescribed, so that various companies adopted various standards of reporting. Some reported all accidents, even trivial ones; others reported only the serious ones. But in the year 1895 an order of the Board of Trade was made during the permanent Secretaryship of Sir Courtenay Boyle, by which the standard of accident to be reported was assimilated to the standard already in force for the reporting of accidents in factories and workshops, namely, that all fatal accidents should be reported, and all non-fatal, whenever they incapacitated a man from work for five hours on any one of three days next after the accident. The advantage of this order was that it at once established a basis of comparison between the dangers of work in factories and in railways. But there is ground for thinking that the standard was a little low. A trifling finger cut may prevent a man from working in some trades for an afternoon. The reporting of every trivial accident tends also to obscure the graver ones, and in some cases to make dangerous trades appear less dangerous than they really relatively are. In any case, however, it is desirable to have one standard of reporting, and it is a matter for regret that there is no standard of reporting non-fatal accidents in mines, so that it is still impossible to compare mines with factories or railways as to the non-fatal accidents that occur in them.

The numbers of persons employed on railways largely increases from year to year. Returns of these numbers are now furnished every three years. We have therefore not at hand the means of working out the percentage of accidents in every year exactly; but without the danger of grave inaccuracy we may assume that the increase in the numbers employed is uniform during each period of three years, and thus we may by a process of proportion arrive very nearly at the numbers of men employed at any particular period. On looking at the figures for any[195] year, say for the year 1898, we find them set out in two tables, one showing those due to the movement of trains and vehicles, the other to those which occurred otherwise than by moving trains. They are divided up so as to show 41 different occupations of the persons killed and injured. From these tables we find that, in 1898, 522 railway servants were killed and 12,826 injured, out of a total of 534,000. This would give 1 in 1000 killed, and 24 in 1000 injured each year. When we reflect that this figure is about the same as the numbers killed and injured in mines, it might perhaps be argued that the figures are not very large, for it must be admitted that service on railways must always be considered rather a dangerous occupation. But an analysis of the risks to various branches of railway labour dispels this illusion.[47] For in these figures are reckoned numbers of men whose duties are not of a manual character, such as 53,000 clerks, who hardly ever meet with death or accident except from causes common to the whole community. Besides, about 70,000 mechanics are employed in building engines and locomotives, and work in factories, which are under the Home Department, and, strictly speaking, are not railway servants at all.

In railway service there are three occupations which from the number of accidents reported appear to present special dangers, namely, plate-laying and repairing of lines, shunting and managing goods trains. When plate-layers (of whom there are 63,000) sustain an accident, it is generally by being run over, and in more than one case out of every three they are killed outright. Out of every thousand 2 yearly meet their death, and 3 are injured. Of goods guards and brakesmen, nearly 15,000 in number, 3 out of 1000 are yearly killed, and 48 of 1000 are injured. But the business of a shunter presents the gravest dangers. The number of shunters is 9244, and with the exception of the calling of a seaman it is the most perilous trade known. For no less than 5 men are yearly killed and 66 are injured out of every 1000 employed. And from this it follows that if the average duration of a man’s service be from the age of twenty to forty, the balance of probability is against his leaving the trade without a violent death or injury. This is not satisfactory. It has been pointed out that this yearly death risk of 5 in 1000 per annum is greater on the average than[196] that to which soldiers are exposed, taking one year with another, and war with peace. This is probably true, but the risk is far less than that of soldiers in a campaign. It has been estimated that the year’s loss from October 1899 to October 1900, of the troops serving in South Africa, has been 19 per thousand privates, and 72 per thousand officers killed, in addition to 30 per cent. of officers and privates who have died of disease. Thus of the officers engaged about 1 in 10 has died, and of the men 1 in 20.

But any figures of deaths due to accidents in industry are too large if they are preventable, and it is too much that in ten years a railway servant should run the same risk as a private in a year of a campaign.

The work of shunting is necessary to rearrange, or, as it is called, to marshal the trains. At a large goods depôt a number of trains laden with trucks come in destined for various localities. The trains have to be dissected, and all the trucks resorted, and made up into fresh trains to be sent off in various directions. Hence, therefore, it is necessary for an engine to draw the waggons on to a line of rails, and then to shunt or direct them on to sidings in different directions in order to sort them into their right places. This involves the coupling and uncoupling of the waggons. Passenger waggons have a screw coupling by means of which they are screwed up together, so that the buffers press firmly together, and thus jolting is avoided. But goods waggons have no such luxurious appliances, nor have they in all cases spring buffers. The coupling is simply a ring hitched into a hook at the end of a three-link chain, and on the starting or stopping of a goods train any one may hear the succession of slams with which the waggons clash together. When it is necessary to shunt, an engine pulls the waggons along to the place where they are to be detached. While the tension is on, of course, it would be impossible to unhook, therefore the engine stops suddenly. For an instant the waggons by their momentum go forward, bumping up against the engine and one another. For that instant, and until the rebound takes place, the hooks are free, and a skilful man, generally with a pole, and but rarely running in between the waggons, neatly slips the ring off the hook. This is all done while the waggons are in motion, so that he has to run alongside the train, skipping over the signal wires and hopping over the cross rails, keeping his eye always on the coupling, and sometimes encumbered with a pole in one hand, and at night with a lamp[197] in the other. If he does not look out he may fall between the wheels, or be run down by the engine. And while engaged in his work express and other trains come tearing down the main line, exposing every one to the risk of being run over. Therefore in all goods sidings it is desirable in the interests of safety that the through traffic should be as small as possible, that there should be plenty of room between the lines of rails, that wires and other obstacles should be boarded over where possible, and that there should be a good light at night. But many sidings are greatly crowded; the work has to be got through rapidly, and accidents are the result. On the other hand, in the private sidings of collieries operations are leisurely; no express trains come along the line, there is no night labour, and consequently the accidents are very few. In America until lately the means of coupling waggons were more imperfect than those in England; many accidents therefore occurred, and the trains frequently broke asunder.

In order to expedite work and promote safety, experiments were made in 1868 with automatic couplings which should close like a snap-lock. American waggons differ from those in use in England, in that they are longer and larger, and have a central buffer. In 1874 the public attention was called to the great number of railway accidents, and in the more civilised states, such as Massachusetts, a movement arose for the compulsory employment of automatic couplings. Finally a coupling was devised, very like a hand with the fingers bent, and a hinge at the knuckles. When two waggons were brought together the hand caught automatically into a similar hand on another waggon, and could be released by withdrawing a pin. At first these couplings were badly made; gradually, however, they improved, and are now on the fair road to perfection. They were gradually introduced upon one railway after another. The rich eastern States took the lead, the wild west was more slow; but curiously in proportion as the couplings were adopted, so did railway accidents become less. It would be wrong to conclude that therefore the whole of the diminution of accidents was due to the adoption of couplings. But it is a fair inference from the state of railway management in the east and west of America to conclude that with careful management and State-imposed regulations, accidents can be very materially reduced.

This was the state of the problem in 1898, in which year Mr Ritchie, then President of the Board of Trade, determined to make an effort in favour of safety. For this purpose he commissioned[198] Mr Hopwood, the Assistant Secretary of the Railway Department, to visit America and examine the system of coupling there in use, and its effects in preventing accidents. In December 1898 Mr Hopwood presented his memorandum. He says (quoting the Railway Times), “Our Railway Companies’ Association still lacks the moral force, to say nothing of the initiation which characterises its sister body across the Atlantic.... This view fairly reflects the opinion I formed that the progress made in the United States is greatly due to the fact that the American Association has taken great trouble, and the railroads have not spared expense in order to give a trial to promising inventors,” and he concludes by recommending that Parliament should be asked for powers to be given to the Board of Trade to order the use of a suitable coupling. In accordance with the recommendations in this very able report, the President of the Board of Trade introduced a Bill providing for the compulsory use of steam brakes for engines, and automatic couplings for carriages and waggons, also brakes on both sides of waggons, and labels on both sides of waggons, but giving to the companies two years and five years respectively to introduce these improvements.

The Bill was introduced by Mr Ritchie on 27th February 1899. He said, “I am afraid that whatever we do, a number of accidents amongst railway servants will continue to happen. They are engaged in extremely dangerous operations, and necessarily many accidents must and will continue to occur. But, sir, if it is possible by legislation or otherwise to take means to reduce the number of accidents, I think it is the bounden duty of Parliament to take those means.” Of course this announcement caused considerable agitation in the railway world, and on 16th March a deputation of the private waggon owners of the United Kingdom pressed upon the President of the Board of Trade the necessity for further inquiry. Mr Ritchie endeavoured to meet the current of opposition which his proposals had aroused, by offering to make it clear that the portion of the Bill dealing with automatic couplings should not come into operation until a satisfactory coupling was found, but he ultimately decided to withdraw the Bill and refer the whole question to a Royal Commission. He determined, however, that the inquiry should be an effective one, and therefore he enlarged its scope, and referred to the Commission not merely the question of coupling, but the whole question of accidents to railway servants and the means of preventing them. This action had very important[199] consequences, as will presently be seen. He selected as Chairman Lord James of Hereford, who had already done excellent work as the mutually-accepted arbitrator in various disputes between capital and labour, and whose disinterestedness and fairness could be relied on. The Commission was composed of members of the House of Lords and Commons, representatives of the railway companies, private waggon owners, and railway servants, experts and Government officials. It was supposed in some quarters that the question had been comfortably shelved for at least three or four years. But the Chairman took a very different view of the position. With almost unexampled energy, he assembled the first meeting on 16th June 1899, a fortnight after the warrant appointing the Commission had been signed. The last witness was heard on 3rd August, and the report was presented to Her late Majesty the Queen on 20th January 1900.

From the very mixed character of the Commission, it might have been expected that views would differ, and that it would have been difficult to draw a report that would be signed both by the railway companies’ representatives and by the representatives of the men. But the report was unanimous, and what was more remarkable still, it went far beyond the proposals of Mr Ritchie for couplings, and dealt not only with these, but proposed a means of preventing all accidents whatever. The principle that lay at the whole root of the report was the assimilation of means to prevent railway accidents to those already adapted for the prevention of similar accidents in factories and mines.

In the Coal Mines Regulation Act, 1860, a procedure had been adopted of special rules in mines. The rules were to be agreed upon by the Secretary of State and the mine owners. If they could not agree, then arbitrators were to be named who were finally to settle them. This procedure was adopted in all successive Acts relating to coal mines. Being found useful, it was adopted into the Factory Acts in 1891 in all cases of specially dangerous trades, among others the cases of industries where lead poisoning, phosphorus poisoning, and other dangers are experienced. But by the Factories Act, 1901, an order of the Secretary of State, after hearing the parties, is now substituted for arbitration.

When the Royal Commission sat, the first question that arose was whether the accidents to railway servants were so numerous[200] as to constitute it a dangerous trade. Figures soon settled this point, and appear from the following table:—

From this it will be seen that while on the average work on railways is almost as dangerous as mining, yet where particular branches of it are considered, such as shunting, it is far more dangerous, and those who advocated a policy of non-interference found it impossible to explain their position consistently with the admission of the expediency of the existing factory and mine laws. It is impossible to put the matter more clearly than in the following short interrogation of one of the principal witnesses on behalf of the railway companies by the Chairman.

Q. 6374. Do you approve of a dangerous trade being inspected?—Yes. All dangerous trades?—Yes. For instance, merchant-shipping?—Yes. Mines?—Yes. Factories?—Yes. Textile and non-textile?—Yes. Machine shops on your railway?—Yes. The witness, however, contended that the case of railways was different from that of mines and factories, because railways were more amenable to public opinion.

Another witness who held these views was compelled to admit that the force of public opinion had not on all lines secured punctuality of trains. On the other hand, an argument was brought forward by Mr Gibb, the General Manager[201] of the North Eastern Railway Company, which deserves attention, because it exhibits a phenomenon that is frequently observed in industries. By a table he showed that the accidents on railways since 1872 had been decreasing in a ratio almost as fast as the decrease in mining and factory accidents. At first sight this would appear to show that accidents decrease as fast without legislation as with it. But it must be remembered that the Mines and Factories Acts had been some years in operation, and had already before this date effected their principal results, and that the accidents were far fewer than in the dangerous branches of railway service. Moreover, the reports of previous Royal Commissions on Railways had been followed by legislation, and by increased vigilance on the part of the companies. It was proved also that this decrease had not taken place in the dangerous branches, and that the number of deaths of men engaged in shunting had actually increased.

The position taken up by the railway companies deserves attention. Their representatives were confronted with a vista of increased wages, increased cost of coal, and a fall in profits. It was asking much to expect them to apply the knife to their own throats and vote that restrictions should be imposed upon them. As a rule, although we all believe in the necessity of compelling others to do right, few people can be brought to believe that it is needful that the same principle should be applied to themselves. And yet, to the everlasting credit of the railway companies, it must be said that as soon as they were convinced that a case for intervention had been made out, they acquiesced in it. And the waggon owners, although the accidents on private lines were exceedingly few, withdrew their objections. In the result a report was unanimously signed, recommending that in the case of all dangerous trades of railway service the Board of Trade should have power to propose regulations which in case of dispute were to be settled by the Railway Commissioners.

The question of the possibility of automatic couplings was discussed before the Commission. If it had been fully gone into, the question would have taken years to consider, and, without experiments, no conclusions could ever have been arrived at. But with great tact Lord James determined that unimportant issues should be eliminated. He referred the question to a strong subcommittee, and before the Commission had gone far it was seen that it was quite possible to deal practically with railway accidents, without first determining whether or no there was a practical[202] automatic coupling. No definite opinion on this question was expressed by the Commission.

To give effect to these recommendations Mr Ritchie introduced a Bill into the House of Commons. It was taken charge of by Lord James of Hereford in the House of Lords, and with some amendments it passed both Houses without opposition. The effect of this Bill is to bring dangerous processes on railways under regulations similar to those which can be made in the case of dangerous processes in factories and mines. No particular operations are specified; there are powers to meet all dangers as they arise. It is too much to say that this Bill will not need amendment, but it must be a source of satisfaction to the late President of the Board of Trade and his officials to have inaugurated, and successfully carried through with the unanimous consent of all interested parties, a scheme of legislation which brings railway labour within the circle of protected industries, and which establishes a fundamental principle so wide as probably to dispense with the necessity for further legislation upon the subject for many years.

Henry Cunynghame.

Amidst the variety of dangers which attend those who are employed in factories none occupies so prominent a position as that arising from machinery moved by mechanical power; others, such, for instance, as periodical outbreaks of industrial poisoning or the occurrence of disastrous explosions, may from time to time attract public attention more vividly, but we have only to refer to the statistics issued annually by the Home Office to perceive how ever present and ever recurrent are the risks incurred by factory workers from machinery. From these statistics it appears that during the year 1899 there occurred in factories 301 fatal and 19,321 non-fatal accidents, all attributable to machinery moved by mechanical power. Beyond, however, stating that the numbers are the highest yet recorded in any one year, no useful purpose would be served by comparison with former years, or by inquiry as to the reasons of the increase in spite of legislative and executive requirements for safe-guarding. The Factory and Workshop Act of 1895 introduced such an entirely new element by the inclusion of every dock, wharf, warehouse, laundry, etc., in the definition of the term “factory,” that any comparison would be entirely misleading, whilst the facilities afforded in recent years by the introduction of, and improvements in, gas engines have added largely to the number of small factories using mechanical power, and therefore to the number of persons brought into direct contact with machinery. The statistics quoted are, however, in themselves sufficient to establish the importance of the subject of safeguards and the prevention of accidents.

In searching for the causes of such a large number of annually occurring accidents they are found to be various, but after enumerating several, such as carelessness on the part of operatives, unsuitable clothing, insufficient lighting, etc., there remains a very considerable proportion directly attributable to the absence of proper safeguards. It is with this cause that this paper proposes chiefly to deal.

[204]

With a view to prevention of such a distressing number of accidents, Parliament has, from time to time, passed enactments requiring certain steps to be taken for safe-guarding machinery, and the appointment of Inspectors has been made for the purpose of seeing that these provisions are duly carried out. Much, however, still remains to be done, not only through further legislation, but also by enforcing the requirements of the law as it at present stands. The latter course at first sight might appear to be feasible enough, but in reality it is a Herculean task, as difficult to accomplish as the destruction of the many-headed hydra of ancient fable, and is due to the fact that as fast as the requirements of the law are insisted upon and carried out in the case of machinery already existing in factories, so fast do makers of machinery send out new machines in a similarly defective condition. If the desired finality is to be arrived at, it must be by pressure brought to bear upon machine makers. At present machinery does not come within the provisions of the law as to safety till it is in actual use, when the attention of the user is perhaps first drawn to its defects by the occurrence of an accident. Much, no doubt, could be done were purchasers in all cases to insist on due regard being paid to this point by makers, but experience shows that this is done in very few instances. Whilst some parts of prime movers and mill-gearing must necessarily be fenced after being placed in position, there is no reason whatever why the effectual guarding of cog-wheels, the countersinking of set-screws, the provision of loose pulleys and strap forks, and the substitution of plate wheels for exposed arm wheels, which are all intrinsic parts of machines, absolutely necessary for ordinary safety, should not be dealt with in the first instance by makers who can provide more effective and neater guards at a much less cost than the user.

The subject of safe-guarding machinery is such a wide one that it will be impossible, within the limits of this paper, to do more than briefly touch upon the more salient points which naturally present themselves to one accustomed to inquire into the causes of machinery accidents. For this purpose it will be most convenient to deal with machinery under the four following headings:—

Each of these divisions is separately dealt with by the provisions of the Factory Acts, but it should be pointed out that whereas belts[205] have herein been coupled with mill-gearing, yet by Section 37 of the Factory Act of 1891, all “driving straps and bands” are expressly included in the term “machinery” and are therefore subject to the provisions laid down for the third division.[48] They are, however, so intimately connected with mill-gearing as more properly to belong to that class, and they will therefore be more conveniently dealt with in connection with mill-gearing, between which and the machine tools themselves they are the connecting link.

Prime Movers.—Prime movers are of various kinds, consisting of heat engines, such as steam, gas, and oil engines, electric and hydraulic motors, water-wheels, turbines, and wind-mills. Of these, those most commonly found in factories are steam and gas engines. The provisions of the Factory Acts as to safe-guarding prime movers are absolute. No matter what its position, every part of an engine moved by mechanical power is required to be securely fenced, and such fencing must be constantly maintained. Thus:—

Such absolute provisions, if strictly carried out, should be amply sufficient to prevent almost all accidents arising from prime movers; but the danger lies in the fencing being in the first instance insufficient, or not properly and constantly maintained, in accordance with Sec. 10 (d) of the Factory Act of 1901. Accidents caused by prime movers are, of course, restricted in number, partly owing to the fact that they are usually in the sole charge of one man, and partly because, in the case of steam engines at least, they are generally placed in a house or compartment set apart for them, but it will be noted that the words “whether in the engine-house or not” are expressly used for the protection of the engine attendant himself.

Occupiers of factories, owing to their absolute obligation to fence securely every part of a prime mover, and to their liabilities for any neglect to do so, should be specially careful to see that the law is fully carried out before an engine is put into use;[206] whilst no exception should be tolerated for a moment by those whose duty it is to enforce the requirements of the law.

The necessity of fencing being thus absolutely enjoined for every portion of a prime mover, the only point that remains is as to what constitutes secure fencing. Types of engines, however, are of so various a character, and the local surroundings so distinct, that it must suffice for the purposes of this paper to point out what parts of an engine are most liable to cause accidents, and, generally, the most approved steps which should be taken for their prevention.

Steam Engines.—As regards steam engines, all parts on the floor or platform level, such as fly-wheels and fly-wheel pits, crank and crank-pits, crank shafts, connecting rods, cross-heads, etc., should be securely fenced by means of rail fencing, whilst in the case of large vertical or beam engines, all stairs, platforms, and stagings should be efficiently guarded in similar manner. The fencing adopted should consist of double rails, the upper one being not less than 3 feet in height, whilst in many instances a skirting board 5 to 6 inches in depth should be added; single rails are either so high that persons may slip under them, or so low that they may fall over them. Care should also be taken that no railing be placed within a foot of the moving parts, the placing of such rails too close thereto being a source of great danger; whilst, on the other hand, the practice of leaving so much space between any moving part and the guard as to allow of a passage between them is equally to be condemned; moreover, the keeping of oil-cans, tools, etc., or the hanging up of clothes within the space fenced in accordance with statutory obligations should be absolutely forbidden. Other parts of steam engines requiring fencing which may be mentioned are piston rods prolonged through the end covers of cylinders, governor balls encroaching on a passage, and pinion wheels operating the governors.

Gas and Oil Engines.—The use of prime movers of the gas engine type has enormously increased of late years, adding greatly to the number of small factories as distinct from workshops. The safe-guarding of these, though they are relatively much smaller than the generality of steam engines, is none the less essential, for whereas the latter are usually placed in an engine-house specially built and separated from the factory itself, the former are in numerous instances placed within the factory, in some cases with a wooden compartment erected round them, and in others with nothing but the statutory fencing[207] separating them from the rest of the works. Where these compartments are large enough, similar railing to that described above for steam engines will be found sufficient, but in many instances they are so confined as to necessitate more complete fencing in order to comply with the requirements of the Acts as to fencing securely any fly-wheel, whether in the engine-house or not.

Fig. 1.—Strong’s “Standard Guard” for engine fly-wheels.

Wherever possible gas engines should be placed in a room set apart for them, so as to be isolated from the approach of unauthorised persons; those situated in the machine room of a factory are not only a source of danger to those employed therein, but so contaminate the atmosphere as to necessitate the provision of a fan to remove the fumes. In many cases, owing to the confined space of the engine compartment, or to the fact that the fly-wheel is in an exposed position facing into the machine room, a complete wire-work guard should be provided; these can be made either to slide, swing, or to be lifted so as to suit local surroundings; an illustration of such guards is shown in Fig. 1. Shaft ends projecting into passages should be fitted with metal caps so as to avoid the danger of clothing being caught. The common practice of starting a gas[208] engine by hand, by pulling round the fly-wheel, is also attended with risk, but this can be avoided by the use of a starting handle, Fig. 2.

Fig. 2.—Safety starting-gear for gas and oil engines. The gear can be attached to either end of the shaft.

Other Prime Movers.—Very similar rail-fencing to that described above for steam and gas engines may be applied in the case of other prime movers where electricity or water provide the moving power. As regards water-wheels, it should be noted that, although situated in a wheel-house, the same obligation to guard securely prevails as in the case of a steam engine, and in every instance the wheel-race must be fenced close to its edge.

As for turbines and wind-mills, the most dangerous parts requiring to be fenced will be found to be toothed gearing and shafting.

Electrical Generators.—The special risks attendant on electrical generators from shocks scarcely perhaps come within the scope of this paper. Ordinary rail-fencing may be relied upon for protection of moving parts, though the railings should be made of some non-conducting material such as wood.

Mill-Gearing.—Mill-gearing is defined by Section 156 of the Factory and Workshop Act, 1901, as comprehending—

The provisions of the Factory Acts bearing on mill-gearing enact that:—

Accidents caused by mill-gearing and belts are not only amongst the most numerous, but certainly amongst the most[209] serious of all those to which persons employed in factories are subject, and yet nearly all such may be avoided by strict observance of the precautions proposed to be set forth herein.

Fig. 3.—Coupling with dangerous projecting bolt-heads.

Fig. 4.—Safety Coupling with countersunk bolt-heads.

Fig. 5.—Collar with dangerous projecting set-screw.

Fig. 6.—Collar with countersunk set-screw.

Mill-Gearing.—First, as to construction and position, whilst the distance between the bearings which support a shaft must vary with the weight of the shaft and pulleys, and tension of the belts, it should never exceed 13 feet, and in order to comply with the requirement of the law quoted above, both shafting and pulleys should, wherever possible, be not less than 7 feet above the floor, otherwise the obligation to fence prevails. Shafting of considerable length is composed of separate parts connected by couplings. These couplings should always be near a pedestal and not in the middle of a span, and should invariably present a perfectly smooth surface, free from bolts or screws, which are liable to catch the clothes of workmen—the old-fashioned couplings with projecting heads of bolts and screws (Fig. 3) are the worst possible form; there are many kinds without any projections whatever (Fig. 4). Ends of keys fixing the pulleys or bevel wheels on to the shafting should either be cut off or protected by a key cover. All set-screws fastening collars to the shafting should be countersunk (Figs. 5 and 6). In fact it should[210] be an absolute rule that projections of every kind should be removed from shafting. The dangers of shafting, however, do not cease with projections: it is an established fact that perfectly smooth shafting is highly dangerous; should the shaft be greasy or his clothing damp, a workman may be caught by a perfectly smooth shaft. That being so, no one should ever be allowed to come into direct contact with shafting in motion: cleaning or lubricating should only be done when it is at a standstill.

Access to Shafting.—Where shafting is of the requisite height named above, no further protection is required round the shafting itself, but seeing that it is necessary at times to reach it, proper and secure means of access should be provided. This can be done either by a service platform, when the shafting is very high, or by ladders adapted for the purpose. A service platform, whilst providing easy access to shafting, should keep the attendant at a safe distance from it, and at the same time guard against his falling. With a view to this it should be provided with a hand-rail not less than 3 feet in height, and a skirting board of 5 to 6 inches in depth to stop the foot in case of slipping. Ladders should invariably be supplied with hooks at the upper ends and spikes at the lower, the latter where the nature of the flooring permits. In no case, however, should an attendant be allowed to fix a ladder against a wall so as to place himself between the shafting and the wall.

Fencing of Low Shafting, etc.—Where, however, shafting and pulleys are not of the desired height above the floor, the obligation to fence both arises. When shafting is near the floor it should be completely covered by a sheet-iron or wooden casing, and the pulleys fenced so as to afford a safe passage for workmen by either stepping over the casing or crossing it by means of steps according to the height from the floor. Shafting from 3 to 6 feet above the floor should be protected by a secure rail preventing access to it except by passages so arranged and boarded as to prevent any contact with the shafting. Vertical shafts should in every case be surrounded by a sheet-iron or wooden sheath firmly fixed.

Pulleys.—Whenever driving pulleys are so situated that a workman has reason to pass near them, they should be securely fenced by means of boards or metallic netting, and it is desirable to fill up the pulleys with a disc of wood or sheet-iron fastened to the arms by means of screws. Loose pulleys should not be placed on the shafting itself; lest they grip the shaft and carry the belts round with them, but should be mounted independently.

[211]

Driving Belts.—Driving belts are a constant source of accidents. When a belt has been thrown off its pulley it should never be allowed to rest upon the shaft; when in that position it is liable to be wound rapidly round the shaft, carrying with it anything with which it comes into contact. This danger is easily avoided by means of a belt rest or hook fixed according to available surroundings. Another fruitful source of accidents through belting is the method in which they are joined; one should always be selected which presents no projections capable of catching clothing or dealing severe blows. Accidents have frequently occurred in both ways; hence the necessity of avoiding all projections on belting.

Shipping of Belts.—Accidents constantly occur during the shipping of belts. Workmen should be absolutely forbidden to put a belt on to a pulley by hand whilst the shaft is in motion at its full speed. It should be stopped altogether, or at least be greatly reduced in speed, in which latter case a man should be ready to complete the stoppage at once in case of danger occurring.

Belt Poles.—Where it is desired to avoid stoppage of the engine or shafting, belts should in all cases where possible be put on to the pulleys by means of a belt pole. It should be carefully borne in mind, however, that a short belt pole is in itself a source of danger, owing to its liability to deal a severe blow in case of the pin of the pole becoming in any way entangled; fatal accidents have occurred in this way, and therefore it is most important that the length of the pole should be nearly equal to the distance of the shafting from the floor, thus forcing the workman to hold it at his side instead of in front of him. In cases where, for some reason or other, a belt pole cannot be used, the necessity of stopping the shafting in order to put on the belt by hand may be avoided by means of an appliance termed a belt shipper, of which there are a number of types, and which enable a workman to ship a belt with the shafting in motion whilst he is standing on the floor.

Protection of Belts.—Owing to the danger arising from clothing being caught by belts, it is desirable in many cases to protect them; thus belts passing through floors should in all cases be surrounded with a casing of wood; oblique or horizontal belts should be protected by a railing preventing access to them, or by a trough below the belt securely fixed; the same remarks will apply to driving ropes, whilst the splicings of the latter should be frequently[212] examined, owing to their liability to break and cause serious accidents in falling.

Bevel Wheels.—Bevel wheels on shafting should be encased with sheet-iron cover, with one of its faces opening for purposes of oiling.

Means of Stopping Machinery.—Many of the most serious accidents through mill-gearing and belts might be avoided if means existed for stopping the machinery quickly. When it is necessary to go to the engine-house to warn the engine driver to stop the engine, the mischief is done before this can be effected; some means, therefore, should be at hand to stop the machinery at once. In choice of the method by which disconnection is to be accomplished, preference should be given to one which brings it into play from many parts of the factory by mechanical or electrical means, whilst in some cases a brake acting upon a special pulley is provided and brought into play at the same time by the same means. The stoppage of the engine or the disconnection of the main shaft is attended by the disadvantage of stopping the whole of the machinery in the factory, and it is better, therefore, to disconnect each driving shaft individually, thus stopping the machinery in one room only. The disconnecting arrangements which are open to selection are numerous, but mainly consist of two classes, viz., toothed and friction clutches; of these preference may be given to friction clutches for various reasons.

Lastly, with regard to mill-gearing, its care should be entrusted to special and experienced men, and no one else should be allowed to interfere with it. Attendants should, as far as possible, only approach it when it is at a standstill, and their clothing should invariably consist of tight-fitting jackets or jerseys, with nothing whatever loose about them.

Machine Tools.—Having thus disposed of the two first main branches of our subject, viz., prime movers which supply the motive power, and mill-gearing and belts which transmit it, it remains for us to deal with the vast number of machines to which the motive power is communicated and by which the manufacturing processes are carried out. These are so numerous that it would be useless to attempt to deal with them individually in this paper. It will, however, be possible to set forth certain rules which should invariably be observed in order to minimise the risks which at present unnecessarily present themselves to those whose duty it is to attend to machine tools. Whilst the danger of accidents from prime movers and mill-gearing is greatly restricted owing[213] to the fact that they are, or ought invariably to be, in the sole charge of a limited number of experienced persons, the machines themselves are attended to by large numbers of men, women, young persons, and even children. There is, therefore, the greater necessity for taking every precaution possible to prevent the occurrence of accident thereby.

The provisions of the Factory Acts with regard to machine tools are as follows:—

By these provisions it will be observed that machine tools are placed on the same footing as mill-gearing, but with the additional precaution that—

In connection with this latter provision it is important to notice that in the case of Pearson v. Belgian Mills Co., (1896), 1 Q. B. 244, it was held that the words “the same” in the section, refer to the machinery as a whole, whether fixed or in motion, and not merely to such parts of it as are in motion; the employment, therefore, of a child to clean the fixed part of machinery in motion constitutes an infringement of the Act.

Further enactments for safety in connection with machines are that—

The Acts also give powers to deal with dangerous machinery or parts thereof:—

Fencing of Dangerous Machinery.—With respect to the fencing of machinery in a factory, the importance of the words “all dangerous parts of the machinery,” which were superadded by Sect. 6 (2) of the Factory Act of 1891 to Sect. 5 (3) of the Act of 1878, should be carefully noted. Formerly there was absolute obligation to fence only in respect of prime movers and mill-gearing, whilst in the case of other machinery which an inspector considered dangerous, he was required by Sect. 6 of the 1878 Act to serve notice to fence on an occupier, who was empowered, if he thought fit, to have the matter determined by arbitration. Now the obligation to fence extends to all dangerous parts of the machinery, and the question whether it is dangerous or not has to be decided by the Court in each case. In connection with this it should be noticed that in the case of Hindle v. Birtwistle (1897) the Court of Queen’s Bench held that the enactment applies to all machinery from which, in the ordinary course of working, danger may arise by reason of carelessness on the part of the workmen, or of external causes. It should therefore be sufficient, in order to prove the dangerous character of any part of a machine, to show that accidents are frequently caused thereby.

In propounding certain rules for safety, which should be carefully carried out in the construction of all machines, it may be pointed out that these are not based upon mere opinion, but on the experience and statistics of many years.

Set-screws.—It has been one of the most pernicious habits of almost all machine makers in this country to send out their machinery bristling with projecting set-screws, etc., which are not only unsightly, but also the frequent source of accidents through catching clothing. They are often situated either on or in close proximity to shafts, spindles, collars, or cog-wheels,[215] whereby the dangers attendant on these are greatly enhanced. Hence our first rule, which should be absolute respecting all machinery, should be: (1) No projections shall be allowed on anything that revolves. There are various methods of avoiding such projections by countersinking or otherwise, of which illustrations are given above (Figs. 7 to 9).

Fig. 7.—Shows a safe form of set-screw (s), which is deeply recessed, and can only be adjusted by a box key (k).

Fig. 8.—For use with screwdriver.

Fig. 9.—Halstead’s Patent Unbreakable Square-hole Solid-ended Grub Screw. For use with square-ended key, similar to railway carriage key.

[216]

Fig. 10.—Incomplete guards for spur wheels. (The points of danger are marked A, A and B, B respectively.)

Fig. 11.—Spur wheels with suitable guards (G, G). (The arms of wheels may be covered with discs if needed).

Toothed Wheels.—Toothed wheels are probably the cause of more accidents than any other portion of a machine, and their protection has been and is still sadly neglected. They are frequently sent out by makers either with no guard whatever, or[217] with such an inefficient guard as only to partially cover the wheels, thereby doubling the danger to be met by forming two points of junction between the wheels and the guard instead of one only presented by the wheels themselves (Figs. 10 to 12). Our second rule should therefore be: (2) All toothed wheels shall be so effectually covered as to leave no danger between the guard and the wheels.

Fig. 12.—Shows a good form of guard (D, D) to cover bevel wheels (E, E).

Shaft or Spindle Ends.—Machine makers frequently leave projecting shafts or spindles at each side of a machine so as to allow of choice in the arrangement of pulleys. These are frequently a source of serious accidents, and our third rule should be: (3) All exposed shaft ends shall be securely covered. This can easily and simply be done by means of a metal cap fitting sufficiently close to revolve with the shaft, but which will instantly stop on clothing, etc., being caught by it (Fig. 13).

Fig. 13.—Shows a method of covering shaft ends with a sheet-metal cap (G).

Loose Pulleys and Strap Forks.—Most machines are now supplied by makers with loose pulleys and strap forks, but exceptions can[218] be found, more especially in the manufacture of cotton, in the case of carding engines and drawing frames; on the former, though loose pulleys are invariably supplied, strap forks are in most instances absent, thus necessitating the moving of the belt from one pulley to the other by hand or by a stick, a very dangerous proceeding, causing frequent accidents. The most dangerous point is where the belt first touches the driving pulley, and this is guarded where a well-arranged strap fork is provided. In the case of drawing frames both loose pulley and strap fork have generally been omitted, with the result that the undershaft cannot be stopped for cleaning without throwing the belt off by hand, causing additional danger in replacing the belt on the pulley. Our fourth rule, therefore, should be: (4) Loose pulleys and strap forks shall be provided for all machines.

Plate Wheels.—Arm wheels running at high speed are frequently the cause of accidents. Such are specially found in the balance wheels of power looms, the rim pulleys of self-acting mules, and the speed wheels of platen printing machines. These wheels can in almost all cases be made safe, and our last rule should be: (5) Plate wheels or wheels filled in shall be substituted, wherever possible, for arm wheels running at high speed (Fig. 22).

Each of these rules relate to intrinsic parts of the machines, and should therefore be dealt with by the makers themselves, who can carry them out with little or no extra cost at the time of making. Unfortunately, however, it has been in many instances the practice to have one type of machine for the home, and another for the foreign market, the latter with much more efficient guards, owing to the stricter laws which prevail in certain countries as to the occurrence of accidents.

Hoists.—We now come to the last head of our subject, viz., the safe-guarding of hoists and other lifting tackle. The requirements of the Factory Act as to these are absolute.

The importance of this enactment may be gathered from the fact that in 1899 there occurred 27 fatal and 315 non-fatal accidents from hoists alone, whilst other lifting tackle was responsible for 66 fatal and 1497 non-fatal. Parliament has fully recognised[220][219] the dangers arising from this class of machinery by the omission, in the Factory Act of 1891, of the limitation contained in the Act of 1878, “near to which any person is liable to pass or be employed,” thus placing hoists on precisely the same footing as prime movers, the fencing of which, as shown above, is absolutely compulsory.

Fig. 14.—Knowles’ Improved Safety Hoist.

Cage hoists are most frequently found in factories, and in these the cage should invariably be roofed over, whilst each side of the cage should be cased in, except that used for exit, thus avoiding danger from anything falling down the hoist-way, and also from projecting obstacles therein. On each floor the hoist-way should be guarded by doors not less than 5½ to 6 feet in height. The single bar or chain which used so frequently to be found is a constant source of danger from persons looking down the well and being trapped between the bar and the bottom of the cage. Falls down the hoist-way through absence of any protecting gate, through the latter being carelessly left open, or owing to the cage being moved to another floor without warning, frequently occur. For perfect safety hoists should be in the sole charge of a special attendant, whose duty it should be to travel with the cage, opening or shutting the doors at each landing as required, the fastenings of which should be accessible only from the inside. Otherwise, automatic gates may be used, so adjusted as to open on the arrival at, and close on the departure of the cage from, each landing; it should not be practicable to open these from the outside, and where there is not sufficient headway for a gate six feet in height, it may be made to telescope.

There are several patent hoists which answer to this description in greater or less degree, but we must content ourselves here with an illustration and description of one of the best methods of safe-guarding hoists, viz., by means of the Knowles safety locking gear for cage hoists (Fig. 14).

Careful attention should be paid to the gear for suspending the cage, in order to prevent accidents from the breaking of the ropes and the precipitation of the cage to the bottom of the hoist-way. For greater safety two wire ropes should be used, which should be periodically and systematically examined. Some one of the various safety gears for arresting the fall of the cage should also be adopted; in this connection we give an illustration (Fig. 15) of “Morgan’s patent safety catches,” which sustain the cage in case of the hoisting ropes breaking through some mishap. In the matter of safe-guarding hoists, also, we are far behind other[221] countries where the law compels employers to provide safety catches and doors for every cage hoist.

Teagles.—Hoisting of goods is often performed by means of a teagle either outside the buildings of the factory, or inside through openings in the floors. In the latter case these openings in each floor should be securely railed; whilst in the former the attendant should invariably be supplied with a safety belt, strong enough to suspend him in the air should he fall. In case, however, of an outside teagle, the dangerous and laborious work of swinging the goods into the room can be avoided by the use of a self-landing and delivering hoist (Fig. 16), which will not only lift goods off the lorry and take them into the room, but will also pick them up inside the room, travel with them outside the doorway, and lower them on to the lorry.

Fig. 15.—Morgan’s Patent Safety Catch.

Cranes, Winches, etc.—Although the Factory Acts deal specifically only with “hoists” and “teagles,” yet the numerous accidents mentioned above as attributable to other lifting tackle, plainly point to the urgent need for safeguards, and care in its use. The provisions of the Acts as to hoists are of long standing, and were enacted when the term “factory” did not embrace every dock, wharf, quay, warehouse, and building in course of erection. Great care, however, should be taken to securely fence all bevel wheels of cranes, winches, etc., and periodical examination of all chains, ropes, etc., should be strictly carried out. It should be[222] remembered that steam cranes partake of the nature of the two first divisions of our subject, viz., engines and mill-gearing.

Fig. 16.—Wadsworth’s Self-Landing and Delivering Hoist.

Fig. 17.—Self-acting Mules. Guards for the drawing-out band, and pulley at the out end of frame. Shows unsatisfactory guard (A).

Fig. 18.—Shows a guard which completely covers the band round pulley (C, D).

In the preceding pages some pains have been taken to set forth certain regulations which should equally apply to all[223] machinery. It has been shown that the provisions of the law as to fencing prime movers and hoists are absolute, and equally so those applying to mill-gearing unless it be in such a position and of such construction as to be equally safe, as if it were fenced, whilst the machines by which the manufacturing processes are carried out are dealt with by means of the general instruction that “all dangerous parts of the machinery shall be securely fenced,” subject to the same reservation as to position and construction[224] as in the case of mill-gearing. Except in the instances of grinding in tenement factories, chaff-cutting machines, and perhaps it may be added, of self-acting machines, the law has not yet entered into any details as to safe-guarding machine tools. Apart, however, from general rules applicable to all, there remain certain machine tools which, owing to the nature of their construction and use, are peculiarly liable to the occurrence of accidents. For these special guards are necessary, and their invention and use have been spurred on by the liabilities of employers under the Compensation Acts. It would not be possible here to illustrate a tithe of these machines and the most approved guards invented for them, but it is proposed to select a few machines which are shown by statistics to be the most frequent cause of accidents, and the means by which these accidents may, in part at any rate, be obviated.

Fig. 19.—Self-acting Mules. Elevation—Foot-guard for carriage wheels. The guard (G) is fixed to the bracket (B), and surrounds the wheel (W) at a slight distance above the slip or rail (S).

[225]

Self-acting Mules.—Dealing first with our great textile industries, and specially with that of cotton, it will be found that by far the greatest number of accidents occurs in the mule-rooms. Owing to the complicated nature of their construction no one illustration could exhibit all the necessary guards for self-acting mules, but an analysis of the accidents caused by them shows that the parts which are the most fruitful source of injuries to workers are:—

For the first, incomplete and approved guards are shown in Figs. 17 and 18; whilst for the second, two types of guards in common use are illustrated in Figs. 19 to 21.

Fig. 20.—Hargreave’s Mule Carriage Wheel Guard.

Fig. 21.—Hargreave’s Mule Carriage Wheel Guard.

Looms.—Next to mules, power looms are the most frequent cause of accidents in a cotton mill. These present an excellent specimen of the dangerous character of exposed arm wheels running at high speed alluded to above. An illustration of safeguards for the ends of looms will be found in Fig. 22. During 1899 flying[226] shuttles were the cause of 1 fatal and 161 non-fatal accidents. Shuttle guards, of which an example is given in Fig. 23, are either[227] rigid or semi-automatic, but in either case great care has to be taken that they are not fixed too high on the slay cap.

Fig. 22.

FRONT

Balance Wheel removed, showing guard over spur wheels.

SIDE

Spur Wheels guarded at intake side.

FRONT

Balance Wheel (Plate Wheel) in position, guarding the crank and tappet wheels (toothed).

Fig. 23

Turning to non-textile machinery, probably no three classes of machine tools show so large an array of accidents as:—

Each of these classes present dangers peculiar to itself, and therefore needs special safeguards.

Fig. 24.—Elvatka Guard.

Circular Saws.—Circular saws during the year 1899 were responsible for 1289 accidents, of which 9 proved fatal. The[228] purposes for which they are used are so various that no one universal guard is practicable, but in all cases a riving knife should be provided at the back of the saw, whilst as much of the top and front should also be covered as circumstances will permit. Figures 24 to 27 show illustrations of a few guards which appear best to fulfil these requirements.

Fig. 25.—Longmore’s Guard.

Fig. 26.—Victor Guard.

[229]

Fig. 28.—Campbell and Greenwood’s Guard.

Planing Machines.—Accidents through planing machines are of frequent occurrence. They are often of such a severe nature that no planing machine should be permitted to be used without an efficient guard, of which an illustration is given in Fig. 28.

Fig. 27.—Woodhouse and Mitchell’s Guard.

Power Presses. Power presses like circular saws are put to so many uses that various forms of guards are needed to suit the variety of work. They are usually put into motion in one of two ways: either the plunger is released by means of a foot treadle or by a hand lever. Of these the latter naturally presents the fewest elements of danger, owing to the necessary position of one hand whilst using the lever. Additional safety has recently been imparted by the introduction of machines furnished not only with hand levers, but also fitted with slides obviating any necessity for either hand to approach the die.

[230]

Fig. 29 illustrates an approved guard for an ordinary tin stamping or cutting press.

Fig. 29.—Power Presses.

Fig. 14.—Description of Knowles’s Improved Safety Hoist.

Fig. 15.—Morgan’s Patent Safety Catch. (An improved safety gear for colliery cages, hoists, lifts, etc.)

H. S. Richmond.

Agriculture

(1) Labourers.—The manifold occupations included under the general term of tilling the soil, exercises a beneficial effect on the husbandman as regards mere length of days, for he often lives far beyond the allotted span, although he rarely comes to the end of his career a hale and hearty old man. His operations are carried out for the most part in the open air, leisurely, and in a greater or less degree of isolation. His condition, therefore, has its drawbacks as well as its advantages. As one of the oldest occupations of mankind it has been very largely adopted as a means of gaining a livelihood, and, until recently, the supply of farm labourers has exceeded the demand. It is badly paid; the farmer, at least in England, has many anxieties, disappointments and losses in his crops and stock; the labourer receives but small wages, and has perforce to put up with scanty living and poor accommodation. The living is made worse by the ignorance of cooking and domestic economy, which is so general amongst the wives and daughters of the labouring class. Field work begins early in the morning, and leads to exposure in all weathers. It is usually so monotonous, that it is unattractive to the better intellects amongst the lower orders; it is sometimes very hard, as during hay-making and harvest, and it is occasionally dangerous, as in hedging and ditching.

“Rheumatic” affections are foremost amongst the bodily ills of field workers, not often as acute rheumatism, but rather in some of the protean forms which affect the connective tissues. Osteo-arthritis, sciatica, lumbago, and valvular heart lesions are commonly met with. Indeed, the rheumatic affections of old age have been known for so long a time that Scapula, in his great lexicon, says, with doubtful, though picturesque, etymology, “Γέρων, the Greek word for an old man, has been derived by some παρὰ τὸ εἰς γῆν[233] ὁρᾷν, because old men by their stooping look towards the earth; though others, with more probability, derive it from the same stem as Γέρας, on account of the reverence due to age.” The etymology, whether right or wrong, draws attention to the stooping habit which is typically a senile kyphosis, though it is accentuated by occupation, and is found early in middle life in agricultural labourers, as often as in tailors, cobblers, clerks, Swiss mountain porters, and, latterly, in some bicyclists. True senile kyphosis or stooping arises from simple weakness and wasting of the tissues, with absorption of the intervertebral discs, and is not necessarily due to rheumatism. But amongst agricultural labourers, it is usually associated with osteoarthritic changes, which tend to unite the individual vertebræ by bridges of bone, whilst it thickens the spines and hardens the ligaments. The stage of anchylosis is often preceded by a period of inflammatory softening, which leads to more or less deformity of the vertebral column, for lateral curvature is nearly as common as the forward stoop to which the name kyphosis is given.

The same factors of hard manual labour, often in constrained attitudes and under unfavourable conditions of weather, produce other “rheumatic” affections, such as pains in the limbs, aching in the bones and stiffness in the joints, which disturb the comfort without lessening materially the wage-earning power of the rural population. No one can have attended the local fair or feast without noticing the peculiar shuffling walk, and the knock-knee of the ploughboy, the results respectively of flatfoot and over-growth, aided by badly fitting, uncouth boots, and a habit of walking over uneven surfaces.

The palmar fascia of the hand often becomes contracted—Dupuytren’s contraction—a condition whose cause is unknown, though it has been variously attributed to such predisposing causes as gout and rheumatism, or to habits and occupations necessitating pressure in the palm and flexion of the fingers, as in digging. The contraction usually begins in that portion of the fascia which is continued on to the sheath of the flexor tendon of the little finger, afterwards attacking the portion extending to the ring finger, and sometimes the remaining fingers. The fingers are thereby flexed and drawn down towards the palm, with which they may even be fixed in contact. This form of contraction may be distinguished from that due to a contracted tendon, by the puckering of the skin in consequence of its adhesion to the fascia, and by the contracting band bifurcating to be inserted upon either side of the flexor tendon,[234] whilst the contracted tendon is placed centrally, and can be traced under the annular ligament.

The kindness of the late Dr Tinley, and Dr Granger at Whitby, and of my brother-in-law Mr G. H. Fosbroke, the County Medical Officer of Worcestershire, has lately allowed me to examine the death returns of two typically rural districts. The chief causes of death are bronchitis, including pneumonia and pleurisy; heart disease, a very vague term covering a multitude of pathological conditions; and phthisis. The deaths from bronchitis and heart disease, in a period of ten years, are nearly equal in number, whilst those from phthisis were only half as many as either of the other two.

Typhoid fever is endemic in many districts, owing to the improper disposal of excrement, and from the use of polluted water in surface wells.

Some of the older countrymen living in the fen districts east of Cambridge still take opium regularly to keep off ague, and I have a working hypothesis that these same dwellers in districts which were once highly malarious are now more subject to cancer than persons who live in towns where the soil is drier and insects are fewer. Be this as it may, however, gardeners and those who have to handle soot in the course of their work are liable to develop epitheliomatous ulcers of the hand and wrist more often than those who are free from such source of local irritation.

Lunacy is increasing markedly amongst the rural population in some parts of the country, and notably in Ireland. This is probably due to the tide of emigration carrying away the more highly endowed and enterprising, whilst it leaves the old and those who are enfeebled in body and mind.

Agricultural labourers do not, on the whole, fare very badly. Even with low wages and bad sanitary surroundings, the social condition of the English farm hand compares most favourably with that of the peasantry in many European countries. The absence of the three great diseases epidemic amongst those who are reduced to the lowest depths of misery by chronic starvation, is a proof of this superior position. The three diseases are ergotism from the use of spurred rye; pellagra due to bad maize; and lathyrism caused by the consumption of the chick-pea.

Ergotism is rife amongst the rye-eating inhabitants of Germany, Bohemia, Sweden, Russia, and the central provinces of France. It occurs especially after rainy seasons, and the bread[235] made from the diseased rye is violet in colour, and of a disagreeable taste and smell. It is usually badly made and badly baked. The symptoms of ergot poisoning are either acute or chronic. The acute form begins with giddiness, headache, lassitude, and disturbances of sight and hearing, which have led to its being called “ergot intoxication.” The chronic poisoning is ushered in with symptoms of ergot intoxication, but the later stages are either convulsive or gangrenous. The convulsive form is marked by intermittent clonic spasms of the limbs, with dilatation of the pupil, delirium, and coma, which soon ends in death, without any appearance of gangrene. The mortification in the gangrenous form is preceded by pain in the part, with intolerable “creeping” feelings, followed by diminished sensibility, which ends in dry gangrene, and finally in separation of the affected tissues. The patients suffer occasionally from vomiting of blood, or from passing blood in the urine, the bleeding being as difficult to arrest as in hæmophilia.

Pellagra from the consumption of bad maize, truly known as the malattia della miseria, is epidemic in parts of France, Spain, Italy, Africa, and Brazil. It requires for its full manifestation a most wretched peasantry. Pellagra is characterised by headache, depression of spirits, sleeplessness, cramps, palsies, giddiness, and dyspepsia. There are vague but often severe pains in the spine and joints, and there is a skin eruption, which begins in April or May, and goes from bad to worse, until it begins to improve in July or August. The eruption is an erythema of the parts exposed to the sun. The skin becomes swollen and tense, with petechiæ and bullæ, which leave indolent ulcers when they break. The attacks recur in the spring of each year, until in time the skin becomes thickened and of a light sepia colour. The nervous symptoms culminate in a settled melancholia. The spinal cord appears to be definitely affected both in ergotism and pellagra, the posterior columns suffering chiefly in ergot poisoning, the lateral columns in pellagra.

Lathyrism results from the use of the chick-pea (Lathyrus sativus, cicer, or clymenum) as an article of diet. Like ergotism and pellagra, it is associated with extremely wretched conditions of life, and has been observed in France, in the Abruzzi, at Allahabad, and in other parts of India. Oxen, horses, pigs, and geese are attacked as well as men. The symptoms point to an affection of the lower part of the spinal cord, and are manifested by a sudden inability to use the legs in the ordinary manner.[236] The legs are so stiff that when the patient walks he is obliged to throw his body into a succession of curves, so that he describes a screw or figure of eight as he proceeds. There is much hyperæsthesia of the lower extremities, which may be followed by loss of sensation, though the patient complains of the same tingling sensations as are felt in ergotism. The onset is usually sudden, and is coincident with the advent of cold weather, but the symptoms take four or five weeks to reach a maximum.

The increasing use of machinery in ploughing, reaping, threshing, and other farming operations leads necessarily to a greater number of machine accidents than was formerly the case when labour was abundant and machines were few. Even small farmers now possess a chaff-cutter, and injuries to the hands and arms produced by its cog-wheels are correspondingly frequent. Much more serious injuries are caused by the large threshing and reaping machines, which are sometimes tended by unskilled persons, as they are often let out on hire. Overstrain from the lifting of loads in awkward positions during harvest is no uncommon cause of hernia in those who are otherwise predisposed to this condition. Poisoned wounds of the hand, and penetrating wounds of the eye, are often sustained in the occupation of hedging and ditching, a form of labour which is also the cause of rheumatism. Occasionally, too, an agricultural labourer presents himself with a viper bite, for vipers are still indigenous in several parts of England. He complains of a burning pain at the part bitten, the limb swells and becomes discoloured within an hour or two, there is great prostration marked by sweating, vomiting, feeble pulse, and restlessness. The more acute symptoms usually pass off in the course of twelve to twenty-four hours, but in unhealthy persons the swelling increases; there may be suppuration, and the bite then ends in a severe attack of inflammation of the tissues, known as cellulitis.

In like manner stings from bees, wasps, hornets, and gnats, which are usually of small importance, may become serious, either from the bad condition of the patient’s health, or from the position of the sting, as when the mouth or conjunctiva is affected. A tolerance is established for bee-stings and gnat-bites, as is shown by the very slight reaction which takes place in bee-keepers and the inhabitants of mosquito countries, as compared with the sufferings of a town-bred man who is stung by either of these insects.

[237]

In mushroom-poisoning the poisonous constituent is muscarin, a nitrogenous body allied to cholin. It causes vomiting, diarrhœa, and prostration, with convulsions and contraction of the pupil. Death may occur from syncope and failure of respiration, but such an ending is rare, except in children, because the vomiting promotes the evacuation of the poison. Atropin is the physiological antidote, and a subcutaneous injection of as much as ¹⁄₃₀ to ¹⁄₁₆ of a grain may be given hypodermically, whilst diffusible stimulants are administered by the mouth.

(2) Gardeners appear to suffer from many of the affections common to farm-labourers, except that as they receive higher wages they are better clothed, better fed, and better housed, and are thus able to withstand climatic changes more successfully. It is said, on the other hand, that gardeners are somewhat more liable to phthisis. Their work in hothouses causes them to catch cold more easily, and may thus increase any predisposition to infection by the tubercle bacillus. The handling of such plants as the Primula obconica sometimes produces a very troublesome erythema of the skin, whilst constant contact with fresh soil allows greater opportunities of contracting tetanus.

The Museum of St Bartholomew’s Hospital contains an interesting specimen, showing that the epitheliomatous form of cancer sometimes follows the irritation produced by gardening. The specimen consists of the hand and part of the forearm removed on account of a growth covering nearly half the surface of the skin. The growth is warty, very vascular, superficially ulcerated, and with an everted sinuous edge. It bears a close resemblance to an ulcerated cancer of the scrotum in chimney sweepers. The patient was forty-nine years old. Five years before the amputation of his hand he was employed as a gardener in strewing soot over the ground for several mornings in succession; a warty growth then formed, and it increased and ulcerated in the spring of both the following years, whilst he was similarly employed. After this, though he was no longer in contact with soot, the disease increased until the limb was removed. He recovered completely after the operation. The case is related by Sir James Earle in his edition of Percivall Pott’s works.

Dupuytren’s contraction of the palmar fascia is by no means uncommon in gouty and rheumatic gardeners as they become advanced in years. It is best treated by dissecting out the contracted bands, if this can be done without suppuration, the resulting scar being afterwards kept supple by daily massage.

[238]

Horses.

(3) Ostlers, Stablemen, and Cartmen.—This class of men, from their close attendance in stables, necessarily contract the diseases which are transmissible from horses to ourselves. Foremost amongst these diseases are glanders and farcy, of which I have seen several cases in veterinary students; and tetanus, whose bacillus is said to live in the horse’s intestines.

Glanders, in its acute or generalised pyæmic form known as farcy, attacks grooms, ostlers, coachmen, knackers, and veterinary surgeons, because they are brought into contact with diseased animals. It has also been seen as a result of accidental infection in the pathological laboratory during the preparation of mallein; in surgeons who have operated upon glandered patients, and even in washerwomen who have washed the clothes of those affected.

Glanders occurs in an acute form which kills in eight to fifteen days, and a chronic form said to last as long as eleven years.

Acute glanders in man has an incubation period of three to eight days, though the symptoms are occasionally delayed for three weeks, or they may appear within twenty-four hours, and suppuration may occur at the end of the second day. The patient complains of a general feeling of ill-health with headache, and such vague pains in the muscles and joints as lead him to think that he is about to have acute rheumatism. The symptoms increase in severity, and there is often sufficient gastro-intestinal disturbance associated with deafness and stupor to lead to an erroneous diagnosis of typhoid fever. The pulse is full and soft, beating 90 to 100 in a minute; the skin is dry; the mouth foul, and epistaxis is frequent. Swellings—“the farcy buds”—soon appear in the intermuscular planes near the joints on both sides of the body. The swellings are at first hard, but they quickly soften, point, burst, and leave large foul ulcers, which eventually contract into sinuses if the patient survive. The case may then be looked upon as one of chronic pyæmia, especially as rigors are numerous and severe, but all doubt as to the true nature of the disease is set at rest when the face becomes affected. The skin over the nose is reddened and swollen, whilst the mucous membrane is injected and discharges a fœtid secretion, clear at first, but soon becoming yellow, purulent, viscid, and finally blood-stained. Ulceration of the nasal mucous membrane occurs less frequently in man than in the horse. The conjunctivæ are often affected in a manner similar to the nasal mucous membrane, and the inflammatory[239] condition spreads to the pharynx, palate, and glottis. Dyspnœa, with pleuritic pain, may be a marked symptom of the disease, extensive gangrene may occur, and death follows.

Glanders is generally inoculated through a wound or abrasion, but the bacilli are able to penetrate to the uninjured lymphatics of the skin by way of the hair follicles, and in the case of two veterinary students who have been under my care the infection was directly traceable to their being sneezed over by a glandered horse they were examining. If a wound be the seat of infection it may heal, but in a day or two it becomes swollen and painful, an eruption of vesicles often appears round it, and the lymphatics become swollen and painful, though the glands are rarely affected. The skin, in some cases of farcy, shows erythematous patches like those of erysipelas or erythema nodosum. The patches become pustular or phlyctenular, or a pustular rash without umbilication may first be noticed. The latter form of rash is said to be of very grave significance, for recovery seldom if ever takes place when it makes its appearance.

Glanders affects many animals besides horses, mules, and donkeys. It has been seen in lions, leopards, tigers, and bears in various menageries; field-mice, guinea-pigs, and hedgehogs are highly susceptible. Infection may result not only from direct contact with the sick animal and its nasal discharge, but also from the pus, saliva, and milk. Food and drink may convey bacilli directly into the alimentary canal, which is thus affected primarily, the nasal mucous membrane becoming involved as part of a secondary process.

Chronic glanders may last for years, the patient suffering from acute but intermittent attacks of fever, in one of which he may die, or from which he may wholly recover. The skin in these cases is often the part chiefly affected. It becomes swollen and œdematous, with nodules, which only appear in one part and break down into indolent ulcers. The ulcers heal and leave scars which, with the destruction of the septum of the nose and the ulceration of the pharynx and soft palate, sometimes raise a suspicion of syphilis.

The disease depends upon the presence of the bacillus mallei and the toxic substances produced during its growth. The bacillus may be isolated from the abscesses, blood, enlarged skin follicles, and the ulcers. They are more easily recognised in properly stained “smear preparations” than in sections, and are readily cultivated in three to five days on acid potato media at a[240] temperature of 35° to 37° C. as a brownish, moderately thick and opaque growth. The active principle of the growth is “mallein,” which can be obtained as a syrupy fluid. Mallein injected into a glandered animal produces an inflammatory swelling at the seat of inoculation. The tumour is tense, painful, and very extensive. The lymphatics from the seat of inoculation to the neighbouring lymphatic glands become inflamed, and are painful, swollen, and sinuous. The local tumour increases in size for twenty-four to thirty-six hours, but does not suppurate unless septic organisms have been introduced at the time of the inoculation. It subsides slowly in eight to ten days. Inoculation is followed by a general reaction, which appears within eight hours of the time of injection, reaches a maximum in ten to twelve hours, and lasts twenty-four hours. The animal shivers and sometimes has well-marked convulsions. The test is a very valuable one for latent glanders in horses, and as mallein diluted with ten times its volume of a ½ per cent. solution of carbolic acid preserves its qualities unimpaired for many months, it is now largely used in all parts of the world. A healthy horse either does not respond at all to a much larger dose of mallein than will affect a sick animal, or else a small swelling appears at the seat of inoculation, which only lasts for twenty-four hours. Glandered men, in the few cases where it has been employed, show the same reaction to mallein as glandered horses. The Straus test is also valuable in the diagnosis of glanders. It consists in diluting the suspected secretion with sterile water, which is then injected into the peritoneal cavity, and beneath the skin of male guinea-pigs. The testes appear to swell two or three days after the injection, and the animal dies in four to fifteen days with acute inflammation of the tunica vaginalis, the testicles and epididymis being only rarely affected.

Acute farcy is very fatal, but 50 to 60 per cent. of the patients affected with chronic farcy recover. The treatment at present is most unsatisfactory. Stimulants and tonics must be given liberally. Every abscess must be opened and disinfected as soon as possible, and benzoate of soda may be administered in drachm doses three or four times a day. In chronic cases marked improvement is said to have taken place after the continued injection of mallein in doses of ¹⁄₂₀ to ¹⁄₁₅ c.c. at intervals of two or three days.

Tetanus, often called lockjaw, is due to the poison produced[241] by certain bacilli, which were first isolated by Kitasato, Tizzoni, and Cattani, in 1889. The micro-organisms are delicate threads with somewhat rounded ends, which reproduce by sporing. When the bacilli are about to spore one end becomes enlarged, and the organism resembles a pin or a drumstick. The spores are extremely tenacious of life, they resist the effect of high temperatures for an unusual length of time, they survive a temporary immersion in strong antiseptic solutions, and they have been known to retain their vitality for more than twelve months if they are protected from light and air. The parent bacilli are widely distributed in garden earth, in dust, and in the excrement of animals, especially in those of the horse, for this animal seems to be their natural host. They have been found, therefore, in stables and in manured fields, and they have the power of growing outside the body.

During their growth the bacilli produce a powerful poison, which is formed so slowly that it may take two or three weeks to produce its full effects. This poison is formed at the seat of inoculation, for the bacilli do not seem to travel far from the place where they are introduced, and it is generated more rapidly and abundantly in suppurating than in aseptic wounds. It produces its effect by a definite action upon the nervous system, and probably travels through the circulation, though there is still some doubt whether it does not reach the spinal cord by way of the nerves, so definite are some of its early effects. Tetanic symptoms can be produced by the inoculation of toxins, which have been purified of bacilli, and mice appear to be especially susceptible to the disease thus produced.

It will be clear from what has been said that tetanus is by no means rare. It may ensue from a wound at any part of the body, the wound varying in severity from a total crush to a slight abrasion which has passed unnoticed, and the case is then looked upon as one of spontaneous origin. It is especially frequent after injuries of parts which are usually dirty, and is consequently somewhat more common after wounds of the hands and feet. Though gardeners, horse keepers, and agricultural labourers often suffer, I have repeatedly seen cases in people who have been run over, and inoculated with the foul mud of an ill-kept London street. Horses, sheep, and cattle are also liable to infection. But on the whole tetanus has become less frequent, since an attempt has been made to keep wounds aseptic, or at any rate to shorten the process of suppuration.

[242]

The onset of the disease is usually marked by a feeling of general uneasiness and depression, unless the wound is too severe to allow of this manifestation. The first symptoms usually consist of a feeling of stiffness or soreness about the jaws and throat, with some tonic contraction of the platysma-myoides, causing the risus sardonicus, which is particularly well marked when the patient is asked to protrude the tongue. Spasms of greater or less severity then occur in the voluntary muscles, the pain varying greatly in different patients, though it is usually less than that of ordinary cramp. The muscles, especially those of the abdominal wall, are in a state of persistent tension in the intervals between the attacks, the tension being reduced to a minimum during sleep or anæsthesia produced by artificial means. The intellect remains undisturbed unless there is much fever. Death takes place from exhaustion as early as the third day in acute cases, but it is often postponed for a fortnight or three weeks.

The prognosis seems to vary with the rapidity of onset, for the mortality is great when the incubation is under ten days, whilst nearly half the patients recover if the symptoms do not appear for more than a fortnight after the injury.

The treatment is largely prophylactic. A wound contracted under suspicious circumstances, as when other cases of tetanus have occurred in the same village or stable, should be immediately rendered aseptic by a process of thorough cleansing. This is preferable to the use of the actual cautery, which leads to suppuration, and thus tends to increase the growth of the bacillus. When the initial symptoms appear, the injured part must be removed, as the wound is a local factory for the production of the nerve poison. Doses of antitoxin must be administered by hypodermic injection, and I prefer to do this by injecting it deeply into the gluteal muscles rather than into the brain or subarachnoid space, as is now the custom. The maximum dose of Tizzoni’s antitoxin is 40 c.c., which is equivalent to 2,500,000 units. This large dose may be given at once, 5 c.c. injections being afterwards given two or three times a day until the tonic contraction of the muscles has disappeared. The antitoxin appears to cure the slighter cases, and it produces a temporary relief in the most severe, but all the severe cases I have seen have died in spite of treatment.

Hydrophobia, the rabies of animals, is another form of poison acting upon the spinal cord, to which huntsmen and[243] stablemen are peculiarly liable from the nature of their occupations. The pathology of the disease, however, is much less clearly understood than in the case of tetanus. Dogs, foxes, wolves, and cats; horses, cows, and deer, may contract rabies and transmit it to man by the saliva, or more rarely by the milk; whilst monkeys, rabbits, and guinea-pigs are susceptible to infection. The latent period appears to vary enormously, as its limits have been given as fourteen days to five years, though the ordinary incubation period seems to be from three to six weeks, the length of time depending upon the ease with which the poison reaches the nerve sheaths, and passes along them to the nerve centres in the medulla and upper part of the spinal cord. There is no doubt, however, that the poison of rabies can be absorbed from the uninjured mucous membranes of the body, especially from the conjunctivæ and the nasal mucous membrane.

In the cases which I have seen the symptoms have been preceded by two or three days of mental agitation and apprehension without apparent cause. Hiccough and difficulty in swallowing were the earliest signs of the disease, and these slight symptoms of undue reflex irritability gradually increased until the whole body became convulsed, the patient’s sufferings being increased by the viscid saliva, which he has attempted in vain to expectorate. Death took place suddenly either from cardiac failure or from spasm of the glottis.

The Pasteur treatment offers the best chance of a cure to a person who has been inoculated with rabies. Its success depends upon the fact that the spinal cord of a rabbit dying of rabies contains the poison, which becomes progressively less virulent after death, if the cord be protected from decomposition by exposure to pure dry air, until on the fifteenth day it is harmless, and a solution of the cord may be injected into a susceptible animal without producing any effect. Successive inoculations of an animal already infected show that it is possible to establish a condition of complete tolerance, even for a strong dose of the poison previously introduced, though the process of inoculation has not been begun until five days or longer after the bite. The Pasteur treatment at the present time consists of a series of simple inoculations lasting fifteen days, during which emulsions from cords of fourteen to three days’ desiccation are injected in doses of 3 to 2 c.c. at a time under the skin of the abdomen. There is also an “intensive”[244] method, for more serious cases, such as the bite of a mad wolf, or when the wounds have been on the face. In this method the number of injections which are usually spread over five days is compressed into three days, the whole duration of the treatment being twenty-one days, a fresh series of injections being recommenced on the fourteenth day. Certain modifications of Pasteur’s method have been adopted, notably the use of an antirabic serum from the dog, prepared by Babes of Bucharest, and an attenuated vaccine by a process of peptic digestion, recommended by Tizzoni and Centanni.

As anthrax or charbon, sometimes known as splenic fever or malignant pustule, is considered elsewhere in this work, it is only necessary to state that the disease is due to the Bacillus anthracis, which is readily communicated from domestic animals to man. It is met with in the following classes: (1) those who come into contact with living animals suffering from anthrax, as drovers, shepherds, farmers, farriers, and veterinary surgeons; (2) those who touch the carcasses of animals that have died of anthrax, as knackers, slaughterers, and others; (3) those who handle the offal, skins, hoofs, horns, hair, wools, and other derivatives from such diseased animals, as tanners, fell-mongers, wool-workers, hair-workers, horn-workers, rag-sorters, plasterers, furriers, felt-workers, brush-workers, mattress-makers, and so forth; (4) in those who have a less direct connection with infective materials; as, for instance, those who live in the neighbourhood of such manufactories or occupations, for the disease may be carried by animals and insects; (5) anthrax has been transmitted from person to person by accidental contact, and may be contracted at a post-mortem examination upon a patient or animal who has died of the disease. There is some reason for supposing that small meat-eaters are more susceptible to anthrax than those who are accustomed to much animal food.

Influenza has long been known to occur in horses, and in several epidemics the disease has been observed to spread from these animals to their attendants. Mr Youatt first pointed out that influenza attacked horses in very local epidemics, so that the majority of horses on one side of a yard might be attacked, whilst there was not a single sick horse on the other side. These prevalences and exceptions are altogether unaccountable, but the probability of the disease is in tenfold ratio to the number of horses inhabiting a stable. Two or three shut up in a comparatively close stable would escape,[245] and out of thirty distributed through ten or fifteen little stables, not one would be affected. But in a stable containing ten or twelve horses, although proportionately larger and better ventilated, the disease would assuredly appear, and when it enters one of the largest stables almost every horse is affected. Horsekeepers may also suffer from horsepox or “grease,” a specific eruption transmissible from the horse to man, of which further details are given at page 246.

Much riding early in life may produce a condition of knock-knee or bowed legs quite apart from rickets. Later in life, the tendon of the adductor longus muscle at its point of origin below the spine of the pubes, and more rarely the tendon of the adductor magnus, may become partially calcified, leading to the condition known as “cavalryman’s leg,” whilst the calcified portion is known as “rider’s bone.” A wrench or sprain of the adductors, “rider’s sprain,” is not an uncommon accident in the hunting-field. It leads to a very troublesome form of chronic inflammation, which may quite prevent riding exercise, and has proved the starting-point of a “rider’s bone.” “Rider’s bursæ” are described as occurring in the fold of the groin and on the inner side of the knee. They are probably enlargements of the ilio-psoas bursa or of the bursæ situated between the semi-membranosus and semi-tendinosus tendons, or beneath the inner head of the gastrocnemius muscle, but I have never seen cases of either occurring in riders, though they are common enough in tuberculous patients. Popliteal aneurism is said to be somewhat more common in jockeys and grooms than in other persons, and these occupations lead also to an increased liability to fractures and dislocations.

Cattle.

(4) Butchers, Slaughterers, and Tanners.—Butchers and slaughterers suffer from an undue tendency to diseases of the throat and chest, because their occupation, at any rate in London, entails very early rising to attend market, their shops are usually quite open, and they are some of the few tradesmen who still cry their wares. Their wounds are very likely to become poisoned, and as they are often overfed and gross in habit, erysipelas is a common sequel of slight injuries. Many porters from the Metropolitan Meat Market apply annually at St Bartholomew’s Hospital for the relief of hernia and ruptured muscles, which[246] they attribute to the strains produced by carrying heavy carcasses and to slipping on greasy pavements. The hospital practice seems also to contain a considerable proportion of cases of aneurism amongst the same class of men.

It is said that the habit of eating tiny bits of raw meat from the chopping block sometimes causes butchers to become infected with the various parasitic worms, which can be transmitted in this way. Their meat-eating and beer-drinking habits, coupled with a sedentary occupation, must be held accountable for their obesity and for the frequency with which they suffer from gout.

I do not know whether tanners are liable to any special diseases except anthrax, but in the business of leather-dressing which is carried on in connection with tanning, the various eruptions produced by aniline dyes are not uncommon, and there is some danger of arsenical poisoning from the use of orpiment.

(5) Cowmen and Dairymaids.—Cowmen and dairymaids in those counties where they are brought into direct contact with cows as milkmaids, are liable to several diseases by reason of their occupations. Foremost amongst these, and of the greatest historical interest, is vaccinia or cowpox, though it is quite a rare complaint in English dairy farms.

Vaccinia is a specific disorder occurring in epidemics amongst bovine animals. It is transmissible to the goat, dog, ass, camel, rabbit, guinea-pig, monkey, and with greater difficulty to the sheep. It is characterised in the cow by a local eruption almost exclusively confined to the udder and teats. The eruption passes through the successive stages of papule, vesicle, and pustule, the number of pocks always being few, and there is considerable constitutional disturbance. The lymph from the vesicles of a cow suffering from pox is sometimes inoculated on the hands of the milkers, when inflamed spots appear more particularly about the joints and tips of the fingers. The spots become vesicular, with a swollen, hard, and inflamed base. The axillary glands become inflamed, and the disorder is attended with some constitutional disturbance. An analogous condition in the horse is called “grease” or horsepox, and inoculation of the horse with cowpox will produce “grease.” Cowpox in bovine animals and “grease” in horses can also be produced by inoculation with human smallpox. Both “grease” and cowpox are transmissible to man by inoculation, both diseases render him to a certain extent immune to smallpox, and both render him less liable to a second attack of cowpox or horsepox. It appears[247] therefore that smallpox, cowpox, and horsepox are very closely allied to each other. They may be identical, the features being modified by transmission through different animals, or they may be descended from a common disease which was more akin to cowpox than smallpox.

Tuberculosis is so common a disease in cows that it is no wonder if phthisis in their attendants sometimes derives its origin from a diseased animal. The disease, however, is much more often carried by the milk, and it is therefore a wise precaution to boil every drop of cow’s milk for three minutes before it is given to a child or to one who is predisposed to consumption. I have seen local tuberculosis of the skin in one or two cases contracted by veterinary surgeons in the course of their duties. Free excision of the affected part has always been followed by prompt healing, and I have never known of any generalisation.

Diphtheria is sometimes carried by milk, the infection being derived either by accidental contamination or from the cow itself. The symptoms of diphtheria in the cow are those of “chapped teats,” viz., rise of temperature and an eruption on the udder and teats. The eruption begins as vesicles, which pass rapidly into pustules, scabs, or ulcers. When the disease is transmitted in this manner the cream and skim milk appear to be more dangerous than the new milk, probably because the organisms have a longer time to grow. Pigeons, turkeys, and cats have also been credited with the power of conveying diphtheria, and in the case of cats the accusation is proved.

There is good reason, too, for thinking that cows suffer from scarlet fever, and that the disease is transmitted by their milk, for in no other way is it possible to account for local epidemics of scarlet fever which have been traced to large dairy farms.

Cows certainly suffer from ringworm, and the tinea is transferred to those who lean their heads against them in the act of milking.

Foot and mouth disease is highly contagious amongst ruminants and pigs. It has often been transmitted to man, usually by the milk of cows suffering from the disease, sometimes by the butter, but most often by direct contact with diseased beasts. Milkmaids, cowmen, shepherds, and veterinary surgeons are thus especially liable to infection. The disease, as it occurs in man, is ushered in by rigors, diarrhœa, and some rise of temperature. On the second or third day a vesicular eruption appears on the gums and tongue, and it may also occur on the fingers or other seat of inoculation.[248] Fortunately the disease as it occurs in man is not serious, and recovery usually takes place spontaneously in the course of a fortnight.

Actinomycosis.—This disease is sometimes derived by inoculation from cattle affected with the fungus, but it comes more often from infected grain. The symptoms are those of a chronic abscess affecting the skin, mucous membranes, or viscera, especially the lungs, liver, and ileo-cæcal portion of the intestine, where it is liable to be mistaken for appendicitis. It appears on the skin in the form of numerous globular masses, which are soft and spongy, and have an indurated erythematous base. Pus which contains the yellow granules characteristic of the disease exudes from the ulcerating points. The disease runs a very chronic course, which is shortened, and the patient cured by enormous doses of iodide of potassium. Doses of a drachm may be given three or four times a day, and the patient not only shows no symptoms of iodism, but improves markedly in general health.

(6) Shepherds suffer by reason of their occupation in two ways. They are of necessity closely associated with dogs, and are thus more liable to hydatids and rabies, whilst from the sheep they obtain flukes, and in the process of dipping they may suffer from arsenical poisoning.

A hydatid is the asexual and cystic form of the Tænia echinococcus, a small tapeworm consisting of three segments, found in the intestines of dogs and wolves. The fertilised ova are swallowed with impure water or with uncooked vegetables, like lettuce and watercress, fouled by the excreta of infected dogs. The hydatid cyst develops slowly in any part of the human body. It is most common in the liver and intermuscular connective tissues, but it is not unusual to find a hydatid cyst in the lungs, kidneys, pelvis, and brain, and I have seen specimens in which the vertebræ and os innominatum were involved. The symptoms are very obscure, and are usually dependent upon the amount of pressure exercised by the tumour. There is sometimes a characteristic hydatid thrill, but its absence does not invalidate the diagnosis. For practical purposes the cyst is composed of two layers, an external or adventitious covering formed by irritation from the tissues of the host, and the soft and white but tough internal cyst, filled with a limpid fluid, containing the characteristic hooklets. The inner lining of this cyst develops daughter cysts by a process of budding, though it is sometimes sterile.

The treatment is essentially surgical. Whenever it is possible[249] the tumour should be freely exposed, the fibrous cyst opened, the fluid contents removed, and the whole endocyst withdrawn. The edges of the ectocyst may then be sutured, and the external wound closed if union by first intention can be practically guaranteed. But if there is any doubt as to the probability of securing asepsis it is better to free the edges of the outer cyst from its attachment to the surrounding organs, and then suture it to the sides of the external opening without including the skin. The cavity usually has to be plugged after the removal of a hydatid from the liver.

It is not supposed that the liver fluke, or Distoma hepaticum, is transmitted from the sheep to man, as is the hydatid from the dog to the man, but it is probable that the shepherd has become the involuntary host of the distoma in the same way as the sheep, by drinking water containing the amphibious snail (Limnæus trunculatus), which is the true intermediate host of the liver fluke in the sheep. This trematode worm has been found in subcutaneous abscesses more often than in the human liver. The treatment, when possible, consists in opening the abscess and thoroughly scraping out its contents, for they show a great tendency to refill.

Pig-keepers.—It does not appear that pig-keepers suffer from any particular diseases by reason of their occupation. It is possible that where only a few animals are kept and are afterwards eaten by the owners there may be some increased liability to trichiniasis, which is an inflammatory state of the voluntary muscles due to the irritation produced by the presence of the nematode worm, Trichina spiralis. I recently saw a young lady who was suffering from a chronic trichinosis. She had numerous hard masses beneath the skin of her legs, which were locally irritable when they first appeared, though they soon ceased to give trouble. At first it was thought that the tumours were multiple fibromata, but on cutting one out and submitting it to microscopic examination it was found to contain encapsuled trichinæ.

D’Arcy Power.

This article is simply an attempt to apply expert knowledge to the practical purpose of safe-guarding those employed in electrical works. The writer was a member of the Home Office Committee on Dangerous Trades, and of necessity much that now appears is a repetition of what was presented by that Committee in its Second Interim Report in 1897. It is satisfactory to record that many of the suggestions offered by the Committee have been accepted without hesitation and acted upon.

The generation and distribution of electrical energy, so far as it relates to the health and safety of the workers, may be considered under the following heads:—

(a) The risk of shock by accidentally coming in contact with conductors at high pressure, whether in generating or transformer stations.

(b) The fencing of all mill-gearing and machinery used for the conversion of mechanical into electrical energy.

(c) The health of the operatives.

Before dealing with these specific points it may be desirable to state in general terms what is meant by “generating and transformer stations.” A generating station is a place in which, by the aid of steam, gas, water, or other source of power, mechanism is used for driving dynamos, which are machines for converting mechanical into electrical energy, whether for producing light, driving machinery, running railways, tramcars; for depositing metals, plating, welding, heating, etc., etc., or for charging storage batteries.

Transformer stations vary in size from buildings of considerable proportions to mere cellars, or even boxes too small for entry. In such places are found appliances for the conversion of small current at high pressure to large current at low pressure, or vice versâ. Stationary transformers are used for alternating currents, while rotary converters or transformers, requiring more room and attention, are necessary for direct currents.

[251]

To appreciate the risks hereafter described, a statement in the most elementary terms now follows, showing how mechanism can produce the foregoing results.

A conductor of electricity, e.g., a piece of copper wire made to traverse a magnetic field (that is, the space between the poles of a magnet), has an electro-motive force, or difference of electric pressure, set up in its ends, which depends upon its length in the field, its velocity, and the strength of the field, being in fact proportionate to the product of these three. As the movement cannot continue in a limited field in one direction indefinitely, it must be reversed, thus causing a reversal in the electrical state of the ends. If the ends slide on stationary conductors, these too will share the electrical state of the ends, and alternating current will pass between these stationary conductors if they are joined by a conducting wire. This current will be greater as the difference of pressure is greater and as the electrical resistance of the conducting circuit is less. In order to increase the effect of a moving conductor, its length may be increased by suitable windings, the arrangement of which, however, cannot be described in these pages. The effectiveness, moreover, is enormously increased by winding over a laminated iron core, which greatly increases the magnetic force. If, instead of connecting the ends to sliding contact rings from which an alternating current is taken off by stationary contact brushes, the ends of a number of coils are joined to a series of insulated commutator bars, it is possible by suitable connections so to arrange that all the coils remain in action and that the points of the commutator rubbed by the fixed conducting brushes do not change in their electrical pressure, so that a direct (i.e., non-alternating) current is the result. This is desirable for arc lighting, and is essential for charging batteries and generally for effecting chemical change.

Dynamos of many forms are made. Sometimes the field magnets revolve, the armature being stationary, but usually the reverse is the case. In some machines there are two poles only, in others, many. The main principle, however, is the same in all.

When the direction of the current is not commutated, it will, in consequence of the rapid revolution of the armature, alternate or change its direction very frequently, 100 alternations in a second being not uncommon. The currents produced[252] may be classed as low pressure, high pressure, and extra high pressure. Currents at low pressure distributed from generating stations are invariably direct. High pressure currents are distributed either as direct or alternating. One, if not more, extra high pressure station in Great Britain supplies alternating current.

Opinions differ as to the pressure at which these currents become dangerous. The recommendation made by the Committee before referred to was to the effect that currents should be considered dangerous at 700 volts direct, and 350 alternating; and that all metal conductors carrying a current equal to or greater than this should be deemed to be at high pressure. It is from currents at high pressure that we may expect special danger to life from shocks caused by parts of the body coming in contact with conductors differing considerably in pressure, not necessarily metal conductors, for one contact may be with earth, especially if the ground is damp. American experts have laid down that the pressure which may be relied upon to cause death is 1500 volts. According to this standard, the Home Office Committee would appear to have erred on the side of extreme caution. Subsequent events, however, have proved that this is hardly the case. Possibilities fore-shadowed in section 19 of its report have almost literally been realised in a large factory at Bradford, where a lad, aged nineteen, engaged in doing repairs, came in contact with a frame of an arc lamp. He was working in a warm cellar, his boots were damp, and, unhappily, he stood upon an earthed metal plate. The frame of the lamp accidentally touched formed part of the circuit. A leakage from the positive brush to the dynamo-frame, which was earthed, created a short circuit between the frame of the dynamo and the frame of the lamp, the man forming a part of the circuit. A direct current, of 250 volts only, passed through his feet, probably through his heart, causing death. It is much to be regretted that artificial respiration, as recommended by eminent authorities and described in the report of the Committee, was not attempted. An article published in Nature of 23rd August 1900, gives in detail a description of experiments carried out by Professor H. F. Weber, of the Zurich Polytechnic, to decide what pressure is dangerous on electric railways with overhead trolley wires. These experiments were undertaken owing to a dissension,[253] between a firm of electrical engineers and the Baden authorities, as to the proper pressure to be used for two electric railways to be worked by the 3-phase alternating current. The details showing the physiological effects on the human body are highly interesting, Professor Weber allowing himself to be the medium of the experiments, and constituting himself the measuring instrument. Two series of experiments were made. In the first, a person seized the two bare leads with both hands simultaneously, or both of the leads fell upon a bare part of the human body. In the second, a bare part of a person standing on the railway, or on a car, came into contact with one of the leads. Professor Weber draws the following conclusions:—

“These results,” continues the article, “are consistent with several disasters which have happened in practical life.

“In 1896, in Horgen (Switzerland), a man, to prevent himself falling from a ladder, seized with both his hands two non-insulated leads with a P.D. of 240 volts between them, and was immediately killed. In a mine in Silesia, a workman seized in the same manner some non-insulated leads and was killed, on account of his being unable to release them, the P.D. being 300 volts. In the Electric Central Station in Olten, a workman, desirous of proving to his companions that a pressure of 500 volts was quite safe, seized both of the leads and was killed instantly. From this it is obvious that the general opinion of a pressure of 500 volts not being dangerous does not hold good, the limit being much lower. In spite of the great number of disasters which have already happened, the danger does not seem to have been generally appreciated, and workmen and erectors are often seen to deal with leads and apparatus of relatively high pressures in the most careless manner. That disasters have not taken place oftener may be due to the fact that in most cases help has been readily at hand.”

In the second series of experiments the person is supposed to stand on one of the poles itself, namely, the earth, being rather well insulated by means of his shoes. In this case the conclusion arrived at is that—

It is of interest to note that the authorities, after the investigation, decided upon allowing a working pressure of 750 volts. Both series of experiments relate to alternating currents.

There is perhaps no better method of impressing upon people the dangers of electric shock than by stating briefly, as under, some of the fatal accidents that have happened during the last few years in electrical stations, factories, and other places in the United Kingdom. Fatalities in transformer stations will be separately noticed. The voltages in most cases were from 2000 to 2400; in one case 1000, and in another (a high pressure station) 10,000:—

1. Touching exposed terminals when manipulating a switch at a generating station.

2. Accidentally grasping an insufficiently protected volt meter wire.

3. When up a ladder in a central station, deceased accidentally came in contact with a highly charged metal conductor.

4. When oiling the bearing of an alternating machine, and using a metal can, the can came in contact with a highly charged conductor. Deceased had one hand on a metal rail intended for the protection of the machinery. The current passed through the metal can, through his body, and thence to earth.

5. When doing repairs at the back of a switch at a central station, deceased accidentally touched two metallic connections varying greatly in pressure.

6. When a workman was carrying an iron ladder in a factory the ladder touched a highly charged conductor in an arc lamp circuit, the current passing to earth through the body of deceased.

7. Whilst performing test operations at an electrical station.

[255]

8. An operative was putting some capping on a casing in an electric lighting works. Inadvertently he drove a screw through the insulation of a cable then “dead.” The current was turned on. The operative touched the screw head and at the same time an adjacent water-pipe. The current passed from the screw through his body and the water-pipe to earth. (A brother of this man was killed in a transformer chamber.)

9. An operative, when at work in a factory, accidentally stumbled, and seized hold of a wire stay supporting a pole of an arc lamp. There must have been a defect in the insulation, and this stay was highly charged, the man being killed instantaneously.

10. When covering wires leading to a switch, deceased fell across the terminals of one of the machines.

11. By accidentally touching a synchronising switch in a generating station when doing repairs. The current passed through deceased’s body to an iron column that he happened to be touching at the same time.

12. A boy employed in a large steel factory accidentally came in contact with the frame of an arc lamp lowered for the purpose of recarbonising.

13. An operative employed in ironworks accidentally touched a wire used for raising and lowering an electric arc lamp. He was found on his back in a weighing-cabin. Another workman thought that he was in a fit, and went to his assistance. Both men received fatal shocks.

14. At an extra high pressure generating station an operative was found dead on the floor. Medical evidence tended to show the difficulty of stating with certainty whether the man died from shock or from heart disease. The coroner’s jury, however, found that death was due to asphyxia produced by electric shock.

Our attention may now be turned to fatalities in transformer stations, or boxes in which alternating currents at high pressure are converted to large currents at low pressure. A dangerous pressure is found in the main conductors, this being reduced by causing induced current in the consumer’s circuit, the strength depending upon the proportion of the windings in the primary and the secondary circuits, the secondary being in no way metallically connected with the high pressure main. Under these circumstances, and under normal conditions, the safety of the consumer should be secured. That, unhappily, cannot be said so[256] far as relates to the workers, whose duties take them near the transforming apparatus. It is undesirable to give names, places, or dates, but the following brief summary of fatal accidents that have happened during recent years in transformer stations may be relied upon as being generally accurate. Many non-fatal accidents have happened, but these are not noticed.

1. Attempting to assist a servant of an electrical company, who was working in a cellar on the consumer’s premises, and who received a severe but not fatal shock.

2. Killed when pulling back the slack of a main wire in a street surface-box.

3. Accidental contact with undischarged and unfenced omnibus bar in high pressure distributing station.

4. A second accident of the same kind as the last foregoing, and at the same station.

5. Killed when dusting a high pressure fuse in a cellar transformer.

6. Contact with dangerously placed terminals at a transformer chamber in a cellar.

7. Accidentally touching a high pressure terminal when cleaning or repairing in a street transformer chamber.

8. Touching a highly charged transformer frame in a street chamber. Defective insulation in the main conductor led to leakage and to the frame becoming highly charged.

9. When descending by an iron ladder to a street transformer chamber, the operative came in contact with a highly charged frame of a transformer.

10. Two workmen were removing a transformer from a corporation sub-station. They accidentally put on a wrong switch. The exposed ends of the cable, which were in contact with the transformer frame, caused the frame to become highly charged. Two men touching the frame were killed, others were seriously injured.

11. A workman, when making a connection in a corporation sub-station, came in contact with the bared ends of a highly charged cable.

12. Killed by grasping an imperfectly insulated connection in a street transformer pit.

Such accidents are not confined to operatives. The following are known to have been due to electric shock. At Bournemouth, ’bus horses outside a hotel fell down dead. At Norwich, dogs that passed a certain spot uttered an unearthly howl. At Hartlepool[257] an overhead wire broke, killing a horse. Two cabmen who came to the rescue received severe shocks. The Matin of 27th January 1897 describes how two horses were suddenly struck down by the current from a subterranean cable used for running an electrical tram. In Dublin a gentleman was standing close to an electric lamp in the street, which he states paralysed him, causing him to fall “like a lump of lead.” Others going to his assistance received shocks similar to those of the two cabmen at Hartlepool. The Melbourne Argus records a fatality to a young man who climbed a pole supporting a heavily charged wire, which he touched. “This,” says the Argus, “is not the first terrible accident which has happened in connection with the lighting of the city and suburbs. At the Richmond works of the New Australian Electric Light Company, whose wires were concerned in Saturday’s fatality, a workman or overseer was killed instantaneously through touching a “live” wire. Another, who was engaged in the A. U. Alcock works in the city was more fortunate. He seized a wire with one hand to prevent himself from falling, and was so seriously shocked by the current that he could not let go. Another workman, observing his predicament, cut the wire, and he fell to the ground. A third and even more remarkable case than the others occurred some time ago in Russell Street. There had been a violent storm, and a post carrying electric lighting wires had been blown to the ground. In the fall some of the wires broke and trailed across the footway. A pedestrian idly picked up the end of one of the broken wires. In a moment he was kicking and plunging upon the ground, unable to release his hold of the wire. Another pedestrian, who saw the accident, and who recognised that it was a struggle with death, hastened to the rescue, and attempted with all his strength and both his hands to drag the first man into safety. His good heart cost him his life.”

Enough has been said to show that a shock, whether from a direct or an alternating current at high pressure, is highly dangerous to life, many authorities being of opinion that the alternating is the more deadly current of the two.

Where a direct current is transformed, it is done by mechanical appliances. The risks to operatives in such a case include those that are incurred where machinery is left unguarded; but in dealing with alternating currents no mechanism is used, and the risk is confined to the danger from shock. The cases quoted show, better than detailed explanations, the manner[258] in which these shocks are received, and it cannot be out of place to urge the importance of insisting on all known precautionary measures for the protection of those whose duties take them into transformer stations. The number of such places increases year by year, and they are likely to increase to a greater extent in these days, when induction motors, driven by alternating currents, are so rapidly coming in favour for running machinery in factories. Modern science has shown that the alternating current can be used in this manner, and that by substituting the alternating for the direct current, power may be economically conveyed for considerable distances, the advantages of the alternating current being the ready conversion of high to low pressure, and hence the saving of copper in the conducting wires, the further saving of the cost of brushes and commutators, whilst the absence of “sparking” lessens the risk of fire, and the non-handling of brushes, etc., reduces the danger of shock. These advantages were referred to and summarised in the report of Mr Bremner Davis, reproduced in the Report of the Chief Inspector of Factories for the year 1898.

Science has not yet explained what is the mystic force known as “electricity.” Its effects, however, are known. How the human system is affected by contact with a conductor charged with electricity at high pressure has been fully considered by eminent scientific men, such as Drs D’Arsonval, Goelet, Hedley, and Lewis Jones, to whom the public are indebted for suggestions on which were based the excellent rules published by the Electrical Review, for dealing with apparent death from electric shock. A copy of these suggestions is appended, and one should be found and understood in all places where electricity is used.

The highly interesting question as to how death from electric shock is caused, is ably dealt with by Professor Thomas Oliver, who in an article published in the British Medical Journal of 15th January 1898, placed the public in possession of knowledge gained by experiments and long and careful study. He believes that electricity kills either by suddenly arresting respiration, or by stopping the heart’s action. A series of experiments carried out by him showed that in most instances the effect of the electric shock was felt principally by the heart. This organ immediately ceased to beat where very high pressure currents were used, whilst breathing might continue a few minutes longer. Within the last few months, Drs Prevost and Battelli, of the Geneva University, have instituted a fresh series of experiments, and they have found[259] that whether the direct or the alternating current is used, death comes, practically speaking, in the manner stated by Dr Oliver, viz., by paralysis of the heart. Dogs were in this way immediately killed, and yet the breathing continued for a few minutes afterwards. When fairly high voltages were employed, e.g. 550 volts, these experimenters found that the heart was suddenly arrested by one shock, and that, while the breathing was at the same time suspended for a few seconds, respiration gradually returned in a feeble and superficial manner, and soon finally ceased.

After all, the main question is, how to avoid death from electricity; and the obvious reply is, avoid shock. This is no simple matter, but to some extent a solution is found in the recommendations made by the Home Office Committee, which were largely based upon the opinions of Professor C. V. Boys (a member of the Committee), and other eminent electricians. These recommendations are here reproduced in appendix form. In the light, however, of fresh experience showing that an artisan working in a factory was killed by direct current at 250 volts, prudence may hereafter suggest that precautions should be taken in places where the voltage is lower than that named by the report.

The operatives engaged in electrical works do not appear to be subject to any exceptional risks so far as health is concerned; but those who work where plates for storage-batteries are manufactured, or who subsequently manipulate the plates, are liable to suffer from plumbism. Special Rules founded upon the recommendations of the Home Office Committee appointed in 1893, and known as the “White Lead Committee,” were issued by the Home Office. These apply to electric accumulator works, and require the provision of bath and lavatory accommodation, hot and cold water, soap, brushes, towels, respirators, and overall suits for persons employed in mixing dry red lead and dry litharge, and gloves and aprons for persons engaged in “rubbing,” that is, rubbing red lead into the interstices of the lead plates.

Rooms in which accumulator batteries are found are always well-ventilated, preventing any undue accumulation of oxygen and hydrogen gas given off during the charging process, but in electric launches or tramcars, where the accumulator cells are shut up in confined spaces, dangerous explosions have taken place.

So far as the fencing of machinery and mill-gearing used in the generation of electricity is concerned, common sense points to[260] precautions being taken, such as are required in all factories. All dangerous mill-gearing, such as cranks and fly-wheels of engines, shafting, wheels, drums, pulleys, etc., for communicating the first moving power to the machines, should be securely fenced. In doing this, however, special care should be observed lest in removing one source of danger another may be created. In ordinary factories fencing-rails are almost universally of metal. These rails in generating stations should be of wood or other insulating material; for should, perchance, an operative make an accidental contact with metal at high pressure in the circuit, at the same time touching any part of a metal rail, the current would pass through his body to earth, always assuming that the rails are not sufficiently insulated from the earth. Such accidents have happened, and are liable to occur again, to men engaged in oiling bearings, adjusting brushes, cleaning commutators, collector-rings, etc., the risk of course being increased should any defect in insulation cause the current to run to frame. Terrible fatalities due to unfenced machinery have occurred in generating stations, as in other works, none more painful perhaps than one that happened to an engine-driver at an Electric Supply Company’s works, who, when examining bearings, fell into some part of the machinery driven by a 7000 horse-power engine, and was torn to pieces.

As time goes on, there appears to be a fuller realisation of the dangers incurred, and it is not too much to expect that those in positions of responsibility will heartily co-operate with public officials in taking precautions suggested by prudence and common sense.

APPENDIX I.

The following recommendations were made by the Dangerous Trades Committee of the Home Office. For the purposes of these regulations a station where the direct current generated is at 700 volts or any higher number, or where the alternating current generated is at 350 volts or any higher number, shall be considered a “high pressure station,” and all metal conductors, whether they be on the dynamos, the switchboard, the mains, or any other part of the station carrying a current at a pressure equal to or greater than that above mentioned, shall be deemed to be at “high pressure.”

The Committee recommend that the following regulations[261] should be applied in all those cases mentioned in paragraph 1 where electricity at high pressure is in use. It is not intended that they should be applied to low pressure systems:—

APPENDIX II.

The “Electrical Review’s” Suggestions for dealing with Apparent Death from Electric Shock.

The following suggestions are based on the recommendations of Drs D’Arsonval, Goelet, Hedley, and Lewis Jones, for the treatment of persons apparently killed by electricity:—

[264]

Fig. 30.

[265]

Fig. 31.

[266]

Hamilton P. Smith.

General View of the Subject.

Were it not for dust, fume, or gas, there would be little or no disease due to occupation except such as might be caused by infection, the breathing of air poisoned by the emanations of fellow-workmen and exposure to cold after working in overheated rooms. Dust plays such a prominent part in the causation of occupation disease that I have thought it advisable to discuss the subject in a general way apart from the various industries detailed by separate writers. The harmful effects of dusty trades have long been known. As far back as the end of the seventeenth century, Ramazini, who was the Professor of Medicine in Modena, and subsequently at Padua, had drawn attention to this subject. He showed in his treatise, the Diseases of Artificers, how ill-health was caused by the inhalation of subtle particles that were offensive to human nature, and its aggravation by the unnatural postures of the body assumed in certain occupations. He also pleaded for the introduction of such contrivances as would lead to the safety of the workmen and the necessity for their being medically inspected. In these senses, therefore, he was the pioneer of the State Medicine of our time.

Apart from anything inherently poisonous in the dust that is given off in a particular trade, dust itself, mechanically speaking, is prejudicial to health. A considerable length of our respiratory passages is lined with a layer of ciliated epithelial cells, i.e., cells from the free end of which project numerous hair-like processes that execute a rhythmic bending movement, like a field of wheat when a current of wind passes over it, and whose function it is, owing to the cilia actively bending in an outward direction, to prevent dust getting into the lungs, and to favour its expulsion should it have gained access to the smaller bronchial tubes. Nature, anticipating that dust would be drawn into the[268] lungs in inspiration, has therefore provided this means for making its access as difficult as possible, and of effecting its removal when the breathing of the dust is intermittent. When animals are exposed for a period to a sooty atmosphere and are subsequently killed, their lungs are found to be perfectly black, but if other animals, after similar exposure, are allowed freedom in the open air, the lungs after death exhibit few dark patches. One of the effects of recurrent inflammation of the bronchial tubes is to bring about detachment and removal of this ciliated epithelium, and with its disappearance an important safeguard to the lungs is lost.

Dust affects the body by being deposited upon the skin, hair, eyelids, and the oro-nasal passages. Through the mouth and nose it is aspirated into the lungs during respiration, or it reaches the alimentary canal through the saliva or with the food.

When the skin becomes affected through an individual working at a dusty trade, the lesions thus caused are called dermatoconioses, similar affections of the lungs constitute pneumoconioses, while those of the gastro-intestinal tract are known as enteroconioses. Although the intestine, as in plumbism, is one of the most important and frequent channels by which industrial poisoning occurs, yet, pathologically speaking, the lesions of this canal are the least definite.

So far as dermatoconioses or inflammatory affections of the skin are concerned, it is mostly in industries in which dry dust is given off that these are met with, as, for example, in dry bronzing, but certain fumes also cause them, as is seen in the smelting of antimony. No portion of the skin is free from the possible contamination by dust, but it is upon the hair, beard, eyelids, under the nails, upon the lips, and inside the nostrils, upon any uncovered part of the body when the individual is at work, or where the clothing loosely meets the skin, also in such flexures of the body as the armpits and the groins, and where the garters fix the stockings, that the effects of dust are mostly observed upon the skin. When the factory is warm, or the work heavy, and the individual perspires freely, the dust mingling with the products given off by the humid skin either falls off in muddy drops of sweat, or it cakes and forms crusts. As a consequence, there is a variety of lesions, e.g., simple irritation or itchiness, known as pruritus; inflammation or erythema proceeding to eczema; or, as in the case of antimony smelters, vesicles that become pustular, and in arsenic grinders, ulceration. Since dust [269]that of itself is harmless can induce disorders by mechanically blocking the pores of the skin and the excretory ducts of glands, so, too, can harmful dusts act, but they produce in addition certain irritating and poisonous effects proper to the peculiar character of the dust. Some dusts are crystalline or sharp-pointed, and penetrate readily and deeply, while others have a distinct caustic action, and erode or eat away the tissues, as is the case with the bichromate compounds. Some forms of dust again are composed of soft particles that of themselves inflict little local damage, and only become harmful like flour in forming plugs; while attached to some forms of animal products, such as horsehair used in brushmaking, are micro-organisms that become a source of danger. It is unnecessary to mention the various skin affections or dermatoconioses produced by dust. They are all more or less the result of inflammation. In many of the erythematous forms of skin eruption the redness of the skin may simply be the result of the mechanical action of the dust, or the dust may be absorbed. One consequence of local irritation may be the formation of vesicles. Sometimes the itchiness becomes so great that scratching is resorted to and there follows eczema. Where the vesicles become pustular, this is generally due to the action of metallic poisons of an acrid character, or to poisons of an animal nature, as in anthrax. Ulceration of the skin, on the other hand, is the result of such caustic action as that induced by arsenic and the chrome compounds. The accompanying Photographs show various forms of dermatitis that occur in flax spinners, also of diseases of the finger nails in hide dressers. They are introduced here not as illustrating the harmful effects of dust, for they occur in the wet processes of an industry, but as indicating what is meant by the term dermatoconioses.

Fig. 32.—Mild form of Dermatitis in Flax spinner (moist method); girl aged 16. Three years’ service in Factory. (Dr Glibert).

Fig. 33.—Medium degree of Dermatitis in Flax spinner (moist method); woman aged 33. Eighteen years’ service in Factory. (Dr Glibert).

Skin Diseases of Flax Spinners.

Fig. 34.—Severe form of Dermatitis in Flax spinner (moist method); woman aged 19. Eight years’ service in Factory. The small punched-out looking sore on thumb resembles what is known to medical men as “Specific” ulceration, but it is in no ways connected with it. (Dr Glibert).

Fig. 35.—Severe form of Dermatitis in Flax spinner (moist method); woman aged 19. Eight years’ service in Factory. Observe special round callosity on ulnar side of hand, an affection first pointed out by Dr Van Eecloo of Lille. (Dr Glibert).

Skin Diseases of Flax Spinners.

Skin Diseases of Flax Workers.

It is through the kindness of Dr Glibert, Medical Inspector, Labour Office, Belgium, that I am able to show in the accompanying Photographs these particular lesions of the skin. The four Photographs in which the palmar surface of the hand is shown, are taken from flax workers. They indicate varying degrees of erosion, due to the frequent contact of the hands of the female worker with the irritating materials contained in the liquid used for spinning. At the commencement of the malady, as is well shown in the Photographs, the lesion is limited to an exfoliation of the epidermis, and this is not accompanied either[270] by pain, pruritus, or functional trouble of any kind. Later on the dermis itself, or true skin, becomes involved at certain places, usually very few, and at these spots there exists considerable irritation, also a sensation of painful pricking, especially pronounced after working, and when the wounds are brought into contact with the air. As a rule, the malady does not proceed beyond this stage, but in some rather rare cases, met with mostly during severe weather, the ulceration tends to pass into the deeper tissues of the skin, and to assume an appearance which, to an unskilled observer, recalls the lesions met with in syphilis. There is nothing, however, in the flax workers’ dermatitis to confirm this suspicion. It is necessary to remark that there is never produced erythema, the formation of vesicles or a vesico-pustular eruption, and still less the glossy and bright appearance of the skin of the hand observed in eczema of a lichenoid character. Dr Glibert has frequently met with this form of eczema, to which Dr Leloir and his pupil Lefèbvre have drawn attention, but the ulcerative type of dermatitis indicated in the accompanying Photographs is absolutely distinct from these, and must not be confounded with them. It is only right to mention that although dermatitis has been observed in Belgian flax spinners, Belfast operatives similarly employed do not, according to Dr Purdon, suffer.

Diseases of Nails in Furriers.

The two Photographs showing the back of the hands of workmen who scrape rabbit and hares’ skins used in the manufacture of artificial furs exhibit an affection of the nails, to which Dr Glibert of the Belgian Labour Office drew attention in the Annual Report of the Inspection of Labour, 1896. The work of separating the layer of aponeurosis, which occurs on the under surface of the hide, causes in the dresser a special disease of the nails of the fingers. The groove under the nail becomes deeper, the nail is subsequently detached from the finger and falls off, either by some peculiar pathological process unaccompanied by ulceration, or by one of an inflammatory nature akin to what occurs in whitlow. The malady may attack all the fingers of the two hands, but it seizes by preference the thumb, the middle and ring fingers of the right hand. It is a common affection in fur-pullers in Belgium. Dr Glibert is the only writer I know who has described it. Of 22 workmen whom he examined, it was present in 18. He regards the lesion as distinctly microbic.

Fig. 36.—Disease of Finger Nails in Hide dressers. Man, aged 35. Fifteen years’ service. (Dr Glibert).

Fig. 37.—Severe type of disease of Finger Nails in a Hide dresser. Man, aged 49. Twenty years’ service. (Dr Glibert).

Disease of Finger Nails in Furriers.

[271]

Lung Diseases due to Dust.

In pneumoconiosis the lung is altered in structure as the result of irritation caused by inhaled dust. A healthy lung is composed of loose spongy tissue, through which run in all directions the bronchial tubes and their fine ramifications (see Fig. 38). The essential part of the lung is made up of alveoli or air-cells, like the meshes of a net. Just as an ordinary net is made of strands of cord, so are the walls of the pulmonary alveoli formed of delicate lines of connective and elastic tissue, in which run capillary blood-vessels. The partitions thus formed are coated on both sides by a layer of flattened epithelial cells. It is this loose and almost uncovered condition of the pulmonary capillaries that allows of the rapid interchange of gases between the blood circulating in the alveolar walls and the air in the lung during respiration. Nature has placed certain obstacles in the way of particles of dust gaining easy access to the lungs, to wit, the narrow openings of the nostrils, the mucus secreted by the lining membrane of the nose, and of the trachea and bronchi; the narrow chink between the larynx and trachea known as the vocal chords, the ciliated epithelium already described, and a mechanical difficulty generally; so that while even with forced inspiration it is not easy for dust to be carried into the lungs, yet the fact remains that where an individual is working in the dusty atmosphere of a factory for several hours a day, week after week, particles of dust ultimately find their way into the finer bronchi, and subsequently into the pulmonary tissue itself. It is the repeated working in a dusty atmosphere that causes the trouble. A good deal depends, too, upon the character of the dust. Certain fine dusts, such, for example, as flour, may for a time be arrested in the mucus secreted by the respiratory passages, and be expectorated; while others, such as white lead, become dissolved in the alkaline mucus, are absorbed into the system, and thus induce constitutional poisoning. Fine fluffy material, like that given off from cotton and flax, can reach the lung, while sharp-pointed particles of metallic dust wound the epithelial lining of the smaller bronchi and penetrate into their walls, or they destroy the protecting layer of epithelium, and reach the alveoli either directly or indirectly through the lymphatics. These particles set up irritation in the lung, followed by a very marked increase of its fibro-connective tissue, which encroaches upon the spongy structure of the lung and destroys its aerating function. In the[272] coal-miner’s lung, for example, there can be observed small masses of cells deeply laden with carbon particles surrounded by a hardened zone of altered lung, numerous black streaks underneath the pleura or covering of the lungs, ink-like dots in the walls of the small bronchi, and enlargement with pigmentation of the bronchial glands. The special pathological changes in the lungs in the various pneumoconioses are peribronchitis, and a great increase of the fibro-connective tissue, whereby the lung becomes converted into a hard and almost solid organ, incapable of carrying on the work of respiration. Hence are explained the difficulty and shortness of breath in people thus affected with what is called fibrosis of the lung. On examining microscopically a portion of lung that has undergone this change, there can be seen imbedded in the thickened fibrous tissue, particles of grit which exactly correspond in shape and size with those found on examining the dust removed from the mine in which the person works, or from the factory, in the case of steel-grinders’ lung. The identity of the particles of grit in the lung and those in the dust of the factory can be additionally confirmed by chemical examination. Such, in a few words, is the effect upon the lung caused by inhalation of the dust generated in a dusty occupation. The newly formed fibro-connective tissue is of low vitality, and is badly supplied with blood-vessels, and yet it goes on increasing and encroaching more and more upon the lung tissue, which it replaces. Although it seldom tends to break down, the consolidated tissue notwithstanding shrinks, the chest becomes smaller, cough more harassing, and emaciation progressive. The affected workman is regarded as the victim of consumption, but the disease is not necessarily tuberculous. Under these circumstances, where a lung has become altered in structure and its vital resistance diminished, it becomes an easy matter for true tuberculosis, as the result of its specific bacillus, to be grafted on to a pneumoconiosis, or dust lung disease. In people who have worked in a thick atmosphere there is therefore found a form of consumption due to the inhalation of dust, and another the result of the tubercle bacillus, but in old-standing cases the two are generally found combined. The tendency of modern pathology is to look upon all pulmonary phthisis or consumption as tuberculous, but the fact remains that phthisis can be caused by dust. Pneumoconiosis differs from the tuberculous type of lung disease in being more amenable to treatment in the early stage, also in the fact that while both lungs are affected, it is the bases rather than the apices that suffer. If the workman, for example, [273]leaves his dusty employment, especially in the early stages of his illness, the malady may be arrested. Usually the march of the disease in this form is slower than the tubercular. It is an old idea, yet one that many seek to palm off as modern, that pulmonary consumption is an infective disease. In factories where many persons are at work, there are almost sure to be some who are tuberculous, and who cough and expectorate upon the floor. The expectoration dries, is trodden under foot, and, mingling with the dust, it rises into the atmosphere and is inhaled. Infection from consumptive fellow-workers must therefore play a part in the propagation of industrial phthisis, but the bulk of such cases do not assume the character of the occupation form of fibrotic phthisis to which we have just alluded, and which is known to occur frequently in men employed in dusty trades conducted in the open air, e.g., in masons and French millstone builders, in whom infection is less likely to prevail, and where the breathing of close and impure air can play no part.

Fig. 38.—Human Lung in health.

Fig. 39.—Lead Miner’s Lung. × 70 diameters. (T. O.)

Fig. 40.—Steel Grinder’s Lung. × 70 diameters. (T. O.)

Fig. 41.—Coal Miner’s Lung. × 70 diameters. (T. O.)

There are four recognised types of pneumoconioses or industrial lung disease: (1) Chalicosis or silicosis, due to stone dust and siliceous material, as in masons’ phthisis; (2) siderosis, due to metallic dust; (3) anthracosis or coal-miners’ phthisis; and (4) byssinosis, caused by inhalation of cotton particles.

Gastro-intestinal Lesions.

The enteroconioses or gastro-intestinal lesions induced by dust are less well-defined pathological entities than the affections of the skin and lungs, and yet they play an important part in poisoning by such metallic dusts as lead, arsenic, and mercury. Apart from such symptoms as vomiting, diarrhœa, and colic; which these cause, there are the well-marked physical signs of poisoning present in the gums, as, for example, the “blue line” in plumbism, and the loose teeth and ulcerated gums in mercurial poisoning.

The attention of the reader is directed to the accompanying series of Microphotographs as illustrations of some of the forms of dust seen through the microscope, to which workpeople in various trades are exposed. Apart from the poisonous character of any particular kind of dust, e.g., that of lead and arsenic, the presence of chemical irritants inherent in the dust itself as in bichromate compounds, and the clinging of micro-organisms to such animal products as horsehair and wool, there is an opinion[274] entertained by pathologists that the actual form of the particle of dust and its hardness are responsible for much of the damage inflicted upon the lungs of workmen engaged in dusty trades. Mineral and metallic particles of dust are hard and often sharp-pointed. Theoretically, therefore, it is expected of them that when they reach the lining membrane of the respiratory passages they will inflict greater damage than particles of dust that are softer and rounder. How far pathological experience supports this expectation I am not prepared to say. The dust that is given off in various occupations may be mineral, metallic, vegetable, or animal. I have reproduced some Microphotographs taken from Dr Migerka’s monograph, Staubarten in Wort und Bild, Vienna, 1895, and have added a few taken by Dr R. A. Bolam and myself, of dust from various industries, supplied by H.M. Inspectors of Factories. Some of these Microphotographs may be briefly described:—

Fig. 42, cement dust. Under the microscope are seen a few sharp-edged little plates and amorphous masses like small clumps. The particles are not of themselves so dangerous as might at first sight appear. Although cement workers suffer from pulmonary disease, they do not do so to the great extent that might be expected. Probably the harmful effects are largely due to the hygroscopic character of the particles and their alkaline reaction. Hirt gives the following percentage statistics of diseases for comparison:—

Comparing Figs. 43 and 44, sandstone and granite, it will be observed that the granite dust is lightish-grey in colour, with black specks, and contains numerous flat, transparent splinters of quartz. Sandstone dust, on the other hand, is a finer powder, it is yellowish, and equal in colour throughout; it is rather an amorphous powder; in some samples a few sharp-edged plates of quartz can be seen. From microscopical appearances it might be assumed that granite dust would be very much more hurtful to the workmen than sandstone, and yet, according to Arlidge, Diseases of Occupations, p. 303, who made special inquiries into [275]this subject, the workmen employed around Aberdeen in the cutting, dressing, and polishing of granite, are seldom the victims of pulmonary disease attributable to their occupation. This circumstance may be due to the igneous character of the rock, and the small quantity of dust that is thrown off, especially in the act of chiselling. Besides, as the particles of dust are of considerable size, they would, if inhaled, be caught in the upper part of the respiratory passages, and therefore not have the opportunity of inflicting damage upon the lung. The fact remains that while Aberdeen granite workers suffer from chronic bronchitis, they are remarkably free from the pulmonary fibrosis to which stone masons and French millstone builders are liable.

Fig. 42.—Cement.

Fig. 43.—Sandstone.

Fig. 44.—Granite.

Fig. 45.—Lead Dust from Printing Shop, and Type casting.

Microphotographs of Dusts developed in Dusty Trades. The first twenty are reproductions after Migerka: the last six after Bolam and Oliver.

In Fig. 45, lead dust, as obtained from a printer’s shop, the particles are seen to vary in size and form. The particles are for the most part round, and not unusually sharp. This dust is not harmful on account of its form so much as dangerous through being absorbed into the blood. The dust that is given off in file-making contains particles of iron as well as lead and charcoal (see p. 342), and this is productive of a large amount of pulmonary disease in men and women engaged in this trade. But with file-cutters as with printers and typographers generally, the unhealthy and close workrooms in which they follow their avocation are to some extent also responsible for the lung diseases. As bearing upon this subject, the annual reports of Benefit Societies are not without interest. The reports of the Benefit Societies of the printers and type-casters of Vienna, from 1889–1892, give the following percentage of illnesses:—

It is the typist and caster who suffer most from diseases of the respiratory organs, while among the printers and their assistants, the average is just above the normal. So far as diseases of the digestive organs are concerned, the printers suffer less than the others, but there is a preponderating amount of sickness among the females in nearly all branches of the industry. When the amount of general sickness in these trades is examined, it is found that the averages of total sickness are as follows: typists, 44.7; male casters,[276] 41.2; female casters, 91.2; while printers are only 27.9, and assistants 28.5. These remarks are introduced here to emphasise the fact that in the printing trades it is not alone the dust that is injurious, but the lead poisoning which it causes, and they also strengthen an opinion expressed in other parts of this book, viz., that females are more liable to plumbism than males, as the following figures also show. The percentage of plumbism in male casters in Vienna is 8 per cent.; in female casters it is 22.7 per cent.

In Fig. 47, dust developed during needle-grinding, the particles of dust are frequently hook-like in appearance and sharp-edged. Lying among these are also observed particles of quartz with edges that are more or less sharp.

Fig. 48 represents dust from mother-of-pearl grinding. Hirt regarded this trade as extremely dangerous. He found that 15 to 16 per cent. of the men engaged in this trade died from phthisis. According to Guggenbauer, turners of mother-of-pearl are said to suffer from a peculiar affection of the bones (osteomyelitis) owing to absorption of carbonate of lime from particles of the shell that have been inhaled. It is said that obscure rheumatic-like pains subsequently occur, and that the bones ulcerate. I have visited mother-of-pearl grinding shops in Sheffield and interrogated the workers there, but have been unable to find any evidence to support Guggenbauer’s contention. The grinding in Sheffield is done by the wet process, and none of the men seem to suffer in the manner alluded to.

Flax dust, Fig. 50, is injurious to the worker. It contains mineral particles, vegetable cells, and broken stalks—so too does hemp, Fig. 51. In the teasing and spinning of cotton, Fig. 53, there is a considerable amount of dust raised in which fine fibres of cotton are found, Jute, Fig. 52, shows vegetable fibres which are often torn and ragged, and therefore with difficulty detached from the bronchial mucous membrane. In the figures representing dust obtained from felt-making, fur-brushing, and rag-cleaning, may be observed various forms of hairs and vegetable structures, with numerous foreign particles adherent to and encircling them. Some of these particles are of animal origin and may carry micro-organisms. The dust obtained during wheat-cleaning, Fig. 61, contains pointed vegetable hairs and numerous particles of organic and inorganic material, and would, if inhaled, be particularly irritating to the bronchial mucous membrane.

Fig. 46.—Gilchrist-Thomas Slag.

Fig. 47.—Needle Grinding.

Fig. 48.—Mother-of-Pearl.

Fig. 49.—Sawdust.

Fig. 50.—Flax.

Fig. 51.—Hemp.

Fig. 52.—Jute.

Fig. 53.—Cotton.

Fig. 54.—Silk.

Fig. 55.—Horn.

Fig. 56.—Ivory.

Fig. 57.—Felt Manufacture.

Fig. 58.—Dust from Fur Brushing Machine.

Fig. 59.—Dust from Rag Cleaning.

Fig. 60.—Bone Meal.

Fig. 61.—Dust from Wheat Cleaning.

Fig. 62.—Ordinary Slag. Consett Iron Works.

Fig. 63.—Basic Slag. North Eastern Steel Works, Middlesbrough.

Fig. 64.—Ganister. Messrs Grayson, Lowood & Co., Middlesbrough.

Fig. 65.—Dust from Fork Grinding on dry stone. Sheffield.

Fig. 66.—Powdered Flint. Earthenware Works, Stoke-on-Trent.

Fig. 67.—Glaze cleaned off Ware. Stoke-on-Trent.

Microphotographs of Dusts, high-power. (T. Oliver and R. A. Bolam).

It is a well-known fact that some forms of basic slag are more injurious than others. From a microscopical examination of the [277]various dusts sent to me by Commander Hamilton Smith and Mr H. J. Wilson, H.M. Inspectors of Factories, and others (see Microphotographs, Figs. 62–67, by Dr Bolam and myself), I do not find sufficient evidence, judging by its appearance alone, to explain why one kind of basic slag manure is so very much more harmful than another. There may be chemical as well as physical causes at work in the production of pathological changes in the bronchial mucous membrane of those who work in basic slag. Some slags, for example, contain larger quantities of lime than others.

Thomas Oliver.

Many readers are probably not aware that there is such a recognised employment for women as the sifting and sorting of the refuse of our houses. Any one wishing to observe how this work is carried on can see it daily in the dust-yards and wharves of London. In these places there are women who are actually spending their lives handling all the obnoxious waste that a great city produces. Dust-carts bring load after load of refuse to the yards. The drivers tip the contents of the carts before the women, who are drawn up in line and whose duty it is to sieve and sift this refuse, and then to sort into the different baskets that are standing close by, such things as rags, bones, string, cork, boots, paper, coal, broken glass, etc. It is a dirty and dusty occupation, and as a rule the women have their clothing covered and permeated by the dust, and their hair laden with it too, notwithstanding the handkerchief or shawl that covers their head. Wrapped with a piece of old sacking round their skirts and cloth bands round their legs, they lean over their work and inhale the unsavoury dust that has gone forth from the houses and the shops of the city. In one sense it is fortunate that this unpleasant operation is conducted in the open air, for therein to a large extent lies the comparative harmlessness of the employment. From time to time the hands of the women get cut by broken glass, and there is incurred the risk of festering wounds and the danger of blood poisoning.

The story of dust women is told by Miss Emily Hobhouse in the Economic Journal, September 1900, p. 411, from whose interesting report I have drawn largely for the information supplied in this article. Miss Hobhouse naturally raises the question as to how far the sifting and sorting of refuse is a fitting and sanitary employment for women. Theoretically it cannot be a pleasant one, considering what the refuse may and does contain, and yet from the organic and inorganic materials, the dead and[279] dying organised heaps that leave our houses as refuse, these women pick out certain things that are sent to manufacturers and reappear for sale in the form of glue, soap, bottles, and paper, while even such a thing as broken glass is rescued, transported to Sweden, and comes back to this country in the form of emery paper for polishing steel.

The employment of dust women is dwindling, and must perforce disappear owing to the multiplication of destructors, the expense of dealing with the ever-increasing refuse by means of sifters and sorters, and the growth of public opinion, which is certainly opposed to regarding this work as a proper employment for women. It is a well-known fact that if a woman takes to refuse picking early in life she becomes almost utterly unfit for any other employment. At the present time the destructors do much of the work that has hitherto been done by men and women, but these furnaces can only destroy certain things in the refuse, and consequently leave a residue that has still to be got rid of. The question of removing the increasing amount of refuse from London and our large towns is a difficult one to solve. It has an economic side which cannot be ignored. In some of the vestries of London the clinker and fine ash that are removed from the destructor are converted into mortar, and the steam that is generated by the destructor is used for driving the machinery for grinding the mortar and clinker. It has been ascertained by sanitary engineers that town refuse has about ⅑ the heating power of coal, and that in a large city like London it can be destroyed for 2s. 5d. per ton, a less sum than it costs to barge it away. Some of the Boards of Works dispose entirely of their refuse by destructors, while others only do so partially; some again have their own yards or wharves, but not in all of them are women employed. Twenty-six of the vestries let out the work to contractors, many of whom, on account of the cheaper labour, employ women. In London alone there are at least 300 women employed as dust sorters. The wages given by the vestries, and the conditions of labour found under them, are much superior to those under contractors. The vestries pay the women 15s. a week, each day’s work, except Saturday, extending from 5 o’clock A.M. to 5 P.M., but 7s. to 8s. a week is all that can be obtained from the contractors. The broken-down appearance of the women who work for contractors, and who are sweated beyond all bounds, causes them to compare most unfavourably with the dust sorters for the vestries.

The evidence obtained from officials, contractors, and the[280] women themselves rather went to show that the general health of the men and women working in the dust-yards was good. Owing to being so much in the open air the women seemed hale and well-coloured, and they contrasted most favourably with those who were working in the factories or at home. Occasionally such troubles occur among them as sore throat, ophthalmia or “blight,” poisoned wounds, and among the elderly women recurrent attacks of cold on the chest, due to exposure to severe weather and the wet. On the whole, however, it would seem as if the open air life agreed with the women. In some of the yards the sifting is done by machinery, and the women only do the sorting. In these yards the women complain of finding it hard to keep pace with the machinery and of having to lift too heavy loads.

Under all circumstances dust-sorting is dirty and disagreeable work. It is generally undertaken by women of the lowest class. The only zest that is given to the occupation is the prospect of finding money. Occasionally a copper, silver, or gold coin is found, and in most of the yards the money belongs to the finder. Such a piece of good luck, however, seldom benefits the individual, for it is made the excuse for a drunken spree that often lasts for days. The work is hard and exposed. It not only unfits women for other employment, but even for the ordinary duties of housewife and motherhood. It destroys the best instincts of maternity. The work takes the mother away from her children, who are consequently ill-tended and often die from neglect. Although several children may be born of these women, in many instances none of them live beyond a few months, not by the employment affecting the children through the mother, but because maternal duties are totally disregarded. For these reasons, therefore, it is scarcely desirable work for women under thirty years of age. It is with dust women as with many of the laundry women in London; they form a class by themselves, and so the work becomes more or less hereditary.

As to the occupation being unsanitary, medical opinion is divided. Dr Thomas of Limehouse does not think it increases the death-rate, and Dr Dudfield reports that he has not observed any bad effects upon the health of the women. On the other hand, Dr Priestley states that while he has not observed any actual injury to health from the sorting of refuse, he thinks there cannot be any doubt that the trade is dangerous to health, and on this ground he recommends its discontinuance. The occupation is one which theoretically might be expected to be prejudicial[281] to health, and yet experience indicates that the women become hardened to the work and immune to its possible evil effects. It is an undesirable employment for women all the same. If it is to continue, it ought to be brought under the supervision of the Factory Department of the Home Office, and as the conditions of labour under a private contract system are in this instance worse than when conducted and controlled by municipal authorities, Vestries or Boards of Health should retain the management of dust-yards in their own hands.

Thomas Oliver.

Of all the metals employed in the arts and industries, none lends itself to such general applicability as lead. In its metallic state it is so plastic that it can be readily moulded. It forms compounds which for colour and persistence have enduring properties superior to most of the metals. There are few articles of manufacture that have not been directly or indirectly brought into contact with lead, and in many of the newer industries the association is extremely close. The census for 1891 showed that there were 132,010 persons employed in lead processes. Of these, 123,829 were painters, 2431 workers in leaden goods, and 5750 were lead-miners. If we add to these the numbers employed in the potteries, electric accumulator works, etc., it will be at once seen that a very large proportion of the artisan class is brought into contact with lead. It is this wide use of the metal, the extremely poisonous character of its compounds, and the peculiarly subtle manner in which they act upon the human organism, that make lead a dangerous substance. Besides, it is frequently present in the water, the aërated beverages, and the wine we drink; the food we eat may be contaminated by having been cooked in common earthenware or in cheap enamelled pots, or by tinning as in canned goods. The acid juices of fruits or foods may dissolve out the lead in the solder. The clothing we wear may have been dyed by lead compounds, and thus not only industrially but in our domestic and personal lives we are daily running the risk of plumbism.

Lead-mining and the Health and Surroundings of the Miner.

Professor Louis, in his article on Mining, p. 538, has briefly alluded to lead-mining. As in the following pages the subject of lead generally is dealt with, I feel that the reader will have a fuller grasp of all the points relating to lead and its history, if I slightly amplify what he has said by throwing a little side-light[283] upon the medical and social aspects of the lead-miner’s life. Lead-mining in this country is an extremely old industry. Bars of pig-lead have been found in Derbyshire stamped with the imperial arms of Rome, indicating that the Romans worked our mines and smelted the ore. Since 1401 lead-mining has been carried on in the North of England, and has given employment to many families in the remote dales of Cumberland and Durham. It was formerly a source of very great wealth, but the mines have been gradually closing, owing to the importation of cheaper lead and of ores richer in silver than those that exist in this country. To-day it is rather a decaying than a prosperous industry. At present only 15,000 tons of lead are melted annually on Tyneside. Most of it is foreign pig-lead. During 1895 there were 250,000 tons of ore converted into pig-lead in this country. It is perhaps more to the poverty of silver in the native ore than to the cost of production of the raw material that the diminished output of recent years is to be ascribed. It hardly pays the proprietor to extract the silver when it is present in small quantity. English pig-lead contains a very small percentage of silver, seldom more than from 8 to 10 ounces to the ton. Foreign ores vary as regards the amount of silver held. In Spanish ore there may be as much silver as 40 to 80 ounces to the ton, and in Greek 80 ounces. Australian ores show very great variations. In some of the veins the ore contains 60 ounces to the ton, while in other samples there may be 500 ounces or even more.

So far as lead-mining in the North is concerned, the methods adopted for obtaining the ore are antiquated. Owners are apparently afraid to risk money in the enterprise, and as a consequence the means by which lead is mined are much inferior to those for getting coal. Lead mines, too, are not under the same Government regulations as collieries. Their ventilation is bad, the roadways are ill kept, and the mines are often damp, while the means of descent into, and ascent from, the mines, by a series of ladders, are arduous for the workers. So far as the mining of the ore is concerned, there is in this country practically no risk to the miner from lead poisoning, for he is dealing with almost a pure ore, viz., galena, which is a sulphide. Metallic lead is harmless compared with its compounds, the oxide and carbonate. It is this circumstance that explains why lead-miners at Broken Hill in Australia suffer so severely from colic and convulsions, while their confreres in England escape. The ore at Brocken Hill is very largely a carbonate. The English lead-miner runs the[284] ordinary risks to life and limb from accidents, and in a special manner his health is endangered by pulmonary consumption and rheumatism, largely the result of exposure when returning from work heated and fatigued, also of the barrack system in vogue in certain places for housing the miners.

There is not much lead-mining carried on in France, but where it is there is freedom from plumbism among the miners as in our own country, with the exception of an outbreak of colic that occurred among the men who were working in the veins at Asprières (Aveyron), where the mineral was found, like the Australian ore, to be composed mostly of cerusite or carbonate of lead. It is to a similar condition of the ore in the lead mines of Sierra de Gador that are attributed the 400 to 500 cases of colic annually observed by Dr Bayer among 12,000 miners—a malady to which the crushing of the cerusite in the dry state no doubt very largely contributes. (Poisons Industriels, Paris, 1901, p. 14.)

Fig. 68.—A Lead Mine. Large building on right is the lodging for the Miners; lower part of building is occupied as a stable. Top of shaft seen high up on left; lower down, the “level” or drift with hauling machinery.

The dales of Durham in which lead-mining is carried on are sparsely populated: they are bleak, and swept by cold winds for the greater part of the year. In many instances the miners live a considerable distance from their work, and as railways have not yet penetrated into these remote corners of England, the men have to cover the ground on foot. Lead-miners are brought very little into touch with the outer world. They form a class by themselves, and cling with affection to their homes on the hillsides: they closely intermarry, and thus form not only one family socially but industrially as well. Their wages are small, seldom more than ten to twelve shillings a week, and yet, unless compelled through sheer necessity to renounce their badly paid and not too healthy occupation, they will not leave the district for the more lucrative work of coal-mining. As a class they are thrifty, intelligent, temperate, and religious. They are not long-lived. Pulmonary phthisis is extremely prevalent among lead-miners. In close proximity to some of the mines large “lodging shops” or “barracks” have been erected, where many of the workmen stay during the week. In one district, Dr William Robinson of Sunderland, formerly of Stanhope, found that 166 miners occupied one of these shops during three or four days and nights in the week. Often the barracks are in a filthy condition, for they are badly kept. As the sleeping accommodation is limited, the bedrooms are crowded to excess. In one room, 16 feet by 13½ and 9¾, there were 20 miners accommodated, i.e., at the rate of 124 cubic feet of air per man, while the model regulations of the Local Government Board require not [285]less than 400. Most of the rooms have no fireplaces: the windows are fixed, and consequently there is no means of ventilation. As large numbers of men have to be accommodated, the beds are crowded together in two tiers 3 feet 6 inches from each other, so that there is barely space to pass between them. Since the rooms are occupied by different sets of miners working alternate shifts, the beds are hardly cooled before being again occupied, while in consequence of the air of the rooms not being renewed, the stench is overpowering. Bad as the sleeping accommodation is, the day rooms are not any better. The closet accommodation, too, is scanty and often badly placed. In his lodgings as well as at his work many a lead-miner is exposed to the influence of very unwholesome atmospheric conditions, the results of which are seen in his deteriorated constitution and diminished resistance to disease. The air of the lodging-shops is heavy with the effluvia from the bodies of their occupants. Sooner or later lead-miners suffer from asthma and pulmonary catarrh, the end of which is often tubercular consumption, and as the men expectorate upon the floors of the sleeping-room, the tubercle bacilli find in the badly-lit and ill-ventilated rooms the conditions which favour their multiplication. In this manner, and apart from his work, the lead-miner is brought under the influence of the microbe of pulmonary phthisis. The excessive amount of carbonic dioxide in the mines, the unconsumed products given off by the burning candles and those given off by explosion of gunpowder, render the atmosphere of the mine for the greater part of the twenty-four hours unhealthy. By the workman who lives a few miles from the mines, and who has to walk home across a bleak and wind-swept moor, tired and heated after a hard day’s work and wearing wet clothes, colds on the chest are readily caught and not readily got rid of. Out of these repeated pulmonary catarrhs consumption is prone to develop. Commencing work in the open air as a crusher and washer of ore, the son of a lead-miner—for the occupation is largely hereditary—will for health compare most favourably with any young artisan, but he has only to work a few years in the mine when he becomes short-winded. Once this defect is induced it gradually increases, and so at the age of forty to forty-five the lead-miner is old for his years: an asthmatic, he is the subject of wheezing cough and expectoration, and is often obliged to give up work entirely before the age of fifty. Life, however, may be prolonged for years, for the summer months bring abatement of the symptoms; the improvement, however, is only temporary, for the cold winds of winter and spring again light[286] up the chest affection. Since in the mine the air is dusty, and the worker inhales particles of grit, pathological changes in the lungs are established similar to those mentioned in the chapter on Dust and Disease. The lung of one lead-miner that I have is almost solid from excess of fibrous tissue, and it feels as hard as stone, see Fig. 39. On microscopical examination the alveolar structure of the lung is found to be replaced by dense fibro-connective tissue. In the expectoration of some of the lead-miners I have found tubercle bacilli. The pulmonary disease of lead-miners, therefore, like that of workers in dusty trades, may be either a simple form of fibrotic phthisis due to inhalation of grit, or it may be a truly tubercular lesion grafted on to the less formidable fibrosis. The average age at death of lead-miners is about fifty. Nearly 50 per cent. of them die from chest diseases. In the dales around Stanhope, in the county of Durham, the death-rate from phthisis among a secluded population of lead-miners was 4.7, while in another part of the same Union composed of farmers it was only 0.6.

Lead-smelting.

While the miners in this country do not suffer from lead poisoning, the same cannot be said of the men who smelt the ore. I have seen several smelters die from plumbism. In a few instances I have witnessed son after son in a family thus carried off before the age of thirty. The fume that escapes from the flue of the smelting shop contains oxide and sulphate of lead, and it is the inhalation of this that causes plumbism. Usually the lead fume is conducted into a long flue, 5 feet high and 3 feet wide; in some places the flue is carried up the side of a hill for a mile or two before it terminates in the chimney. This allows of the deposition from the fume of some of the oxide and sulphate of lead which is recoverable. At one large smelting works which I visited along with my colleagues on the White Lead Commission, we found that recovery of the deposited lead by men entering the flues was attended by such serious symptoms that we recommended two hours at a stretch as the maximum time for men to work in cleaning out the flues. Twenty cases of plumbism in lead-smelters were reported to the Home Office in 1900.

Fig. 69.—Other View of Lead Mine. Crushing Machinery, etc., in shadow; Washing Troughs, Sluices, “Sludges” in foreground.

Although British galena contains usually but a very small quantity of silver, this can be profitably extracted when present in the ratio of even 2 of silver to 1000 of lead. Frequently the amount of silver present in foreign ores is so large that manufacturers prefer to extract the more valuable metal only. Desilvering of lead ore is generally carried out by the Pattinson process, introduced in 1829. Until that date silver was not extracted from galena. The ore had to be converted into an oxide in order to separate the silver, and the oxide resmelted to recover the lead, but unless the lead contained 8 to 11 ounces of silver to the ton it did not pay to extract it. While its removal has increased the production of silver, its extraction is by some authorities believed to have improved the quality of the lead. On the other hand it is stated that lead pipes made from desilverised ore are, when used for conveying drinking water into our houses, found to be too soft. They are more readily acted upon by water, and become consequently a more frequent cause of plumbism than the harder pipes made from British galena, from which the silver has not been extracted. The introduction of the Pattinson process has caused silver extraction to become a special industry. The process depends upon the formation of an eutectic alloy of silver and lead.[50] It is unnecessary to describe the Pattinson process, since it is detailed in all text-books on metallurgy and chemistry. Suffice it to say that the desilvering plant usually contains five pots made of cast iron and set in masonry, and by a series of melting and skimming, cooling and transferring the separated silver and lead to a series of pots in succession, all the silver, practically speaking, can be removed from the lead. Although I have frequently examined men engaged in desilvering lead I have rarely found them the subjects of plumbism. Two cases of lead poisoning were reported to the Home Office in 1900 as having occurred in silver-smelters.

Red Lead; Lead Oxide; Litharge; Massicot; Minium.

Lead oxide, the yellow and red, is got by melting metallic lead in a furnace exposed to atmospheric air. By means of a long iron rabble a workman keeps raking the molten liquid so that it is brought into intimate contact with the oxygen of the air. When removed from the furnace and cooled, the product assumes a red or yellowish colour according to the amount of oxygen it contains, and is known as the red oxide of lead and minium, or as massicot. During the operation of melting and raking the lead a certain amount of fume escapes from the open mouth of the furnace. The fume ought to be removed by a strong[287] upward draught through a hooded chimney. Where this is not done and the men approach too near the mouth of the furnace, fume is inhaled, with the result that the workmen suffer from plumbism. A fairly large number of red-lead makers become anæmic and suffer from colic and wrist-drop. Great as is the risk run by the red-lead worker through inhaling the fumes from the molten metal, it is less than that incurred during the crushing and packing of the finished product. The substitution of mechanical agitation of the molten lead in the furnace for that done by hand by the workman would diminish the danger, since it would allow the doors of the furnace to be closed, except during the charging of the interior. The packing of casks with red lead should be conducted in closed spaces provided with a hood and such means as will create an effective draught. The workmen ought to wear overalls, have frequent baths, and be inspected at least every fortnight by a doctor. Men can work longer in red than in white lead without losing their health. There is no truth in the statement that they are absolutely free from the severer forms of plumbism. As a rule, I have found the symptoms of lead poisoning in massicot makers on the average milder than those observed in white-lead workers; but the result depends upon the proximity and length of exposure to lead compounds rather than upon the particular nature of the compound itself—always, of course, remembering that the more soluble the lead compound the greater the danger. Some physicians have had quite other experience. Layet, for example, in a paper read before the Congress of Hygiene at Turin, 1880, stated that minium is more dangerous than white lead, and that the form of poisoning is just as severe, if not more so. He had found red-lead makers more liable to what is known as encephalopathy, i.e., the cerebral type of Saturnism, than white-lead workers.

[288]

Fig. 70.—A “Blue” Bed in a White Lead Factory, showing tan in lowest part, and resting on it rows of earthenware pots containing acetic acid. Resting upon the pots in left hand corner can be seen thin sheets of metallic lead.

Fig. 71.—Female carrying Basins filled with Washed White Lead from Vat to Stoves.

White Lead; Carbonate of Lead (Céruse, Fr.)

All the soluble salts of lead are capable of inducing plumbism, and of these the carbonate is perhaps the most prolific cause of lead poisoning. In Britain most of the white lead of commerce is made by the old Dutch process. Thin sheets of metallic lead (wickets) are taken to the stacks or blue beds. The floor of the stack is covered by a layer of tan, and on the tan is arranged a series of earthenware pots containing dilute acetic acid. Upon the pots [289]are placed the sheets of lead. Boards are laid over these, and thus the first layer is formed. Tan is thickly strewn over the boards, and when this has reached a sufficient thickness, other rows of pots partially filled with dilute acetic acid and covered over by thin sheets of lead are arranged on the tan, and the whole is covered over by boards. This second layer is followed by others similarly constructed, until by a succession of tiers the ceiling is reached, when the doorway is built up by boards and kept closed for a period varying from ten to fifteen weeks, during which the conversion of blue into white lead by corrosion takes place. The stacks are ventilated by means of a shaft at each corner. Once the “blue” beds are made up and the doorway closed, the tan begins to get warm and evolve carbonic acid. In consequence of this heat the acetic acid becomes volatilised, and through the interaction between the lead and acetic acid on the one hand, and the carbonic acid on the other, chemical changes of a nature not thoroughly understood occur, which ultimately end in the production of the basic carbonate of lead, or what is popularly known as white lead. When this conversion is believed by the manufacturer to have taken place, the stack is opened. It is then no longer spoken of as a “blue” but as a “white” bed. Workpeople enter the white bed to strip it of the corroded lead. What was originally placed in the blue bed as a thin layer of metallic lead has become converted, if the corrosion has been satisfactory, into a much thicker plate made up of a white crisp incrustation of lead carbonate, which often conceals from view very thin pieces of unaltered metallic lead. In stripping the white lead off the unchanged metal a considerable amount of dust is given off, the inhalation of which was previously much more frequently a cause of plumbism in the workpeople than now, owing to the fact that present regulations require that the white beds must be watered by means of a “rose.” The carbonate and unaltered lead removed from the white beds used formerly to be taken direct to the rollers, crushed and washed, so as to separate the two. After washing, the white lead is placed in earthenware vessels and taken to the stoves to be dried. The emptying or drawing of stoves has been the cause of a larger number of severe and fatal cases of lead poisoning than any other department in a white lead factory. Until 1898 the filling and emptying of stoves was very largely done by women, young and middle-aged, but the work was found to be so detrimental to female life that the White Lead Commission recommended that no woman or girl should be allowed to work in the stoves. I have known young women die[290] from plumbism within three months after entering a white lead factory and working in the stoves. It takes from three to five days for the white lead to become thoroughly dried in the old form of stoves, after which it is packed into casks. Since the White Lead Commission published its Report there have been many improvements in stoves. There are many now in use which will tend still to diminish plumbism. In some factories wagons ladened with basins of moist white lead are run on rails into the drying chamber, while in others the white lead is made to fall mechanically on to a series of large revolving discs in a closed chamber heated by air. Packing is often a dusty and dangerous process if it is not conducted in a confined space ventilated by a shaft and fan. The white lead is mixed with oil and converted into paint. When visiting the white lead works in Paris of Messrs Expert-Besançon et Cie., a short while ago, I found that while the old Dutch method of manufacture was in use there was an immunity from plumbism among the employés that created a favourable impression upon me. That freedom I found was in the main due to the following circumstances: (1) no female labour was employed; (2) stoving was practically done away with; (3) the white lead was taken direct from the stacks to the rollers, where it was crushed and washed; then (4) passed through a series of rollers and mixed with oil, which gradually displaced the water,[51] so that a perfectly finished paint escaped from the last roller, practically free from, or containing only a very small percentage of water, and was passed automatically into casks, thus abolishing some of the dusty and dangerous processes as well as the handling of the white lead; (5) careful personal supervision of the workers, and attention to cleanliness; (6) regular medical inspection; and (7) alternation of employment. I reported to the Secretary of State upon these facts, with the result that they were laid before the white lead manufacturers of this country, many of whom adopted in a modified form the practice observed in Besançon’s works. English makers have since then informed me that it not only saves labour and therefore cheapens production (the product itself not suffering in quality), but has materially diminished the number of cases of lead poisoning in their factories.

White lead can be made by other methods. In what is known as the chamber process strips of lead are suspended over parallel bars in a chamber, which is heated by steam, and into which [291]carbonic acid is passed, while acetic acid is present in pans on the floor. The result is the same, viz., formation of white lead by a process of corrosion, only the conversion is much more rapid, being four or five weeks as against the ten to fifteen required by the stack process. The subsequent treatment of the white lead is the same in both cases. Much of the white lead manufactured in Germany is made by the chamber process, and in that country emptying the chamber is regarded as dangerous to health.

Fig. 72.—Interior of Stove for drying White Lead.

By the old Dutch process an excellent and very pure white lead is no doubt produced. The drawbacks to the method are that it is tedious, and that some parts of the process are extremely dusty, and therefore dangerous. There have been various attempts to manufacture lead carbonate by quicker methods, and of these the method of obtaining white lead by the action of acetic acid and glycerine upon the red oxide may be mentioned. In it the first step consists in reducing metallic lead to litharge by placing pig-lead in a furnace and allowing a jet of steam to play upon the vapour of the molten metal. The lead oxide is subsequently crushed into a fine powder. This, as I saw it, can be a very dusty and dangerous process. The red oxide is placed in large revolving barrels along with acetic acid and glycerine, and the churning is allowed to go on for about two hours. A greenish-white liquid is the result, and this is allowed to escape from the barrels into storage vats, from which it is conveyed into large cylinders called carbonators. Into these carbonating tanks carbonic dioxide obtained from burning coke and lime is conveyed, and the gas is allowed to bubble through the mass for about an hour, when carbonate or white lead is formed. After running off the supernatant liquid, the deposited lead carbonate is removed through pipes to the presses, where it is washed and any acetate that may cling to it is removed. After this it is taken to the stoves, into which it is run on a series of long narrow wagons, the workmen not entering the stove at all. By the third day it is sufficiently dried to be ready for packing or mixing with oil to make paint. This method of manufacture is known as the precipitation process. In it there is no handling of the white lead until it reaches the presses. The dangerous parts of the process are: (1) the grinding of the lead oxide: this is dusty; (2) the pressing: in this the men handle the white lead, and as a consequence I have observed in young workmen marked anæmia, tremor of muscles, colic, and the presence of a deep blue line on the gums; and (3) filling the barrels with the finished white lead, when danger arises from[292] inhalation of dust. In some works ammonia is substituted for glycerine. Conducted as an experiment, white lead manufactured on the lines just detailed is extremely satisfactory, but financially it is not very successful. Although the precipitation process is more rapid it is more costly, and as a consequence factory after factory which has adopted this method has been obliged to close.

In the manufacture of white lead by the Bischof process the first stage consists, after converting metallic lead into litharge, in the reduction of the litharge to suboxide in gas-tight cylinders by means of water gas at a temperature of about 300° C. The suboxide is moistened in mechanical mixers with water, and converted into hydrate. By means of carbonic acid, dilute acetic acid and glycerine, the hydrate is converted into white lead in a gas-tight apparatus, and after separation of the liquid and washing of the sludge, the aqueous white lead is mixed with oil by mechanical means, and becoming thus ordinary white lead paint, it is packed ready for the market. No female labour is employed in the factory. The manufacture of white lead by the Bischof process at the time of writing is still to a large extent experimental, but it gives promise of commercial success. As the work is done by machinery, and is for the most part wet, there is no dust given off. The only possible unhealthy part of the process I observed was the mixing of the suboxide of lead with water, but where this is done mechanically, as I presume it can be in chambers provided with ventilating shafts, all danger can be averted.

In white lead factories the dangerous processes are emptying the white beds, washing the incompletely converted metallic lead plates, crushing, grinding, sifting, filling the pots with white lead for the stoves, emptying the stoves and packing the barrels with the dry white lead. It is the continual absorption into the body of very minute quantities of lead compounds either by the pulmonary or digestive tract that causes plumbism. The skin, too, offers another channel by which it may enter the system. Although it is usually in the form of dust that lead enters the body, it can also enter it in the form of fume, and possibly, too, mixed with steam in which the particles of lead are either dissolved or suspended.

Lead carbonate is an extremely fine white powder, and is largely sought after as a pigment by house painters, by plumbers for searing joints, and by pottery manufacturers for making the glazes in which the ware is dipped. As a pigment it is said by a large number of house decorators to be superior to any other.[293] There is a decided preference in the trade, too, for that made by the stack process. It always commands a higher price, the reason being that it is believed to have much greater covering power than white lead made by some of the other processes. On account of white lead being such a dangerous product, both in its manufacture and manipulation, the question of finding a suitable substitute has often been raised. This subject was carefully gone into by the White Lead Committee a few years ago.

Zinc white, for example, was recommended, but the opinion come to was that while zinc oxide was practically free from the dangers incidental to lead carbonate, and answered well for internal decoration, for covering purposes and endurance in all kinds of weather there was no pigment equal to white lead. It is this widespread belief among house painters generally that makes white lead such a valuable commercial product.

The question of finding a substitute for white lead has not been confined to Britain alone. One hundred and twenty years ago, Courtois presented to the Academy of Dijon some zinc white, which was remarkable on account of its permanence, and in 1783 Guyton de Morveau recommended, from hygienic motives and on account of its chemical properties, zinc oxide for lead carbonate. Ten years ago a small representative committee reported to the Commission des Logements Insalubres of the city of Paris upon zinc white as a likely substitute. As far back as 1849 the Minister of Public Works ordered that all the Government buildings in France were to be painted with zinc oxide instead of lead carbonate, and although in 1852 the Minister of the Interior followed with a similar request to the various prefects, the resolution remained a dead letter. It was indicated to a fresh committee, appointed in 1891, that from an economic and industrial point of view, zinc white was inferior to white lead, that it had no great covering power, little durability, that it cost more, and that therefore the painting of State buildings by it would entail an unjustifiable expense. Some persons, on the other hand, held the belief that zinc white possessed just as good covering properties, so long as it was mixed with a larger proportion of oil and less of turpentine, and that the painter gave a sufficient amount of attention to his work so as to make the coating flat, also that it was not so readily blackened by sulphurous vapours. As for the increased expense, it was to be remembered that if zinc white costs more, it is also less heavy, and therefore weight for weight gives a larger body of material. The Commission, taking into consideration[294] the hygiene of dwellings, the health of the workers, and the interest of landlords, and having the choice of two substances before it, of which one is almost harmless, and the other a strong poison, adopted the following resolutions: (1) the employment of zinc white to the exclusion of white lead will be specified in all the orders for painting; (2) the Commission renews the wish expressed in 1880 in regard to the exclusion of white lead in all public works. No special action followed these recommendations. Within the last few months the question has again been raised in France, and on this occasion more vigorously than before. The operative painters met in congress, and passed resolutions denouncing the use of lead in the manufacture of paint, and demanding that the law for compensation for accidents should be extended to include cases of plumbism. To the painters’ representatives the Minister of Commerce, at a personal interview, while admitting that the law on accidents was imperfect, stated that it was too soon to hope for its amendment. He undertook to do all he could to enforce the decree of 1849, that no more lead should be employed in painting and decorating State buildings. In France zinc sulphide, oxysulphide, and oxide have all been tried as substitutes for white lead, but although there is a belief that these can replace lead carbonate, there is an unwillingness on the part of architects and house-painters to discontinue the use of lead. In Britain other chemical compounds in addition to the above have been tried, e.g. sulphate of barium, but although this is a beautifully white substance, it does not mix so well with oil nor has it the covering power of white lead. The surface of the object painted can be seen through the coating of barium sulphate, a circumstance probably due to the fact that the barium salt exists in a more highly developed crystalline form than the lead compound.

In March 1901 the Comité Consultatif d’Hygiène of France reported upon this subject[52] that the manufacture of white lead has become less and less the harmful industry it was owing to the Expert-Besançon process of grinding and mixing the white lead in water, with the subsequent addition of oil as it passes through the rollers, careful medical examination of the workmen employed, and the removal from the works of those who seem to be susceptible to plumbism, or are inclined to the free use of alcohol. The Committee of Hygiene recognises that in house painters, want of cleanliness, also the excessive use of alcohol and absinthe, are responsible for much of the lead poisoning, and therefore,[295] since it is impossible to regulate and control the habits of these men, they ought to be provided with paints which do not contain such an injurious substance as white lead. In zinc white the committee is of opinion that a proper substitute can be found for lead for most purposes. Many architects and builders still object to the use of zinc white, but there are many, on the other hand, who claim for it the same advantages as regards covering power and endurance, and who maintain that when exposed to sulphuretted vapour it forms a sulphide which is white compared with the black sulphide similarly obtained from lead. The zinc coating dries more slowly, and there is therefore some loss of time; the work of laying on, too, may be a little more difficult, and for polishing purposes zinc mastics do not harden so well. Zinc is not so good in calico-printing as white lead. There are some things therefore, the committee admits, that lead may be better for than zinc. It is also admitted that even zinc oxide may be accidentally contaminated by small quantities of arsenic and lead, also that it is slightly more expensive—for example, it costs 0.0152 franc more for each metre of work done. The committee concludes its report by stating that both in the manufacture of zinc white and in its application as a paint it is free from the dangers incidental to lead, and therefore it is worthy of a lengthened trial as forming the basis of colours for house painting, since there is a considerable amount of educated opinion to show that it can be substituted for white lead. The French Government is asked to set the example by having the public buildings painted with oxide of zinc.

No industry, unless, perhaps, it be that of pottery manufacture, has caused so much plumbism as the manufacture of white lead, and yet in none has strict attention to regulations and personal hygiene been so productive of good as in these two industries.[53] The bulk of the work is unskilled labour. In Newcastle and neighbourhood, until the last three years, most of the work in the dangerous processes was performed by women who led rather a casual life, and who took to the trade as a last resource, owing to the idleness, illness, or death of their parents or husbands. They[296] were mostly of the poorest class, and were often ill-fed and ill-clad. After a few weeks or, at the most, a few months of pretty regular employment in a lead factory, particularly if much of the time was spent in stripping the white beds or emptying the stoves, young women would suffer severely from plumbism. As already stated, I have known young women who were strong and healthy when they entered a white lead factory, die from Saturnine poisoning within three months. In one instance a young woman had, to my knowledge, only worked forty days, spread over a period of nine weeks, when she succumbed to lead poisoning. I am firmly convinced that women, especially young women, are much more susceptible to plumbism than men. The predisposition to lead poisoning is in both sexes doubtless spread over all periods of life, but so far as occupation exposure to lead is concerned, my opinion is (1) that women are more susceptible than men; (2) that while female liability is greatest between the ages of eighteen and twenty-three years, that of men is later; and (3) that while females rapidly break down in health under the influence of lead, men can work a longer time in the factory without suffering, their resistance apparently being greater. In addition to a sexual predisposition to plumbism there is also an individual and a family tendency as well. It is difficult to explain this susceptibility of certain persons to lead poisoning. As to the fact, however, there is no doubt. It is partly a constitutional, and it may be partly a temporary and accidental condition. We find illustrations of constitutional predisposition to certain maladies in the greater liability of some people, for instance, to contract infectious diseases than others, in the readiness, for example, with which they catch typhoid fever and suffer severely from it. We have similar illustrations of the influence of age in the early years of adult life being those in which enteric fever is most severe. As[297] an indication of how susceptibility to plumbism may be accidentally and temporarily developed, I would instance the influence of poverty, which, by preventing the purchase of wholesome and abundant food, allows the gastric juice probably to dissolve out more of the lead that has been swallowed. No doubt much of the greater prevalence of plumbism hitherto observed in women who have worked in white lead factories is to be explained by the fact that they have until recently worked in larger numbers than the men in the dangerous processes, for since June 1898, the date in which the Home Office required that male should replace female labour in these processes, the number of cases of plumbism in the men has increased, and correspondingly decreased among the women. Taking for example my own district, the number of cases of plumbism notified to the Home Office from Newcastle-upon-Tyne for the two six months’ periods preceding and succeeding June 1898, the date of the displacement of female by male labour, is as follows:—

1st December 1897 to 31st May 1898	Notifications.		Fatal Cases.
	Males.	Females.	Males.	Females.
	19	66	1	4
	85		5
1st June to 30th November 1898	82	12	0	2
	94		2

Between January and October 1898, Dr M. Legge states that there were received at the Home Office from certifying surgeons, 192 reports of plumbism. Of these the stoves supplied 76 patients and the white beds 31. The ages of the workers being—

In three instances the patients had worked less than one week in the factory. In four-fifths of the total cases the lead poisoning took the form of colic, in the remaining one-fifth paralysis and cerebral symptoms.

Next to the susceptibility of women generally, and of young women in particular, I would say that all young adult life offers less resistance to plumbism than mature and middle age. In the House of Commons, 17th February 1898, the Home Secretary stated that there had been 37 cases of lead poisoning in factories and lead works among boys under eighteen years of age which had proved fatal.

Looking back upon the tables just presented, it will be observed[298] that when males undertake the work hitherto discharged by females in white lead factories they develop plumbism in a ratio which might raise doubt in the mind of the reader as to the susceptibility of women to plumbism being greater than that of men. Admitting for the moment that the susceptibility is equal in the two sexes, and the fact, too, that in both the illness may be severe, still I unhesitatingly assert that in the main the symptoms are neither so severe in men, nor does the malady run so rapidly to a fatal termination as it does in women. In a word, females contract lead poisoning more readily, the symptoms are usually more acute, they suffer more severely, and they succumb to it more quickly than males. In women acute lead poisoning is more prone to assume the cerebral type than in men. We have, it is true, only the experience of the last three years to enable us to form an opinion as to the abolition of female labour in the dangerous processes of white lead manufacture having been a wise recommendation on the part of the White Lead Commission, but limited as the time is, the records of the Newcastle-upon-Tyne Royal Infirmary are not devoid of interest on this point.

LEAD POISONING.

In-patients admitted into Royal Infirmary, Newcastle-upon-Tyne.

A decade ago the Newcastle Infirmary wards were scarcely ever clear of a case or two of lead poisoning. At present weeks or months may pass without one being in the wards. Beyond male labour having been substituted for that of females in the dangerous processes in the factories, and the circumstance that men are believed to do more work than women, I am not aware that[299] there has been any reduction[54] in the number of people engaged in white lead manufacture on Tyneside that will explain the smaller number of cases of plumbism coming into the Infirmary, nor beyond the workhouses is there any other institution in this neighbourhood, other than the Royal Infirmary, to which patients suffering from plumbism could go. During 1898, the year in which men exchanged places with the women in the dangerous departments in white lead factories, the number of cases of plumbism admitted into the Infirmary was slightly greater than for one or two of the previous years, a circumstance possibly explained by the greater irregularity of work on the part both of the men and women, and the fact that the men were of a casual class and had not become accustomed to the work. Immediately after the abolition of female labour, not only is there observed a marked fall in the number of female admissions, but there is this astonishing feature, that while during 1900 only 14 cases, all males, were admitted, for the first time in the history of the Newcastle Infirmary within our memory a whole year passed without even one female being received. During the last three years, as also during 1893–1894, no death from acute lead poisoning took place in the Infirmary. There has been, too, a remarkable absence lately in the Newcastle daily press of announcements of coroner’s inquests having been held upon fatal cases of lead poisoning in the district compared with what there was a few years ago. Nothing could be stronger testimony to the wisdom of the Home Office in having enforced the recommendations than these facts. Although the manufacturers at the time strongly resisted the recommendation of the White Lead Committee, I believe they now[300] admit that it was a proper step, also that work under the present system is better done than formerly, and that there is less sickness among the employés. The difficulty of substituting male for female labour, which manufacturers anticipated and which was their principal objection, has not been realised; the men do more work, and therefore the cost of production has not been increased, although wages have been higher; the men, too, are more cleanly. Improved methods of manufacture and diminished handling of products have doubtless contributed also to this satisfactory result. As the men have come to recognise the dangerous character of their occupation, and have made up their minds to follow it until they can get something better, they have become more careful, and therefore suffer less in proportion from plumbism. Casual work and irregularity of employment certainly play a not unimportant part in causing lead poisoning. The casual labourer is often ignorant and careless. As these pages are passing through the press, a man who had been stripping a white bed in a factory on Tyneside was found eating food with hands unwashed and covered with dust, while his face and beard showed only too plainly the presence of the same material. He stated that he had not been informed of any danger, and that no regulations had been read out to him. How easily, therefore, lead poisoning may be caused and almost as easily prevented. Dr Morison Legge found that of 1463 persons employed off and on in white lead works, the incidence of lead poisoning was 6 per cent. of the average number regularly employed, and in those with casual employment 39 per cent. Taking the whole number of hands passing through white lead factories in a year, the difference between these two, however, is less marked than at first appears, the numbers being 5 per cent. for the employed and 8.3 for the casual workers. Out of thirteen factories with regular employment four of them had no cases of plumbism to report at all, even although in one of these factories 110 persons were employed, whereas from two factories in which there was a large amount of casual employment 50 cases of plumbism were reported. The reasons why casual hands suffer more than those regularly employed are to be found in their carelessness and want of personal cleanliness, intemperate habits as regards alcohol, tobacco-chewing when at work, and unwillingness to wear respirators. During 1900 there were reported to the Home Office 356 cases of plumbism in white lead workers, but Dr Legge says, if two firms, one in Newcastle and the other in[301] London, were excluded from the 18 firms, the total would fall to 175.

I have dwelt at considerable length on female labour and casual employment in lead works, and I hope have shown that the abolition of women’s work in white lead factories has been followed by marked improvement both in the conditions of labour and in the reduced number of cases of plumbism. Female labour, however, is still very largely employed in other trades where lead compounds are used. It may therefore be expected that I should offer some explanation of the attitude I have assumed in regard to this important industrial question. Where the two sexes are as far as possible equally exposed to the influence of lead, women probably suffer more rapidly, certainly more severely than men. To a certain extent the reason is to be found in the fact that lead exercises an injurious influence upon the reproductive functions of women. It deranges menstruation. Usually there is an excessive loss at the monthly periods, which causes women to become anæmic; in a few instances, on the other hand, the loss is scanty. It is upon pregnant women that the metal exercises its worst effects. The ecbolic or abortifacient action of lead is beyond dispute. It is knowledge of this fact that has caused women of the lower classes when pregnant to resort to diachylon pills, which contain a small quantity of lead, for the purpose of producing miscarriage. When a white lead worker becomes pregnant it is almost impossible for her to go to the end of term if she continues to follow her employment. As a rule she mis*-carries, but if, perchance, she goes to term, the child is either born dead, or dies shortly after birth from convulsions. In the liver and kidneys of still-born children of female lead workers that I submitted to Professor Bedson for chemical analysis, there were found minute quantities of lead. Chemical analysis, therefore, confirms clinical experience as regards the cause of death in these children. As to the injurious influence of lead upon maternity I shall give a few illustrations taken from my own and others’ experience. Mrs H., aged thirty-five, worked in a white lead factory for six years, before which she had four children born at full time. Since going to the lead works she has had nine miscarriages in succession and no living child. Mrs M., aged thirty, has had seven children and three miscarriages. The last two children were born and all the miscarriages took place after entering the lead factory. Mrs F. has had three miscarriages since taking up lead work. Mrs K., aged thirty-four, had four[302] living children before going into the lead factory, and two living children afterwards. Still following her occupation, she had six miscarriages in succession, became the subject of plumbism, and was under my care in the Infirmary for a few months on account of colic and paralysis; she made a good recovery, but did not return to the lead factory; next pregnancy she went to term and had a living child, which survived. If additional medical testimony were required to support the opinion I have put forward as to the pernicious influence of lead upon maternity, it is to be found in that of M. Constantin Paul, a French physician, who has published in detail his experience of 15 pregnancies of 4 women working in a type foundry. Ten of these pregnancies ended in abortion, 2 in premature labour, 1 in a still-birth, and 1 in a living child, who died a few hours after birth. In another series the facts are just as instructive. Five women before working in lead had borne 9 children without one abortion. After exposure to lead there was a total of 36 pregnancies. Of these, 26 ended in abortion, 1 in premature labour, 2 in still-births, while 5 of the children born at full time died within one year after birth. Constantin Paul, grouping together a large number of pregnancies, viz., 123, found that of these, 64 ended in abortion, 4 in premature confinement, 5 children were born dead, and 20 of the infants died within the first twelve months. Of 1000 pregnancies reported by Tardien, 609 ended in abortion (Poisons Industriels, Office du Travail, Paris 1901, p. 5). In the potteries Miss Paterson and Miss Deane, two of H.M. Inspectors of Factories,[55] found that “out of the 77 married women reported as suffering from lead poisoning during this period (the year ended 31st March 1897) 15 have been childless and have had no miscarriages; 8 have had 21 still-born children, 35 have had 90 miscarriages, and of these, 15 have had no child born; 36 have had 101 living children, of whom 61 are still alive, the great majority of the 40 who are dead succumbed to convulsions in infancy.” Dr J. F. Arlidge,[56] Certifying Surgeon for Stoke, has published his experience of 239 married women working in lead processes in the china and earthenware industry. Of the children born before the mothers worked in lead 40.4 per cent. died. Of each 100 pregnancies there were 7.0 miscarriages, while, during or after lead employment, of the children born only 36.5 per cent. died, and the percentage of miscarriages was 11.8. Of the[303] 239 women there were 71 who had had no children prior to working in lead. These 71 women had subsequently 302 children (of whom 114 died) and 38 miscarriages; that is, for every 100 children born 37.7 died, and 11.1 of every 100 pregnancies resulted in miscarriage. Dr J. F. Arlidge’s statistics show that in female pottery workers employed in lead processes the percentage of miscarriages is higher than in those engaged in other departments, but neither is this nor the death-rate of children born under these circumstances so great as M. Paul, Tardien, and I have found.

If lead exercises a prejudicial effect upon the reproductive powers of women it is also capable, although to a less degree, of diminishing the virility of men. Children of female lead workers almost invariably die of convulsions shortly after birth or during the first twelve months. If a child is the offspring of parents, both of whom are lead workers, it is puny and ill-nourished, and is either born dead, or dies a few hours after birth. The power of lead not only to kill the offspring but to destroy for the time being the child-bearing powers of woman is remarkable, and it is this circumstance, along with the fact that women suffer more readily and severely from lead poisoning, that are the main arguments for keeping them out of the dangerous processes in any industry in which lead compounds are used. It is through the intermediary of the temporary structure known as the “after-birth” that the poison is transmitted to the fœtus in utero. Roques (Mouvement Medical, 1872), is of opinion that a mother working in lead conveys through her milk to the child she is suckling the metallic poison, and that there is produced a slow and progressive deterioration of the infant’s constitution. Prof. Bedson has analysed for me the milk of suckling lead workers without finding any trace of lead therein. Whether or not lead is only occasionally present in the mammary secretion, it is undesirable that women who have an infant at the breast should work in the dangerous processes.

Lead is a subtle poison. Most of its salts have in small doses no unpleasant taste nor odour, they are very soluble, and they produce their baneful effects sometimes in such an insidious manner that the health of the operative becomes so gradually undermined that he is often precipitated into a serious illness without any warning. In most instances, however, there are prodromata, for lead causes colic or severe pain in the abdomen. Usually this is one of the earliest symptoms to cause a lead worker to seek medical advice, while in others, as[304] just mentioned, there is such a gradual deterioration of health that it is not until the system is thoroughly impregnated with lead and pathological changes have been established in the internal organs that the individual comes for relief. Lead poisoning is widespread owing to the large number of industries into which lead in some form or other enters, and the accidental contamination of our food and drink. The metal gains an entrance into the system through the respiratory passages, the digestive canal, and very occasionally through the skin. It has been demonstrated clinically that the injection of acetate of lead up the nostril has resulted in the absorption of the salt by the nasal mucous membrane, and the production of paralysis. How far very fine white lead dust falling upon the eyelids may be dissolved in the lachrymal secretion and be absorbed, I am not at present in a position to state. Inhaled as impalpable dust, it is drawn into the respiratory passages, where it is dissolved and passes into the blood, or it is suspended in the saliva in the mouth and swallowed. On reaching the stomach it is acted upon by the hydrochloric acid of the gastric juice, converted into a soluble salt, and absorbed. Elsewhere[57] I have given in detail a series of experiments showing the solubility of white lead in the juices of different parts of the digestive tract, which, while confirming, at the same time explains the important fact already known to managers of white lead factories, viz., the great danger of employés commencing work in the factory in the morning without having breakfasted. As lead is a direct poison to the system, nature does her best to eliminate it by the fæces and through the kidneys.

The symptoms of plumbism are manifold. Usually easy of recognition, they are sometimes so obscure as to render the malady difficult of detection even by a careful physician. One of the earliest signs is pallor of the countenance. There is developed a degree of anæmia which gradually increases until the features become altered and expressionless, a form of bloodlessness which since it is characteristic of lead poisoning, is spoken of as Saturnine cachexia. This becomes very pronounced, so that it is easy to recognise lead workers by sight. A few weeks’ work will transform a healthy-looking, florid young woman or man into a pallid and listless individual. During the time that pallor is[305] developing, the individual often complains of a disagreeable metallic taste in the mouth, especially on rising in the morning, and of a distaste for food, so that he proceeds to his work in the morning without breaking his fast. There is no more certain way of courting plumbism than for any one to work in a factory where lead compounds are handled without having food in his stomach. This is a fact which the digestive experiments alluded to in my Gulstonian Lectures have placed beyond all question. It was therefore not only a humane action, but it was a wise step, from a white lead manufacturer’s point of view, when the employers gave a free breakfast to their hands before beginning work each morning in the factory, and it was a short-sighted policy that led them to abandon it.

Two forms of lead poisoning are met with, the acute and chronic. It is with lead as with many other poisons. One individual may work for several months or years without suffering, while another may succumb to its harmful influence in as many weeks. The manufacture of white lead is one of the industries that will not allow of familiarity breeding contempt. The most careful worker may suffer, so too may the oldest who has passed unscathed for years. Alcoholic excess predisposes to plumbism. Why colic is such a common and early symptom of Saturnine poisoning is because the alimentary canal is one of the principal channels by which lead enters the system, and lead is known to have a special affinity for muscular fibre and nerve tissue, and to induce spasm. Colic is often attended by vomiting and by obstinate constipation. The pain is of varying degrees of severity. Sometimes it is so mild that the individual is able to follow his occupation but in discomfort. At other times it is so severe that he rolls about in agony, and is with difficulty kept in bed. Occasionally relieved by pressure of the hand upon the abdomen, it is under other circumstances often aggravated by it. The pulse is slow, small, and feeble during the attack, although at times it is found to be hard and showing high tension. In severe colic the individual is collapsed—the face wears an anxious expression—there is sleeplessness, and the function of the kidneys is seriously impaired. Notwithstanding the severe nature of the pain in lead colic and the general derangement of internal functions, the symptoms by degrees yield to treatment. After recovery most of those who have been ill return too early to their employment. One attack of plumbism unfortunately predisposes to another. On examining the mouth of a lead worker there is usually to be seen a bluish line along[306] the margin of the gums close to the teeth. The gums are ulcerated, and in the case of old lead workers they are retracted, and thus expose a considerable length of the fang. Although a valuable help in diagnosis, the presence of the blue line on the gums must not be regarded as an indication that the individual possessing it is at the time suffering from lead poisoning, for the line may be present for months without there being either any complaint or any symptom of ill-health. It tells the tale that the individual has been exposed to lead, and that the metal is present in his system, so that when associated with certain other signs and symptoms the presence of the blue line on the gums clenches the diagnosis of plumbism. The line itself is due to a deposit of sulphide of lead in the epithelial cells of the gum or in the large connective tissue cells present along the ulcerated edges. The blue line is met with under two different circumstances. It may be observed on the sound gums of white lead workers who have recently entered a factory, and who have been employed for a few hours in emptying a stove. If the mouth is rinsed with water it disappears, a circumstance which shows that this line is simply a deposit of lead on and not in the gum. The other is much more permanent: it persists for months despite the use of mouth washes and the administration of medicine internally. I know of no mouth wash, tooth paste, or drug that is capable of removing the blue line from the gum under from eight to twelve weeks.

It is upon the nervous system that the worst effects of lead are seen. Usually after having experienced one or more attacks of colic, but sometimes without these, a lead worker suddenly or gradually loses power in his hands and fingers. His hands become paralysed, hang powerless by his side, and the patient is said to be suffering from “wrist drop.” This renders him unable to feed or dress himself. Both hands are usually affected, but not in equal degree. Bilateral paralysis is always suggestive of some form of metallic poisoning. In “wrist drop” the extensor muscles of the fingers and wrists rapidly waste. As a rule the affection is painless, but in some instances the loss of power is preceded by muscular tenderness. The muscles of the shoulders and upper arm, too, may be affected, or the weakness affects the muscles of the foot, and causes “ankle drop.” When the malady is of a more pronounced type the muscles of the trunk become paralysed. In this form the individual is perfectly helpless: he lies like a log, unable to turn or move himself in bed, and for the time being his condition is usually one of danger. It is characteristic of lead paralysis[307] even in such minor forms as “wrist drop,” that it not only completely unfits the individual to earn his living, but to attend to his own personal wants. The paralysis is slow to disappear even when medicine, massage, and electricity are used.

One of the worst forms of acute plumbism is what is known as acute lead encephalopathy, and to this women seem to be more predisposed than men. A female lead worker has perhaps been observed by her friends to have been getting paler and paler, and to have lost her appetite. She complains on getting up in the morning of severe headache which prevents her taking food, but notwithstanding these she goes to work, and is probably not more than an hour or two in the lead factory when she is seen to fall on the floor in convulsions. She is unconscious, and the convulsions come and go. In this condition she is taken home or to an infirmary, where within the next two days she dies, never having regained consciousness; or by the third day consciousness returns, but she keeps moaning on account of severe pain in her head. It is now noticed that she is blind; she loathes her food and is often sick. Recovery is slow. The power of vision may be gradually restored, or it remains permanently lost, and thus it happens that, at a comparatively early age, a young woman who has only worked in the dangerous processes of a white lead factory for a few weeks or months, and who has suffered from acute encephalopathy, not only swims for her life during the seizure, but may be rendered permanently blind, and thereby completely unable ever afterwards to earn her living. In the form of lead encephalopathy that I have just portrayed, there is usually some premonitory headache before the individual is struck down in convulsions, but in not a few instances the warning is of another kind, and of such a nature that it may be overlooked even by experienced medical men. I refer to symptoms of hysteria occurring unexpectedly in a young female lead worker. The patient does not seem ill. There is rather an exaltation than depression of her mental faculties and her feelings, and yet out of what appears to be ordinary hysteria the patient may pass into a state of coma, with or without convulsions, and die within three or four days. Under any circumstance it is a very fine line that divides functional from organic disease of the brain, and in lead poisoning this is particularly the case. To toxic hysteria, therefore, which often masks a deeper malady and is apt to throw both the friends of the patient and the medical attendant off their guard, I attach considerable importance as a premonition of acute lead encephalopathy. We have seen that after recovery[308] from acute encephalopathy a patient may remain temporarily or permanently blind, and there may or may not be paralysis, but in some instances the mind is so shattered by the illness that complete consciousness is never regained. The patient passes into a state of acute mania, which is usually fatal, or the symptoms are subacute, recovery is incomplete, and the individual passes the remainder of his or her days in an asylum.

The question of insanity in lead workers has been very ably dealt with by Dr Robert Jones,[58] the Medical Superintendent of the London County Asylum, Claybury, Essex. Taking the proportion of 1 lead worker, in the broad sense of the word, to every 58 of the adult population, there ought to be in Claybury 18 male patients belonging to that class. As a matter of fact, however, out of 1050 males in the asylum, there are 35 who have been lead workers, plumbers, painters, and glaziers, but excluding pottery workers and miners. In examining the histories of 3500 male patients admitted into Claybury, Dr Jones found that of these 133 were artisans, who in their trade had possibly become impregnated with lead; their occupation was as follows:—

Of these, 19 had signs of lead poisoning upon admission, such as paralysis, colic, and blue line on gums, while in 22 there was a history of convulsions (encephalopathy), headache, giddiness, and paralysis. Of the 133 cases the following is the analysis of their mental condition:—

[309]

“The proportion of general paralytics among these possible lead cases is 18 per cent.: the average yearly percentage of general paralytics to the total average number of male patients admitted into asylums for the five years 1893–97 was 13.1, and it appears to me there is a strong presumptive evidence that lead may be a factor in the cause of general paralysis of the insane.” Elsewhere[59] I have drawn attention to the association of lead poisoning and general paralysis, and indicated that as there is in the plumbic form a larger percentage of recoveries than in general paralysis proper, the probability is that the malady is not exactly of the same nature, but is rather a pseudo-general paralysis. Dr Jones summarises his conclusions thus: (1) that lead poisoning is a contributory factor to insanity; (2) that the mental symptoms may be grouped among one or other of the following varieties: (a) toxæmia, with sensory disturbances, which tend to get well; (b) hallucinations of sight and hearing, usually chronic and irrecoverable; (c) general paralysis with tremors, increased knee-jerks, inco-ordination, listlessness, and dementia, which tend to get well.

So far I have depicted the acute rather than the chronic form of lead poisoning. There still remains that form in which the individual, after having been exposed for a lengthened period to the influence of lead, and having experienced one or more attacks of colic, indicating that his system is becoming impregnated with lead, is never well; he is profoundly anæmic, is the subject of frequent headache, imperfect vision, and incomplete wrist drop. Albumen is present in the urine, and there is a slight degree of dropsy of the face, hands, and feet, physical signs that point with these just mentioned to structural alterations having occurred in the kidneys, liver, heart, and blood-vessels, retina, and nervous system. Life drags on from day to day, only to end in a lingering illness, or it is brought to a sudden close either by uræmic convulsions, or in consequence of rupture of a blood-vessel in the brain. At the post-mortem examination in chronic cases the kidneys and liver are found to be hard and their secreting structure replaced by a low form of connective tissue, while in acute lead encephalopathy the brain may be dry on its surface and retracted, on section hard and dry, or watery and pale, the blood-vessels being congested. On microscopic examination very delicate changes have been found in some of the large nerve-cells of the brain and spinal cord, and also in the structure of the liver and kidneys. What, then, is the cause of death in acute lead encephalopathy?[310] In most of my own fatal cases, lead was detected in the liver, kidneys, muscles, and brain, etc. To the fact that lead has been found in the brain, and has probably formed some complex chemical compound with it, may be attributed the convulsive seizures, insanity, and possibly, too, death. At the most it has always been a very minute quantity of lead that has been found in the brain after death. In one of my patients Professor Bedson found on chemical analysis only O.779 grain in a brain and cerebellum that together weighed 51.5 ounces: while from another brain and cerebellum that weighed 48 ounces, he obtained only 0.634 grain of lead. From another brain Professor Bedson removed 4.04 milligrammes of lead, while in a case reported by Mr Wynter Blyth there were 99.7 milligrammes of sulphate of lead found in the brain and 17.4 in the cerebellum. A brain whose nerve-cells have become poisoned by lead cannot functionate as in health, but as in some of the rapidly fatal cases of encephalopathy, occurring in young female lead workers hitherto healthy, no trace of the metal was detected in the brain on careful chemical examination, death must have been caused by some other circumstance than the hypothetical presence of lead in the brain. The human body is a laboratory, wherein even in health animal products are hourly being formed, and which if retained in the system would poison the individual. Were it not for the activity of such eliminating organs as the kidneys and bowels, life would be constantly menaced by this auto-intoxication. Lead in some people rapidly induces structural changes in the liver and kidneys, or it quickly interferes with the functional activity of these organs, so that poisonous materials generated by the individual himself are not removed. It is the circulation of these in the system and their action upon the brain, aided probably by the presence of a soluble compound of lead in the blood, that is the cause of the convulsions and death in some cases of acute lead encephalopathy. Occasionally lead workers are admitted into hospital suffering from convulsions and delirium, which are not due to lead, or at any rate to lead alone. In many of these cases there is a strong alcoholic history, that it is difficult to say how much is due to lead and how much to alcohol. Alcohol we know predisposes to plumbism.

Treatment—Preventive and Curative.

Of precautionary measures requiring mention I would allude to the avoidance of excess of all kinds on the part of the workpeople,[311] including the use of alcohol; to the need of nutritious food, plenty of milk, and the avoidance of acid fruits; attention to personal cleanliness as secured by frequent washing, change of working clothes, good ventilation of the workrooms, and the wearing of respirators.

A year ago, M. Armand Gautier presented to the Prefect of Police in Paris a report in which he showed that in Paris alone there were upwards of 30,000 persons exposed to the fumes, dust, and combinations of lead, and that the hospital treatment of the working people whose illness was due to lead poisoning cost the municipality a very large amount of money every year. In an earlier report presented to the Council d’Hygiène, and dealing with the admissions into the hospitals between 1870–80, he showed that this expense corresponded to a residence of 11,140 days in these institutions. In 1881 the French Government appointed a Commission to inquire into the prevalence of lead poisoning, and to draw out regulations. The enforcement of the rules was followed by a decided improvement in the number of cases. From 1881 to 1883 the number of patients fell from 552 to 421, and the number of days spent by patients in the hospitals fell one-half. This satisfactory decrease, however, was not maintained, despite the fact that the Clichy white lead works, which used to contribute nearly 50 per cent. of lead cases, was closed, and new methods of production had been introduced. So far as white lead works are concerned, there is not the least doubt that the substitution of the moist for the dry method of dealing with lead carbonate materially diminished the amount of ill-health among the workpeople, and yet, while this improvement was taking place, the number of cases of plumbism rose all over Paris, owing to an increase in the amount of lead used in other trades, which had not attended to hygienic requirements. The number of fatal cases also of lead poisoning in Paris rose. Of 552 patients ill between 1877 and 1880, 5 died; of 248 ill between 1887 and 1889, 16 died; of 302 ill between 1890 and 1893, died; while of 314 ill between 1894 and 1897, 17 died. The fact therefore remains that since 1881, when fresh and more stringent regulations for French white lead workers were introduced, the number of patients suffering from lead poisoning, and dying from it, in Paris, has risen. The explanation of this anomaly is to be found in the fact that the victims of plumbism are no longer supplied by the white lead works in the same proportion as formerly, but that they come from other industries that have not yet been brought under the[312] regulations. Of these industries house painting has contributed the largest number of patients. This trade, along with colour grinding, supplied no less than 223 patients during the years 1894 to 1898. The proof that improvement in methods of manufacture, e.g. the substitution of the wet for the dry method, has been satisfactory, is shown by the fact that before the introduction of the regulations of 1881, white lead operatives occupied the second line on the list of dangerous trades, to-day they occupy the sixth. It is in consequence of the increasing prevalence of Saturnine poisoning in house painters that the agitation at present going on in Paris against the use of white lead as a pigment, and alluded to in previous pages, has reached such dimensions.

A few years ago the white lead works at Clichy furnished for a long period nearly one-half of the cases of plumbism admitted into the hospitals of Paris. Demolition of this factory was followed by a rapid diminution in the number of cases of lead poisoning seeking admission. This circumstance shows that in some factories the conditions under which the work is carried on are more unhealthy than in others. On Tyneside we are not without a similar experience. There are some white lead works in which there is always more plumbism than in others, and the explanation is that either the works are older and the ventilation worse, or that the general management is in some way or other not so good. It is the same class, often the same people, who work in all the factories, for they occasionally migrate from one to another, and yet there remains the undesirable fact of a larger amount of sickness among the hands in some of the works than in others. As an illustration, take for example the lead-poisoned patients admitted into the Royal Infirmary, Newcastle-upon-Tyne, from October 1890 to March 1893—

Of 88 patients, one factory, not the largest, supplied nearly two-thirds of the total admissions. As illustrating the preventableness of industrial white lead poisoning, it is worth mentioning that in one of the largest and best conducted factories in the Newcastle district, there has only been one fatal case of lead[313] poisoning within the last twenty years, and since the enforcement by the Home Office of the recommendations of the White Lead Committee, the factory that sent 52 out of the 88 cases stated in the preceding table to the Infirmary in two and a half years, at present scarcely sends one patient per annum. Lead-poisoned females are now practically never met with in Newcastle, and male patients are becoming every year rarer. As long ago as 1849, Combe proposed that instead of washing, then drying the white lead in stoves, and subsequently packing it in barrels for sale, it would be safer from a worker’s point of view, since it would rid the atmosphere of dust, if the lead carbonate on its removal from the white beds were ground and washed at once in water, then forced to travel through a series of rollers and washers into oil under rollers. The oil displaces the water, and as a consequence the white lead escapes from the last roller as finished paint.[60] In order to obtain the white lead as a paint, the soft paste as it comes from the grinding stones, and which contains 15 to 20 per cent. of water, can be at once mixed and incorporated as it passes through the rollers with increasing fractions of 10 per cent. of oil. The water is thus gradually eliminated from the paste, so that the product as it escapes from the last roller contains hardly 1 per cent. of water, can be packed, and is ready for the market. Mr T. H. Leathart of Newcastle-on-Tyne, who has adopted this method in his works,[61] informs me that the paint is, practically speaking, free from water, there being not even .5 per cent. of it in the finished product. By the adoption of this method of manufacture there has not only been a saving of labour, but better health among the workmen, owing to the absence of dust. This small change in the method of manufacture has had a wonderful influence on health. The grinding and packing of all dry white lead should be conducted in hermetically-sealed compartments. Even to this there is the drawback that as time goes on, owing to the vibration of the machinery, the joints of the wood and iron become loose and the dust escapes. The defect, however, can be easily remedied.

In 1899 the Chief Inspector of Factories issued special rules for white lead works, which were an advance upon those of previous years, and which have undoubtedly diminished plumbism in this industry. It is unnecessary to reproduce these rules here, but the main points included in them are that plans for new works or[314] structural alteration of old factories must be submitted to the Chief Inspector of Factories; white beds must be watered when being emptied; drying stoves are to be ventilated, and no person is allowed to draw a Dutch stove on more than two days in any week; no women are allowed to work in the white beds, rollers, washbecks or stoves, or in any place where dry white lead is packed, or in other work exposing her to white lead dust; there must be weekly medical examination of every person employed in a lead process, with suspension in the case of illness, and medical re-examination before returning to work; suitable respirators, overalls, and head-coverings must be provided by the occupiers; adequate washing appliances are required, with cessation of work ten minutes before each meal-time and the end of the day’s work for the purpose of washing. The duties of persons employed are similarly defined, and any person obtaining employment under an assumed name or on any false pretence is liable to a penalty. It is enacted, too, (Factory and Workshop Act, 1891, sections 9 and 11) that the rules shall be kept posted up in conspicuous places in the factory, so that they can be conveniently read by the persons employed. Any person who is bound to observe the rules and fails to do so, or acts in contravention of them, is liable to a penalty. In such cases the occupier also is liable to a penalty unless he proves that he has taken all reasonable means by publishing, and to the best of his power, enforcing the rules, to prevent contravention or non-compliance. To extreme temperance in the use of alcohol, and to a weekly or fortnightly alternation of employment for the workpeople in the factory, I attach great importance as preventive agents.

A sanitary drink has to be provided for the workers by the employers. It is usually composed of Epsom salts and lemon juice, or some other acid, dissolved in water. The provision of an acidulated drink for persons employed in white lead works is a subject to which the members of the White Lead Commission gave considerable attention, but I candidly confess that the Committee never attached any great importance to it as a means of preventing plumbism. The theory upon which its administration is based is that the sanitary drink converts any lead which may have been swallowed into the rather insoluble sulphate, and that thereby the risk of plumbism is diminished. When the drink contains a slight excess of acid, then instead of being a safeguard it may become the reverse. Besides, after all, lead sulphate is not very much less insoluble in gastric juice than lead carbonate, and the men who go to the barrel to obtain the sanitary drink are not careful enough to[315] rub their moustache clean before drinking. Within limits, when carefully prepared and not too acid, the sanitary drink possesses certain advantages on account of its being a mild aperient, but beyond this it is only doubtfully a preventive. The workpeople should be given to understand that there is no real antidote to lead poisoning, and that they must be constantly on their guard against it. Personal cleanliness is, I repeat, of the greatest importance. Such drinks as the acid lemonade just described, milk and coffee, etc., however useful they may be of themselves, cannot altogether prevent lead poisoning, and it is unwise therefore to allow the workpeople to shelter themselves under this belief.

Curative.—During the attack of colic, warm applications to the abdomen, and the administration of a mild aperient, such as magnesium sulphate or castor oil, especially if there is constipation, and there is the prospect of the medicine being retained on the stomach. Occasionally a warm bath may be called for, or if pain is severe, the administration of a hypodermic injection of morphia. In milder cases, or when the immediate urgency of the colic has passed away, iodide of potassium is a good eliminant, but the internal administration of this drug in plumbism requires caution, since it may dissolve out lead that has been deposited in the tissues, flush the blood with a soluble lead salt, and thereby aggravate, and often dangerously too, the symptoms of lead poisoning. For paralysis the internal administration of iodide of potassium with nux vomica, and the use of massage will, in most cases, succeed, but recovery is usually slow and often incomplete. Electricity gives encouraging results, and as practised in the manner suggested by Dr Lewis Jones (see p. 375), has been productive of a great amount of good. For acute lead encephalopathy the subcutaneous injection of pilocarpine and the inhalation of nitrite of amyl have in my hands answered well. Bleeding, and the injection of large quantities (about 500 centimetres) of an artificial serum made from sulphate of soda, 5 grammes; common salt, 1 gramme; corrosive sublimate, 0.05 gramme; and distilled water, 200 centimetres, under the skin of the abdomen, is a line of treatment that finds favour with many French physicians. I need scarcely add that lead poisoning is too serious a malady for its treatment to be undertaken by the laity without the advice of a doctor.

Chromate of Lead; Dye Works.

The use of chrome dyes has been followed by lead poisoning[316] which in a few instances has ended fatally. Chrome dyeing by means of lead compounds was one of the unhealthy occupations relegated by the Home Secretary to the Dangerous Trades Committee for its opinion. The dye is obtained by mixing a solution of bichromate of soda or potass with sugar of lead, or by acting upon lead carbonate with a solution of bichromate of soda or potass. In the Final Report of the Dangerous Trades Committee, p. 26, it is stated how the different colours may be got. To obtain deep orange colour, hanks of yarn are dipped first in a solution of lime, and then in a solution of brown sugar of lead; the dip is again repeated, and after this the hanks are dipped in bichromate of potass or soda, and finally they are boiled in lime water. For yellow chrome colour the treatment is similar, with the exception that the goods are not boiled in lime water, but washed in dilute hydrochloric acid. To obtain chrome lemon colour, the yarn is dipped first in an alkaline lead solution, then in bichromate of soda, and subsequently washed in cold water. Green chrome is got by dipping the lemon-stained yarn in an indigo bath. In all of these processes the bichromate of soda acts upon the lead and produces a chromate. This forms not so much a dye as a coloured coating on the surface of the fibre of the yarn. In the process of dyeing no risk to health is incurred by the workpeople. The danger commences when the goods have become dried and the coloured dust of chromate of lead is given off, as may be seen in the noddling and bundling departments of a factory. In several large dye works, both in England and Scotland, I have seen the girls who handle and pull the yarn covered with yellow dust, found them anæmic, complaining of headache, and showing a well-marked blue line on their gums, while several of them complained that they had suffered from colic, and been off work through it for a time. In some instances more serious symptoms developed. A fatal termination is not unknown. The contents of the stomach when vomited often exhibit the same colour as the yarn the girls handle. In one mill there was quite an epidemic of lead poisoning among the women owing to some of them, on account of the cold weather, having stopped the running of the fan. As a consequence the atmosphere of the carding-room became impregnated with yellow dust, and many of the girls became ill, one of them dying from unmistakable lead poisoning. When the fan was re-started all the illness disappeared. Improved ventilation puts an end to poisoning in chrome dye works. The dust-laden air ought to be drawn down and away from the workers. In the[317] dyeing of cotton, lead compounds are similarly used, but an effort is being made to supplant these by aniline and vegetable dyes. Whether aniline colours are capable of entirely taking the place of lead chromate under all circumstances of climate, etc., still remains to be seen. The opinions of manufacturers are divided upon the point of aniline dyed goods standing exposure to the sun like those coloured by lead chromate. Some maintain that the colours are not so permanent. The subject is therefore not yet ripe for the expression of an absolute opinion. Another danger to which workers in chrome dyeing works are exposed, is the occurrence of chrome holes or scars on the hands of the men who work with the bichromate solution. Perforation of the septum of the nose does not occur.

Calico Printing.

This subject may be conveniently discussed with that immediately preceding. The pattern is printed on the cotton cloth in lead salts. The cloth is then passed through a solution of bichromate of soda. Only the letters or portions of the pattern that have been printed in lead retain the chrome colour. There is no risk to the operative in the process of printing. The danger resides rather in the dust given off in the drying-room, to which the cloth is taken. Here, owing to the heat of the room and the handling of the calico, a certain amount of dust may be present. The question of aniline substitutes for lead has been discussed by manufacturers, but among them there is no unanimity upon the matter, especially in those engaged in the export trade. In indigo blue dye works where the calico is printed with copper sulphate and lead acetate, the men may suffer as much from the copper as the lead.

Enamelling of Iron Plates and Hollow Ware.

The enamelling of iron plates is an industry which is mostly confined to Birmingham and Wolverhampton and their immediate neighbourhood. Enamelled iron plates are used for advertising purposes, for announcing the names of railway stations, etc. The process of manufacture consists in first cleansing the iron plate, smearing it with gum-water, and sifting a fine dust on to it, or in allowing to trickle over it powder suspended in water. The powder may contain as much as 25 per cent. of lead, or in some instances no lead at all. The plate having been coated in one of these ways is placed in a furnace and exposed to an intense heat.[318] On removal it is seen on cooling to have received its first coat of enamel. In order to obtain the required red, blue, or brown colours the plate is subsequently swilled. The colours are put on at first roughly with a broad brush, and then a finer one so as to get an even surface, after which it is smoothed by a camel’s hair brush. The plate thus swilled is allowed to dry on hot pipes at a moderate temperature. The process up to this stage is wet, and therefore not dangerous, besides the lead compounds used are often fritted, and these are known to be very insoluble. It is in the subsequent treatment known as stencilling that the danger commences. This part of the work is generally done by women, who by means of a nail-brush rub off the colour on the surface of the plate which is exposed through the openings cut in the stencil, and which correspond to the alphabetical letters, etc., of the advertisement. This is a very dusty process. The atmosphere of the workroom becomes thick from the coloured particles of dust given off from the plate, and these fall upon the hair and clothing of the workpeople. There is often a large percentage of lead in the dust, so that when this is inhaled for several hours, during each working day in the week, it becomes a cause of plumbism occasionally of a severe character, and running to a fatal termination.

Brushing-off through the stencil is usually performed over perforated tables down which there is a strong draught, but if the aspirating force is weak the dust rises and impregnates the atmosphere, so that it is almost impossible to see across the workroom. After the plate has been stencilled it is again placed in the furnace, and the processes of swilling, drying, stencilling, and firing are repeated according to the kind of colours required in the advertisement. These processes may be repeated as many as eight or nine times. Red and other compounds of lead are largely used for enamelling, and may be present to the extent of from 25 to 33 per cent. Formerly arsenic was also used, but such serious consequences followed that its employment has been discontinued.

In this industry, as in white lead works, it is the young female operatives who are the most susceptible to plumbism. A few years ago there was a great amount of ill-health among the hands owing to imperfect ventilation of the workrooms. The White Lead Committee recommended that there should be a medical inspection of all the workers once a month, and that no girl under 20 years of age should be employed as a brusher-off in the stencilling process; that no female should be employed without medical testimony as to her fitness for the work, experience[319] having shown that anæmic, scrofulous, and ill-nourished persons are more predisposed to plumbism than those that are healthy; that after an illness of any kind a medical certificate should be furnished. The Committee would have been glad if the employers could have seen their way to give half a pint of milk every forenoon to each of the workers, for experience has shown, both in this country and abroad, that milk is to some extent a prophylactic against plumbism. Dr Morison Legge,[62] in his report upon the enamelling of iron plates, says that for last year only 10 cases of lead poisoning occurred in 689 persons engaged in the dangerous processes. He attributes the fact of the cases being few to the periodic medical examination, the removal of dust by fans, and the encouraging efforts which are being made by large firms to substitute other things for lead.

Tinning and enamelling of the hollow ware used for culinary and domestic purposes is an industry confined for the most part to Wolverhampton, Bilston, and Dudley. The iron kettle or saucepan about to be tinned is first cleaned or prepared by being swilled in a mixture of dilute hydrochloric acid and chloride of zinc. The process of tinning consists in dipping the utensil into a trough containing molten tin and lead in the proportion sometimes of 60 per cent. of metallic lead and 40 of tin. Owing to tin being the more expensive metal, the cheaper ware is often dipped in a composition of 70 per cent. of lead and 30 of tin. The dangers incidental to tinned hollow ware are twofold: first, if the workman who dips the utensil in the molten lead is not careful, cleanly, and temperate as regards the use of alcohol, he may suffer from lead poisoning; and secondly, the poorer working classes, who buy the cheaper ware, which has been nominally tinned but is in reality leaded, also run the risk of becoming poisoned by the food either having become contaminated by lead in the act of cooking or subsequently. When the cauldrons containing the molten metal, into which the workman plunges the pans, etc., are hooded, the fumes are not so readily inhaled. It is a common belief among these men that the poison enters the system when they are wiping off the metal from the hot sauce-pans, etc., by means of tow. In the white enamelling of iron hollow ware many manufacturers are now using a leadless glaze with every promise of success.

The enamelling of copper letters or tablets is shown by Dr Legge to be a source of plumbism. Four cases were reported to[320] the Home Office in 1900. The danger occurs during the “brushing on” and “wooling off” of a black enamel powder, which was found to contain as much as 67.0 per cent. of lead.

Electric Accumulator Works and Lead Poisoning.

The manufacture of electric accumulators for telegraph and telephone purposes and for motor cars has become a very important industry, and is likely to become still more important as time goes on. There is one process in the manufacture which is distinctly dangerous. The workmen who rub the red lead, made into a paste by means of dilute sulphuric acid, on to embossed or perforated plates occasionally suffer from plumbism. When the plate leaves the workman its interstices look as if they were filled with red clay. Both sides of the plate have to be treated by the workman, whose hands are generally covered with indiarubber gloves. During the mixing of the dry red lead or litharge with the dilute sulphuric acid a considerable amount of dust is created. The indiarubber gloves which are worn by the men who fill the perforations in the plates with the lead paste become in time thin and worn, or they get torn, and as a result certain parts of the hands of the men become coated with the red composition. By this means, as the work entails a considerable amount of friction, lead poisoning may readily occur. In visiting electric accumulator works, I found several of the workmen, especially the younger men, extremely pale, and suffering from headache; some of them had been laid off with colic, and they presented a well-marked blue line on their gums.

The colic of electricians is not a new disease. In one electric accumulator works in La Hague in 1894, there occurred 37 cases of plumbism in 252 male workers; and in another factory in Wiesbaden 12 cases of lead poisoning occurred in 90 workers. Of 30 patients suffering from lead colic admitted into the Hospital Bichât, Paris, during 1899, Talamon says more than one-half were electricians, the remainder being made up of painters, plumbers, and typographers. So prevalent had lead poisoning become in Germany that the Imperial Health Office directed an inquiry[63] to be made into the conditions of labour in electric accumulator works. In consequence of this, special rules were issued, and as these now govern the industry in Germany, it will not be out of place if I quote at some length from the Report, a translation of which has been kindly placed in my hands by Dr Morison Legge.[321] The information embodied in the Report was collected by a circular letter of the Chancellor, and deals with the extent of the manufacture of accumulators and the dangers of working. From one factory alone the following particulars were received as to the special incidence of plumbism in particular processes.

As regards remedial measures, special attention was directed to: (1) casting and preparation of the plate; (2) mixing the paste; (3) actual pasting; (4) the drying and building into batteries of the various segments; (5) forming and changing plates. As regards these various headings the information gathered is as follows:—

(1) Ordinary lead, often containing a trace of antimony, is used for casting the plates. From the surface of the lead in the melting pots fume rises (oxide of lead), so that it is recommended to have the melting pots arranged that they can be provided with an efficient hood and shaft leading either into the open air or into a chimney. The need for these precautions lies in the fact that not only are the fumes of lead and antimony harmful when inhaled, but commercial lead often contains traces of arsenic, varying from 0.1 to 7.9 per cent.

(2) Litharge and red lead are used for making the paste, and as these come to the works in casks, the dry material is transferred from the cask to the worker’s bench by means of a shovel or trowel. Dust thus becomes scattered about in all directions. It is, therefore, desirable to have the floor of the workrooms moistened and swept daily. The mixing of the red lead and sulphuric acid should be done in a closed chamber or under an exhaust shaft.

(3) As regards the wearing of gloves by the men who paste the plates, reference is made to the difficulty of keeping the gloves in good repair. The same difficulty, as I have already mentioned, occurs in Britain. In some of the electric accumulator works the[322] gloves worn are too short. The dry red lead occasionally gets inside the gloves, and as these tend to keep the hands hot and cause them to perspire, plumbism is rather encouraged than prevented, or skin eruptions develop. In order to avoid, therefore, as far as possible absorption of lead by the skin, two alternatives are put forward by the German Committee of Enquiry: (a) the work is not to exceed eight hours a day, to be broken by a pause of at least one and a half hours; or (b) there is to be one six-hours’ spell of work in the day. The Committee is in favour of the latter. Respirators for the men engaged in pasting are not considered necessary.

(4) In building up the batteries by means of solder, ordinary solder is not used, but a very pure lead instead, in order that the connections made between the plates may not be affected when they are subsequently exposed to the acid. To bind these plates together by solder, the heat from an oxygen or hydrogen blow-pipe flame is used, but frequently the temperature reaches a height sufficient to cause volatilisation of the lead, and statistics show that persons engaged in this occupation run a considerable risk of lead poisoning.

(5) Opinions were found to differ as to the effect of the dilute sulphuric acid vapour in the formation-room upon the workers. There was said to be medical testimony as to its good effects upon workpeople, who are the subjects of chronic bronchitis. Reference is made to the difficulty of providing fans for ventilation of these rooms owing to the deleterious action of the acid upon the metal contained in the fan, and yet some form of artificial ventilation is necessary.

The method adopted in the factory of determining the presence of lead in the air was the simple one of suspending, at the level of the worker’s head, a sheet of blotting paper, 100 centimetres square, previously moistened. Subsequent treatment with dilute acid and exposure to the action of sulphuretted hydrogen showed whether lead was present or not.

Motor Cars.

In Paris, motor cars are much more in evidence than in this country. There are very few in London compared with the French capital. Dr Proust has reported four cases of lead poisoning in Paris, in women aged eighteen, nineteen, twenty-five, and thirty-nine years respectively, whose work consisted in coating with oxide of lead small leaden rods, and fixing them in position. All of[323] these women entered the electrical department of motor car manufactories in good health. At the end of six weeks to two months they had colic, loss of appetite, constipation, and abdominal pain of such severity that they had to be taken to the hospital, and detained there under treatment for more than a fortnight. In one patient the symptoms of plumbism returned shortly after resuming work. With the dangerous nature of the occupation the employers were quite familiar. They not only paid a doctor to visit the works once a week to examine the workers, but they were in the habit of giving to the female workers honey and sulphur, iron pills, and half a litre of milk daily. Ample provision was made for washing; tooth-brushes were provided, also sulphur baths once a fortnight, and yet, notwithstanding these precautions, four of the women quickly developed symptoms of lead poisoning.

Electric Tramways.

An accident of rather a peculiar character occurred on 8th Oct. 1901, on a tramway car in Paris. I state the facts for what they are worth. During the course of the evening, nearly a dozen of the travellers were suddenly seized with violent pains in the abdomen and by syncope, and were obliged to be treated at a chemist’s shop en route. On an inquiry being instituted, the opinion was expressed that the symptoms were due to poisoning caused by fumes given off by sulphuric acid acting upon the lead in the electric accumulators.

Recommendations.

It is evident that as electricity will be the motor power of the future and will be turned into numerous channels of application, the number of electric accumulator works in Britain is sure to increase. The necessity for putting into force several of the recommendations mentioned in these pages is almost sure to arise. So far as the hygiene of the works is concerned, the same rules ought to apply to them as are now in force in red lead works.

Soldering.

Common solder is an alloy of tin and lead, equal parts. Fine solder is composed of 2 parts of tin and 1 of lead; coarse solder, of 2 of lead and 1 of tin. The extensive consumption of tinned meats and fruits is responsible for some cases of plumbism,[324] owing to the acid juices dissolving some of the lead out of the solder, but workmen who solder, e.g. tinkers, have been known to suffer from paralysis of the muscles of the fingers and hands, owing to volatilisation of the lead and inhalation of the fume.

Typefounding; Printing; Typesetting; Linotyping.

Type metal is an alloy of lead with ⅓ to ¼ of antimony. The antimony is added to harden the alloy, for lead is a soft metal. Occasionally small quantities of tin and copper are added, so that the alloy may be composed of 70 parts of lead, 18 of antimony, 10 of tin, and 2 of copper.

We have already dealt with the smelting of lead ore and the melting of pig-lead. The smelting of antimony ore is not attended with such serious risks to health as is the case with lead. One of the largest antimony works in this country is on Tyneside. I have had the privilege of visiting the works and of examining the workmen. The raw ore or sulphide comes from Japan. It is smelted with iron filings. No constitutional bad effects were noticeable in the men who smelt the ore. To some extent this freedom from illness may be due to the fact that the men are not closely exposed to the fume, and that, owing to good ventilation, the fumes were quickly got rid of. The only trouble the workmen seemed to experience, and it was more of a complaint than an illness, is that as the work is hot they perspire freely, and the skin in consequence becomes extremely irritable and itchy. An eruption appears on the skin. This at first shows itself as a crop of vesicles, which ultimately become pustular. Formerly more than now it was a medical practice in the treatment of disease to apply an ointment composed of tartrate of antimony to the skin in order to bring out a pustular eruption, which acted as a counter irritant. Knowing this to be the local action of antimony, it is easy to understand, therefore, the development of the skin eruption spoken of as “pox” upon the neck and upper part of the abdomen in antimony workers. Eulenburg says that exposure to the fumes of oxide of antimony is followed by pains in the region of the bladder and urethra, and by impotence in the male. My experience does not confirm this statement. Several of the men looked rather pale, probably as the result of exposure to the heat, and a few of them had suffered from gastro-intestinal pains like colic, usually relieved by taking a dose of Epsom salts. A case of industrial antimony poisoning is published in the Report of the[325] Chief Inspector of Factories for 1900, p. 332. It is that of a man who had worked as an extractor of the metal, and who in consequence of having inhaled the fumes suffered from paroxysmal attacks of difficulty of breathing without any physical signs of disease in his lungs. He complained of a sense of constriction in his chest, nausea, a metallic taste in his mouth, backache, weakness in the muscles of his legs, profuse perspiration, headache, and dimness of vision.

It is, however, not so much with antimony as with the presence of lead in the printers’ type that we are here concerned. Printers’ colic was a much more common malady two or three decades ago than now. It is due to handling the type, and to the dust that is given off. Typefounders also suffer from plumbism, but in not a few cases the illness has been caused by the workpeople eating their food without previously washing their hands. Printers as a class are often pale and unhealthy looking. Much of this may be due to the fact that they work in overheated rooms for long spells at a time, and have late hours. H.M. Medical Inspector of Factories reports that during 1900 there were 17 cases of lead poisoning in printers. One of the patients died. Ten of the men were compositors, 4 were linotypists, and 2 stereotypers. Dr Stühler, of Berlin, taking his statistics from the reports of sick benefit societies, states that of 3000 printers in Berlin 313 were annually sick from lead colic, i.e., about 10.4 per cent. of printers’ compositors suffer from plumbism, either by absorption through the skin, caused by handling the type that has become oxidised during wear, or by swallowing the dust through eating with unwashed hands. Fromm discusses this subject, and alludes to the analyses of dust of printing-houses made by Stumpf, who found that it contained often as much as 14.43 per cent. of lead. In a report recently presented to the German Board of Health, Faber states that he found in the dust collected from the floor 11.51 per cent. of lead: that the dust taken from a shelf in the room contained 6.59 per cent. of lead, while dust collected in the gangway between the desks in the composing room of a newspaper office contained 4.7 per cent. of lead. In analysing the air of printing shops Keygi[64] found that the dust contained from 10 to 15 per cent. of lead, which came from the wear of the type. Inhalation of the dust of the oxidised metal in all probability, therefore, plays a very important part in the causation of plumbism in printers’ compositors. During 1900, printing was in Britain[326] responsible for 17 cases of lead poisoning. In 2 of the cases there were symptoms of lead encephalopathy, one of which proved fatal, and in another there was paralysis. Ten of the patients were compositors and 4 were linotypists.

It has to be borne in mind that compositors do a great deal of their work in an artificial light. As they are obliged to handle type very freely, the skin on the inner aspect of the last phalanx of the right thumb, forefinger, and midfinger occasionally becomes thick and hard, also the skin of the last phalanx of the left thumb, and the interdigital eminences of the left hand. According to Choquet, typographers suffer from two distinct maladies, one directly due to the mechanical nature of their work, and the other attributable to the medium in which that work is carried on. Standing on their feet for long spells at a time, they run the risk of developing varicose veins, and as the rooms are either too brilliantly lighted, or the reverse, to affections of eyesight. Older compositors frequently show a trembling of the right hand, due to fatigue caused by grasping and distributing the type, but in producing this tremor plumbism no doubt plays a part. Analogous to writers’ palsy, the tremor is sometimes so persistent that it obliges the individual to renounce his work. The channels by which lead dust effects an entrance into the system are the buccal and nasal mucous membranes, the skin, the respiratory passages, and the alimentary canal. So slight are the initial troubles of the typographer, that for a time they are unperceived. Acute plumbism does not occur among compositors, it is always chronic. By degrees the individual begins to look pale; the skin becomes greyish and exhibits a slightly jaundiced tint; the appetite, too, fails, and digestion becomes weak, and obstinate constipation occurs. A blue line, if sought for, will be seen in the gums, and there is complaint of an unpleasant metallic taste in the mouth. The breath becomes fetid, and motor and sensory troubles develop, especially at those parts that have been brought into the closest contact with the type. Often commencing with a sense of fatigue in the muscles, the paresis proceeds to motor paralysis. In female typographers excessive menstrual losses, such as are known to occur in female white lead workers, have been noted.

Whatever tends to interfere with the elimination of lead from the system encourages necessarily the development of plumbism. Alcohol has this tendency. It is said that if the skin of a compositor gets broken, the wound heals slowly and is apt to become[327] erysipelatous, but I have not observed this. Some typographers are more susceptible to plumbism than others. It is largely a question of well or ill ventilated workrooms, and of personal resistance. Tanquerel found in France that the ages between thirty and forty years gave the largest amount of ill health, and that in the hot seasons of the year most cases occurred. Dr Motais, who is a member of the Departmental Council of Hygiene of Paris, in an address recently delivered at a conference of typographers, recited a story of animal life which had been told to him by some of the printers themselves. For twenty years these men had tried to keep cats in the workrooms. The animals were well fed; they received plenty of milk. For a time all would go well with them, and then the same train of symptoms would invariably develop; the eyes would lose their healthy lustre, the limbs become paralysed, and the animals die, presenting the same cerebral symptoms as are observed in the acute lead encephalopathy of man.

Precautions.—Printing houses should be so situated that free currents of air can get to them, and not, as at present is too frequently the case, shut in by other buildings. Plenty of daylight and, if possible, sunlight are very desirable; daylight if introduced by one side should enter preferably on the left of the compositor, so that no shadow is thrown upon the case that contains his type. Light coming in from the roof obviates all this. So far as artificial lighting of the rooms is concerned, there is an opinion that the electric light is more hurtful than gas, and gas again more harmful than lamps. There should be tinted shades on the gas or lamps, green externally, white internally. The workroom should be well ventilated and without draughts; any dust generated should as far as possible be removed by fans. The type boxes should be kept clean and the floors periodically watered. By young compositors long hours ought to be avoided. No food should be eaten in the workrooms. Compositors should never do any work fasting, and should avoid smoking when at work. Excesses of all kinds ought to be avoided, particularly the immoderate use of alcohol. Milk should be freely taken. On the occurrence of colic, the individual should at once give up his work and be medically treated. Washing the hands and rinsing the mouth before eating are absolutely required, also a bath once a week, and the wearing of overalls when at work.

It is an old opinion attributed to the French physicians Tanquerel and Pidoux, that there exists an antagonism between[328] plumbism and pulmonary tuberculosis. Facts so far as applied to compositors do not support this statement, hence the desirability of printing houses receiving plenty of sunlight, and of the undesirability of persons who are bronchitic or susceptible to lung diseases being allowed to work in printing houses, unless they are careful of how they dispose of their expectoration. One of the great foes of the printer is pulmonary phthisis. Much of this is undoubtedly preventible, since the disease is encouraged by the unhealthy conditions under which the work is carried on. Smith[65] found that the mortality from consumption was 60 per cent. greater than in most of the other trades. Of 799 deaths published by the London Society of Compositors for ten years, 1880–1889 inclusive, Arlidge found phthisis as the cause of death in 296, bronchitis and asthma in 85, pneumonia and pleurisy together were responsible for 67 deaths, paralysis and apoplexy for 61, and Bright’s disease for 21. Pulmonary phthisis caused 37 per cent. of the deaths. The largest number of deaths occurred between the ages of thirty and forty years. Since the statistics given by Dr Arlidge are more than ten years old, and as tabulated are not comparable with the general death-rate all over the country of persons between twenty to sixty-five years of age, I communicated with the Secretaries of the Typographical Association, also the London Society of Compositors, for their annual reports, from which I am able through the kind assistance of Dr Henry Armstrong, the Medical Officer of Health for Newcastle-on-Tyne, and his clerk, Mr Gillinder, to supply more recent information, as indicated in the following table (pp. 329–330).

These statistics unfortunately are not exactly comparable: the time periods are not the same for all three. This is unavoidable, owing to the census returns for later periods not having been published while I write. They are, however, not without value, for they strengthen the suspicion of greater liability of the printer to pulmonary disease.

The figures underlined in column 12 indicate the increased tuberculosis mortality rate of the two associations as compared with the whole of England and Wales. In column 11 it will be observed that in the Society of Compositors there is an increase in tubercular disease, but not great, over the corresponding rate for the entire country. It may be therefore taken as a fact that printers are more liable to tubercular consumption than men engaged in most other trades. In the half-yearly Report of the Typographical Association ending December 1900, there[329] is a list of 74 deaths for the half-year in the Society, whose members number 16,179. Of these 74 deaths, 32 were caused by pulmonary disease, and of these 32 deaths, 22 were caused by tubercular disease, mostly pulmonary phthisis. There is an opinion, but it is erroneous, that smoking tobacco or chewing it is more or less a protection against plumbism, because the men expectorate; but apart from the fact of spitting being a dirty practice, the habit of expectorating upon a printer’s floor is to be discouraged, especially if the workman has a cough and is the subject of lung disease, for it is largely by means of the sputa thrown upon the floor and becoming dried that the bacilli of tubercle disseminate pulmonary consumption.

MORTALITY TABLES OF TYPOGRAPHICAL ASS0C.

TYPOGRAPHICAL ASSOCIATION.

[331]

In thus expounding the subject of lead poisoning in printers, I have rather drawn attention to dangers that were more common in the past than exist at present, for, fortunately in this country at least, plumbism among compositors is very much on the wane. It is seldom that we meet with cases of printer’s colic in these days, owing very largely to the change in the method of printing newspapers. Until recently the printing of newspapers was done by ordinary type, the compositor setting the type by touch and not by sight. He quickly picked out the required letters, deftly inserting the nail of his thumb into the groove on one side of the type. It was through these operations that the skin of the fingers became thickened, and lead dust got under his finger nails. Having set and printed the paper, he had to take up, wash the type in lye, and subsequently distribute it, i.e., put each type back into its proper place. The distribution of the type required even more care than the setting of it, for a type wrongly distributed became a source of future trouble. Printing by hand type is rapidly on the decline, and is being replaced by stereotyping and linotyping. For newspaper printing there are now several fast printing machines in existence. Stereotyping has made it possible to print from a stamped cylinder without making direct use of the individual type. Endless rolls of paper, too, feed the printing machines. As many as 10,000 thirty-two page periodicals can be thrown off in an hour, but by perfecting the apparatus, as in Hoe’s machine, as many as 24,000 are capable of being thrown off in an hour. It is in typesetting machines with automatic distribution that the greatest progress has been made. The Merganthaler linotype machine, which is used for newspaper printing, produces and gathers in order successive bars of metal, each of the required length and breadth of a line, and bearing[332] on its upper surface the type which prints the line. In the machine are small brass matrices, representing the different letters, etc. When the operator presses a finger-key on the board in front of him a single matrix bearing the required letter falls out of the magazine, and is carried to the assembling block, where the various matrices are set up, side by side, in a line or row. Subsequently these are transported to the face of a vertical mould wheel. Into the face of the mould molten type-metal is pumped, and thus a slug or linotype is produced. As the formation of the slugs is effected automatically, the operator does not handle the metal, consequently plumbism is rare, only two cases of lead poisoning in linotypists appearing in the Annual Report of the Chief Inspector of Factories for 1899, and four in 1900.

The new methods of printing have certainly diminished the numbers of cases of lead poisoning among printers, but the introduction of linotyping is losing us, as a people, an art. No person contends that, for finish, linotyped printing is equal to that obtained by hand-set type. Except for book-printing, in which the letters stand out boldly and clearly, and which as a trade is being relegated to a few towns, stereotyping and linotyping are in our own country rapidly eliminating typography. Since this is unavoidable, it is to be hoped that linotyping will yet further improve, for badly-printed newspapers are trying to the eyes. On the Continent most of the small newspapers are still printed by hand-set type, and consequently lead poisoning among printers is more prevalent there than here.

Compositors working the linotype machine run little risk of lead poisoning if they keep themselves and the workrooms clean. In linotypists the danger is not in handling the metal, for the need of doing this is rare; it is rather through inhalation of the fumes of the molten lead or from oxidation of lead particles that are lying about on the machine and floor. I have met with a few cases of colic in linotypists, but the attacks of pain have been mild and much more quickly got over than in compositors who use the ordinary type. In some, too, I have observed some of the milder derangements of the nervous system, mostly functional, that are the result of plumbism.

[333]

Plumbing.

Plumbers are not a long-lived class. They suffer from lead poisoning in consequence of handling sheet-lead, pipes made from the same metal, also from working with white lead. They often complain of a sweet metallic taste in the mouth during the beating of the lead and the application of solder.

Gasfitters and plumbers run the risk of being poisoned also in another manner, to which allusion may be incidentally made here. When making the necessary connections between the pipes going into the houses and the mains, the gas in the latter is not shut off on account of its requirement by consumers. As a consequence of exposure to coal gas escaping from the main pipes, the workmen occasionally become dizzy and unconscious, lose their eyesight for several minutes, as well as the muscular power of their limbs. They have to be removed by their fellow-workmen, who often administer an emetic of salt and water when consciousness has sufficiently returned to enable them to swallow. The vomited matter smells strongly of coal gas. The symptoms are known as “gassing” by the workmen. In some of the men who have thus suffered I have found that complete muscular power had not returned to the limbs three months after the accident, that the knee-jerks were exaggerated, and that the patients were nervous and the subject of tremor. Albumen or sugar may be temporarily present in the urine.

House Painting.

House painting is a prolific cause of plumbism. Dr Stühler, of Berlin, who obtained his facts from benefit societies, states that of 3000 painters in Berlin 313 or 10.4 per cent. were annually off work from the effects of lead poisoning. In Paris, Gautier found that out of 14,000 painters and varnishers 250 on an average attended the hospitals on account of plumbism, and that an equal number was treated at home, making a total percentage of 3.5. Of late the admissions into the hospitals of cases of lead poisoning have been increasing notwithstanding the regulations issued by the French Government, and the fact that the patients coming from white lead works have been getting fewer. This circumstance is explained by other industries sending more patients than formerly, and of these industries house painting has contributed the largest number. During the years 1894–98 this trade alone, and[334] colour-grinding, contributed 223 patients, while white lead works only sent 4, and the occupation of plumbing 22. Of 86 fatal cases of lead poisoning in Paris during the five years mentioned, 43 occurred in painters, 2 in plumbers, and only 1 in a white lead worker. In consequence of the large amount of plumbism that prevails among house painters in Paris, it is Gautier’s contention that the occupation should be brought under closer Government supervision. The same remark applies equally to the trade in our own country. Lead poisoning among house painters is much more prevalent than people imagine. Taking a few monthly reports at random, there were 12 cases of plumbism in house painters (with 1 death) reported to the Home Office during the month of June 1900; in the month of November 1900 there were reported 11 cases of lead poisoning (including 2 deaths) among house painters and plumbers, and in the following month 14 cases of lead poisoning (including 4 deaths) in house painters and plumbers. During 1900 there were 199 cases of lead poisoning in house painters and plumbers reported to the Home Office. These figures show that if Saturnine poisoning in house painting was notifiable, both it and plumbing would be found to be trades that are the cause of a great amount of sickness, of which at the present time we hear very little. During the year 1899 upwards of 100 cases of lead poisoning were notified, while from district registrars information was received of 18 fatal cases of plumbism attributed to the occupation of house painting. Notification of lead poisoning in house painters is not compulsorily required by the Home Office. Cases of industrial lead poisoning, also arsenic, phosphorus, mercury, and cases of anthrax, are obliged to be reported to the Chief Inspector of Factories by the medical men who attend the patients, and by employers, but an exception is made in regard to house painting, one of the reasons being that as painters pursue their avocation largely in the open air and in houses away from the employer’s premises, it is difficult to say where the poisoning was contracted. Industrial lead poisoning to be notifiable to the Home Office must have occurred in places that are controlled by the Factory and Workshop Acts. When a painter, who is following his occupation in a factory or workshop and is engaged in grinding or mixing colours, develops lead poisoning, the illness has to be notified. As the Act stands at present, the Home Office cannot deal with certain forms of industrial lead poisoning, nor have the factory inspectors power to enforce improved conditions of[335] labour. In view of house painting being ultimately brought under Special Rules, it is very desirable that all cases of sickness in house painters and deaths from plumbism should be reported. To the ordinary medical practitioner, who has been informed that he must report all cases of occupational lead poisoning coming under his care, it is embarrassing for him to draw a distinction between lead poisoning caught by one man filling a barrel with dry lead carbonate in a workroom, and another man who uses this as a paint in decorating the interior of a house or shop, and yet while the former is notifiable, the latter is not, although the same cause is in operation in both. The sphere of Home Office influence ought therefore to be extended so as to include house painting, and this might be done under the Act that allows the Home Secretary on sufficient evidence to schedule a trade as dangerous.

There are several ways in which painters and colour-mixers become the victims of lead poisoning. The men who grind or mix the colours run the risk of inhaling the dust. Unless this process is carried on either in closed spaces or in airy and well-ventilated rooms, the atmosphere becomes thick and can only be cleared by means of a fan. In this country there are, excluding house painters, upwards of 6000 persons employed in the manufacture, mixing, and grinding of paints and colours. Of 48 cases of plumbism that occurred among these persons in 1899, 30 were grinders and 7 of them packers.

For the purposes of house painting, the pigments are generally mixed with oil and a turpentine body. It has sometimes been thought that the lead poisoning of painters is due to the inhalation of the terebinthated vapour that rises from the painted surface. That this is a possible source is shown by the outbreaks of “belly ache,” or colique sèche, that occurred a few years ago in the Tropics, and played sad havoc with the sailors of the French Navy. For a long period the nature of the illness was not recognised. It was thought by some to be a neurosis of the abdominal sympathetic nervous system, and due to chill, while other physicians regarded it as a form of malarial disease. Lefèvre, the Director of the Naval Sanitary Board at Brest, ultimately gave it as his opinion that “the colique sèche of the French Navy is nothing more than lead poisoning, and the reason why colic was more frequent among French sailors than those of other countries was due to the fact that lead entered more into the construction of their ships of war. It formed the tanks for holding the drinking water and the pipes for carrying the water; it was present in the paint of the[336] cabins, in the enamel of the drinking-cups, and in the cooking utensils.” Out of this number of possible causes some of the cases of colique sèche might have been due to sleeping in cabins newly painted with lead compounds, although drinking contaminated water would be the more probable cause. A common cause of lead poisoning in house painters is inhalation of the fume evolved during the burning-off of old paint. When engaged for long at this kind of work the men complain of headache, nausea, and occasionally have colicky pains in the abdomen. There is yet another manner in which plumbism may develop, and this occurs in finer work, where several coats of paint have to be applied. After what is called laying-on of the prime colours and puttying with white lead comes the flat colouring. When the coats of paint have become dry the workman is obliged to use sandpaper to rub the surface flat. In doing this a considerable amount of dust is given off which is rich in white lead. It is inhalation of this dust that so frequently induces colic and paralysis of the hands in house painters. Carelessness and ignorance are frequently contributing causes. Men, while laying-on the white paint with a flat knife, have often been observed using the hollow of their left hand as a reservoir for the paint. If there is any erosion of the skin, absorption of the poison is sure to follow. Layers-on are an unhealthy class of men. In Paris alone there occurred 18 deaths during the years 1898 and 1899 in a small union of 200 members, the greatest age at death being 35 years.

A fresh danger has been recently introduced into house painting. A few months ago a house painter, aged 40, was admitted into the Newcastle Infirmary suffering from extreme blueness of the face, lips, ears, hands and fingers, and from colic. He had also a very blue line on his gums. The illness was plumbism, but with something superadded. He had been engaged in removing the varnish and paint from old Venetian blinds, and had been using a dark brown liquid with a pungent, penetrating odour, known in the trade as a special patent. During the process of rubbing and swilling the blinds, and subsequently of sandpapering them, a strong sickening odour arose, which caused him to vomit and to have severe headache. The vapour, too, caused him to become so drowsy that he would almost fall asleep. He would feel giddy, but had no difficulty in walking, nor was his eyesight affected. The man was pale as well as blue, he had a haggard expression, and there was the most marked cyanosis possible. He had colic and constipation. His internal organs were healthy, including the[337] kidneys. He had marked tremor of both hands, but no paralysis. It was quite clear that there was an acute intoxication of some kind or another, over and above lead poisoning. Several examinations of the urine were made by Dr R. A. Bolam, who had charge of the patient, with the view of establishing the nature of the poison. The symptoms reminded me of those observed in men who are employed in painting ships with quickly-drying spirit paints. It was thought at first that the symptoms were due to the presence of aniline oil in the “patent,” or of some chemical akin to the pyridine group of compounds. The case is an illustration of the danger incidental to the use of highly volatile, complex, and unstable chemical compounds whose nature is not quite known, whose effects upon the human body can only be learnt by experience, and which have for their object, from a trade point of view, rapid execution of work.

Painters of ships’ cabins suffer from plumbism as much if not more than house painters, since they are often obliged to work in close, confined spaces; so, too, do the painters of the back of mirrors, from using red lead; also painters of agricultural implements, etc.

It is worthy of mention that shipbuilders have found in the red oxide of iron a cheaper and safer pigment for painting the outside of steel plates than red lead.

The question as to whether any comparatively harmless substitute for white lead can be found for house painting is discussed at p. 293, q.v.

Coach Painting.

Lead poisoning in coach and carriage painters is far from being rare. In the painting of carriages there are often as many as eighteen coats of paint and varnish applied. Frequently the work is done in rather close and very ordinarily ventilated places. In Newcastle it is the practice of large firms of coach makers to give a carriage three coats of primary paint, six of filling up, three or four of oil colours, two of varnish colour, i.e. oil and varnish mixed, and, finally, about four coats of varnish. The colours used are white lead, dry and ground in oil: lampblack, ultramarine, yellow chromes, zinc white, and others known by particular names in the trade. “Driers” are also used, such as sugar of lead and terebene. Coach painters become the subjects of plumbism[338] chiefly through inhaling the dust when sandpapering to get a good surface. They suffer from colic and wrist-drop. Many of the cases approach in severity the lead poisoning of file cutters. Dr Morison Legge states that the percentage of chronic plumbism among coach painters is greater than among file cutters.

Several cases of plumbism have occurred in the painting of new carriages, also in the breaking-up and burning of the wood of old railway carriages. Thirty-four of the cases of plumbism reported during 1900 as having taken place in coachbuilders. occurred in men engaged in railway shops.

It is almost unnecessary to repeat that in all places where lead paints are being handled and used, as in workshops, factories, ships and dockyards, there should be adequate washing accommodation, with plenty of soap, towels, and nail-brushes, and sufficient time ought to be given to the men to wash before leaving work.

Glass Polishing.

After glass and crystal have been cut they have to be polished. The polishing is generally conducted on a revolving wheel or table made of wood, and upon which water, containing rouge or putty powder in suspension, is allowed to drip. When the article to be polished is a plane surface, e.g. a mirror, the wheel is a horizontal one revolving on a vertical axis. The water containing the rouge or putty powder escapes by a narrow opening from a conical vessel placed above the wheel. When finer work is required, e.g. the polishing of wine-glasses, electric-light globes, etc., the water drops on to a hard brush, which is attached to the external rim of a vertical wheel, from four to six inches in diameter, running at a high speed and revolving on a horizontal axis. For this kind of polishing putty powder alone is used. In some factories the liquid putty powder is fed on to the brush by a boy; in others the supply, as already mentioned, is automatic. Several samples of putty powder were sent to the Dangerous Trades Committee, and subjoined is the analysis of two of them:—

In the very free use of this putty powder, rich in lead, the clothes and hands of the workers become bespattered by the thick[339] spray thrown off from the rapidly-revolving wheels. Putty powder administered to animals in their food causes symptoms of Saturnine poisoning almost as quickly as white lead. In the evidence given before the Dangerous Trades Committee there was abundant proof of the extremely harmful effects of the use of putty powder in glass polishing. Many of the workers examined had suffered from colic, while others had been obliged to give up their employment on account of paralysis of the fingers and hands. It was ascertained that several of the male workers had died from acute convulsive seizures due to poisoning by lead. Another point to which attention was drawn was, that plumbism might develop in workmen in a glass-polishing shop who were not engaged in the actual process of polishing, and who had therefore not been directly brought into contact with the putty powder. This was due to the dried liquid on the floor becoming rubbed and trodden upon, rising as dust into the atmosphere, and being inhaled by the workmen in the shop.

Putty powder is a frequent cause of lead poisoning. The master polishers have for years tried to find a substitute for it. In many factories rouge is used. This is considered by many of the employers to be innocuous. On analysing rouge powders for the Dangerous Trades Committee, Professor Thorpe found that they contained commercial oxide of tin: that in one powder 0.13 per cent. of arsenious acid was present, and in another a trace of the same substance. Probably not much danger would follow the use of rouge powders containing such a mere trace of arsenic, but their employment would not be altogether free from risk; besides, since it can be shown that the presence of arsenic is not essential, then it ought to be eliminated altogether. The difficulty in regard to the use of harmless rouge powders is rather a technical or industrial question than medical. Do they answer the purpose as well as putty powder? The Dangerous Trades Committee found that opinions were much divided upon the point. Some of the glass polishers stated that rouge did not give such a fine effect, and that it took a longer time. On the whole, however, the results obtained have been such as to encourage employers to adopt it more freely. Where putty powder has been interdicted by the masters and only rouge used, the health of the workmen has wonderfully improved.

A few years ago M. Geroult proposed to the French glass polishers and crystal manufacturers, metastannic acid as a partial substitute for the putty powders that contained a large percentage[340] of lead, and which had been the cause of several fatal cases of plumbism. The Academy awarded the Montyon prize to Geroult for his discovery. For the last ten years the new method has been followed in the glass works of Baccarat, and has given the most satisfactory results. Dr Schmitt, the surgeon to the works, says, that since 1891, the date of the substitution of the new for the old method, there has not been one single case of lead poisoning among the crystal cutters and glass polishers, nor an acute attack of plumbism in those workers who had previously suffered from lead poisoning. Formerly the putty powder contained 62 per cent. of lead, but in that recommended by Geroult there is only 20 per cent., and even with a smaller percentage of lead good manufacturing results can be obtained.

Glass polishing is one of those trades in which personal cleanliness of the worker can do a very great deal to prevent plumbism, and, knowing this, employers ought to provide ample washing accommodation and appliances; overalls should be worn; no food should be taken into or eaten in the workshop. All polishing should be conducted as far as possible in semi-enclosed cupboards, with draught tubes and fans, and the feeding of the wheels should be done automatically. There ought also to be frequent periodical medical examination of the workers, with power to suspend in case of signs of plumbism. These were the recommendations of the Dangerous Trades Committee, and as one result of their being put into practice the Medical Inspector of Factories, in his Report for 1899, says he is satisfied that the introduction of fans has materially diminished the danger of lead poisoning in the process of glass polishing. It has, practically speaking, abolished the bespattering of the workmen’s clothes and the splashing formerly observed during glass polishing.

File Cutting.

Hand file cutting, although still giving employment in this country to a fairly large number of people, is generally stated to be a decaying industry. This is controverted by Dr John Robertson, Medical Officer of Health, Sheffield. It is, however, an unhealthy trade. In 1898 there were 46 cases of lead poisoning reported in file cutters, in 1899 the number was 41, and in 1900 there were 40 cases. The centre of the industry is Sheffield, but the manufacture is carried on in London, Glasgow, Rainhill, and Birmingham.[341] There are upwards of 2000 hand file cutters in Sheffield alone. In the Annual Report on the health of the City of Sheffield, 1900, it is stated that there are 2040 persons engaged in 546 hand file cutting shops. Files can be cut both by hand and by machinery, but as file cutting by machinery is usually carried on in modern and well-ventilated factories, this method of manufacture need not detain us, for it is a healthy occupation, there being no lead used in the process. It is otherwise with hand file cutting. Seated on a “stock,” the hand file cutter has in front of him a stone block, into the centre of which a small piece of bar steel called a “stiddy” is inserted, and on this stiddy is placed a piece of metallic lead, which is called the “bed.” The file about to be cut is strapped on to the bed. The lines that are seen on a file are made by means of a chisel and hammer, each line representing a blow. The reason for using the lead bed to strike the file upon is, that while there may be as little recoil as possible, there shall yet be sufficient resistance to develop the line in its entirety as a result of the blow given by the hammer and chisel. As a consequence of constantly striking files of uniform size a groove comes to be formed on the lead bed, into which succeeding files easily fit. When he has cut one face of the file, the workman rubs that side with charcoal, turns it over, and then proceeds to cut the other side, after which both faces are briskly rubbed. The file cutter grips the chisel between the index finger and thumb of the left hand, and in order to get a good grip of the chisel, he often licks his finger. A good deal of strain is experienced by the fingers in a day’s work. The steel hammer used by a cutter generally weighs from 7½ to 9 lbs., and as each line on a file represents one stroke of the hammer, and there are often on large files as many as 3800 lines, it is estimated that in the course of one day a file cutter will lift a weight equal to several tons. A Gateshead file cutter, who consulted me recently, works with a hammer 7 lbs. in weight; he cuts files 16 inches in length. Each file receives 1500 “bats,” and he makes one and a quarter dozen of files daily, working eight to eight and a half hours. In the course of a day’s work he lifts 157,500 lbs. weight.

File cutting by hand is properly regarded as a dangerous industry. Although it claims annually large numbers as the victims of plumbism, it is difficult to say exactly in what form lead enters the system. In Sheffield the work is for the most part carried on in small, badly-ventilated, and overcrowded shops,[342] more like outhouses, often situated in backyards or in the rear of dwellings, and not unfrequently contiguous to privies. Of 546 hand file cutting shops, in only 48 was there any means of ventilation provided, and in many of these “the means of ventilation consisted of a brick taken out of the wall.” Inside, the floor in nearly all of them is the bare earth, or bricks badly placed together. The workers are closely packed together without any consideration of the cubic space of the workroom. Hand file cutters as a class are anything but cleanly. Possibly their sense of indifference to dirt is largely the outcome of the long custom of the men taking their meals in shops totally unprovided with washing appliances. As a consequence of hammering and brushing the files, a considerable amount of dust is created, some of which must be inhaled, as the man or woman—for both sexes follow the occupation—bends closely over the stock. In several samples of dust removed from the stocks and rafters of the shops, lead[66] was found, the other constituents of the dust being particles of iron, charcoal, and chalk. File cutting is a sedentary occupation. In order to get as much light as possible upon their work, the men sit close up to the window, but they object to any part of the window being open on account of the cold and draughts. Owing to the close and dusty atmosphere in which the work is carried on, the general health of the file cutter becomes gradually undermined. As a consequence of this diminished vital resistance, and the practice of eating his food with unwashed hands, the licking of his fingers when at work, and inhalation of dust, the file cutter, in course of time, becomes the victim of lead poisoning. It is metallic lead dust that is given off during the blows with the hammer and chisel upon the file. Lead in this form is certainly much less harmful than when in such a soluble combination as the oxide or carbonate, but oxidation of the surface of the lead is constantly taking place, thereby rendering the metal more or less absorbable.

In addition to the ill-health caused by lead, pulmonary consumption carries off a large number of file cutters. The men work in a stooping position in overcrowded and ill-ventilated shops for long hours daily, with the result that the trade occupies an unenviable position on account of its mortality from phthisis. It[343] is not, therefore, lead quâ lead that is the sole danger, but the unhealthy conditions under which the labour is carried on.

In Sheffield, file cutting has received considerable attention from members of the medical profession. Thirty years ago Dr J. C. Hall denounced the trade as unhealthy, and demonstrated how, with such simple means as the free use of soap and water, much of the suffering and ill-health traceable to lead could be averted. Drs Sinclair White, Porter, and Harvey Littlejohn have in recent times written upon the evils of the trade from different standpoints. Notwithstanding all the attention the subject has received, hand file cutting still remains a most unhealthy industry. All the workers look anæmic. Many whom I examined both in Sheffield and in Rainhill had suffered from colic; several were completely disabled on account of paralysis of the extensor muscles of the fingers and wrists. It is rather in the chronic forms of plumbism, and in those persons in whom the kidneys become affected and health breaks down, that the worst effects of file cutting as an occupation are seen. Out of 100 file cutters examined by Dr Sinclair White, 74 had a blue line on the gums, 28 had had lead colic, and 20 paralysis of the wrists and fingers. The trade is characterised by a high mortality, the figures being 316 against 123 for occupied males in general.

The possibility of finding a substitute for the lead bed upon which the file is cut is, although not a new subject, one to which the Dangerous Trades Committee gave considerable attention. It was felt that if lead could be eliminated, the occupation would be rendered much less harmful. It was ascertained that in Germany pads of paper had been tried for small files, also that clay and sand encased in canvas, bars of wood, copper, vulcanite, and various combinations of indiarubber and gutta-percha had been tried, but each in turn discarded, owing to its unsuitability as a bed. This is a field of inquiry that would well repay any practical file cutter.

File cutters may work at their trade for years without becoming ill. Others again early suffer from colic, and the attacks of abdominal pain keep recurring every few months. Gradually, or suddenly, in those who have been thus afflicted, or even in those who have not had colic, paralysis of the fingers and hands develops. The peculiarity of file makers’ paralysis is, that while the extensor muscles of the fingers and wrists may become affected, so as to constitute a veritable “wrist-drop,” there is[344] observed more frequently paralysis with wasting of the smaller muscles of the fingers and thumb. The loss of power is usually confined to the fingers of the left hand. It is with the left forefinger and thumb that the chisel is grasped, and as a consequence of the workman holding the chisel in this position during a great portion of the day, there is an amount of muscular strain experienced which cannot but play a part in determining the paralysis and its location. It is not the sole explanation, however, for the paralysis also affects at times the muscles of the right hand of the file cutter. This is the hammer hand that really does the hardest work, though not of the same strained character.

While it is to the fact of the work being conducted upon a lead bed, and the want of personal cleanliness on the part of the file cutter, that plumbism is mainly due, there are, as seen in Sheffield, contributory causes in operation which tend to increase the harmfulness of the occupation. One of these is, that file cutting is often a home industry. The work is frequently carried on in the living room or kitchen of a dwelling-house. Domestic and family duties come to be disregarded by the mother, for she, no less than the other members of the family, interruptedly lends a hand to increase the income of the home. Readers of this paper are prepared to learn that work under these circumstances is usually carried on in houses of the poorest description, and that, as a consequence of the dangerous character of the occupation, the unhealthy atmosphere of the workroom, and the constitution of the workers having become undermined through poverty, lead poisoning when it occurs is not only extremely severe, but may affect those who are simply living in the house and not actually engaged in file cutting at all. How to grapple satisfactorily with this most unhealthy trade is one of the many difficult labour problems that have been presented to the Home Office. Both for it and the peculiar tenement conditions under which the industry is carried on in Sheffield, fresh legislation is required.

In file cutting shops generally, the air space ought to be extended to 450 cubic feet at least for each person (it is 600 feet in cotton factories); there should be greater distance between the stocks, say 4 feet; better ventilation; washing appliances, with plenty of soap, water, towels, nail-brushes; wearing of overalls; periodic lime-washing of the workshops; concrete, asphalt, or wooden floors, which can be damped and swept[345] regularly; prohibition of the taking of food into the workshops; and in the event of new buildings being erected, submission of the plans to the Home Office. For ventilation purposes Dr John Robertson recommends an inlet of the type of a Sherringham valve.

The report on the sickness experience of the Society of File Cutters by Hand in Sheffield, by Mr Stuart Uttley, Secretary of the Federated Trades Council, and which is published in the Fourth Interim Report of the Dangerous Trades Committee, 1899, p. 21, shows the extent to which file cutters are thrown off work every year through illness, including lead poisoning. This Society does not contribute any sick benefit, but during the illness of members their contributions to the Society cease. In this way it is readily known how many members are off work. The report deals with adult males only, and the dates chosen are 1891 and 1896, two years when trade was good, when all the members were at work, and malingering was practically beyond question. Out of 1092 members in the Society in 1891, the claims for exemption on account of sickness were equivalent to 1109 weeks, or a fraction of over one week per man per year. It is not maintained that all the sickness was due to plumbism. In 1896, 961 file cutters who were working in Sheffield claimed 951 weeks’ exemption from payment of contributions on account of sickness, or a fraction under one week each per man per year. There were 36 cases of plumbism in file cutters notified in Sheffield from July 1898 to June 1899, and of these 35 were men. A glance at Dr Tatham’s tables of comparative mortality, in an earlier part of this book, will show to what a large extent pulmonary consumption prevails in file cutters.

Dr Harvey Littlejohn found that in twelve years there occurred 91 deaths from plumbism in Sheffield, and that of the 91 people who died, 56 were file cutters. These statistics, however, do not represent the total number of deaths from lead poisoning. Plumbism is sometimes so tardily developed, and the constitution of the workman so gradually undermined, that as pathological changes are very slowly induced in internal organs, such as the kidneys, an individual may die long after he has given up working in lead, and the death be registered as having been caused by chronic disease of the kidneys, which but for lead poisoning would probably not have developed at all. It is thus that many fatal cases of lead poisoning fail to be attributed to their proper cause, owing to the fact that[346] as death is the result of well-defined disease of internal organs, the connection of which with plumbism is overlooked, the occupation of the patient is either not inquired into or is completely ignored by the medical attendant. It was with the view of minimising this error, and of bringing into greater prominence the connection of lead poisoning with industrial occupation, that the Dangerous Trades Committee suggested in its final Report, 1899, p. 6, that if all deaths among workpeople who had been employed at any time within three months immediately preceding death in a trade in which Special Rules are established were compulsorily reported to the coroner, many facts of intrinsic and statistical value would be ascertained, and much light shed upon some of the occupations that give rise to industrial disease. By this means much injury and suffering might be mitigated at an earlier date than at present through alteration of the conditions under which the particular industry is carried on. Possibly six months would be better than the three suggested in the above sentence. Usually lead poisoning is so slowly and insidiously developed in file cutters, that the workpeople become indifferent to the dangers, and yet when symptoms of plumbism occur they can be very severe. Occasionally in female file cutters the malady shows itself at an early date after exposure, and the symptoms are those rather of the acute than the chronic form of plumbism.

Since, doubtless, the tendency to plumbism in file cutters is favoured by the nasty habit indulged in of licking their left thumb in order to get a better grip of the chisel, the application of resin to the finger has been recommended, but the suggestion does not appear to have met with much approval. Allusion has been made at the commencement of this article to the fact that it is only hand made file cutters who suffer from lead poisoning. In the United States all file cutting is done by machinery, and in that country plumbism among file cutters is unknown. In Britain machine-made files are slowly supplanting those cut by hand, but the customs of a trade die hard.

Use of Lead in Potteries.

Staffordshire is the home of the pottery industry in this country. In Stoke-on-Trent, Burslem, Hanley, Longton, Fenton, and Tunstall, the trade is centred. These towns form what is called the “Potteries,” a district of about ten miles in length and four in breadth. Here nine-tenths of the earthenware produced in[347] the United Kingdom are manufactured. The location of the manufacture of pottery in Staffordshire is an illustration of how industries cling to particular districts. At the present time none of the clay which is used in the manufacture of the finer earthenware is found in the neighbourhood. Originally there was plenty of coarse clay, and there is still abundance of marl, which is used for making saggers and firebricks. Coal, however, is abundant, and cheap fuel is an important item in the manufacture of pottery. In the early part of the seventeenth century there was a good supply of clay and fuel in the locality. The ware produced at that time was made from yellow or red marl, glazed with galena, or crushed raw lead ore brought from the Derbyshire mines; but in 1680, common salt was substituted for galena in the glaze. The articles produced were known as Crouch ware. It was in Burslem that this ware was first made. In 1759, Wedgwood perfected the white cream ware, and introduced many improvements into pottery, especially in the manufacture of green, black Egyptian, and jasper wares. Although England never outrivalled France and Germany, e.g. Sèvres or Dresden, in the manufacture of soft china, yet she has produced earthenware on a larger scale and supplied more of the world’s markets than other pottery districts, and is still doing her utmost to maintain her supremacy. In Staffordshire there is plenty of common clay, marl, or fireclay which, as already mentioned, is useful for making saggers, i.e. the large vessels in which earthenware is fired. The clays necessary for making the finer earthenware and china are brought from Dorset, Devon, and Cornwall. The clay or felspar used is, roughly speaking, a silicate of alumina in combination with water, potass, soda, lime, or iron. These ingredients act as fluxes on the silicate, and therefore help its vitrification. For earthenware, two kinds of clay may be used, the blue or ball clay and kaolin, but for porcelain only kaolin. It is estimated that upwards of 70,000 tons of ball clay are annually imported into the Potteries from the south of England. Kaolin, the Chinese word for the clay out of which porcelain is made, is in Staffordshire called China or Cornish clay, and is got from granite rocks. Workmen mix this Cornish clay with water in a large tank. The quartz, mica, and undissolved felspar sink to the bottom, while the thick white water in which the fine particles of kaolin are suspended is run off into another tank in which the kaolin is allowed to become precipitated. The precipitate is subsequently removed, dried, and exported from the south of England[348] as a very fine white clay, which contains more alumina but less iron than the untreated clay. Of this material about 130,000 tons are sent to the Potteries every year. In Staffordshire what is called Cornish stone is also used. This is a kind of granite in which the felspar retains its alkaline elements, and is also useful as a vitrifying agent. Ground flints, too, are employed in the manufacture of earthenware. Ball clay forms the foundation of earthenware; flint is simply the whitening material. The addition of Cornish clay makes the body still whiter and less liable to break under a heavy weight and changes of temperature, while Cornish stone renders the ware more compact and of a closer texture. A mixture of these substances when fired would not produce earthenware of a perfectly white colour. The iron contained in them would impart a yellow tinge. This is overcome by adding oxide of cobalt, which neutralises this tendency so completely that white ware is produced.

It is unnecessary to describe at any length the process of manufacture. Once the ware is made it is gently dried by exposure to the ordinary air; afterwards it is placed in saggers and fired in large cylindrical ovens, slowly at first to prevent too sudden evaporation of moisture and to prevent splitting. When the ware has undergone its first firing it is known in the trade as biscuit. Common terra-cotta and stoneware only require one firing, but for all English ware it is necessary that it should be placed twice in the oven so as to get a denser texture of the ware, also for the purpose of glazing, or that process whereby the article is dipped in a liquid in which usually raw or ground vitrified lead is suspended. If the ware is to remain white, it is, after it has been biscuited, sent to the dipping department to be glazed, and if it is to be decorated and sold as an inexpensive ware it goes in addition to the printing shop, where by means of thin paper transfers it receives the desired coloured impression. The more expensive ware is painted by hand in the ordinary way by means of small brushes. In underglazed colouring the decorated ware is placed in a kiln and brought to a red heat so as to burn off the oil in the colouring. The earliest glaze used in Staffordshire contained galena or sulphide of lead. The materials used for glazes are the same as those for the body, viz., silica as found in flint, and felspar, to which is often added Cornish stone. These are called the hard materials, and they are vitrified by such fluxes as oxide or carbonate of lead, borax or boric acid, potash, soda, carbonate of lime and barytes. In the Potteries[349] each manufacturer has his own receipt for glazes, and he guards it with a conservatism that to outsiders seems unnecessary in these days of advanced chemical research. The ingredients or the glaze can be rendered very insoluble by vitrifying them in a reverbatory furnace or crucible by exposure to an intense heat, whereby a compound like green glass is obtained, which is called a fritt. This is subsequently ground and mixed with water. Into this liquid the ware is dipped, and having been biscuited, the porous ware rapidly absorbs the water, leaving the solid particles of the glaze on the surface. Instead of fritting the lead, many manufacturers until lately simply added raw lead, i.e. white lead or carbonate, to the other ingredients in the dipping tub, and it is owing to persistence in this practice that lead poisoning has been so prevalent in the Potteries. After the ware has been dipped in the glaze it is fired for a second time in a manner similar to the first, only in smaller ovens, and with greater care, the individual pieces being better separated from each other. On removal of the ware from the oven it is ready for the market. In most factories the ware, after having been dipped, is dried and cleaned by women, i.e. the borders are scraped with a knife to remove any surplus glaze. When this process of cleaning is conducted over a trough that is aspirated there is very little dry glaze dust scattered about the room, but if performed in a room without proper ventilation the atmosphere becomes dusty and dangerous. Ware cleaning ought never to be conducted in the same room as the dipping.

What is called porcelain or china differs slightly from earthenware. There are three kinds of porcelain: (1) that made from kaolin and felspar, with the addition of quartz: this is manufactured in Limoges in France; (2) soft porcelain, which was formerly made at Sèvres, near Paris; and (3) English porcelain, which, like the first, is made from kaolin and Cornish stone, but differs from it in containing calcined bones. For hard porcelain, the glaze is made from felspar, which contains a variable quantity of quartz, while in the glaze used for the other two there is usually some silicate of lead and borates, the presence of which allows of a lower temperature being used for the biscuited ware. Thirty-five firms in the Potteries make china, and 195 earthenware.

The population of the Potteries and of the district immediately round about is probably not less than a quarter of a million. It[350] is estimated that there are from 46,000 to 50,000 people working in the Potteries, of whom 4703—viz., 3123 males and 1580 females—are engaged in what might be called lead or dangerous processes. In his Annual Reports the Chief Inspector of Factories shows that in 1898 there were 457 cases of lead poisoning notified to the Home Office from the Potteries, 249 in 1899, and 200 in 1900, whereas for the same periods the following numbers were reported from all other trades combined, excluding house painters, 1278, 1258, and 1058. The number of persons working “in the lead” in the Potteries in July 1898 was 4703, and were classified as follows:—

Number of Persons employed in Processes where Lead is used in the manufacture of Earthenware and China, North Stafford District, July 1898.

At the date of the Report on the Use of Lead in Potteries, presented by Professor Thorpe and myself to the Home Secretary (1899), the total number of cases of lead poisoning in the Potteries during the previous three years, i.e. since the Act of 1895, as to compulsory notification, came into force, was:—

[351]

These were distributed thus:—

Number of Persons reported as suffering from Lead Poisoning during the years 1896, 1897, and 1898.[67]

Comparison of Number of Persons “Working in Lead” in July 1898, with number of cases of Lead Poisoning reported in year 1898.

[352]

These statistics were obtained for Professor Thorpe and myself by Mr J. H. Walmsley, H.M. Inspector of Factories, Stoke-on-Trent, and are reproduced from our Conjoint Report to the Home Secretary on Lead Compounds in Pottery. From these figures it is seen that of the total male workers 4.9 per cent. become “leaded,” whereas of the female workers, who form the smaller body, the proportion is as high as 12.4 per cent.; and if the official figures for 1897 had been taken, the results, it is believed, would have been even higher. Before Professor Thorpe and myself commenced our investigation of lead poisoning in the Potteries, Special Rules had been issued by the Chief Inspector of Factories in 1898, the good effects of which were already being felt at the time of our visits to Staffordshire. From the Annual Report of the Chief Inspector of Factories it appears that in 1900, 200 cases of lead poisoning in the Potteries were reported, as against 249 notified in 1899. Dr Morison Legge in alluding to this subject remarks that it is natural to attribute the diminution partly to the new Special Rules (1898), and to the fact that in some factories the use of raw lead has been discontinued. The numbers of cases of both sexes in 1899 are much fewer than in 1898; but of the total persons, it is to be noted that whereas females constituted 55.2 per cent. and males 45.8 per cent. during 1898, the reverse occurs in 1899, viz., 51.4 per cent. males and 48.6 females. The alteration in sex distribution among persons attacked is attributed by Dr Morison Legge to the medical examination, in which adult males did not participate. It would appear, too, that there is a diminution in the number of severe cases reported, a circumstance which is also attributed to the medical examination. The diminution is most observed among ground layers and colour dusters, but not in ware cleaning or dipping operations.

What are called the dangerous processes of pottery manufacture are those in which the worker is brought into contact with lead. The preceding tables show that from lead poisoning a very high percentage of colour and litho-dusters suffer, also that dippers’ assistants, ground layers, ware cleaners, majolica paintresses, and dippers run a considerable risk from plumbism. There are fewer women than men working as dippers, and in this department the incidence of plumbism is nearly equal in the two sexes. With the exception of glost placing, i.e. filling the ovens with the ware about to be fired, and which is heavy labour and only fit for men, females predominate in all the other departments. From these figures it is seen that males who are[353] colour dusters suffer in much larger proportion from lead poisoning than do females, but in nearly all the other processes it will be observed that the percentage of lead poisoning is higher in females than males. It is the lead processes that have justly caused pottery manufacture to be regarded as one of the dangerous industries, and whatever may be said to the contrary, women, especially young women from seventeen to thirty years of age, and all young males or females, are especially susceptible to plumbism. Lead poisoning in pottery manufacture has for long been known, but neither had the Home Office, nor employers and the public, any adequate idea of the extent to which the evil prevailed until industrial plumbism became notifiable. It was with the view of throwing light upon this subject that the Secretary of State invited Professor Thorpe and myself, in May 1898, to institute a special inquiry into the hygienic questions involved in the use of lead in pottery processes, and to ascertain—

Professor Thorpe and myself, either singly or together, visited not only the potteries in Staffordshire and in Scotland, but several of the leading manufactories on the Continent, e.g. at Delft, La Louvière, Maastricht, Copenhagen, Charlottenburg, Dresden, Limoges, Choisy-le-Roi, etc., and our opinions and recommendations are embodied in a Blue Book which was presented to the Home Secretary, Sir Matthew White Ridley, in February 1899. These, it is to be hoped, will ultimately form the basis of legislation for the trade in this country. At present our recommendations have been challenged by the manufacturers, and are the cause of considerable dispute between the master potters of this country and the Home Office. I therefore reproduce our recommendations:—

These were our recommendations, and while they received a considerable amount of approval throughout the country, some of them, as might be expected, have been the subject of hostile criticism on the part of the pottery manufacturers. It should be borne in mind that a few years previous to our inquiry a Committee appointed by Mr Asquith, then Home Secretary, and composed of Mr S. W. May, H.M. Superintending Inspector of Factories (Chairman), Dr John T. Arlidge, Mr W. D. Spanton, F.R.C.S.E., Mr A. P. Laurie, M.A., Mr J. H. Walmsley, H.M. Inspector of Factories, and Mr W. D. Cramp, H.M. Superintending Inspector of Factories (Secretary),[355] had reported to the Secretary of State, and made certain recommendations, including one specially by Mr Laurie, in which it is suggested that the manufacturers should be circularised from the Home Office to experiment with and test the uses and the effect upon the health of the workpeople of glazes and colours in which all the lead had been fritted; also the practicability of making a glaze that would be harmless to those employed in the manufacture, and at the same time would not injure the ware. It remains a cause of disappointment that, considering the assistance rendered by the 1893 Committee, the pottery manufacturers did so little to introduce the improvements that were recommended so as to minimize the evils that were yearly increasing. Periodical medical examination of the workers, male as well as female, they certainly encouraged, and they admit that the result was beneficial. There is a feeling that, had the manufacturers bestirred themselves a little more in the direction of using properly fritted lead compounds instead of raw lead in the glaze, and of again experimenting with leadless glazes to see what they could accomplish, plumbism in pottery manufacture would have materially diminished, our inquiry might not have been necessary, and certainly the recommendations made by Professor Thorpe and myself would not have been viewed, as they are by employers, in the light of a menace to the industry and a check to its commercial prosperity.

If there is one thing upon which the British public has made up its mind in regard to some of the important labour and social questions of to-day, it is, that there ought to be fewer cases of lead poisoning in the manufacture of pottery generally, and that plumbism should be practically abolished in the production of certain kinds of earthenware. It would therefore be rather to the advantage of the industry than otherwise, were the Staffordshire employers to meet the wishes of the public in this respect, by making a greater effort to produce ware dipped in leadless glaze. When the Home Secretary published our recommendations, and stated to employers that it was his intention to give effect to them, the pottery manufacturers assumed an attitude partly of agreement and partly of disagreement. They at once stated their willingness to discontinue the use of raw lead in glazes; they asked for a lengthened period to test and experiment with fritted lead, while in regard to leadless glazes they have taken up the position which, up to the time of writing, may be regarded as one of no compromise. The abolition[356] of raw lead, if carried out, would mark a very important stage in the pottery manufacture of this country, and of itself would do much to reduce the number of cases of lead poisoning. The use of fritted lead compounds would also prove helpful; but in order to obviate the risks of plumbism from the use of these substances, the fritting of the lead compounds has to be done carefully, for although less soluble than raw lead, yet plumbism has followed their use. A simple silicate of lead possesses advantages over the carbonate, both in its physical and mechanical characters; it is, for example, less dusty and clammy than either white or red lead, and is more easily removed from the skin by washing. Such an ordinary silicate may contain as much as 70 per cent. of lead oxide, and 25 per cent. of silica, with small quantities of alumina, lime, magnesia, and alkalis, corresponding in fact to a crude mono-silicate, “and this compound, which is generally understood as ‘fritted’ lead, is hardly less soluble in acids than basic lead carbonate,” besides “glazes in which the whole of the lead has been fritted as a properly compound lead silicate—that is, fritted directly with the other components of the glaze, so as to form a double silicate—have been found to possess greater covering power than a glaze containing the same relative amount of lead in the ‘raw’ state, with the further advantage of enhancing the colour.” When the amount of silica is increased the fritt becomes more innocuous, but there is a limit to which silica can be added to litharge, so as to produce a homogeneous silicate. Even bisilicate of lead is not wholly insoluble in acids. Professor Thorpe found in his experiments, conducted in the Government Laboratory, that it was not desirable the fritted lead should be a simple silicate, also that a properly compounded double silicate could be made that would fulfil all the requirements of the potter, and at the same time be practically insoluble in acids. He suggested the following as a suitable constituent of glaze, and as a compound that would be only slightly attacked by hydrochloric acid, viz.—

This combination can be obtained by “fritting an intimate mixture of litharge, flint, felspar, tincal, and chalk, or an intimate[357] mixture of litharge, flint glass, borax, china clay, and ground flint; or, as is done on the Continent, a portion of the flint may be replaced by white sand, the colour if necessary being corrected by cobalt.” There is a very strong feeling that in Staffordshire the pottery manufacturers have been using more lead than is actually required to make a good glaze. Lead has been used without proper discrimination. As to what the amount of combined lead, calculated as oxide, which the glaze of “glost” ware should contain, the opinion of even practical potters is divided. It has been thought by some that 20 per cent. is required, while others fix the limit at 10. Professor Thorpe found excellent examples of lead-glazed ware in which the monoxide of lead did not exceed 12 per cent. of the total weight of the glazing materials, while on analysing some of the liquid taken from the dipping tubs in the potteries, he found the amount varied from 13 to 24 per cent., and even higher. If, therefore, the use of lead compounds is still to be permitted, and, as has been shown, fritted lead in the form of a simple silicate is not much less soluble than raw lead, it is apparent that, with the view of preventing injurious consequences, their use must be restricted and regulated. It was with this object that the Home Office insisted upon all fritted lead compounds conforming to a certain test of solubility, and it is around this point there is considerable disagreement between the master potters and the Home Office. In a Report on the “Use of Lead in the Manufacture of Pottery,” presented to the Secretary of State by Professor Thorpe (1901), the Government chemist deals, among other things, with the relation between the composition and solubility of lead silicate, as shown in the following table:—

I have not reproduced in the table the percentage composition of the other ingredients of the fritt, but it is maintained that the[358] solubility does not depend upon any of the constituents, nor does any single base or acid increase or decrease continuously as the solubility of the fritt increases. Although in a general sense the solubility increases with the sum of monoxides present in the fritt, yet there is no regular progression. The solubility, according to Thorpe, depends upon the value of the ratio bases/acids which, judging from the results obtained by him, should not exceed 1.45, or thereabouts, if the fritt is to be practically insoluble in 0.25 per cent. hydrochloric acid and be therefore safe. With the view of coming to some understanding upon this question a conference was held between representatives of the pottery industry and the Home Office on 31st October 1899. Two months afterwards the Secretary of State intimated that it was his intention to propose that after a certain interval a standard of insolubility for fritted lead employed in glazes should be observed by the manufacturers—the standard of insolubility being that the glaze should not yield more than 2 per cent. of lead when acted upon by hydrochloric acid, under certain conditions. Permission was granted to manufacturers to submit specimens of fritted lead to Professor Thorpe, so that they might have the necessary chemical assistance if wanted. Several samples were received, and on examination it was found that they could contain amounts of lead ranging from 24 to 53 per cent., and yet be capable of conforming to the standard of solubility required by the Home Office, although generally speaking they yielded slightly larger quantities of lead oxide to dilute hydrochloric acid than the insoluble silicate prepared from Continental fritts. In a short Report by Dr Thorpe, dated 20th November 1900, are published directions for the fritting of lead. The manufacturer, for example, “may, in the first place, fritt together all the materials given in the receipts—that is in one operation. If he chooses to take this course it would, as a matter of economy, be preferable to substitute litharge, if not for the whole of the raw lead, at least for the white lead. It seems absurd to pay for the trouble of putting the carbonic acid and water into the white lead, when these ingredients are expelled by the heat of the kiln. The required alteration in the receipt may easily be calculated from the fact that 1 lb. of litharge contains the same amount of lead oxide as 1.02 lb. of red lead or 1.18 lb. of white lead. Or the manufacturer may make up his fritt by commingling two other fritts. Thus he may fritt together borax, stone and flint, and fritt also the lead oxide, flint and stone, each in such proportions that the two when mixed with[359] the whiting and china clay form a composition containing 18 per cent. of lead oxide.” It was urged by the manufacturers that the 2 per cent. solubility of lead in a glaze would be materially affected by the degree of fineness to which the fritt might be ground, but experiments showed that while within limits increased solubility of the fritt and fineness of grinding were concurrent, yet this question was rather of an academic nature, and had no practical bearing upon the use of fritted lead compounds in pottery. In our Conjoint Report, dated 1889, when discussing the amount of combined lead that might be allowed in glazes, we stated as the opinion of practical potters that it should be from 10 to 20 per cent. We ourselves suggested 12 per cent. Subsequent experience and experiment convinced Professor Thorpe that 12 per cent. is higher than is actually necessary in earthenware and china glaze. Nor does he regard the limit of 2 per cent. of solubility as too hard or stringent a requirement. The manufacturers pressed the Home Office to raise the limit to 5 per cent., but to do this in the face of existing evils was far from helping the object that the Home Office had in view. The stamping out of lead poisoning in pottery manufacture is a most desirable object, and one all must wish to see accomplished without, if possible, any injury to the trade. “If the limit is raised, as suggested, to 5 per cent., it means that the lead in an ordinary earthenware or china glaze, as at present used, may be so soluble that one-third of it may be extracted by very dilute acid at ordinary temperatures in one hour.” More than that, to raise the limit to 5 per cent. would be to throw away all the result of the experience that has been gained by experiments conducted over a period of three years, and would tend to perpetuate the evils that at present exist.[69]

No matter in what form lead is used for glazing pottery, there is always a risk of plumbism. The French pottery manufacturers employ for enamelling purposes a glaze the principal ingredient of which is calcine—an alloy of 15 to 20 parts of tin, and 100 parts of lead. An ordinary composition for white glaze for table ware is—

Yellow and green coloured enamels are got by adding to the white[360] glaze a quantity of antimoniate of lead, but for other colours no lead is used. (Poisons Industriels, Office du Travail, Paris, 1901, p. 45.)

Since the publication of the Report on Pottery Manufacture in 1899, by Professor Thorpe and myself, in which we recommended the use of leadless glazes for cream and white ware, electrical fittings, sanitary ware, etc., attempts have been made to place leadless glazed earthenware and china on the market. Commercially the thing can be done. The Worcester Porcelain Company, also Messrs Mortlock, Maling & Sons, and others, are willing to supply china finished with a glaze quite free from lead. The Coalport China Company state that they have used a leadless glaze for the past eighty years, and that they have never had a case of lead poisoning in their works. Messrs Maling & Sons, Newcastle-upon-Tyne, regularly produce a large amount of ware dipped in leadless glaze, particularly jam-pots.

In France a circular issued by the Minister of the Interior, and bearing date 19th June 1878, interdicts the manufacture and sale of pottery, either of French or foreign manufacture, glazed by means of oxide of lead which has been incompletely fritted, and which gives up readily oxide of lead to feeble acids. I am not in a position to say how far this has been given effect to.

In potteries where red or brown ware is used plumbism is not unknown. It has generally been traced to the use of red lead. Occasionally lead poisoning from red earthenware potteries, mostly in the form of wrist drop, has come under my notice at the Newcastle Infirmary. Some of the cases have been drawn directly from the immediate district, while others have come from Sunderland. With the view of diminishing plumbism in the manufacture of red and brown earthenware, Professor Thorpe suggested that where employers decline to use fritted lead, on the ground of expense, there would be no practical hardship in adopting the use of ground blue lead or galena, i.e. the native ore, instead of red or white lead. It is cheap, but it requires to be ground. The drawback to it is that it gives off sulphur fumes when fired, but the amount of sulphur oxides given off is small to that formed in the combustion of the coal in the oven. It gives a faint yellow or brownish tinge to the glaze, but this does not seem to be objectionable. In visiting potteries in Holland, I found one firm in Gouda which used ground galena for glazing this kind of ware. They had not only every reason to be satisfied with the results, but in the factory plumbism was[361] unknown. Several decades ago galena was similarly used in Staffordshire.

I have dwelt at considerable length upon the question of fritting lead compounds and the use of leadless glazes, both in defence of the attitude which Professor Thorpe and myself have assumed, and to show the reasonableness of our recommendations.

If our recommendations were adopted they would certainly make for better health of the operatives engaged in pottery manufacture. At the time of writing they have not been adopted. Some months ago a statement was issued by a joint committee representing 283 of the 579 manufacturers coming under the Special Rules, challenging our Report. The manufacturers say that it is impossible to glaze the greater part of their ware without lead, and that serious injury will be done to the trade if a radical measure of so sweeping a character is enforced without giving sufficient time to test the products so treated. Employers maintain that from a trade point of view existing regulations are hard enough. They suggest that there should be an extension of the medical examination of all operatives engaged in lead processes quite irrespective of age or sex. The Home Secretary subsequently indicated to the manufacturers the steps he proposed to take with the view of protecting workers from lead poisoning in china and earthenware, viz.—(1) relaxation of the Special Rules for factories or processes in which no lead is used; (2) medical examination of male workers in lead processes; (3) use of fritted lead—six months being allowed before this becomes compulsory; (4) fixing of standard of safety in fritts as regards solubility in acids.

There is everything to show that within the last three or four years the conditions of labour in the Potteries have materially improved, and that there has been a distinct diminution in the number of cases of lead poisoning. The operation of the Special Rules, the periodical medical examinations, and a more restricted use of raw lead have largely contributed to this satisfactory result. A return of cases of lead poisoning reported under the Act 1895, occurring in the manufacture of earthenware and china from 1st January 1899 to 31st December 1900, and presented to the House of Commons by Mr Jesse Collings, 27th February 1901, conveys information upon this particular point. During the year 1899 there were in the Potteries 129 persons suspended from work on account of lead poisoning, and in the following year 95. In 1899, 34 of the 129 persons were ware cleaners, 29 worked in the dipping house, 26 were majolica paintresses, ground layers[362] formed 14 of the total, and 10 were colour dusters, while for 1900 the numbers were respectively 20, 42, 8, 6, 13. The districts of Hanley, Burslem, Tunstall, and Stoke include practically the whole of the North Staffordshire Potteries, where about 46,000 persons are at present employed in the manufacture of china and earthenware, and of whom 4700 are employed in lead processes. Taking, therefore, the cases of lead poisoning in the Potteries for the last four years, they run as follows: in 1897, 446; in 1898, 457; in 1899, 249; and in 1900, 200.[70] Allowing a margin on either side for discrepancies and incompleteness in the statistics, these figures at once show how in a trade that has hitherto been regarded as dangerous the conditions of labour can be materially improved, with a very marked gain in health to the workers. These encouraging results are, it is hoped, only a forecast of others yet to come.

There is considerable discrepancy in the returns of lead poisoning in the Potteries, due to the source from which the statistics have been obtained, and the manner in which the cases have been notified. All the statistics concur in showing a declension of plumbism. From an article in the Times, 24th September 1901, the following has been taken:—“That lead poisoning has rapidly diminished among potters and increased among other trades is proved by the following table of cases reported in the last four years, and compiled from the Labour Gazette and other official sources.”

It will be thus observed that there has been a progressive diminution in the number of cases of lead poisoning in the pottery trade, a diminution that is still proceeding, judging from the returns of the first half of the year 1901. The cases reported for the six months, January-June, in the last four years are:—

“In the course of three years the amount of lead poisoning has been reduced to one-fourth of that reported in 1898.” The manufacturers attribute this result to the monthly medical examination of women and young persons brought into contact with lead.

An accidental delay in the passage of these pages through[363] the press allows me to add a further note upon the attitude of the Home Office and the pottery manufacturers in regard to the use of fritted lead compounds, the suggested standard solubility, and the use of leadless glazes, and thus to bring up to date the history of this important trade inquiry, probably the last of the large industrial conflicts that will be submitted to arbitration. The questions at issue between the Home Office and the manufacturers were referred to arbitration, Lord James of Hereford being chosen as umpire. The Court sat at Stoke-on-Trent on 7th November 1901, and subsequent days. Mr Chester Jones acted as arbitrator for the Home Office, and Mr Llewellyn for the manufacturers; the counsel being, Mr Cripps, K.C., and Mr H. Sutton, for the Home Office; Mr Fletcher Moulton, K.C., for the manufacturers; and Mr Colefax for the operatives. Evidence was given by Professor Thorpe, Mr Wilton Rix; Dr Wilkin, director of large potteries, Dresden; Mr Alström, of the Rorstrand Potteries, Stockholm; Dr T. M. Legge; Miss A. M. Anderson, Principal Lady Inspector of Factories; and myself, on behalf of the Home Office. The principal points urged were: the possibility of using leadless glazes for certain kinds of ware; the greater safety of fritted lead compounds over raw lead; the greater freedom of Continental potteries from plumbism, where most, if not all, of the lead was fritted, than is the case in Staffordshire; and, in a general way, the better structural arrangements in Continental potteries than in those at home. On behalf of the manufacturers, Messrs W. H. Grindley, G. E. Meakin, H. J. Johnson, J. L. Whittaker, and J. Sherwin gave evidence. It was admitted by the witnesses on both sides that there had been since the introduction of the Special Rules 1898 a very notable decline in the number of cases of plumbism in Staffordshire, and that towards this happy circumstance better ventilation, greater personal cleanliness on the part of the workpeople, and systematic medical examination had doubtless contributed. The main part of the inquiry centred round the subject of fritting the lead for the glaze. It was demonstrated by Professor Thorpe that excellent results could be obtained by the use of vitrified lead, which was soluble to the extent of only 2 per cent. in .25 per cent. of hydrochloric acid. The manufacturers having previously intimated to the Home Office their willingness to accept a 5 per cent. standard solubility as the test of lead in their glazes, wished to recede from this position, and at the time the Court was sitting, claimed the right not[364] to be bound by this or any other test of solubility. In fact, it was admitted that many of the manufacturers had returned to the use of 30 to 40 per cent. of raw lead in their glazes. As to the greater safety in the use of fritted lead compounds of the low solubility insisted upon by Professor Thorpe there can be no question. There never will be absolute safety so long as lead in any form is used; a 2 per cent. soluble fritted lead compound must be much less harmful if swallowed than one containing lead which has a solubility of 5 per cent. or more.[71] My contention, like that of Professor Thorpe, was that the .25 per cent. of hydrochloric test was not at all a hard one; that while this was the amount of hydrochloric acid present in the gastric juice, the test proposed was not so severe as that which would be carried on in the human stomach, where there was a higher temperature, greater agitation, and therefore better admixture of the contents.

It is unnecessary here to reproduce the evidence in detail either for or against the recommendations of the Home Office, which were based upon the Thorpe-Oliver Report; but I may mention one or two additional facts. While the Court was sitting, a male dipper of 20 years’ experience, and who had never been ill, requested permission of Lord James to give evidence. This was gladly complied with. The evidence tendered was directed against the proposed monthly examination of males employed in lead processes. The operative simply wished to assert his right to work in lead even if he was the subject of plumbism, to express his unwillingness to submit to periodical medical examination, and to state that he objected to be bound by the arbitrary order of the certifying surgeon either for temporary or permanent suspension. In a word, he stated that he and his comrades knew the risks of their calling, and they were prepared to take them. He appealed against the application of all official restraint, which he regarded as of too coercive a character. When[365] working men, in whose interests well-meant efforts are being made to render their occupation more healthy, prefer to court death and to throw their wives and families upon the ratepayers rather than forego the loss of a few weeks’ wages so that they may regain their health, the difficulty of bringing into line the many conflicting forces is at once apparent.

To the fritting of lead compounds the manufacturers raised many objections. It was stated that, quite apart from the expense, their use was impracticable. Mr W. H. Grindley of Tunstall stated that he had tried fritted lead, but had relinquished it, as its use had involved him in a financial loss of some hundreds of pounds in a few weeks. Mr Henry J. Johnson and other manufacturers gave similar evidence.

Quite unexpectedly, on the fifth day of the sitting of the Court, Lord James announced his intention of not carrying the inquiry further. Balancing the various conflicting issues at stake, and influenced by the reduction in the number of cases of lead poisoning from 12 to 3.5 per cent. in the four years’ operation of the Special Rules, he postponed the arbitration for eighteen months, during which, putting the manufacturers on their honour, he looked to them to rigidly give effect to the Special Rules of 1898; to take a lesson from Continental manufacturers; to try fresh experiments with fritted lead, and to reduce them to the lowest possible solubility consistent with a satisfactory production of their ware; also to come to some understanding with the workpeople in regard to founding a mutual assurance fund. As the whole subject is to be again discussed in eighteen months, it would ill become me to do more than simply state these facts, and to express the hope that by a loyal adherence to the special regulations the amount of lead poisoning in Staffordshire may meanwhile still further decrease.

Chromo-lithographic Works and Transfer Making.

In the printing of coloured trade advertisements and wrappers there is frequently used metallochrome powder, known under various names, e.g. “flake white,” “china white,” etc. Usually the dry powder is dusted on the sheets of paper by hand and dusted off again by young women or lads, an operation that is extremely dusty, and too often carried on in workrooms totally unprovided with any artificial means of ventilation. Practically speaking, the manufacture of transfers for giving coloured impressions to pottery is a similar operation. The coloured[366] impressions are made upon paper which, when applied to china and earthenware about to be fired, allow of the floral design and pictures being transferred to plates, cups, and saucers, etc. Under all circumstances, whether it is the making of transfers for pottery work, covers for fancy tins of biscuits, mustard, tobacco, etc., or coats-of-arms for railway carriages, the occupation is not only dusty but is dangerous, owing to the fact that metallochrome powder often contains as much as from 50 to 60 per cent. of white lead. In the manufacture of transfers the workers, usually girls, throw the powder loosely on the paper and tilt it from side to side, or what is more common, they gently rub the powder all over the paper by means of a soft cloth or a pad of chamois leather, the superfluous powder being removed by shaking. In visiting factories where transfers are made both at home and on the Continent, I have been struck by the extreme pallor of the workers; frequently they have complained of splitting headache and severe abdominal pains. Nearly all the workers presented a deep blue line on their gums. In Limoges, where large quantities of coloured porcelain are made, the introduction of transfers into the industry took place only about twenty years ago, and it was not until several fatal cases of lead poisoning had occurred that the plumbism was traced to its cause, viz., the making of transfers. Many of the girls had succumbed to that extremely severe and often suddenly developed form of Saturnine affection of the brain, which is attended by epileptiform convulsions, and known as lead encephalopathy. It is when metallochrome powder is used in the dry form, and therefore dusty, that there is danger. When mixed and moistened as in coloured printers’ ink, and the printing is done by machinery, there is no danger. Men, however, have suffered from plumbism after mixing “flake white” and varnish. This is not a dusty process, but there is considerable danger when spirituous materials are used along with lead.

Much of the risk to health in this trade can be overcome by diminishing the amount of white lead in the metallochrome powder. Experience shows that this is often present in excess of what is necessary. A less harmful metal, too, might in several instances be substituted for lead. Barium has been suggested, but time and trial alone can tell whether even the use of barium is quite free from danger. Animals can be fed upon barium salts, and apparently thrive when they would die[367] if given the same quantity of lead carbonate. It is a heavier metal than lead, and on the whole may be said to be safer. Magnesia has also been recommended as a substitute for white lead in the metallochrome powders. The trade of transfer making is one in which, fortunately in one sense for the workers, employment is irregular. Under any circumstance it is an occupation in which the workers should have some alternation of employment, and in which no young person should be engaged, no food should be eaten in the workroom, overalls ought to be worn, and before leaving the factory the hands and face of each worker, should be washed. Not only should adequate lavatory accommodation be provided, but sufficient time should be given by the masters before break, for the workers to wash. In this, as in all trades in which lead is used, the individuals should be subjected to periodical medical examination—experience in the potteries, for example, having shown how very beneficial this has been in preventing plumbism. Such an examination often succeeds in eliminating persons who are susceptible to lead before they have worked too long at the trade. In Limoges, so impressed were several of the large porcelain makers by the great susceptibility of young women to plumbism, that they now only employ men in the manufacture of transfers. The work, too, is no longer conducted on open tables, but in closed glass cases, through openings which are guarded by indiarubber, the hands of the workman are thrust, so that the operation of “laying on” is conducted under cover, the dust created being drawn away by strong aspiration on the distal side of the enclosed space. Since the introduction of this method of making transfers, plumbism has disappeared from most of the large porcelain works in Limoges. In Staffordshire a similar method of transfer making has also been adopted, and with equally satisfactory results to the workpeople.

Eleven cases of lead poisoning were notified to the Home Office as having occurred in litho-transfer works during 1899.

Tile-making and Manufacture of Porcelain Stoves.

The manufacture of tiles for useful and decorative purposes, such as the floor of entrance halls, hearths, sides of fireplaces, and stoves, is a large and increasing industry. The pressing of clay into the form of tiles is done by machinery, and although it is a dusty process, there is usually in operation at the time the pressing is done a strong aspirating draught brought into[368] play, whereby the dust is removed from the face of the worker. The tiles when dried are subsequently dipped in glazes often rich in lead. Usually the lead which enters into the composition of the glaze for majolica tiles is fritted; but some manufacturers have until recently been in the habit of using only raw lead, and it was occasionally in their factories that lead poisoning occurred. The opportunities for a worker becoming leaded are during the dipping, cleaning, or painting. In some of the factories visited by Professor Thorpe and myself, we saw mechanical dippers in use which gave promise of superseding hand-dipping and of abolishing the necessity for cleaning and trimming the edges of the tile. Employment of mechanical dippers and of fritted lead compounds, conforming to the solubility standard required by the Home Office, with enforcement of the Special Rules, would pretty well abolish plumbism in this industry.

During the manufacture, at Velten in Brandenburg, of glazed tiles for making earthenware stoves, there recently occurred a considerable amount of lead poisoning among the operatives,[72] due to the glazing of tiles with oxide of lead. The outbreak is of sufficient importance to be mentioned here. The glazing material is made, first, by firing together lead oxide and tin in the proportion of three to one. To the compound thus obtained there are added felspar, marine salt, and quartz. These are mixed together, and subsequently exposed to a great heat so as to form a fritt. The vitrified material thus obtained is crushed, finely pulverised and mixed with water, while the thick liquid is applied to the surface of the tiles, which are afterwards heated in a special furnace. During these operations there are many opportunities for the workmen to become poisoned by lead. In the act of crushing, a considerable amount of dust rich in lead salts rises into the atmosphere. Rasch caused some of the air to pass through cotton-wool, and he thus arrested the dust. The lead in this he estimated as sulphide. The quantity found by him in 100 litres of air varied between 0.0012 to 0.0066 gramme, which was equivalent to an amount of lead oxide entering into the lungs during the twelve hours’ work in the factory of 0.05 to 0.6 gramme. Upon the clothes of the workmen he obtained as much as 3 to 4.8 grammes. It was found that all the lead in the fritt had not been converted into an insoluble form. There was at least one-hundredth part in the form of lead oxide, a circumstance[369] which rendered the glaze harmful to those who dipped the tiles, and also to those who handled them after dipping. It is needless to say that where this industry is carried on, precautions should be taken similar to those in use in the potteries, care being taken to have the fritting of the lead carried on in well-ventilated places, and the grinding of the fritt done in enclosed machinery.

Washing of Lead-workers’ and Painters’ Clothes.

In my Gulstonian Lectures on Lead Poisoning, I make mention of the fact that dogs which had slept on the coats or jackets of their masters, who were lead smelters in the vales of Durham, sometimes suffered from colic; also that a peculiar epidemic of Saturnine poisoning occurred in France in women who had simply washed the clothes of their husbands, who were workers in lead factories. One of the main reasons for the White Lead Commission recommending the wearing of overalls when at work was that the Committee ascertained that the clothes of several of the female workers, which were often dust-laden, became the bedclothes of the family at night. Lead dust is always a danger, so, too, may be the bespattered working clothes of house painters. A woman, thirty-six years of age, consulted me at the Newcastle Dispensary on account of anæmia, headache, and double wrist drop. In addition she had a well-marked blue line on her gums. There was no difficulty in diagnosing the case as one of plumbism, the difficulty was rather in tracing the lead poisoning to its source. She was a widow and had never worked in any factory, nor, so far as she knew, had she ever been brought into contact with lead. She simply attended to her domestic duties. On inquiry I found that since her husband’s death, in order to increase her income, she had taken to reside with her two male lodgers—her own brother and a nephew. Both were house painters, and they wore the ordinary white jackets and trousers of the artisan. The patient was in the habit of washing their clothes once a week, which were frequently very much discoloured, especially those of the younger man, the nephew. I asked for a bottleful of the water removed from the washtub when she washed the clothes. This water was dirty brown in colour, and contained a good deal of sediment. I submitted it to Dr Bedson, Professor of Chemistry at the College of Science in Newcastle, who reported the presence of a very large quantity of lead in suspension in the water, and a small quantity in solution. That the woman’s ill-health and paralysis of the[370] hands were due to Saturnine poisoning there was not the least doubt, for under medicinal and electrical treatment and cessation on her part of the weekly washing of the painters’ clothes, health was gradually regained and muscular power restored. It is known that women who wash the overalls, etc., in white lead factories occasionally suffer from plumbism.

Lead Foil Manufacture.

Makers of lead foil which is to be subsequently used for the tops of bottles or for wrapping round tobacco, snuff, and cheese, occasionally suffer from plumbism; so, too, do those who handle and fix the lead discs over the corks of bottles. On analysis the metallic foil which envelops Roquefort cheese has been found to contain 12 parts of tin and 85 of lead, among other substances, while in that which envelops Angelots cheese there has been found as much as 95 per cent. of lead. Tobacco smokers and chewers have suffered from using tobacco kept in metallic dishes, and I have had professional experience of the very bad effects of the use of snuff wrapped in leaden foil. An attempt is being made to substitute parchment for lead discs for bottles.

Shoe-finishing and Staining by Lead Compounds.

A few months ago, owing to several shoe finishers in Northampton having been thrown upon their benefit societies, all suffering from the same type of symptoms, ultimately certified to be lead poisoning, the circumstance was necessarily brought under the cognisance of the Factory Inspector for the district. The men worked in the same factory. On investigation it was found that they were in the habit of using, for finishing the bottoms of shoes, certain powders, known in the trade as Chinese red and yellow chrome. These contained lead compounds. In the manipulation of the powders to stain the boots and shoes with, a considerable amount of dust arises. The process is thus described by Mr Wright, H.M. Inspector. Dry China-red powder is by means of a sponge dusted on to the sole of a boot, a piece of fine glass-paper is then used to scour the colour into the leather, a small quantity of grease is subsequently applied, and the sole is polished with a dry cloth. The workman, during the whole of the process, has to bend down closely over the boot, and thereby inhales the coloured dust. Sometimes chrome-yellow is mixed with the China-red. It was found necessary by the Home[371] Office to interdict the use of these powders, less harmful substitutes being suggested.

Lucifer Matches containing Lead.

In order to make matches strike softly, and in other instances with the view of making matches free from yellow phosphorus, various compounds of lead have been introduced into the paste for heading the lucifers. The mixing of the ingredients and the manipulation of the paste were attended by such an amount of sickness among the workers that their use has been discarded, for it was found that although less painful, lead poisoning was just as serious a malady as that caused by phosphorus.

Buffing of Brass Cocks and Plumbism.

In buffing brass cocks upon rapidly revolving wheels covered with leather, the surface of which is kept coated with emery powder, several of the men have become ill, and shown signs of lead poisoning. Buffing is done so as to smooth the brass cocks after casting. In what is known as “gun” and “pot” metal, lead is sometimes present to the extent of 5 to 6 per cent.

APPENDIX

Number of Cases of Lead Poisoning notified to the Home Secretary under Section 29, 1895, during 1898, 1899, and 1900.[A]

[372]

Analysis of Reports on Lead Poisoning by Certifying Surgeon. Factories and Workshops: Annual Reports for 1899 and 1900 (Dr T. M. Legge).

Dr T. M. Legge deals with the age, distribution, and duration of employment in persons brought in contact with metallic lead, and with the salts of lead, either in the form of dust or of paint; and in the following table, taken from his annual Report for 1900, shows that in those who handle metallic lead or use it as paint, symptoms of poisoning are more slowly developed than in those employed in industries in which the salts of lead are present in the form of dust.

The reports bring out the fact that Saturnine palsy is essentially an affection of the male sex, while the symptoms of headache, anæmia, and encephalopathy are more common in the female.

Thomas Oliver.

The treatment of lead poisoning by electricity is based upon two distinct ideas. First, the use of the electrolytic effects of a current to eliminate the metal from the system; and secondly, the treatment of its symptoms, especially its nervous symptoms, by electricity, in virtue of its usefulness as a remedy for paralytic disorders. In any treatment of lead poisoning these two considerations are of importance:—

1. The Elimination of the Metal.—There is no doubt that the elimination of the metal is necessary for the recovery of a patient from the effects of the poison. In the ordinary course of events elimination probably takes place by the sweat glands of the skin, by the kidneys, and by the mucous membrane and glands of the bowel; whereas the direct effect of an electrolytic elimination would be to cause the lead to pass by a process akin to osmosis in some soluble form, most probably as a chloride of lead, from the tissues of the body to the electrolyte surrounding the body, and so to the plates or poles of the electrolytic cell or bath in which the patient is placed. Unfortunately, the experimental evidence that lead can be extracted from the tissues of the body in this way is not free from possible sources of error. The amount of lead existing in the tissues of a patient suffering from lead poisoning may not be more than a few grains in weight, and the quantity which could be deposited by electrolysis in an electric bath of the ordinary strength and duration could not amount to more than a few milligrammes. In solutions such as the juices of the body, containing but little lead, the lead ions could play but an insignificant part in the transport of the current, and therefore there are considerable difficulties in depositing at the poles of the bath a quantity of lead which could only be a small fraction of the total amount contained in the body. Lead compounds also have a somewhat special behaviour when submitted to electrolytic treatment, for whereas most metals are deposited[374] from their solutions at the negative pole, lead compounds when submitted to electrolysis have a tendency to be deposited in part upon the positive pole, as lead peroxide, and in part upon the negative pole, in a spongy metallic form. In the presence of chlorides the lead peroxide does not adhere to the positive pole, but tends to undergo changes and decomposition. Statements have frequently been made that after the treatment of a patient by electrolysis in a bath of water, traces of lead may be found upon the poles of the bath. I have been able to detect lead on the plates in one case of my own in which the experiment was tried. But there is always some uncertainty as to the source of this lead, for in cases of workmen it may very well have come from dust and dirt containing lead which has been mechanically deposited upon the surface of their skin; or again, it may be lead which has actually come from the tissues, but has already been eliminated by the sweat glands, and is lying on the surface of the skin, so that it could be washed away by ordinary washing with soap and water. But at the same time we must not forget that even if the direct electrolytic elimination of lead is a thing which can be brought about by electricity, it is not the only way in which electrical applications may act favourably in removing lead from the system, for by their means we can also influence what may be called the natural processes of elimination, so that after electrical treatment one might expect to find traces of lead in the urine, in addition to that which might be found by a careful examination of the poles of the bath. And so far as mere opinions go, I certainly take the view that electrical treatment favours such an indirect elimination of the poison, and to that extent is of service in the treatment of cases.

2. The Electrical Treatment of the Paralysis caused by the Lead.—This is probably as important, or more important, than the question of the extraction and elimination of the metal. In practical treatment we may say that it is the paralytic symptoms which are most readily dealt with by electrical methods. All forms of electrical application have been recommended for paralysis due to lead, e.g., the constant current, the interrupted current of the coil, and, more recently, the sinusoidal current of an alternating dynamo. These can all be used, and apparently with advantage. As I have frequently maintained in other places, the state of contractility in a paralysed muscle need not necessarily dictate to us the form that the electrical applications are to take. I mean that when a muscle paralysed from lead ceases to react to induction coil[375] currents, it does not at all follow that induction coil currents are useless in its treatment; and, therefore, I consider that the widely held view that a coil should be used only for those muscles capable of responding to it is not correct. Muscles which show the reaction of degeneration, and contract only to direct applications of the constant current, will almost certainly derive benefit from a course of induction coil currents, and these should in every case be given to them, not to the exclusion of constant currents, but in addition thereto. Many of the rules laid down for the treatment of paralysis by electricity are based upon the view that the therapeutic effect of electricity upon a muscle can be measured by the amount of contraction which the electrical application can produce in it; but this is quite wrong. Even in the absence of all visible contractions in a muscle under treatment, electrical applications produce effects—vasomotor, trophic, and other—which are of service. Indeed, we may go further, and say that treatment by currents purposely made strong, in order to set up contractions in paralysed muscles with very feeble contractility, may easily be overdone, and that fatigue and injury may be caused to muscles through too severe stimulation when strong currents are demanded, in order to make them contract visibly.

In the practical treatment of paralysis due to lead, the choice of an electrical method will turn upon the supposed relative advantages of electrolytic extraction of the metal on the one hand, and of electrical stimulation of the paralysed parts on the other. For the former the electric bath with constant current is to be used, and for the latter induction coil currents or sinusoidal currents, with or without a water bath. The advantages of the sinusoidal current over that of the induction coil consist mainly in the greater smoothness with which the current varies in the former case, and in the greater magnitude of the currents which can be borne. The two methods differ from each other rather in degree than in essence. When, as is usual, the case is one of paralysis of the extensor muscles of the forearm, the use of an arm-bath as the medium for applying the electricity has very decided advantages, so that I am accustomed to treat most of my cases by the arm-bath and sinusoidal current. In cases of severe or extensive lead poisoning, or in cases where the muscles of the lower limbs are affected, I make use of the full-length bath, and at the commencement of the case would advise the use of direct and sinusoidal currents on alternate days, in order to secure electrolytic effects as well as those of simple stimulation. It is probable that[376] hot baths, without electricity, are of very decided service in treating symptoms due to lead. In former days the thermal waters of Bath enjoyed a very considerable reputation in this disease. Thus, by combining a full-length bath with electricity, one is able to make use of the increased elimination set up by hot bathing, as well as of the increased elimination set up by general electrical stimulation. The electrolytic effect also comes in if the current used is a continuous one, but not so if it is alternating. In practical treatment, the cases of lead poisoning most commonly met with, are cases of operatives who handle lead, or some preparation of lead, in the course of earning their living. The symptoms of which they commonly complain in London, at least, are wrist drop and paralysis of the extensors of the wrist and fingers. This is the class of case which I have had under treatment during the last ten years; and the opinion which I have formed of electrical treatment is decidedly favourable. Although in a number of cases the lead has had many years in which to poison the patient, yet it is the rule that within a few weeks from the commencement of electrical applications the paralytic symptoms become very considerably decreased. Unfortunately, recovery is usually followed by a return to the old occupation; fresh infection follows, and paralytic symptoms sooner or later reappear. The patient returns for further treatment under conditions less favourable than before. He is older, the system is more seriously damaged, and his recovery is apt to be less perfect than on the previous occasion. It is this state of things which is chiefly responsible for the fact that brilliant results are not often met with in the treatment of lead poisoning due to occupation. In districts where lead poisoning is common, I would recommend an installation for electrical treatment on the following lines: (1) one or more arm-baths; (2) one or more full-length baths for the whole body. Both of these sets of baths should be supplied with sinusoidal current, generated by a dynamo on the premises, or drawn from the mains of an electric light station, if the current supplied in the neighbourhood should happen to be alternating. In each case some clockwork or other mechanical contrivance for slowly varying the current from zero to the maximum might with advantage be installed, although good results may be obtained without this. In addition, for direct treatment by constant current in special cases, it would be necessary to have a battery or other source of constant current, either for use with the bath or for local applications by means of pads and conductors of the usual class. The[377] induction coil may be used where the sinusoidal current cannot be obtained, but wherever possible, the latter should be used in preference. A pressure of ten or twelve volts is about a suitable one for an arm-bath, and if an average of twelve and a half volts per arm-bath is taken, it is sometimes convenient to arrange the arm-baths in series, as is done, for example, at St Bartholomew’s Hospital, where four arm-baths in a series are fed from one source at fifty volts. This, it will be seen, gives twelve and a half volts per bath, minus a small loss of one volt or so over the whole circuit for the conductors. So if eight or ten baths could be employed with advantage, they might be arranged in a single series upon mains of a hundred volts pressure. In the fitting up of a new establishment, it would be convenient to provide waste pipes and water taps fixed over them, to obviate the inconvenience of filling and emptying by hand. A very convenient vessel for arm-bath treatment is an oblong stoneware picklepan, which can usually be obtained in towns; or wooden vessels of the same shape may be made almost anywhere. It is advantageous to use narrow oblong vessels of a suitable length and width to take the arms and hands, because with round tubs there is considerable loss of current, carried by the water without entering into the patient. There is also a certain waste of hot water by reason of the greater capacity of round tubs. The electrodes for arm-baths may conveniently be made of one piece of sheet copper or sheet zinc, shaped like a tennis racket, with the handle bent over in a hook, by which to suspend it to the end of the tub.

The progress of treatment is slow, and without incident. There is a gradual return of power and a gain in thickness of the wasted muscles. The duration of the case varies much with the severity of the poisoning, and the state of health of the patient. The final results are good.

H. Lewis Jones.

Arsenic is employed for colouring purposes in various arts and industries, and may produce injurious effects on the workers and on others who are exposed to the influence of the poison. A Committee of the Medical Society of London, of which I was secretary some twenty years ago, compiled from the information collected by them the following list of articles in which arsenical pigments, dyes, and mordants were used.

Paper, fancy and surface coloured, in sheets for covering cardboard boxes; for labels of all kinds; for advertisement cards, playing cards, wrappers for sweetmeats, cosaques, etc.; for the ornamentation of children’s toys; for covering children’s and other books; for lamp shades, paperhangings for walls and other purposes; artificial leaves and flowers; wax ornaments for Christmas trees and other purposes; printed or woven fabrics intended for use as garments; printed or woven fabrics intended for use as curtains or coverings for furniture; children’s toys, particularly inflated indiarubber balls with dry colour inside, painted indiarubber dolls, stands and rockers of rocking-horses and the like, glass balls (hollow); distemper colour for decorative purposes; oil paint for the same; lithographers’ colour printing; decorated tin plates, including painted labels used by butchers and others to advertise the price of provisions; japanned goods generally; Venetian and other blinds; American or leather cloth; printed table baizes; carpets, floorcloth, linoleum, book cloth and fancy bindings. To this list may be added coloured soaps, wafers, sweetmeats, and false malachite. Arsenic is also used in the preparation of skins for stuffing and of some preservatives used by anatomists. Workers employed in the manufacture of any of these things may suffer from the effects of the arsenic contained in the materials which they handle. The fluid known as “sheep dip,” which is sold for the purpose of killing tic on sheep, contains a large quantity of arsenic. Occasionally the men who manufacture the liquid or who wash the workmen’s clothes[379] have suffered from the effects of arsenic upon their extremities and nervous system.

The metal is mostly employed in the form of green arsenites of copper, known as Scheele’s green, and Schweinfurt or Vienna green. The poison gains admission to the system either by being carried into the mouth on the hands and thence taken into the stomach, or by inhalation into the lungs.

In the preparation of artificial flowers Scheele’s green is powdered over the leaves, and in this process some of the dust is drawn in with the breath, while some may lodge in the furrows of the skin and under the nails. In the manufacture of green wallpapers Scheele’s green and the aceto-arsenite of copper are mainly used; from 1 grain of the poisonous substance to 50 or 60 grains per square foot has been found in different samples. Arsenic has been found in red, orange, brown, and grey papers as well as green. The poisonous material may be dusted off the wallpapers and distributed through the atmosphere of the room. Bamberg, of Stockholm detected arsenic in the atmosphere of a room that had been papered for twenty-five or thirty years. According to Parkes and Kenwood,[75] in the case of the smoother papers arseniuretted hydrogen is formed by decomposition of the size and paste acting chemically on the arsenical salt. The same authors point out that even distempered walls must not be assumed to be innocuous, as there is frequently arsenic in distemper which is mixed with size to make it adhere, thus forming a combination of organic matter and arsenic ready for the development of arseniuretted hydrogen.

Persons living in rooms hung with arsenicated wallpapers, and workmen who strip walls or hang pictures, are liable to suffer from the inhalation of the poisonous dust or vapour. Injurious effects may also be caused by the use of green lamp shades, and of gloves, stockings, and other articles of clothing coloured with aniline dyes in the preparation of which arsenic is largely employed. The use of arsenic in many of the arts that have been enumerated, and particularly in the manufacture of wallpapers and in the tinting of textile and silken fabrics intended for furnishing and clothing purposes, also of arsenical colours, has greatly diminished since attention was called to the danger of these by the Medical Society and by sanitarians, among whom the late Mr Henry Carr[76] deserves special mention. Yet, as is proved by cases which are from time[380] to time reported in the papers, they are still too much employed.

Symptoms.—The symptoms are those of chronic arsenical poisoning, and may vary in severity from slight inflammation of the eyes or conjunctivitis, and running at the nose, or coryza, to prostration, or convulsions ending in death. The strong are attacked as well as the weak. In the slighter forms of the affection they are marked by conjunctivitis, running at the nose, and injection, with dryness and soreness of the throat, accompanied by depression. In more severe forms there is headache with colicky pain and abdominal “cramps,” with vomiting, diarrhœa, and sometimes dysentery; the throat and mouth are sore and parched; there is great thirst, with distaste for food. The congested condition of the respiratory passages manifests itself by cough and bronchial catarrh, sometimes by asthma. If the cause is not removed the affection may last indefinitely in a stage of more or less troublesome indisposition, or the prolonged gastro-intestinal derangement may gradually undermine the health and exhaust the patient. In some cases the nervous system suffers most; there is increasing depression, with restlessness and insomnia; in certain severe cases paralysis of the extremities occurs, with convulsions ending in death. This, however, is altogether exceptional, and indeed death from arsenical poisoning of what may be called industrial origin is decidedly rare.

In certain cases arsenic produces local as well as general effects. According to Arlidge[77] workers employed in the manufacture of arsenical green often exhibit peculiar symptoms. That product is derived from arsenite of soda, which is decomposed by sulphate of copper, and the resultant treated with pyroligneous acid.

The workers are liable to the development of boils and pimples, and suffer from an itching eruption about the nostrils and in the flexures of the arms. In severer cases there is headache with thirst and nausea, and an irritating eruption appears on the scrotum. Vomiting, quickening of the pulse, and conjunctival injection are observed in some persons. In workmen employed in the calcining or “burning” houses for arsenical ores the fumes produce sometimes gastric disturbances, sometimes bronchial and laryngeal irritation. The commonest effect is the production of an eruption about the genitals and on the exposed parts of the body, especially at the bends of the limbs. Stockings, handkerchiefs, gloves, etc., dyed with aniline colours often cause severe[381] irritation, especially on the skin of delicate women and children. This ought never to occur, for if the process is rightly carried out no arsenic passes into the finished dye.

Treatment and Prophylaxis.—The first principle of treatment is removal of the cause. The symptoms will then, in the great majority of cases, spontaneously disappear. Debility or other conditions calling for active measures should be treated secundum artem.

As regards the prophylaxis, in trades where exposure to the arsenic is unavoidable, sanitary precautions on the same lines as those taken against lead poisoning should be enforced. For colouring purposes arsenical colours are unnecessary. In the dyeing of textile fabrics and in the tinting of papers they should be absolutely prohibited.

No paper should be placed on a wall unless it be guaranteed free from arsenic, and even with a guarantee from the manufacturer it is advisable to test a piece with Marsh’s apparatus to make sure.

Malcolm Morris.

In all dusty trades pulmonary disease is the cause of death of large numbers of the workpeople. The manufacture of pottery is a dusty trade. Potters’ asthma and consumption have for long been known. The potteries of Staffordshire formerly had an unenviable notoriety on account of the prevalence of ill-health, and the large death-rate among the hands employed. For much that we know of the pulmonary diseases of potters and of pneumoconiosis in general we are indebted to Drs Greenhow, Addison, Peacock, and the late Dr J. T. Arlidge, who, as Physician to the North Staffordshire Infirmary, Stoke-upon-Trent, had unusual opportunities of observing and recording the prevalent diseases of that district.

In the manufacture of china and earthenware the workpeople are exposed to two dangers: (1) pulmonary disease due to inhalation of particles of clay and flint; and (2) plumbism in consequence of the presence of lead used in the glazes and for colouring purposes. In another part of the book the dangers incidental to lead poisoning in potteries are dealt with. Here we are concerned with mineral dust solely, and its effect upon the lungs. Cheap pottery is made from ordinary clay, but in the manufacture of the finer ware, Cornish clay and stone are used. In firing china, ground flint is largely used as a packing between the cups, saucers, and plates, etc., when these are placed in the “saggers” or burnt-clay boxes in the ovens. In addition to the ingredients mentioned above, ground calcined bone is also one of the constituents of china.

Clay and flint both contain very hard, sharp, angular particles of silex, which when drawn into the respiratory organs during inhalation are not dissolved by the secretions of the bronchi. They become deposited in the smallest bronchial tubes and the pulmonary alveoli, and set up irritation. The initial process in the manufacture of earthenware consists in mixing the clays with[383] ground flints and water. This is rather a dusty operation, but fortunately only a few men are employed at it. When properly mixed, the compound is known as “slip,” and the men are called slip-makers. The mixing of the slip is sometimes done by hand by means of long, broad pieces of wood, but usually by machinery. The next stage in the manufacture is known as “throwing,” where the potter throws moist clay upon a revolving wheel, and by means of his hands and fingers shapes the clay into all forms of useful dishes, elegant vases, etc. These products are known as hollow ware, but other kinds of ware just as useful, e.g. plates and saucers, can be made by pressing. The clay vessel when removed from the potter’s wheel is felt by the fingers when run over it to be rough and uneven, and in order to get the required smoothness it is necessary later on to turn such hollow ware as cups upon a lathe, while flat goods like plates and saucers are made even by being rubbed with tow or flannel upon a rapidly revolving table. This process is called “towing.” Ware thus smoothed is ready for the oven. The first firing is known in the trade as “biscuiting.” After this it is ready to be painted or imprinted by coloured transfers, and then glazed. The ware to be fired is placed in large thick-walled vessels the size of an ordinary cheese, made of very coarse local clay, and known by the name of “saggers.” These are capable of withstanding great heat. Into these the earthenware and china goods are packed, care being taken to separate the individual china pieces from each other by plenty of loose ground flint. The men who carry the saggers into the kilns are called “placers.” They build up the saggers on the top of one another, pile after pile, and when doing this they are naturally exposed to alternating heat and cold, to high temperatures in ovens just emptied, to the fumes of sulphur in the kilns from the expiring fires, and to a considerable amount of dust when emptying the saggers. Coming out of the warm kilns covered with perspiration they run the risk of getting chilled.

In this description of the manufacture we have simply dealt with ware that has not been glazed or in any way brought into contact with poisonous compounds, such as lead. The products have only once been fired. Should the biscuited ware be subsequently glazed, this is done by dipping it into a liquid which contains, among other things, “raw” or “fritted” lead. The man who plunges the ware into the glaze is called a “dipper,” and he is followed in his work by the dipper’s cleaners, who rub[384] the rough edges off the ware, while the person who places the dipped ware in the saggers, which go again into the oven for a second firing, is called a “glost placer.” The workman who fills the unglazed ware in the saggers and carries them into the kilns for the first firing is, as already stated, called a “placer.” He only incurs such risks to health as might be caused by exposure to varying temperatures and to dust, but the “glost placer” runs in addition the risk of lead poisoning. About 3 per cent. of them suffer from plumbism.

Since, however, we are only concerned at present with dust and its effect upon the respiratory organs, we shall adhere to a description of those processes in potteries in which it prevails, and of these the two that are the dustiest and the most dangerous are “towing” or smoothing of the ware before it has been fired, also what is known as the “scouring” or cleaning of china after it has been biscuited. The scouring of china is generally done by women, sometimes by hand, by brushing the ware over a wooden trough so that the ground flint can be collected and used over again. The atmosphere of the workroom is often thick with dust, while the hair and clothing of the women are literally white with the fine particles of flint. For dust and danger there is no comparison between the throwing and turning of unfired clay products and the cleaning of china that has been once fired. Unless provision is made by fans for the removal of the dust, the air is so thick that no person could scour china for even a few weeks or months without suffering from bronchial irritation or bronchitis, cough and shortness of breath. Dr Prendergast of Hanley, Staffordshire, informs me that after two months’ work in scouring china, a healthy woman will often present symptoms suggestive of phthisis, but happily the condition of the lung is remediable. Potters’ asthma and consumption, as indeed all forms of lung disease due to dusty occupations, are becoming fortunately fewer and fewer every year in this country, owing to the improved appliances in factories for getting rid of dust. The late Dr Arlidge told me that the chances of obtaining a good illustration of potters’ phthisis as a pathological specimen was becoming increasingly difficult, and the same information has been sent to me from Sheffield as regards steel grinders’ lung.

In addition to visiting the largest potteries in England and Scotland, I have had the opportunity of inspecting many on the Continent, and particularly the porcelain works at Limoges, where I saw something of the baneful effects upon the French potters[385] of the scouring of china. In Limoges the porcelain is made from a very fine white clay or kaolin, which is found in the district. The products made from this kaolin are dipped in a glaze containing felspar and quartz, and whose composition is silica 70, aluminium 17, potash 13.

For more than a century porcelain has been manufactured in Limoges, a town containing 80,000 people, of whom, roughly speaking, 15,000 are engaged in the potteries in the town and neighbourhood, men and women about equally. The kaolin is found at St Yrieix, a village twenty-six miles south of Limoges. There is therefore very little expense incurred in the railway transport of the raw material. Labour, too, is on the whole cheap. In Limoges there are sixteen or seventeen large potteries with almost double that number of smaller workshops. The brushing-off or époussetage of the fired or biscuited ware is done both by women and men by means of soft feather brushes. It is a very dusty operation, and where there are no fans for its removal, as in some of the factories I visited, the air was thick with dust. The windows were open at the time, but currents of air obtained by this means exercised no very appreciable influence upon the dust. It is not this kind of ventilation that is required under these circumstances. In the matter of the provision of artificial means for the removal of dust and the renewal of air in the potteries of Limoges, some of the manufacturers seemed to me to be rather behind than in advance of the owners of large factories in Staffordshire. Accordingly I was not unprepared for the information that among the potters, especially the brushers-off or scourers, in Limoges, the mortality from pulmonary consumption and chest diseases is high. The harmful operations in porcelain works are the emptying of the kilns, the removal of the ware from the saggers, and the brushing of this ware; while the hard dust that rises during the polishing of the all but finished articles is equally dangerous. The polishing has for its object the removal of any roughness from the edges or surfaces of the ware, and it is generally done on a revolving wheel by means of a broken piece of china, the workman using this as the smoothing agent. The men and women employed in these operations are usually well covered with dust, yet it is seldom that they wear respirators. Fans for the removal of the dust were present in only very few of the factories. The employés objected to them on the ground that they created a strong draught of cold air. Dr Raymondaud, one of the Professors in the[386] School of Medicine, Limoges, has made a special study of the diseases of porcelain makers, particularly of pulmonary consumption and chronic bronchitis. He found that the potteries furnished a larger number of patients suffering from lung diseases than did the other trades of the district. Of 75 deaths registered in Limoges as occurring among china makers, 36 were due to phthisis, and of 30 potters whom Raymondaud examined, 20 were suffering from pulmonary consumption. Pulmonary phthisis is regarded as the principal disease affecting the workers in the Limoges potteries.

The discovery of the tubercle bacillus by Koch has tended to unify medical opinion as to the cause of pulmonary phthisis. The bulk of pulmonary phthisis is tubercular and is due to the bacillus. Other conditions, however, are not without their influence, such as hereditary predisposition, constitutional weakness, infection at home, and the effect of chills; but admitting all these, there is considerable evidence in favour of the view that dust plays an important part in producing potters’ phthisis, which, as previously remarked, differs in some respects from tubercular consumption. Dr Lémaistre, with whom I discussed this subject, had analysed the air of the Limoges potteries, and he found that the dust in some of the workshops is composed of earthy particles, fragments of granite, flint, particles of dried glaze, soot, and wood charcoal. The atmosphere which the brushers-off, the finishers, and the porcelain makers generally work in, he found contained 640 million particles of dust to the cubic metre, while several of the finishers, i.e. those persons whose duty it is to remove the excess of dried glaze on the ware, often work in an atmosphere containing 680 million particles to the cubic metre. The particles in the latter instance are smaller than those first mentioned, and they therefore remain a longer time suspended in the air of the workroom. This large number of particles of dust in the air is one explanation of the frequency of bronchitis and of pulmonary disease, and also of the small chalk-like masses found after death in the lungs of porcelain makers, but which must not be confounded with cretaceous tubercles. Whatever may be the influence of the dust-laden atmosphere of a pottery in causing pulmonary fibrosis, the accidental presence of the tubercle bacillus in addition would go far to aggravate existing pulmonary conditions, and tend to transform a non-tubercular affection of the lungs into one of a true specific character. It is thus that the presence of a tuberculous person in a workroom becomes a source of danger to his fellow-workmen. Particles of clay or china dust, when inhaled, can only act mechanically upon[387] the lining of the small bronchial tubes and pulmonary alveoli, but by making a breach upon their epithelial coating they reduce the local vital resistance, and pave the way for the entrance of the tubercle bacilli. Dust, therefore, weakens the lung, and by altering its structure, induces conditions that favour the development of the tubercle bacilli. Apart from bacillary infection, dust is itself a cause of danger: it is capable of inducing bronchitis, and if long inhaled causes fibrosis of the lungs of potters. The pulmonary consumption of porcelain-makers differs from tubercular phthisis in the fact that it is of slower development, and is of longer duration; that it less seldom attacks the young than those of middle life and more advanced age; also that there may be found in the lungs after death calculous concretions, which on chemical examination are found to be composed of carbonate and phosphate of lime, silica, and oxide of iron, with a certain amount of organic matter. The average age at death of men from fibroid phthisis in the potteries of Limoges is forty-three, and of women thirty-eight years. The same symptoms just described as having been observed in the Limoges porcelain-makers are also found in workers in pottery in this country, viz., cough, shortness of breath, and progressive emaciation, but there is a greater tendency to blood-spitting in French porcelain-makers than Arlidge found among the potters in Staffordshire.

Symptoms.—It is not until an individual has worked, as a rule, some months or years at his trade that he shows signs and symptoms of potters’ phthisis. In this, as in other forms of chronic pulmonary disease, there is cough on getting up in the morning, but this circumstance attracts little or no attention, as the general health usually remains good for a lengthened period. At first white and frothy, or speckled from the greyish-black dust that has been inhaled, the expectoration by degrees becomes purulent, while the cough, no longer confined to the morning, becomes more paroxysmal in character, and is attended by shortness of breath, which tends to get worse with time. On examining the chest it is found that the amount of shortness of breath or dyspnœa is out of all proportion to the amount of consolidated lung that may be present. It is a fact well known to every member of the medical profession that tubercular consumption much more frequently affects the apices or uppermost parts of the lungs, i.e. just below the collar-bones, than the lowest portions, a circumstance very largely due to the imperfect inflation or ventilation of those particular regions, so that when they become the seat of catarrh or of subacute[388] inflammation, the morbid products that are secreted and effused are, owing to the limited range of movement of this part of the chest wall, and incomplete aëration of this part of the lungs, with difficulty expectorated. A catarrh therefore tends to linger in the apices of the lungs, and offers opportunities for bacillary infection. In dust diseases of the lungs, on the other hand, it is not the apices that become affected so much as the lower and back parts of the lungs. This is an important distinction between the two, for it shows that a different cause must have been in operation. Limited areas of dulness, indicating small patches of consolidated lung, can be detected here and there in the chest, especially at the base behind or close to the shoulder-blades. In the early stages there is neither the evening rise of temperature, the feverishness, nor the accelerated pulse and rapid loss of flesh which are so pathognomonic of tubercle. Arlidge says there is, too, a wonderful immunity from blood-spitting. If an afflicted workman, therefore, at this stage were to give up his employment and seek for some occupation out-of-doors, the chances are that he would still have a good spell of life before him; but if, on the other hand, he is contented to remain at his occupation, sooner or later he becomes the confirmed victim of potters’ phthisis. His vital resistance becomes gradually more and more enfeebled. His preference for indoor life, daily exposure to infection in the factory, and his overcrowded home, lay the individual open to the chances of a tubercular lesion becoming grafted upon a fibrotic lung. Dr Arlidge found that the mean age at death of male potters aged twenty years and upwards was forty-six and a half years, whilst that of non-potters stood at fifty-four. Dr Prendergast tells me that potters working in dust generally die at the age of forty-five. Among potters Arlidge found as the most frequent causes of death pulmonary consumption, diseases of the heart and nervous system. In the workpeople of the district other than potters, while the death-rate from diseases of the chest was 7.86 per cent., the rate for potters was 12.29. Taking the male population generally and their entire mortality from all causes at the time that Arlidge wrote, we find that the deaths of male potters from diseases of the respiratory organs were 60 instead of 27 per 1000, and that the decennial period from fifty to sixty gave the greatest number of deaths, each preceding decennium back to twenty giving less and less, while the maximum mortality from phthisis as opposed to diseases of the lungs generally was reached between the ages of thirty and forty years. Before the age of[389] forty, therefore, the bulk of the potters who have contracted lung disease, and who have become tubercular, die; whereas in those who contract the disease later on they become less liable to the tubercular type of the malady. Bronchitis is met with among the male pressers who are exposed to the dust of the clay, but in china scourers pulmonary diseases are extremely prevalent; as many as 40 per cent. were found suffering from phthisis and 25 per cent. from bronchitis. As already stated, the phthisis in potters is in the early stages usually not tuberculous. So much so is this considered to be the case that Dr John Tatham,[78] at page xcvii. of Supplement to the Fifty-fifth Annual Report of the Registrar-General of Births, Deaths, etc., Part II., 1897, in speaking of potters (earthenware makers) sustaining a mortality from phthisis and respiratory diseases together far in excess of that experienced by other groups of workers, e.g. 453 as against 100 agriculturists, says that “potters succumb to non-tubercular disease of the lungs more rapidly than they do to phthisis, and it is certain that much of the so-called ‘potters’ phthisis’ ought properly to be designated non-tubercular cirrhosis of the lung.” Cirrhosis is a medical term sometimes used instead of fibrosis.

Prevention.—Ventilation of the workroom should be by means of fans and not simply by open windows. Scouring of china by hand over an open trough into which the ground flint falls should be discontinued. It should be done in semi-closed boxes with a strong down draught on the offside of the workers, or by revolving brushes driven by machinery in semi-closed spaces similarly aspirated. Overalls and coverings for the head should be worn by the workers; and since the form of pulmonary disease that affects potters develops slowly and is capable of being at least retarded, if not arrested, in the early stages, in the interests of the workpeople themselves their chest should be examined by a doctor once every three or six months, so that those who show signs of commencing lung disease might be pronounced disqualified for further employment at towing and scouring.

Thomas Oliver.

In the manufacture of steel by the Thomas Gilchrist or basic process, there is a large percentage of waste product, which is known by the name of basic slag. This, notwithstanding its high percentage of phosphorus, remained for some years of little or no value, until it was found that its fertilising properties could be obtained by reducing it to an exceedingly fine powder. Since that was done, it has been in great demand as a manure. It is the manufacture of this manure which is said to produce deleterious effects upon the workmen engaged, and which has brought it within the meaning and regulations of a dangerous trade.

The composition of basic slag is:—

Before crushing, the slag is in large pieces, and it has to be ground into an almost impalpable powder, so that 80 to 85 per cent. of it will pass through a mesh of 10,000 to the square inch. There is still a more impalpable dust given off which, notwithstanding the utmost care, escapes from the machinery during the process of grinding.

The grinding is performed in several ways, sometimes by means of edge runners, sometimes by flint pebbles, and sometimes by means of heavy balls called the Krupp ball system. The following is a description of the process as carried on at the North Eastern Steel Works, Middlesborough.

[391]

The main building is of three storeys, the ground floor of which is used for the various pulleys and driving gear for the mill.

On the first floor are six roller mills, and on the top floor are ten Askam separators, three screens, and a main conveyor, into which each separator discharges the dust.

Outside the main building, but connected with it, on the ground floor, is a shed in which are placed four edge runner mills.

The slag is put into the first edge runner, and crushed until it is fine enough to pass through grids at the bottom of the mill, and it falls through these on to an elevator, which takes it up to the screen on the top floor. That which is not fine enough to pass through this screen falls down into the second edge runner, where it is ground in a similar manner and again elevated to the top floor.

After the slag has passed through the screen, it is taken into the first two separators, where the fine dust is taken out and falls into the main conveyor, and is carried by means of this direct to the warehouse.

The tailings from the separator fall into the roller mills on the first floor, where they are crushed up, after which they fall into the second edge runner mill, where they are ground and treated in exactly the same way as in the first edge runner mill. This process being repeated altogether four times, the slag is then found to be pulverised.

The dust made in the separators is conveyed direct to the warehouse, as above described; but that made by the roller mills on the first floor is drawn by means of a fan into a long tube, running the whole length of the building, and from this it passes into a long dust-tight chamber, called the stive room. The floor of this room is cleaned by scrapers, which take the dust into the main conveyor above referred to. The dust is finally received into a hopper, and from this it falls automatically into bags, in quantities of about a hundredweight.

In the early years of its manufacture, the process was conducted in such a way that it was undoubtedly a very dusty occupation, and the men working at it then suffered constantly from what they called the “slag cough.”

Some two or three years after its manufacture was begun, there was an outbreak of epidemic pneumonia in Middlesborough, and it was thought by many to be in some way caused by the new industry. As the disease (in 1888) assumed very serious[392] proportions, it was thought expedient by the sanitary authority to invite the co-operation of the Local Government Board. Dr Ballard came down, and after a most careful inquiry, he reported that “the slag dust to which the epidemic had been attributed was not the cause of the pneumonia, but that when from any cause pneumonia becomes epidemic, persons largely exposed to the inhalation of this dust may and do suffer more than persons not so exposed, and that the disease with them is of high fatality.”

In 1893 the attention of the Secretary of State was again called to the injurious nature of the trade, and Mr Gould, Her Majesty’s Superintending Inspector of Factories, conducted the inquiry, and made a report in December of that year, in which he says:—“Being in its nature extremely fine, it has a tendency, when inhaled, to settle in the farthest ramifications of the air-passages, and to induce in the mucous membrane of these a chronic state of irritation, thus rendering the larynx and bronchial tubes unduly susceptible of further mischief should the subject take cold; and in general creating a distinct predisposition to bronchitis and pneumonia. Moreover, it is found that when pneumonia does supervene, a fatal result not unfrequently follows, with unusual rapidity. But even in a case of complete recovery from an acute attack, the patient will be constantly liable to a recurrence of the same malady, as his breathing apparatus is continually undergoing deterioration, so long as he is subject to the influence of the dust.”

The summaries of these two inquiries may be taken as representing all that could be said about the effects of slag dust at that time; and it remains for me to state whether more recent observations have tended to confirm these conclusions.

In investigating the subject, I have examined a number of men engaged in daily occupation at the mill, and I subjoin a short report of some of them.

S. R., 54, been in the mill twelve years; well nourished; no complaints except occasional cough after starting in the morning; breath sounds not very distinct at the base of the lungs, and expansion of chest rather deficient.

J. R., 32, worked in the mill thirteen years; chest expansion rather deficient; general health good; occasional cough.

E. F., 31, worked eleven years; good appetite and good health; had pneumonia fifteen years ago; does not suffer from colds, but coughs sometimes in the mornings.

[393]

W. J., 44, has worked nine years; always has cough, which is worst about an hour after leaving work; expansion of chest diminished.

J. T., 52, worked thirteen years; health equal to the average. Three years ago had pneumonia; ten weeks off; colds not common; respiratory murmur diminished over the bases of lungs; expansion lessened.

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

In measuring the chest, it was found that there was only a difference of about one and a half inches between that of inspiration and expiration, showing considerable diminution in chest capacity.

With regard to the causation of chest affections there can be little doubt that it produces increased action of the bronchial mucous membrane, and consequent cough. But unless this is accompanied by such influences as wet, cold, exposure, or drink, there is no reason to think that it is the cause of acute bronchitis. Indeed, notwithstanding excessive carelessness in their habits, I should say that the tendency in the great majority of cases is towards a chronic affection of the bronchial tubes, followed after some years by emphysema.

The men nearly all suffer more or less from cough and some mucous expectoration, which makes them frequently seek relief from cough medicines. In the last few years, however, great improvements have taken place in the grinding mills, and the men now tell me that their discomforts are greatly reduced.

In the cases examined, there was accelerated breathing in three, and diminished power of expansion more or less in all of them.

It will be seen from the chemical analysis of the slag that there is nothing in it of the nature of a poison such as to produce immediate injurious consequences, beyond such effects as may be traced to its mechanical action upon the bronchial tubes and air cells. The phosphoric acid is in combination with the lime as a tetraphosphate, which is not corrosive, nor generally harmful. There is, however, a good deal of irritation produced in those unaccustomed to it, for on the last occasion when I visited the works, I felt some tightness in the chest, with cough and roughness of the voice, which lasted three or four hours.

Inquiries have failed to elicit that any undue proportion of slag-workers have been attacked by pneumonia. As the medical[394] profession in Middlesborough had come to suspect pneumonia in slag-workers as infectious, with a view to helping in its investigation an arrangement was come to with the Health Department of the Town Council to have the cases of pneumonia notified. Of these, 36 were labourers, and the other 67 embraced nearly the whole catalogue of special workers and trades, such as crane men, gantry men, carters, trimmers, blacksmiths, joiners, fitters, and moulders, besides printers, barmen, publicans, butchers, teachers, and insurance agents.

During the latter half of 1900, Dr Dingle, the Medical Officer of Health, received 103 notifications of pneumonia in adult males, which he inquired into. After a very careful inquiry, Dr Dingle failed to fix any special degree of susceptibility upon any particular occupation. Slag dust does not play any prominent part in causing pneumonia.

In the treatment of the immediate effects of the inhalation of slag dust, the remedies for ordinary catarrhal conditions of the bronchial tubes answer as well as anything; and as its remote effects are in no way different from those produced by other dusty occupations, remedies which prove useful in those, such as potassium iodide, carbonate of ammonia, digitalis, and strychnine, have, in my hands, proved most efficacious.

But our efforts must be directed more to the prevention of the initial ailments, and to the amelioration of their causes than to their treatment by medicines, for it must not be forgotten that the tendency is always towards the production of structural changes in the tissues of the bronchi and lungs.

There is a standing order in all of the works that the men should wear respirators, and these are provided by their employers. But hitherto no form of respirator has been suggested which answers the necessary requirements of being porous and comfortable, and at the same time impervious to dust. The face bag, which was one of the results of Mr Gould’s inquiry, ought to be of great service; but it becomes saturated with the moisture of the expired air, the result being that during inspiration it is drawn up against the mouth and nose, and a sufficient quantity of air not being available, the workmen slip it down underneath the chin, where, of course, it is useless. No contrivance will ever answer the purpose which does not admit of easy access of air into the lungs, and of complete expiration without effort. For this purpose a light, soft wire mask might be made to fit the face, which should[395] stand out from the mouth and nose. It should contain a shutter, by which several layers of open webbing could be enclosed, through which the breath could be easily drawn; and there should be an opening fitted with a valve, which should open easily for outward, but shut for inward breathing.

The finished material is placed in packing bags, in the fitting of which the openings are tightly fixed round the hopper, and by means of a lever the charge is suddenly dropped into the bag, when a cloud of dust immediately rises. There is consequently more dust in this department than there ought to be, and, moreover, it is the finest dust of all, for it comes through bags of very closely-woven texture. If the packing material were dipped in size, or rendered impervious in some other way, this source of danger would be largely reduced.

There is another improvement which might be suggested, and that is, that the men should be provided with a room, outside the mill altogether, in which to take their meals. As it is at present, the grinding goes on without stoppage for meals, which renders it necessary for the men to be on hand the whole time; consequently there is no opportunity for open-air breathing time. By a little arrangement the men could probably go in batches, and have their dinner in comfort, and for a time be free from the atmosphere of the mill.

John Hedley.

Workers engaged in crushing basic slag, in the breaking of certain rocks, in the manufacture of millstones, in stone-mason’s work and kindred occupations, are peculiarly liable to chronic inflammation of the air-tubes, caused by the inhalation of dust of an irritant kind. This, it is believed, leads to lung fibrosis. Where the operatives form part of a large community in which individuals are employed in many and varied trades, it is conceivable that fibrosis of the lung may be mistaken for tubercular pulmonary consumption, and it may not be realised that the cause is due to the occupation of the sufferer. The late Dr Arlidge, in a public lecture on “The Sanitation of Industries and Occupations,” referring to china clay as a silicious material, states that the dust is most destructive to lung function and lung integrity, as it sets up chronic inflammation of the air-tubes and of the lung tissues, itself accompanied by bronchitis and asthma. The disease thus established terminates in fibrosis of the lung, “a lesion which symptomatically closely resembles pulmonary consumption.”

The risks referred to have in late years more than ever engaged public attention. Already great strides have been made in the provision of remedies. To medical men practising in districts where these dusty trades form the principal occupation, we may look for information of a definite and exact nature as to the health of the workers. A highly interesting article, entitled “Ganister Disease,” was published in the Journal of the Sanitary Institute for April 1900. The writer, Dr C. L. Birmingham, lived for several years in the valley of the Don, the principal centre of this mining industry.

To the general reader it may be well to explain that ganister or calliard is a hard, close-grained, silicious stone which often forms the stratum that underlies the coal seam. A footnote in Dr Percy’s Fuel says—“Dinas rock is believed to be a millstone[397] grit of the carboniferous system, and the geological equivalent of the bed termed ‘Ganister’ at Sheffield.” It is found in Yorkshire, Durham, North and South Wales, and elsewhere. When crushed and ground into dust it is used as a fire-resistant, chiefly for lining Bessemer and other steel-converters, for the manufacture of bricks likely to be subjected to great and continuous heat, and it is sometimes mixed with, or substituted for, Stannington or other clays, which, together with ground cinders and old ground pot, are used for the manufacture of crucibles in which certain kinds of steel are made.

The persons liable to suffer are the ganister miners and those who manipulate the material in mills known as “breaker-mills.” During the mining process much dust is generated in the various stages of blasting, and little doubt exists that it is to this that we must look for a solution of the very high mortality returns. By many it is held that the products of combustion from the blasting charges are liable, when inhaled, to cause (or to predispose the worker to) chest affections. The ganister, in large lumps, is brought from the mines to the mills in small trucks running on metals. Where necessary, these lumps are broken by hand with heavy sledge-hammers, the process being known as “sledging.” Whilst this is being done a certain amount of dust arises. The material is next thrown into breaker-mills of various patterns, for crushing. The mills are in the open air, or in open sheds. As the lumps are thrown into the mouth of the mill where the crushing takes place, clouds of dry dust rise in the face of the workers, and to this operation is attributable much of the illness. Happily, a remedy generally accepted has been found and is being adopted. It is simply a jet of steam playing into the mouth of the mill, damping the material and preventing the dust from rising. In some works, small fine jets of water, such as would run from an ordinary water can, are preferred. Time has not yet allowed practical men to say with certainty that this is an absolute remedy, but they are very hopeful.

The crushed ganister, in pieces about the size of “metal” used for road-making, is carried from the breaker-mills by shoots to edge-runner mills, to be pulverised into a fine dust. During the whole of this process it is thoroughly saturated with water, rendering the escape of dust a practical impossibility. In this state it is ready to be converted into bricks, or to be taken away in railway trucks, carts, or other conveyances, for use elsewhere.[398] It is sometimes found that the ganister mortar is too moist, in which case it is “tempered,” that is, dry ganister-dust, to the necessary amount, is mixed with it. In this process some dust may here arise, but it is hardly in sufficient quantity to affect the health of the workers.

The bricks are made in hand presses. It is not a dusty process until just before closing the press, when many operatives take a handful of ganister dust and throw it over the surface of the brick, to secure a clear and clean impress, showing the name of the maker, etc. This is a dangerous and unnecessary step; damp sawdust is equally efficacious and is now generally used. The floors of ganister brick-drying sheds, as in other brick works where the same method of drying is adopted, are more or less dusty. Under these floors there are pipes heated by steam or hot air, for the purpose of drying the bricks. Each time a dry brick is lifted, dry dust is liberated, but seeing that there is little or no traffic on these floors (except in passages, which can easily be kept clean), the dust rests on the floor, and does not permeate the atmosphere. Mechanical fans have been suggested, but practical men would find it extremely difficult, if not impossible, to find any fan that would carry this dust, and such men certainly would be sceptical as to the wisdom of creating draughts where the desire is to keep the dust on the floor, and not to cause it to fly about. It will be realised that although fans may be, and are, used with the greatest advantage in certain dusty occupations, it does not follow that they will answer in all.

It has been stated, and probably with some degree of accuracy, that the “setter’s” work involves exceptional risk. The process consists in placing the bricks in the kilns for baking, after they have been dried in the sheds. A man standing in an elevated position catches the bricks, which are thrown to him by the man at the mouth of the kiln. As they are thrown, dust is liberated, and seeing that this work is done in a confined space, it is quite conceivable that injurious results to health may follow.

In some works ganister is ground dry in what are known as “sieve mills.” These are ordinary edge-runner mills, with a sieve at the bottom of the pan. The fine ganister passes through the sieve, and is taken by elevators to the sifting machine, where what is fine enough is carried away to the receptacle for holding it, the coarser material being carried[399] by shoots to be again ground in the mill. In many works the ganister, although nominally dry, is damped sufficiently to prevent any escape of dust, and it has been stated by experienced manufacturers that the damping in no way damages the material, nor does it hinder the work. This dry ganister crushing is in most cases a subsidiary process, the quantities required being small, it only being used for the purpose of making a cement, or mortar, for joining silica bricks or other fire resistants.

Ganister workers are peculiarly liable to those ailments incidental to occupations exposing the operatives to extremes of heat and cold, to damp, and to draughts, but the writer believes that he has, in general terms, defined the peculiar and exceptional risks incurred in this occupation. Having done so, it seems difficult to account for the alarming mortality returns published in Dr Birmingham’s article. A possible solution may be found in the fact that where ganister works are situated there are also large numbers of fireclay works in which are made fire-resisting bricks, tuyeres, pipes, gas-retorts, etc. To the uninitiated it might appear that ganister and fire-brick workers were engaged in one and the same occupation, nor would this be unreasonable when the constitution of the two substances is considered. Ganister is stated to contain 95 per cent. of silica, whereas, according to Chambers’s Encyclopedia, from which the following extract is taken, it will be seen that fireclay contains from 54.2 to 65.1 per cent. of silica.

[400]

No. 1, Stourbridge; No. 2, Newcastle-on-Tyne; No. 3, Gartsherrie, Scotland; No. 4, Poole, Dorsetshire; No. 5, Morgantown, West Virginia, United States.”

Ganister is pulverised in the wet state. Fireclay is not moistened, but ground into a fine dry powder, certainly suggesting greater risk to the workers.

Into other industries, such as the manufacture of steel-melters’ composition, the crushing of ganister largely enters. This composition is used for the manufacture of heavy castings, and contains large proportions of old ganister and fireclay crucibles, bricks, mortar, etc., which are ground in open edge-runner mills in the dry state, fed, and often sifted by hand. The work is generally done in the open air or in open sheds, where the dust is blown about, and where it is a practical impossibility for the worker to avoid inhalation of this irritant. The use of closed mills, closed cylindrical worm-screw conveyers, and mechanical sieves, would largely avoid unnecessary risk, and these labour-saving appliances (the writer believes) would soon more than repay any original cost.

The sickness and mortality amongst ganister workers engaged the attention of the poor-law authorities in the district of Deepcar, near Sheffield. Statistics were prepared for them, and a very carefully considered report dealing fully with the subject was submitted by Dr Robertshaw of Stockbridge, Medical Officer of Health for the division.

The attention of Dr Legge, H.M. Medical Inspector of Factories, was called to the subject recently, and he obtained from Dr Robertshaw the lung of a ganister miner, who had presumably died from pneumoconiosis. The following is an extract from the valuable report by Dr F. W. Andrews, Pathologist to St Bartholomew’s Hospital, of the anatomical changes in this lung induced by the inhalation of ganister dust, published in Dr Legge’s Report to the Chief Inspector of Factories for the year 1900.

[401]

Report on Portions of Lung from a Ganister Miner.

The upper lobe is densely indurated, black and fibrotic. The pleura is thickened, especially at the apex. The lower lobe shows less advanced changes; numerous blackish nodules, about the size of a hemp-seed, are scattered throughout its substance with tolerable uniformity. Under a lens many of these indurated patches are seen to contain a minute cavity, as if they had been formed around minute bronchi or blood-vessels. The intervening lung tissue is greyish, scarcely at all pigmented, and not indurated; it has the appearance of slight uniform emphysema. The large and medium-sized bronchi stand out prominently. To the naked eye the lung nowhere shows any evidence of tubercle.

Microscopic Examination.—Seven different blocks of lung tissue were selected illustrating as far as possible the different degrees of fibrotic change present, from an area almost normal up to the densest induration. These were sectioned. The method of staining found most suitable was that known as Van Giesson’s—viz., staining in hæmalum, followed by a counterstain of acid fuchsin with picric acid. In this way the distribution of the fibrous tissue was demonstrated with great minuteness. Nuclear staining was not very well marked, because the tissue had been lying so long in spirit.

All sections show an abundance of foreign mineral particles of a black or brownish colour. The majority of these are minute, irregular, sometimes angular in form. Seen singly they are semi-transparent and brownish, but they are commonly collected into blackish heaps, included in cells, and then appear opaque. Careful focussing, however, reveals the presence of the angular semi-transparent particles in these accumulations. The pigment masses have not the soft and rounded outline of the carbon masses seen in the lungs of town dwellers; nevertheless very finely divided jet black particles are present, which are probably carbon, but they are less abundant than the brownish semi-transparent masses. The pigment masses occur chiefly in connection with the fibrotic areas.

A few simple chemical tests were applied to microscopic sections, and their effect watched under the microscope. Caustic potash (10%) produced no change whatever in the pigment. Glacial acetic acid likewise caused no change. Fuming nitric acid caused liberation of gas bubbles under the coverglass, but the colour and amount of the pigment were in no way altered. From this it may be concluded[402] that the colour does not depend upon altered blood or any organic product, but that the pigment is purely mineral in character—carbonaceous or siliceous. The liberation of gas by nitric acid indicates the presence of traces of carbonates.

The characters of the fibrotic change and its localisation and development could be traced from its earliest commencement. Sections of the least affected portions of the lung present the following appearances. The pleura is scarcely thickened over much of the lower lobe. There is a slight degree of diffuse emphysema; apart from the indurated patches there is a very slight increase in the amount of fibrous tissue present in the alveolar walls generally, but in some places this is barely perceptible. Careful search in the alveolar walls reveals the presence of scanty mineral particles scattered in the tissue. In places these form larger clumps. Some few detached epithelial cells, laden with pigment, are seen here and there in the alveoli; but on the whole, except around the fibroid nodules, the pulmonary epithelium shows no sign of proliferation or catarrh. There is no evidence of general broncho-pneumonia and none of vascular congestion.

The development of the fibroid nodules appears to take place in the first instance around the small arteries, veins, and bronchi. Where a vessel chances to be cut longitudinally, the perivascular thickening is seen to be irregular and patchy, whence arises the appearance of discrete fibroid nodules. When cut transversely, nearly all the blood-vessels display some degree of perivascular fibrosis. This is true also of the bronchi; but these have undergone so much loss of mucous membrane that it is not always easy to say which are bronchi and which blood-vessels. It is not possible to be sure that all the young fibroid nodules have this perivascular or peri-bronchial origin. Some appear to be independent of vessels or bronchi, but it is possible that they are tangential sections of such thickenings. It seems clear, however, that most own such an origin. In any case the relation between the accumulation of mineral particles and the production of new fibrous tissue is obvious and beyond dispute.

Older and denser nodules, such as are visible to the naked eye, as the hemp-seed structures above described, illustrate the further development of the process. In those the vessel or bronchus around which they have presumably arisen has usually disappeared, and they present concentric zones which represent different stages in their formation, and illustrate the manner in which they increase in size. The outermost zone shows the[403] earliest stage: large black pigment-laden cells accumulate; they may be in part leucocytes, in part pulmonary epithelial cells or fixed connective tissue corpuscles. The pulmonary epithelium is here often in a condition of catarrhal proliferation—a localised broncho-pneumonia—each cell full of mineral particles. The next zone consists of a loose connective tissue, the meshes of which contain the large pigment-laden cells previously mentioned. The mineral matter is almost entirely intracellular. The central mass is composed of a dense fibrous tissue in which the cells have almost entirely disappeared, the mineral particles now becoming free and less conspicuous because they are no longer aggregated into dense black clumps. It is easy to realise from the structure of such nodules how they increase in size at the expense of the lung tissue. Beneath the pleura a similar development of new pigmented fibrous tissue similarly occurs. It is to be observed that all this fibrotic change corresponds in its localisation with the distribution of the lymphatic system of the lungs. The lymphatics, originating by stomata between the pulmonary epithelium, fall into two sets—(1) the sub-pleural network, and (2) those which closely accompany the blood-vessels and bronchi, forming a perivascular and peri-bronchial network.

The final stages in the process are shown by sections taken from the upper lobe of the lung, in which the fibrosis is much more dense and complete. Here the individual nodules have so encroached upon the lung tissue that they have more or less completely coalesced. In the most advanced portions, little or no normal lung tissue can be seen, although the focal character of the fibrosis is still perceptible, since islands of dense fibrous tissue are connected by areas in which the pigmental cells are enclosed in a looser connective tissue. The mineral particles are here even more abundant and conspicuous than in the lower lobe of the lung. In one single nodule (in the lower lobe) calcification was seen, but this stage is absent elsewhere.

Although to the naked eye there is no evidence of tubercle in the lung, yet microscopically such evidence exists in at least one of the seven blocks. The process of fibrosis has been traced from its earliest stages, and is most positively non-tubercular in its origin. The evidence of tuberculosis is present, as a recent and accessory phenomenon, only in the most advanced stages of the fibrotic change. It consists in the presence of small miliary tubercles embedded in the fibrous tissue, and showing the characteristic structure of tubercles,[404] with typical giant cells. Even in these no tubercle bacilli can be demonstrated.

The conclusions to be drawn from the preceding observations are as follows:—

The inhaled mineral particles are, in the first place, deposited uniformly in the pulmonary parenchyma. They are at once taken up hence by the lymphatics and carried along by the lymph stream. The lymphatics have a perivascular, peri-bronchial, and sub-pleural distribution, and in these situations the mineral matter specially accumulates, because the amount is greater than can be got rid of by the lymphatics. It is here chiefly found enclosed in cells (phagocytes), and exercises an irritant action leading to the production of new fibrous tissue in these situations. The fibroid areas increase at the expense of the adjacent lung, in part at least by the development of a localised broncho-pneumonia, and in part by thickening and induration of the alveolar walls. When the fibrous tissue is fully formed the cells containing the mineral particles break up and degenerate, and the particles again lie free amongst the fibrous tissue. By the spread and coalescence of the fibroid areas, the lung tissue in the most advanced areas completely disappears. A secondary tubercular infection has now taken place, and miliary tubercles appear in scanty numbers in the fibroid areas.

Chemical Analysis.—Portions of the lung were handed to Mr H. A. Schölberg, M.B., who furnishes the following analyses.

The material supplied was dried at 100°C. on a water bath for three hours. The dry lung tissue thus obtained was used for analysis.

Hamilton P. Smith.

In the Final Report of the Dangerous Trades Committee of the Home Office,[79] the subject of the building or making of millstones by a hard, flint-like stone known in the trade as French buhrstone, and which is imported into this country from Epernon in the Valley of the Seine, and from Fierté-sous-Jouarre, is fully discussed and the dangers exemplified. Buhrstone is one of the hardest stones in nature. It is a variety of quartz, and is so hard and destructive to the steel tools used by the workmen that in ten minutes a workman will knock off the points of as many chisels. The stone has to be shaped into wedges of varying size. These wedges are placed together in the form of a circle cemented together, and subsequently surrounded by one or more strong iron hoops. The millstones are used for grinding flour, cement, feeding stuffs, etc. The chiselling of the buhrstone is generally conducted in the open air or in a shed open at the sides, the rough stone resting meanwhile upon a tub filled with sand, or upon some other solid support. Fortunately French millstone building is a small industry, for it is one that is most destructive to human life. Millstone masons are a short-lived body of men. Their work is hard, most of it is done practically in the open, without adequate protection from cold, wind, and rain; the wages earned are good, often as much as fifty or sixty shillings a week, but as a class the workmen are intemperate and careless. No doubt alcoholism and indiscretion play their part in shortening the lives of the men. As the stone is very hard, and the point of the steel tools with which the men chisel is readily knocked off, the workmen are exposed to two dangers: (1) splinters of steel and stone striking the eye; and (2) inhalation of the dust given off with each stroke of the hammer. Considering the compactness and the great weight of the stone, it is astonishing that the dust evolved in chiselling ever reaches the lungs at all. In dealing[406] with the question of dust generated in any trade, it is to be remembered that while the dust that is seen lying about in a factory may seem to be heavy and the particles large, yet there is a finer and more impalpable dust created at the time the particular work is being done, and it is very largely this which is inhaled and inflicts the damage. When a workman is chiselling a piece of buhrstone, two different kinds of particles are given off, mineral particles from the stone, and metallic from the chisels. These mingle together and form the dust that is inhaled. That steel particles are present in the dust rising from the stone was indicated to my colleagues on the Departmental Committee and myself by a workman who, having magnetised the blade of a pocket knife, placed the same in his waistcoat pocket, and “after moving it about a few moments withdrew it, when it was found to be covered along its edge with a fern-like coating consisting entirely of minute particles of steel.” It is to the presence of very small fragments of steel imbedded in the skin of the arms of the men, who frequently chisel with their sleeves rolled up, that is due the bluish-black mottling of the forearms of millstone builders.

The men, as already stated, are short-lived. Several whom I examined in the stoneyards on the banks of the Thames acknowledged the unhealthy character of their employment, and said that they and their comrades knew they might be able to follow their calling for only ten or fifteen years, seldom more, and that probably before the tenth year was reached, symptoms of pulmonary consumption would show themselves, attended by cough and blood-spitting. Hæmoptysis is a very common symptom, and in this respect, as also in the rapid course of the illness, the pulmonary consumption of millstone builders differs from the phthisis of potters in which hæmorrhage from the lung is rather infrequent. Once destructive changes have been started in the lungs of a buhrstone chiseller, the disease progresses quickly to a fatal termination. The Dangerous Trades Committee found that men who began this occupation when very young seldom lived beyond thirty-six to forty years of age.

Prevention.—It is such a dangerous occupation that if the industry were swept out of existence altogether it would be no great loss either to the commercial world or to civilisation at large. The number of men employed in it is small, and as steel rollers have to a large extent replaced French millstones in the grinding of food and other stuffs, milling can be just as successfully[407] accomplished without as with these stones. The trade will probably die a natural death, but so long as the industry continues, the men ought to wear respirators. If this were done much illness would probably disappear. The men complain of the irksomeness of respirators, and of the heat that they cause. The laborious nature of their employment creates a need for free, full, and easy respiration. The dust that is given off in chiselling the stones is very heavy, and is therefore capable of being readily carried downwards and away from the workmen by powerful suction, yet the conditions under which the work is carried on, viz., in open places and unprotected sheds, makes the use of fans difficult, if not impossible. The wearing of goggles or eye-guards should be insisted upon.

Thomas Oliver.

The process of grinding cutlery and other steel implements is conducted by a class of workmen known as “grinders.” Their trade is a highly specialised one, necessitating a long apprentice*-ship before proficiency is attained; and in the majority of instances the calling has been handed down through many generations. The trade is quite free from the adulteration of casual labour, and consequently statistical data respecting “grinders” possess a relatively high value. For the most part they earn good wages, and being keen sportsmen, get a fair amount of outdoor recreation. Their hours of work are seldom excessive, and their homes and mode of living are up to the average standard of comfort obtaining in the artisan class of the population.

Grinding is done on circular stones turned either by steam or water power. The stones vary in diameter from an inch up to several feet, and are of different degrees of hardness according to the work required of them. On the stones, articles of cutlery are reduced to their proper shape and thickness, and are given their cutting edge, while many other steel implements are ground to remove the roughness of their surfaces. For the most part “grinders” sit astride the grinding stone on a saddle, leaning forward, more or less according to the size of the stone. The position is not an ideally healthy one, but the assertion that it interferes with the free expansion of the lungs is only to a very slight extent true. The attitude, however, renders the workmen peculiarly vulnerable to accident when a stone breaks.

Grinders are divided into two classes, known respectively as “dry grinders” and “wet grinders.” The former are engaged in grinding steel forks, augers, gimlets, needles, and a few other articles; while the latter grind the blades of knives, scissors, razors, and most other cutting implements.

Certain articles of cutlery are ground partly on a wet and[409] partly on a dry stone. Thus the backs of razors and scissors and the bolsters of table-knives are ground dry, while the rest of the blade is wet ground.

Dry grinders form a comparatively small class of workmen, but owing to the excessive mortality which formerly obtained among them they have long attracted the attention of the trade sanitarian. The attrition of the steel against the dry grinding stone gives rise to enormous quantities of steel and stone dust, which renders the atmosphere of the workshop very irritating to the lungs, and produces a pathological condition known as grinders’ phthisis.

The following account of the pathology and symptomatology of the disease has been very kindly written for this article by Dr Duncan Burgess, Senior Physician to the Sheffield Royal Hospital:—

“Grinders’ Phthisis, Grinders’ Asthma, Grinders’ Rot.—This disease is due to the inhalation of dust composed for the most part of gritty particles from the grinding-stone, but also containing fine particles of steel from the implement ground. It has been asserted that steel particles are not found in the grinders’ lung, but a very beautiful microscopical section of an affected lung, appropriately stained, in the possession of Dr Arthur Hall, shows unmistakably traces of iron. Steel dust, however, constitutes only a minute fraction of the foreign pigment in the diseased lung, and its effects compared with those of stone dust may be neglected.

“The frightful mortality among dry grinders before the introduction of fans made the lung diseases of this class of workmen so notorious that the name ‘grinders’ phthisis’ still signifies outside Sheffield the very severe indurated broncho-pneumonia, which past generations of fork grinders were subject to. This extreme form of grinders’ phthisis is now practically extinct, but a modified form of the disease is still very prevalent among Sheffield grinders and cutlers. The whole respiratory tract is exposed to the action of the dust, but its effects on the larger passages are comparatively unimportant. The disease usually manifests itself in the first instance in the form of chronic bronchitis with emphysema. Immunity from symptoms may continue for decades, then in the winter or during foggy weather cough with some expectoration in the morning may be noticed. The cough gradually gets worse, and it may last more or less throughout the winter. Shortness of breath is now complained[410] of, and the grinder may have to leave off work for weeks together from time to time. Finally his cough persists through the summer, and his shortness of breath on exertion forces him to leave off work altogether, it may be after the age of sixty, or even twenty years earlier. If he be examined now his skin and lips will be dusky, and his chest fixed as at the end of inspiration. The breathing is mainly diaphragmatic, and though the auxiliary muscles of respiration stand out in strong contraction, there is very little expansion of the chest. In addition to the ordinary physical signs of bronchitis there may be areas in which the breath sounds are very feeble or absent, and areas in which they are comparatively loud. The grinder is especially liable to have tuberculosis grafted on to his bronchial lesion, and this may occur quite early, or be deferred until late. Wasting, night sweats, and hæmoptysis mark the onset of the rapid change for the worse which follows tubercular infection. The dyspnœa is naturally greater than in ordinary phthisis, and the emphysematous condition of the lung may mask for a time tubercular infiltration. The sputum is at first very scanty, and consists of mucus with dark spots and patches. Later it is more abundant and becomes muco-purulent, with black spots and patches, and occasionally gritty particles. In the terminal stage tubercular bacilli are present, together with other pathogenic organisms. Grinders suffer inordinately from pleurisy and pneumonia.

“The pathological feature of dry grinders’ phthisis is the presence in the cut section of the lung of groups of dark, hard nodules about ⅓ of an inch in diameter. Under the microscope these nodules are found to consist of dense fibrous tissue arranged more or less in layers. Black amorphous masses may be conspicuous in or near the centre of the nodule. The lung tissue in immediate contact with the nodules is converted into less dense but more deeply pigmented fibrous tissue. This merges into air-cells with thickened and pigmented walls. The apices of the lungs are more frequently the seat of nodules than the bases. In an extreme degree of grinders’ phthisis the entire upper lobe may be replaced by a solid, hard, black mass, which on section presents a mottled appearance from the innumerable nodules, thickened bronchi, and pigmented airless lung tissue. The pleura is irregularly thickened, in places forming a milky or thick yellow layer, which may be adherent to the chest wall. A tubercular cavity of considerable extent may be found at the apex or elsewhere.”

At one time dry grinding was perhaps the most unhealthy trade[411] in the country. The late Dr J. C. Hall of Sheffield, in a paper read before the Social Science Congress in 1865, stated that “excluding boys, the average age of dry grinders was only twenty-nine years;” and there can be little doubt that comparatively few workmen were to be found following their employment after the age of forty years. Of late the introduction of fans for carrying away the dust has greatly improved the conditions under which dry grinders work, and, as I shall presently show, this has been followed by a corresponding improvement in health and length of years, but the trade is still an unhealthy one.

Wet grinding is much the more important branch of the grinding trade, and in Sheffield alone it gives employment to several thousand workmen. In revolving, the grinding-stone passes through a thin layer of water placed in a trough beneath the stone, and is always wet, so that comparatively little dust is produced; but as certain other dust-producing processes are usually conducted in the wet grinding workrooms, the atmosphere is not quite free from dust. The processes referred to are:—

(1) Glazing.—Most articles of cutlery after having been ground are “glazed.” This is done on a wooden wheel covered with leather which has received a coating of emery and glue. The rim of the wheel is from time to time rubbed with a cake composed of emery, suet, and beeswax. The “glazer” is used for the purpose of removing marks on the blade left by the grinding-stone. Owing to the greasy nature of its surface there is not much dust formed.

(2) Polishing is employed to give a highly-finished appearance to certain blades. The “polisher” is also made of wood, covered with leather, but instead of emery a fine powder containing oxide of iron, and known as “crocus,” is used. The process gives rise to a considerable amount of dust.

(3) Lapping.—The blades of pen-knives and many razors are subject to a process called “lapping,” which is done on a lead-rimmed wheel called a “lap.” The process is chiefly interesting as being a possible source of lead poisoning, but after careful inquiry I have failed to find any one showing evidence of plumbism from this source.

(4) Racing the Stone.—The grinding-stones are received from the quarries in a rough condition, and the “grinder,” after mounting the stone on its axle, reduces its circumference to the proper shape and degree of smoothness by applying a steel bar to it while it is revolving slowly. This process, which is known as “racing the[412] stone,” gives rise to enormous volumes of dry dust, so that the air in the immediate neighbourhood of the stone is almost unbreatheable. All stones, whether for wet or dry grinding, require to be “raced” in the first instance.

But while wet grinders cannot be said to suffer much from the irritation of dust, they show an appalling mortality from phthisis and other diseases of the lungs, and there is no room for doubt that the damp, stagnant atmosphere in which they work is the principal cause of these diseases. The grinding-stones are constantly throwing off water, which soddens the floor and saturates the air of the grinding-room until, owing to the absence of efficient ventilation, it becomes very like that of a damp cave.

Another danger to which grinders are exposed is the breaking of the grinding-stone when in motion. These accidents are unfortunately common, and often cause frightful injuries and death. They are due to a variety of causes, such as departure from the circular shape owing to one side of the stone wearing faster than the other; flaws in the stone; allowing the lower part of the stone to remain immersed in the water trough when not in use; fixing the stone on its axle by means of wedges instead of using plates and screws for this purpose; and permitting the stone to revolve too rapidly.

In the hafting of certain classes of knives an emery wheel is used for shaping the knife handles, and it produces dense volumes of dust composed of steel particles from the rivets and tangs, also of emery from the wheel, and of bone or other material of which the knife handles are made. This emery wheel is known as a “cutler’s glazer,” and is a comparatively recent invention, having come into general use only during the last twenty-five years, previous to which all handles were shaped with a file. It is most injurious when used for shaping the handles of knives that have scale tangs.

The cutlery manager of one of the largest firms in Sheffield assures me that cutlers as a class have become much more unhealthy since the introduction of the glazer. This opinion is endorsed by other competent observers, and there is no difficulty in accepting the accuracy of it if we reflect that the modern scale tang cutler who uses a glazer is virtually a “dry grinder.”

Grinding is carried on either in separate buildings, which are known as “grinding wheels,” or on premises where other branches of the cutlery trade are conducted. In either case the grinding of heavy articles is done on the ground floor. The rooms, or “hulls,”[413] as they are called, are sometimes sunk below the level of the ground, and are as a rule bounded on three sides by blank walls without adequate provision for cross ventilation. The windows and doors are in the fourth wall, and the former are usually devoid of glass because the mud from the grinding-stones would speedily obstruct the light if glass were used. The hulls are provided with fires for drying the blades, but the fireplaces are situate in front or in one of the lateral walls, and consequently their utility as ventilating agents is not great. Each hull contains one, two, or more troughs which run from front to back, and in them are placed the grinding, glazing, and polishing wheels in the order mentioned. The floors are wet and dirty, and the atmosphere damp and stagnant, particularly at the back, where it is further defiled by the dust given off from the polishing wheels. The cubical space per worker would as a rule be ample if the ventilation was good.

Dry grinding and the lighter branches of wet grinding are carried on in rooms in the upper stories. Better ventilation exists here, but on the other hand the rooms are often overcrowded, and when dry grinding is done there is of course much dust. In the majority of dry grinding rooms fans for the removal of dust are to be found, but occasionally these are absent. One fan is as a rule sufficient for several workmen. Attached to it is a number of tubes, each of which ends in an expansion or hood in front of the grinding-stone. The tubes are put down by the owner of the factory, who likewise occasionally supplies the fans; but as a rule the fans and hoods belong to the workmen, who are known as “piece workers.” When properly constructed and looked after, the fans act admirably for removing dust, and also aid in ventilating the workshops; but as several workmen commonly occupy one room and share responsibility for its sanitary condition, there is the usual failure to carry out efficiently that which is the duty of one in particular. For this reason the tubes are apt to become choked from not being periodically cleaned out, or a trivial defect which a few minutes would suffice to remedy, is allowed to render the fan inoperative for days together. Again, a careless grinder by neglecting to use a hood will seriously discount the efforts of his more careful shopmates to keep down dust. Hence it happens that in many workshops where dry grinding is done the dust accumulates in large quantities on the floor, to rise in dense clouds each time it is disturbed.

In the manufacture of scale tang cutlery, in which glazers are extensively used, the atmosphere under the most favourable[414] circumstances is charged with fine dust. This is especially noticeable where bone is employed for hafting. Moreover, manufacturers complain bitterly that the workmen will sometimes block up ventilators and dispense with the use of fans unless strict vigilance is maintained. It is almost incredible that any one should pursue so suicidal a policy, yet personal observation compels me to admit that these allegations are not altogether groundless.

Another grave defect is the indiscriminate mixing of various classes of workers. Thus in a shop where a dozen men work, only two or three may be engaged in dust-producing processes, yet all are obliged to inhale the dust-laden atmosphere.

The buildings in which grinding and hafting are done vary widely in their sanitary aspects. Many of these places are as perfect as it is possible to make them, having regard to the nature of the work carried on therein; but not a few are just the reverse. Dilapidated buildings, constructed in the first instance without regard to the requirements of health, are sadly too common. In these overcrowding, defective ventilation, and a dust-laden atmosphere are the rule rather than the exception. Externally the condition of affairs is often no better, the factories being shut in by other buildings which exclude sunlight from the lower rooms, and interfere with the circulation of the air.

Trade mortality tables have been carefully compiled by successive Medical Officers of Health for the city of Sheffield, showing the number of deaths, the principal diseases which cause death, and the age at which death took place in a number of trades. The figures have reference to males over the age of fifteen years, and when contrasted with the corresponding figures of the Registrar-General for the entire male population of the country they indicate fairly accurately the relative unhealthiness or otherwise of the workmen concerned. An examination of the returns for grinders shows an appalling death-rate from phthisis and other diseases of the respiratory organs. Thus in every thousand deaths among grinders phthisis causes 345, and other respiratory diseases 295, or collectively these diseases account for 64 per cent. of the entire mortality, whereas among the entire adult male population of the country phthisis accounts for 144, and other respiratory diseases for 182, in every thousand deaths, or collectively to 32.6 per cent. If we examine the ages at which deaths occur, a similar unsatisfactory contrast obtains. Thus 458 grinders in every thousand die between the ages of thirty-five[415] and fifty-five years, as compared with 261 in every thousand obtaining among the entire male population of the country; while only 140 grinders in every thousand have attained the age of fifty-five years and upwards at death, as compared with 391 in every thousand for the entire adult male community.

The dusty nature of a dry grinder’s occupation prepares us to accept these figures as applied to him; but it must not be lost sight of that dry grinders form a very small minority of those engaged in the grinding industry. Moreover, my investigations lead me to believe that dry grinders, although they still show an enormous mortality from phthisis and other respiratory diseases, live to a much greater age than formerly. Thus I found the average age of twenty-two unselected fork grinders to be forty-three years, which is a marked improvement compared with the late Dr Hall’s estimate of twenty-nine years. Again, during the four years 1889–92 the average age at which fork grinders in Sheffield died was forty-five and a half years.

Owing to the conditions already set forth as existing in many grinding rooms, wet grinders are frequently compelled to inhale dust-laden air, and this no doubt is a factor in producing the high mortality which prevails among them. But important as this evil is, it is altogether overshadowed by the baneful influence of the damp, stagnant atmosphere of the wet grinding “hulls,” an atmosphere which is peculiarly favourable for the propagation of diseases of the lungs.

The legislature of this country has done much to improve the conditions under which workmen pursue their various callings, but local peculiarities and unforeseen contingencies sometimes frustrate the beneficent intentions of our legislators, and this is markedly the case in respect of the grinding industry. With few exceptions grinders are “piece workers,” and pay rent for their “stalls” and the motive power which drives their stones. The grinding wheels and cutlery works are frequently owned by individuals or companies who are not themselves manufacturers, but are merely the landlords of the premises, letting off rooms or portions of rooms to workmen who, in the eyes of the law, are the occupiers, and therefore responsible for carrying out the requirements of the Factory Acts. It follows that the owners of the premises are able to repudiate responsibility for sanitary control and that the Factory Inspector, when he wishes to insist on fans or other needful appliances being provided, must proceed legally against the workmen. The outcome of all this is that it is difficult[416] or impossible to apportion responsibility for sanitary requirements; the Inspector’s work is enormously increased, and often rendered excessively irksome; while the amount of good he can do is proportionally lessened. There is but one remedy for this state of things. Sooner or later the legislature will have to fix on the individual, or company, who lets off rooms and power to workmen, the responsibility for carrying out the provisions of the Factory Acts. We shall be told that an enactment of this kind would disturb long-established trade usages, and be unfair to the manufacturers; but apart from the fact that it is the only feasible way out of the difficulty, it would merely place cutlery manufacturers on the same footing as that occupied by most other employers of labour in the country. Moreover, some of the best cutlery firms already recognise their moral responsibility in this respect, and provide for the use of their workmen fans and all other contrivances of a health-saving nature.

The sanitary condition of the workshops in which grinders, particularly wet grinders, work admits of much improvement. These rooms should always be above the level of the ground, and so situated in regard to surrounding buildings as to allow of free entrance of fresh air and sunlight. The floors should have a fall to the front, and be composed of concrete or some similar impervious material. Better ventilation is urgently required, especially towards the back of the rooms, and the fireplaces might with advantage be placed at the back. The polishing wheels should be provided with hoods connected with a fan for the removal of dust and the better ventilation of the room.

Grinding-stones should not be mounted until they have been inspected by some competent person with the view to detecting flaws, and it should be obligatory to use plates and bolts instead of wedges for fastening the stones on their axles.

Dry grinding should be done in rooms specially set apart for this purpose, and not, as is sometimes the case, in rooms where other processes are carried on. The “racing” of stones should be conducted at a time when there are few workmen present, and those engaged in the process should wear some form of respirator.

Sinclair White.

However useful phosphorus has been to man, its manipulation has been a constant source of danger. As there are two forms of phosphorus, so there are two kinds of matches: the safety, which-only ignite on the box, and the ordinary strike-anywhere. Safety matches are made from red or amorphous phosphorus, and the ordinary matches from white or yellow. Oldbury, near Birmingham, is the seat of the manufacture of yellow phosphorus. Although white phosphorus is a dangerous substance, there have been very few cases of ill-health among the men who make it, owing very largely to the fact that in its production from bone, very few people are employed, and the processes of manufacture are such that the workmen are not brought directly into contact with the dangerous substance. Sixty tons of the phosphorus annually manufactured in Oldbury are consumed in lucifer match works in Britain.

The death of a lucifer matchmaker in London five years ago, and the announcement in the daily press of the contemporaneous occurrence of a large number of cases of ill-health in a Metropolitan match works, aroused an amount of feeling, and created such an adverse public opinion in regard to this industry in England, that the Home Secretary, Sir Matthew White Ridley, appointed a Commission, composed of Professor T. E. Thorpe, Dr George Cunningham, and myself, to undertake an inquiry into certain important questions which had arisen with regard to the effect of work in lucifer match factories on the health of the workpeople.

The questions which at the time engaged the attention of the Home Office were:—

(1) The nature and extent of the dangers attending the use of yellow and white phosphorus.

(2) The means whereby these can be lessened.

[418]

(3) The practicability of discontinuing the use of yellow and white phosphorus.

Many match works, both at home and abroad, were visited by the members of the Commission, whose views and opinions upon these questions are embodied in a Report[80] that describes the methods of manufacture, and the legislative measures adopted in most of the countries in Europe to abolish or diminish the ill-effects of the industry upon the health of the workpeople.

The principal malady of the lucifer matchmaker is a localised inflammatory affection of the jawbone, followed by suppuration and death of the bone, constituting what is known as phosphorus necrosis—“phossy jaw,” as it is sometimes called in this country, and mal chimique in France. Other diseased conditions are also met with, but these and the subject of phosphorus necrosis generally will be dealt with further on.

Commercial phosphorus is made from bone-ash by treating it with sulphuric acid, filtering and evaporating the product, heating this with charcoal, and afterwards distilling it. The substance known as white or yellow phosphorus was discovered as far back as 1669, by Brandt of Hamburg, and is, when pure, colourless and transparent, but when exposed to the light it becomes yellowish. During absorption of oxygen from the atmosphere it becomes phosphorescent. The greenish-white light thus evolved can at once be checked by such essential oils as turpentine and eucalyptus. The glow of phosphorus is an indication that oxidation is taking place, and that both phosphorous and phosphoric oxides are being formed, ozone being probably present at the same time. White phosphorus is extremely inflammable: it ignites at a temperature of 34° C., and forms with a plentiful supply of air phosphoric oxide P₄O₁₀, but if the supply of air is limited, phosphorous oxide is formed P₄O₆. It is with a paste made from white phosphorus that the ordinary strike-anywhere matches are headed.

Red or amorphous phosphorus, from which safety matches are made, has been known only since 1845. It was discovered by Schröter of Vienna, and is obtained by exposing ordinary phosphorus for some time in a closed vessel to a temperature of about 250° C. Red or amorphous phosphorus differs from yellow both physically and in other respects. It can be handled, for example, with impunity, and does not take fire when rubbed on any rough[419] surface. It is non-volatile, and since it is not acted upon by the digestive juices of the alimentary canal it is non-poisonous. As much as an ounce of amorphous phosphorus has been given to animals without any bad effects, while one to three grains of the ordinary metalloid have caused death. In order to ignite red phosphorus, it has to be rubbed upon a surface that contains substances rich in oxygen. The heads of safety matches are composed of potassium chlorate and chromate, and other compounds that contain large quantities of oxygen, while the red phosphorus is present in the brownish-red layer that has been pasted on the side of the matchbox. It is significant of the habits of our countrymen that while sixty tons of white phosphorus are converted into the ordinary strike-anywhere matches every year in Britain, only three and a half tons of red phosphorus are required to satisfy the public demand for safety-matches.

White phosphorus is volatile at ordinary temperatures, and its vapour when pure is said by Schonbein to be odourless; the odour that is perceived is a mixture of ozone and phosphorous oxide. On analysing the fumes given off by phosphorus eight-tenths are found to consist of oxides of phosphorus.

Professor Thorpe found that when decayed human teeth were exposed to the fumes of phosphorus for twelve hours they lost 0.37 per cent. of their weight, and that carious teeth when crushed and exposed to a dilute solution of phosphoric acid (1 per cent.) lost 8.9 per cent. of their original weight. When, therefore, the fume of phosphorus co-operates with the saliva of the mouth, it must clearly exercise a solvent action upon the teeth. In the air of the dipping room of a match factory, Thorpe found O.02 milligrammes of phosphorus per 100 litres of air, while the same quantity of air of the boxing-room contained O.12 milligrammes of phosphorus. On analysing the water in which twenty-two of the workpeople had washed their hands, after working a certain number of hours in the factory, 37.3 milligrammes of phosphorus were found, or an equivalent of 4.2 milligrammes of phosphorus per person for each ten hours’ work.

The lucifer match industry of Great Britain and Ireland gave employment during 1898 to 4270 persons, of whom 1166 were males and 3104 females; about 1700 of these were working in phosphorus processes. Of persons under eighteen years of age there were 466 males and 1077 females. The match works were distributed as follows: in England and Wales 17, Scotland 2, and in Ireland 5, making a total of 24. Dr Whitelegge sends me[420] the following information regarding the number of lucifer match works in January 1901—

The Chief Inspector of Factories, in his Annual Report for 1899, p. 318, states that the total cases of industrial phosphorus poisoning in this country within the last twenty years, of which there is a definite record, number 102. Before 1898 there were 92 cases of phosphorus necrosis, 6 in 1896, and 4 in 1899. Three other cases were reported in 1899, and are included in the return, but they did not reach the stage of necrosis. It has been urged with reason that such doubtful cases, when notified, should be placed on a “suspended” list, and judgment deferred until the diagnosis is quite clear. Of the 102 cases 19 terminated fatally. Dr Whitelegge informs me that three cases of phosphorus poisoning were reported during 1900; this brings the total number up to 105 in twenty-one years.

The ordinary lucifer match is dipped in a paste composed of glue, phosphorus, chlorate of potass, powdered glass, sometimes magnesia or lime, and coloured by a magenta dye. On an average there is 5 per cent. of phosphorus present in the paste, but sometimes it is double this amount. The paste or composition, when about to be used, is spread upon an iron slab kept at a moderate temperature. Into this paste the dipper, always a male in this country, quickly plunges the tips of prepared wooden splints that are projecting at a uniform level from a frame, and at once hands them over to a fellow-workman, who removes them to the drying chambers, which are ventilated by means of fans to renew the air, and to hasten the drying of the matches. At the distal end of the slab upon which the dipper heads the lucifers, there is, or ought to be, a fan towards which, when in operation, the fumes of the phosphorus as they rise from the paste can be seen travelling away from the face of the worker. Since the introduction of fans on the far side of the slab, the occupation of dipping in match works has become much less dangerous.

The boxing of matches, when done by hand, is attended by considerable risk to health, especially if the workroom is badly[421] ventilated. In addition to the phosphorus fumes which pervade the boxing-room, the atmosphere is from time to time rendered more unhealthy by dense clouds of smoke given off by the matches that are frequently catching fire.

It was Lorinser of Vienna who first drew the attention of the medical profession to phosphorus necrosis, or disease of the jawbone, in lucifer matchmakers. This was in 1845, or about eleven years after the establishment of the match industry in Austria. Between the years 1839–1845 he had examined nine cases of phosphorus necrosis. Shortly after Lorinser had published his cases, Sir Samuel Wilks in our own country reported the occurrence of disease of the jawbone in a matchmaker, attended by suppuration, and followed by exfoliation of the bone. Since then in every country where ordinary lucifer matches have been made, the use of phosphorus has been followed by such an amount of ill-health and suffering on the part of matchmakers, that almost all the preventive measures which industrial science and legislation could suggest, short of total prohibition, have had a trial without rendering the industry completely safe. More than twenty years ago Denmark interdicted the use of white phosphorus, and the importation of ordinary strike-anywhere matches. France, several years after having made the manufacture of matches a Government monopoly, and having been obliged to pay large sums of money as compensation to the diseased matchmakers of Pantin-Aubervilliers, has commenced to manufacture matches from a harmless sesquisulphide of phosphorus; matches which, while possessing all the freedom from poison claimed for safeties, have the property of striking anywhere. Belgium has not only insisted upon the reduction of phosphorus in the paste to 8 per cent., but with the view of stimulating the manufacture of a satisfactory non-poisonous strike-anywhere match, has offered a prize of 50,000 francs (£2000). Holland[81] insists upon 5 per cent. of phosphorus in the paste, and allows no young person under sixteen years of age, and no woman to work in a match factory where yellow phosphorus is used. In Norway 28 cases of phosphorus necrosis occurred in fourteen years out of a total number[422] of 600 workers. The match industry of Sweden gives employment to about one-twentieth of the artizan population. In the twenty-seven match factories of that country, 5500 persons find employment, males and females about equally. Although a large proportion of Swedish matches are safeties, yet as a matter of fact 80 per cent. of the matches produced are made from ordinary phosphorus. There is a large home consumption of strike-anywhere matches in Sweden. As a consequence of their manufacture, phosphorus necrosis is not unknown in that country, and on more than one occasion the question of the total prohibition of ordinary phosphorus has been discussed in the Rigsdag. Were such a thing to become law the match industry of Sweden, in the absence of an international agreement, would be seriously crippled. During the year 1891 there were 19 cases of phosphorus necrosis reported from thirteen factories. The Commission appointed by the Swedish Parliament to consider the prohibition of ordinary phosphorus did not feel justified in recommending such a sweeping change, believing that in better ventilation of the workrooms, repeated medical examination of the workers, and scrupulous attention to details in the various processes, the manufacture of matches could be robbed of much that had hitherto caused it to be regarded as a dangerous industry. Of the ninety match factories in Germany about thirty make ordinary lucifers. Several cases of phosphorus necrosis have occurred, but since the introduction of stringent regulations in 1884, requiring special ventilation, medical examination of the workers, personal cleanliness and separation of the workrooms, the amount of sickness has, within the last few years, materially diminished. In Austria-Hungary there are upwards of ninety match works. It is an important industry in Bohemia, Galicia, and Hungary. The matches chiefly find their way into Servia, Bulgaria, Roumania, and Turkey. In eighteen years 140 cases of phosphorus necrosis were reported to the Factory Inspectors; as many as 47 cases of phosphorus necrosis having occurred in the year 1888. This unhappy circumstance is to be explained by the fact that the manufacture of lucifers at this time was extensively but secretly carried on as a home industry. Experience has shown that this clandestine practice is always extremely dangerous. Fortunately the authorities have practically succeeded in abolishing this home industry. The regulations in Austria-Hungary resemble those of Germany. Switzerland in 1879 introduced a Bill for the prohibition of the use of yellow phosphorus, and two years afterwards it became law. Instead of[423] abolishing phosphorus necrosis, however, the disease became not only more prevalent, but of a severer type, owing to the manufacture of matches as a home industry. As the interference of the Government defeated the object it had in view, viz., safe-guarding the health of the workers, the Act of 1879 was in a sense repealed. Whilst in Switzerland the importation and manufacture of matches made with yellow phosphorus is forbidden, the manufacture of lucifers is under the control of each canton, the Federal Council holding itself responsible for the conditions that are requisite for the health and safety of the workers, and also of the public.

Phosphorus Necrosis.—It is difficult to say what is the actual cause of necrosis of the jawbone in lucifer matchmakers. As to whether it is a primary lesion or one secondary to a general or constitutional form of poisoning, medical opinion is still divided. Most writers attribute the disease of the bone to the fumes of phosphorus, i.e. to the oxides of phosphorus, acting upon the decayed teeth of the workpeople. The fumes are supposed to penetrate a carious tooth and induce a periostitis or inflammation of the covering of the bone. The gum becomes swollen and painful. To such an extent has this been regarded as the explanation of the cause of necrosis that two of the large match works in this country had at their own expense appointed dentists to examine and keep in good order the teeth of the workpeople. Subsequently the Home Office, as a result of the opinions expressed at an Arbitration with the Match Manufacturers, decided to accept periodical examination of the teeth of the workpeople by a qualified dentist as a substitute for medical inspection. While regarding decayed teeth as a necessary preliminary to inflammation of the dental socket, Roussel holds that it is phosphoric acid that is the destructive agent. Gubler and Lailler,[82] on the other hand, maintain that they have met with phosphorus necrosis in the inferior jaw of a matchmaker whose teeth were perfectly sound, and that if phosphoric acid were the destructive agent the teeth ought to become softened and translucent. Gubler holds, but on what grounds we do not know, that it is phosphorus itself that penetrates into the soft tissues and destroys the nutrition of the covering of the bone. Under all circumstances “phossy jaw” is a painful affection, especially in the early stages, and although naturally it might be expected to occur with greater readiness in workpeople who are ill-nourished, scrofulous, or tubercular, yet I have seen it in male and female matchmakers who were[424] physically strong and otherwise perfectly healthy. This circumstance, therefore, is rather in favour of phosphorus necrosis being in the first instance a local affection and primary. Once suppuration occurs, the painful tooth removed, and the pus thereby allowed to escape, pain is subsequently not a marked feature in the case. As the periosteum is usually separated, the affected portion of bone lying underneath dies and is exfoliated. A piece of bone varying from half-an-inch to three inches is thus thrown off. The process of separation of the bone by ulceration is extremely slow. It may extend over months or years if the bone is not surgically treated, and all this time there is a constant oozing of pus into the mouth of the patient, some of which must be swallowed along with the food, thereby undermining the health and causing anæmia or cachexia, or during sleep it may trickle down the throat into the respiratory passages and set up an unhealthy inflammation of the lining membrane, or it indirectly prepares the way for tubercular disease of the lungs. Either jaw may become necrosed. If anything, the inferior maxilla is more frequently affected than the superior. When the upper jaw is diseased there is a tendency for the inflammation to extend to the base of the skull and to induce a septic inflammation of the membranes of the brain, which is invariably fatal. In France both Dr Magitot of Paris and Dr Arnaud of Marseilles described a constitutional condition or cachexia in matchmakers to which they gave the name of phosphorisme, of which pallor, dyspepsia, albuminuria, and a tendency to bronchitis are the prominent features. Arnaud, with whom I had the opportunity of discussing this subject in Marseilles, found that as many as 28 per cent. of lucifer matchmakers, especially young women under eighteen years of age, suffered from bronchitis, but he did not think that matchmaking per se was a cause of tubercular lung disease, nor was it his experience that pregnant female matchmakers aborted more frequently than their sisters engaged in other occupations. Phosphorisme does not occur to any extent in English matchmakers. In visiting the match factories of Belgium, particularly of Grammont, where I met Dr Brocoorens, who from his large experience of industrial phosphorus poisoning had been invited to give evidence before the French Commission, my attention was drawn to the interesting fact that men who had been dippers and who had suffered from necrosis of the jawbone and recovered, exhibited an unnatural tendency to spontaneous fracture of their long bones, especially the femur. During twenty-five years in Grammont alone,[425] which is not a large town, with six match factories giving employment to 1100 people, Dr Brocoorens treated 30 cases of fracture of the long bones, caused by muscular effort, in dippers who had previously suffered from necrosis of the jaw. This circumstance would rather suggest that in addition to the local disease of the maxillæ caused by phosphorus, there was also induced a wider spread morbid state, which was capable of showing itself long after recovery from the primary lesion. Spontaneous fracture of the long bones of matchmakers is not unknown in England. Dr Garman of Bow, medical officer to Messrs Bryant & May, informs me that he knows of nine cases in which the long bones of the arm and leg of matchmakers have become broken without any injury being received, and Dr Dearden of Manchester relates[83] the case of two dippers, “each of whom has had separately and at different times both thigh bones broken in a ridiculously simple fashion.” Dr Kocher of Berne had experience of a matchmaker who broke his thigh bone five times. These facts indicate that the osseous tissues of the body are in some way or other influenced either by phosphorus itself or its compounds, whereby they become unable to withstand external violence. Dearden is of opinion that the bones of match dippers contain an excess of phosphoric acid, which combines with the pre-existing neutral phosphate of lime to form a slightly acid salt. In this circumstance may possibly be found an explanation of the fragilitas ossium of lucifer matchmakers.

A brief notice of some experiments performed by Wegner may not be out of place here. He believes that phosphorus has a specific action upon bones, especially those of young animals. Wegner found that the administration of very minute doses of yellow phosphorus, ¹⁄₁₀ to ⅕ mgrm., for several weeks to young rabbits was followed by characteristic changes in the growth of the long bones, owing to the phosphorus acting as an irritant or stimulant to the bone-forming cells. Where loose cancellous bone was being formed from cartilage, phosphorus caused the deposition of a layer of dense bone, and if the drug was pushed a little longer, the soft, cancellous bone, formed before the phosphorus treatment was begun, became gradually absorbed. In this way the central or medullary cavity of the bone became enlarged, so that in the case of the long bones this cavity extended into the epiphyses or ends of the shafts. In other instances the newly-formed bone which had developed under the influence of[426] the phosphorus, and also that which grows normally from the periosteum, became denser, so that in fowls Wegner found the medullary cavity obliterated by the deposition of hard bone. When lime salts were withheld from the food of the animals treated by phosphorus, the activity of the bone-forming cells continued, but no lime was deposited, and so there was produced a condition of bone such as is found in rickets. Kassowitz by similar means produced appearances closely resembling the soft and yielding bones that are met with in rickety children. Wegner, by exposing the bared tibia of an animal to the influence of phosphorus fumes, induced periosteal irritation and the deposit of new layers of bone.

Although it takes a long time for the sequestrum of a diseased jawbone to be thrown off in a person the subject of phosphorus necrosis, yet once it is expelled and the wound closed, the patient generally feels well enough to return to work in a match factory, and is placed in a department wherein he runs no further risk. Despite the tediousness and the unpleasantness of the malady, most of the patients recover. Dr Garman of Bow, treating his cases by the expectant method and allowing the sequestrum to be naturally separated, found that 83 per cent. of his cases recovered; Kocher of Berne prefers to remove by means of a surgical operation the affected portion of bone, and 83.7 per cent. of his cases recovered; while Kuiper of Jena, treating his patients on similar lines to Kocher, had 89 per cent. of recoveries.

This account of the diseases of bones of matchmakers allows us now to return to the original question, viz., the cause of phosphorus necrosis. Fume is generally regarded as the cause, but it is probably only an incident. In the pus that keeps oozing away from the necrosing jaw of an affected matchmaker, I have found numerous pus-forming micro-organisms, viz., putrefactive bacilli, streptococci and staphylococci pyogenes, and as Professor Stockman of Glasgow detected in addition in the pus a few tubercle bacilli, he is disposed to regard the “phossy jaw” of lucifer matchmakers as a true tubercular process. In several of the specimens of pus taken from the diseased jawbone of matchmakers sent to me by Dr Garman of Bow, I could find no trace of tubercle bacilli, although these were carefully searched for. The presence of the bacilli of tubercle in Professor Stockman’s specimens, which by the way I have had the privilege of examining and confirming, is an extremely interesting fact, and it[427] certainly creates a bias in favour of the lesion being tubercular. On the other hand, the human mouth under all circumstances contains large numbers of micro-organisms, some of which are capable of becoming extremely virulent under altered conditions, and there is no reason why some of these might not find their way through a carious tooth to its socket in the jawbone or to the periosteum, where phosphorus fumes had previously gained entrance and set up irritation. In these tissues thus prepared microbes would find a suitable nidus for their multiplication. As the same remark applies to tubercle bacilli, it is clear that the final answer has not yet been given to the pathological problem of phosphorus necrosis. There is something in the causation of phosphorus necrosis that is still unknown to us, some peculiar action of phosphorus on the human subject that is not yet fully explained.[84] It is an extremely difficult thing to produce phosphorus necrosis in animals, either by exposing them to the fumes of phosphorus itself, or to clouds of smoke from burning matches.

In many instances where “phossy jaw” has occurred, the workpeople were at the time following their occupation, and had done so for many years. Acute phosphorus poisoning, practically speaking, does not occur in matchmakers. The poisoning is always chronic. Phosphorus necrosis was not recognised in Vienna until the industry had been established seven or eight years. The malady might have existed, and of course not been diagnosed. Most of the patients with “phossy jaw” whom I have seen had worked from seven to fifteen years at the trade, but the disease has been known to occur within twelve months after entering a match factory. Dr Garman has kept a register of all the cases of phosphorus necrosis that have occurred in Messrs Bryant & May’s for the last twenty years. During this[428] period there have occurred 51 cases—31 females and 20 males. The upper jaw was affected fifteen times, and the lower sixteen, in the women: while in the men the numbers were eleven and nine. The severer type of the malady formed 70 per cent. of the cases in females, while in males, who as dippers are more exposed to the fresh fumes of phosphorus, it formed 85 per cent. Of these 51 cases of phosphorus necrosis nine ended fatally; 83 per cent. recovered and returned to work. On examining the register as to the ages at death, I find that these were nineteen, twenty-three, twenty-one, twenty-two, twenty-seven, twenty-seven, nineteen, twenty-two, and twenty-two years. Clearly, therefore, it is not necessary to have a very lengthened exposure to the fumes in order that a fatal result may follow. Co-existing pulmonary consumption was present in two of the patients, and doubtless contributed to the fatal ending. In Great Britain less than 1 per cent. of matchmakers suffer from phosphorus necrosis: in Switzerland it used to be 1.6 to 3, and in France formerly 2 to 3 per cent. Phosphorus necrosis, it is well to remember, does not always develop during the time an individual is following his employment in a match work; it has been known to occur two years after leaving the factory. The early age at which Garman’s patients died suggests that the vital resistance to the malady at this period is less than in later years.

Prevention of Phosphorus Necrosis.—Since the manufacture of lucifer matches is capable of inducing in the workpeople necrosis of the jawbone, which in the early stages is admittedly a painful affection, but fortunately one not often followed by any marked deformity, it is apparent that to the public must be given by the manufacturers some satisfactory assurance, if the use of yellow phosphorus is to be continued, that the industry which at present is harmful shall be converted into one that is free from danger. Is this event possible? Experience of match works, both at home and abroad, shows that where the industry is conducted on the best hygienic lines possible, phosphorus necrosis is practically unknown. This, so far as it goes, is satisfactory. It cannot be said, however, that the employment of white or yellow phosphorus can under all circumstances be rendered absolutely free from danger. The education of the working classes to use only safety matches would of itself very largely diminish the danger by reducing the demand for ordinary strike-anywhere matches. Dipping of the wooden splints in cold composition instead of hot would, as in the case of vestas, in the manufacture of which “phossy jaw” does not occur, also tend to diminish the ill-health of the workers. It has[429] been demonstrated that certain essential oils are capable of checking the oxidation of phosphorus, which is one of the possible causes of phosphorus necrosis. It has, therefore, been recommended to circulate the vapour of turpentine through the dipping and boxing rooms. In some American factories the workpeople wear suspended round their necks small vessels containing turpentine. Of all hygienic measures full and free ventilation is the best. Years ago the scourge of matchmakers in Belgium was “phossy jaw,” but shortly after the introduction of hygienic measures and the reduction of phosphorus to 8 per cent. in the paste, there was observed a very notable declension in the number of cases of necrosis, and in our own country the removal of phosphorus fume by powerful aspiration from the dipping slab, frequent renewal of the air of the drying chamber, and ventilation of each of the benches at which the boxing is done by women by hand, have exercised an undoubted influence in preventing phosphorus necrosis. Periodical examination of the teeth of matchmakers by a dentist, with the necessary local treatment, including temporary suspension from work on the detection of disease in the early stages, will be beneficial. It is one of the requirements of the Home Office that this dental examination shall be periodically made. Whether of itself it is sufficient to permanently obviate the necessity for a medical examination of the workers by a doctor in addition remains yet to be seen. Since the frequent firing of matches is a cause of pollution of the atmosphere of the boxing-room, and filling of the matchboxes by hand brings the worker into direct contact with dried phosphorus paste, it is advisable to discontinue the practice of cutting wooden matches once they have been headed, and to substitute machinery for all hand labour, which, as in the case of the Diamond Match Company, Liverpool, dips, dries, and boxes the matches in large and well-ventilated rooms, and has thereby practically made lucifer matchmaking a harmless industry. It is absolutely necessary that personal cleanliness should be attended to, and that there should be adequate provision of washing appliances with hot and cold water, plenty of soap and towels, that overalls should be worn, frequent change of occupation from one department in the factory to another, and that no food should be allowed into the workroom.

Can any substitute be found for yellow phosphorus, capable of producing a non-poisonous match that will strike anywhere, and yet conform to the same conditions as ordinary phosphorus? France has, within the last three years, ceased to manufacture[430] matches from yellow phosphorus. In that country the manufacture of matches is a State monopoly. A short while ago the Government felt itself obliged to change the method of manufacture, partly on humanitarian grounds, but very largely owing to the numberless claims for compensation by the workpeople upon the Minister of Finance. In the match works at Pantin-Aubervilliers, there were, in 1894, 32 cases of phosphorus poisoning, 125 in 1895, and in 1896 the number rose to 223, or one-third the effective force of the factory. Many of these must have been of a mild nature, and probably some of them were cases of imposition, for when analysed carefully it would appear that between 1888 and 1896 there were eight cases of deforming necrosis, 12 of necrosis requiring surgical treatment, 21 probable cases of phosphorus necrosis, and 18 of phosphorisme, making a total of 59. At this time the match paste, in addition to lead, contained often as much as from 20 to 30 per cent. of phosphorus. From the 1st January to 31st December 1896, the State paid 400,000 francs as allowances to sick-workers, men and women, employed at Pantin-Aubervilliers, or an average of 650 francs per head employed. It was in consequence of this experience that in order to encourage research, which would lead to the manufacture of a non-poisonous match, the State granted financial help. After many experiments—such, e.g., as the matches of M. Ponteau, made from acetate of amyl, during the manufacture of which a splitting headache, a feeling of cerebral fulness, and a throbbing of the head were complained of by the workers, a circumstance that led to their manufacture being abandoned; also the lucifers of M. Miram, which met with a similar fate, since they contained lead, and therefore one poison was simply being substituted for another,—the French Government at present believes that in the substance known as sesquisulphide of phosphorus it has found an answer to the question raised at the head of this paragraph.

The toxicity of the sesquisulphide of phosphorus is small. Messrs Sevène and Cahen gave repeated doses of 3 centigrammes (⅖ grain) of the substance daily to guinea-pigs without these animals appearing to suffer, although the ingestion of 3 milligrammes (¹⁄₂₅ grain) of white phosphorus caused rapid death. The dose of 3 centigrammes (⅖ grain) to a guinea-pig would correspond to 3.5 grammes (54 grains) for a human adult, that is to say, to the amount of sesquisulphide of phosphorus present in 6000 matches. For these and other reasons based upon experience, the French inventors maintain that sesquisulphide of phosphorus[431] matches are harmless. The following is the composition of the paste employed:—

The sesquisulphide is almost inodorous as a powder, and is non-poisonous. When matches are headed with a paste made from it, they are capable of striking anywhere. The only impurity which the sesquisulphide can contain is some red or amorphous phosphorus. At first manufacturing chemists expressed doubtful opinions as to the keeping properties of the matches, also as to their capability of being transported across the seas, and of remaining good in all climates. Two years’ experience of the manufacture of matches from sesquisulphide of phosphorus has demonstrated such fears to have been groundless. Dr Courtois-Suffit, the Medical Inspector of the Match Works at Pantin-Aubervilliers, says that “since substituting sesquisulphide for yellow phosphorus, not only have the workpeople been more healthy, but that there has been no complaint on the part of the consumers.” No match is superior to the lucifer made from yellow phosphorus. French matches have never been regarded as equal to those of English manufacture. France is not an exporting country. While, therefore, the introduction of what is called a sans phosphore match in France has answered satisfactorily, it does not follow that the manufacture of this particular kind of lucifer is the best for all countries, and especially for such a large exporting country as Britain.

In Italy the same subject has received the attention of scientists. M. Bertarelli,[86] in a lecture at the University of Turin, demonstrated the properties of a non-poisonous match made by Dr G. Graveri of Villanova-Sollaro, the principal ingredient of which is persulphocyanic acid, a substance obtained from the residue of gas-works, of a yellow colour, crystalline, soluble in alcohol, ether, and boiling water, decomposing at a temperature of 220° C., and giving rise to sulphide of carbon, ammonia, and sulphur. This is made into a paste with sulphur and antimony trisulphate. The matches ignite when rubbed briskly upon a[432] rough surface, and no cyanogen is evolved. Bertarelli states that he has given to dogs for several days 3 to 4 grammes (46 to 60 grains) of the paste used for heading the matches, and beyond slight vomiting he has not noticed any accident, whilst 0.7 grammes (11 grains) of ordinary phosphorus paste caused death. It is claimed for his matches that they cost less to produce than ordinary matches, they ignite noiselessly, and develop no odorous gases, that they are non-hygroscopic and non-poisonous. The only drawback is stated to be the escape of hydrochloric acid fume during their manufacture, but this can be overcome by efficient ventilation.

Great Britain is not only a consumer but a large exporter of lucifer matches, and it is this circumstance that raises a difficulty in regard to the total abolition of the use of yellow phosphorus in this country. If other matchmaking and large exporting countries, such as Belgium, Sweden, the United States, and Japan, could come to some satisfactory terms of international agreement with Britain not to manufacture lucifer matches from yellow phosphorus, the question would be settled, if not permanently, at least for a time. It would be useless for Britain with her free trade to abolish yellow phosphorus, thereby crippling her own matchmaking industry, and at the same time allow matches made from the poisonous phosphorus to be imported from other countries wherein Government supervision is perhaps less strict than in ours. Such a course would only transfer phosphorus necrosis from our own to other countries. English methods of manufacture, like national customs, die hard. It is pleasing to observe, however, that the objection on the part of British match manufacturers to the use of substitutes for yellow phosphorus is gradually disappearing. Messrs Bryant & May no longer use yellow phosphorus. Mr Gilbert Bartholomew, the Managing Director of the firm, in answer to some queries I addressed him (1901), informs me that “we are well satisfied with our long trial of the new composition. There has not been, and there cannot be, from the nature of the composition, any sickness among the workpeople. We have not used an ounce of yellow or poisonous phosphorus for nearly ten months.... We do not think there is an increased demand for safety matches; the great demand is for strike-anywhere.” It is gratifying to know that some of the smaller firms of lucifer matchmakers have also undertaken to produce ordinary strike-anywhere matches from a non-poisonous substance. How far these non-poisonous substances[433] are quite free from danger and as sources of irritation, remains to be seen, for conjunctivitis, œdema of eyelids, and eczema have been noticed in the workers.[87]

Treatment of Phosphorus Necrosis.—It is unnecessary to enter into this at any length. Such preventive measures as a medical and dental examination of the workpeople before entering the factory, and from time to time afterwards, combined with suspension when necessary, personal cleanliness, and the use of terebinth gargles, wearing of overalls, and a change of employment in the factory, also thorough ventilation of the workrooms and of the dipping tables by reliable artificial means, will, if carefully carried out, do a very great deal to make and keep the workpeople healthy.

Once phosphorus necrosis has developed, it may either be treated by antiseptic mouth-washes, maintenance of the general health by good nourishing food, and a life spent in the open air, thus allowing time for exfoliation of the necrosed bone to take place naturally, a process which, as we have seen, may extend over many months; or it may be treated surgically by removal of the piece of diseased bone. Each method has its advocates, but the results are practically the same, viz., upwards of 80 per cent. of recoveries.

Thomas Oliver.

Introduction.—The number of industries and the number of persons coming into contact with mercury in this country is not large. Probably not more than 500 to 1000 persons are exposed to the danger of industrial mercurial poisoning in Great Britain, but no matter how the metal or its salts are used, those handling it run considerable risk. In some industries, indeed, as, for instance, the silvering of mirrors with an amalgam of tin and mercury, which was for over a century the great source of mercurial poisoning, the matter is now only of historical interest, as the process in question has been replaced within the last twenty years by an innocuous one in which mercury is not used. On the other hand, fresh industries arise in which the metal is used, as, for example, the manufacture of electrical meters and incandescent electric lamps.

Historical.—As far back as the year 1665, in the Philosophical Transactions of that year, a reference is made by Dr Walter Pope to the tremor affecting the hands of a worker in some cinnabar mines in Italy. In 1721 Antoine de Jussieu[88] described the symptoms of salivation, ulceration of the gums, and tremor which affected the workers in the quicksilver mines of Almaden, in Spain. In the various translations of Bernardino Ramazzini’s work, De morbis artificum diatriba, originally published in 1702, an account is given of the effect of mercury on miners and gilders.

One of the first references to the occurrence of mercurialism in the process of silvering of mirrors was made by Bateman[89] in 1812, but the great work which still remains the classical work on the subject of chronic industrial poisoning, due to mercury,[435] was published in 1861 by Adolf Kussmaul,[90] Professor of Medicine in Erlangen. The splendid use which he and other medical men made of the opportunities offered them of studying the clinical symptoms among persons employed in the silvering of mirrors in Fürth and Nuremberg, the principal seats formerly of the industry on the Continent, and the publication of their observations, led up to the introduction of the stringent regulations which have since caused the process to be given up.

In 1829, Dr Reitz[91] of St Petersburg published an account of the danger to health in hatters furriers’ processes in that city, and showed that the solution (regarded then as it still is as a secret), contained mercury, arsenious acid, and nitric acid.

He does not particularly refer to the occurrence of tremor, but describes the death of three men from acute bronchitis after mixing the nitrate of mercury solution.

Industries in which Poisoning may occur.—The industries in which mercurial poisoning may occur are:—

1. Recovery of the metal from the ore.

2. Separation of gold and silver from their ores by means of an amalgam with mercury.

3. The manufacture of barometers and thermometers and other philosophical instruments.

4. The manufacture of incandescent electric lamps, where mercurial pumps are used to create a vacuum.

5. The manufacture of electrical meters.

6. Gilding and silvering, generally known as water-gilding: where an amalgam of gold or silver is applied to the objects, and the mercury volatilised by heat.

7. Chemical works: where pharmaceutical mercurial preparations are made.

8. Paint and colour works: where anti-fouling paints or vermilion are made.

9. In hatters furriers’ workshops: from the brushing of rabbit skins with an acid solution of nitrate of mercury.

10. Bronzing with a solution of nitrate of mercury: as in bronzing the inside of field-glasses.

[436]

In the first six the poisoning takes place almost entirely through the inhalation of mercurial vapour, and hardly at all from dust; in (7) it may arise either from vapour or from, as is the case in (8), contamination of the hands and subsequent ingestion of the salts; in (9) it results from the inhalation of fumes or the ingestion of particles of fur impregnated with nitrate of mercury.

Other processes which deserve mention as a possible source of mercurial poisoning are: electrical engineering, mercury being used in amalgamating zinc plates; taxidermy when corrosive sublimate is used; the manufacture and use of fulminate of mercury in explosive factories; sole-stitching by the “Blake sole-stitching machine,”[92] in which mercury is used to prevent the escape of gas.

Mode in which Poisoning is brought about.—Mercury in the liquid form, even when swallowed in large amount, rarely gives rise to poisoning. When absorbed in the form of vapour it frequently does, but it would be wrong to suppose that the vapour can as such pass through the lining walls of the alveoli of the lungs. It must first undergo condensation, and the tiny globules so formed become oxidised and then dissolved. In view of the fact that expired air is warmer than that inspired, it is difficult to see where this condensation takes place. Von Renk[93] carried out a series of experiments to see whether the mercury that was scattered in rooms where the silvering of mirrors was carried on could be swallowed with the dust. He found, however, such small quantities of dust in the air (only 7.3 milligrammes in 712 litres of air) that he concluded absorption of mercury in this way was improbable. On the other hand, mercury gives off vapour at ordinary temperatures, the amount depending on the vapour tension, and he found appreciable quantities (2 milligrammes) in a cubic metre of air in a room without special ventilation immediately above a layer of mercury half a square metre in area. As in eight hours a worker inhales and expires about 3 cubic metres of air, if the air breathed were charged only to an extent of 1.5 milligrammes per cubic metre, it would mean that 4.5 milligrammes entered the lungs. Were this continued day after day, injurious effects would necessarily ensue.

The reactions which enable mercury to enter the circulation are only imperfectly understood. It is acted on more readily by salt solution than by dilute acids. The presence of both salt[437] solution and free acid must favour greatly the solution of the metal. Corrosive sublimate forms an albuminate with albumen insoluble in water, but readily soluble in the presence of salt solution. In this remarkable reaction of the solubility of albuminate of mercury in presence of sodium chloride lies the probable explanation of the occurrence of mercurial poisoning.[94]

Symptoms.—Although in industrial mercurial poisoning the symptoms occasionally resemble those which result from the internal administration of full doses of mercury, such as excessive salivation, swelling and ulceration of the gums with fœtor of the breath, followed in severe cases by looseness and falling out of the teeth, they are as a rule much slower in their onset and more insidious in character. For years the only sign may be more or less gastric disturbance, a gradually increasing anæmia, a slight increase in the secretion of saliva with tendency to ulceration of the gums, and slight tremor of the muscles of the face and hands, accompanied by a certain amount of nervousness.

Kussmaul, from his wide experience among the silverers of mirrors in Fürth, describes three stages in industrial mercurial poisoning: first, erythism or psychical changes; secondly, tremor; and thirdly, the final or cachectic; and my own experience points to the correctness of his description.

The first commences usually in the digestive tract with slight stomatitis and salivation. The worker becomes pale and loses his appetite. He frequently has headache, giddiness, and transitory pains in the limbs. The muscles of the face twitch, the fingers tremble when spread out, and the tongue is also tremulous when protruded. The mental condition undergoes change. Workers assured of their skill become shy and nervous, especially when watched. Sleep is often interfered with and broken by nightmare. Sometimes the tonsils and pharynx become involved in the inflammatory processes affecting the mouth.

At this stage if the employment be given up, the symptoms disappear in about three weeks. If not, the weakness of the muscles increases. Palpitation, headache, sleeplessness, and emaciation all become worse.

In the second stage of tremor, disturbance of the muscular system preponderates. It is observed principally in the muscles of the face, hands, and arms; more rarely in the legs. At first it may amount only to slight tremulousness, but gradually it advances until the movements become convulsive in character,[438] and the hand cannot be directed with certainty to any particular object. The speech, from involvement of the muscles of articulation, becomes slow and indistinct. The psychical condition changes to one of depression or despondency. There may be hallucinations, loss of memory, and dulness of the intellectual faculties. In women, menstruation is diminished or ceases. Miscarriage is frequent, and the offspring is liable to be the subject of rickets or scrofula.

The condition of the teeth of persons exposed to the fumes of nitrate of mercury in hatters furriers’ processes deserves separate mention. The typical appearance in the teeth of those who are engaged in “carotting,” that is, brushing the rabbit skins with the dilute acid solution for several years, is loss of the molar teeth in the upper and lower jaws. The upper incisor and canine teeth are not infrequently absent, and such teeth as remain (generally the lower incisors and canines) are characteristically blackened and often loose. They show a marked tendency to erosion (a process quite distinct from caries, as the enamel and not the dentine suffers most) from the acid fumes, and frequently the gums recede, so that the anterior surfaces of the roots are exposed.

Chronic mercurial poisoning does not frequently lead directly to death. It appears to lower the vitality of the tissues markedly, and Kussmaul calls attention to the frequency with which mercurial workers die of phthisis.

Recovery from the Ore.—The principal ore from which the metal is obtained is cinnabar, or sulphide of mercury. It occurs principally in Idria in Illyria, where the greater part of the male inhabitants are concerned with its extraction, in Almaden in Spain, and also in China, Peru, California, and in smaller quantity in some of the German States.

The extraction of the metal depends on the principle that by heating the ore in the presence of air, oxidation of the sulphur present results, while the mercury is liberated in the form of vapour, which is condensed in suitable flues kept constantly cool by a stream of water. Complete condensation of the vapour is difficult.

In the actual mining of the ore, poisoning does not occur. Danger principally attaches to the smelting operation, to the cleaning out of the flues, and to the packing of the quicksilver.

The amount of illness caused may be judged from the fact that between the years 1879–1884, of 1000 workers, 112 suffered[439] from mercurialism, although this figure does not take account of gastric symptoms, which, if included, would raise it to 200 or 250 per 1000.[95]

The dangers can be best avoided by suitable arrangement of the furnaces so as to prevent the escape of fumes, the wearing of overalls, and ample provision of washing and bath accommodation.

Making of Thermometers.—In the making of thermometers a small funnel is blown on the top of a capillary glass tube and filled with mercury. Heat from a spirit lamp or gas jet is applied to the bulb, and the expanded air partially escapes. On cooling, a portion of the mercury passes into the bulb to take the place of the air which has escaped. This process is repeated until the bulb and part of the tube are full of mercury. The mercury is then heated to boiling, mercury vapour escapes, carrying with it the air and moisture which remain in the tube. The tube, when full of the expanded mercury and mercury vapour, is hermetically sealed at one end.

The number of persons employed in the industry of thermometer and barometer making is small. They generally describe themselves as experimental glass-blowers. The processes are usually carried on in small workrooms, the conditions in which, owing to the wooden benches and floors affording lodgment in the crevices for particles of mercury and to the gas jets alight at every bench, are not conducive to health. Close observation of almost every worker who has been employed for a few years (and when once entered on it is rarely exchanged for another), reveals the presence of chronic mercurialism either in slight tremor of the muscles of the face or hands, or the characteristic earthy complexion.[96]

Incandescent Electric Lamps.—In the manufacture of incandescent electric lamps, if mercurial pumps are used to produce the vacuum in the glass envelope, the danger from the scattering of mercury, which not unfrequently happens through breakage and careless manipulation, is considerable.

In Berlin and Buda Pesth[97] several cases of chronic poisoning from this source occurred a few years ago. The industry, so far as the operations in the pump-room was concerned, was placed under special regulations in Berlin, requiring (1) mechanical[440] ventilation; (2) overalls and head coverings for the persons employed; (3) provision of a meal room and the washing of hands and face with soap, and the rinsing out of the mouth with potassium chlorate before meals; (4) a warm douche bath three times a week; (5) medical examination of the workers once a week. The effect of these regulations was a cessation almost at once of mercurial poisoning, and they soon led to the introduction of mechanical pumps to replace those of mercury.

In this country no case has been reported in this industry, and the evidence I have found so far of mercurialism among the workers is slight.

Electrical Meters.—The same dangers from the free use and handling of mercury is to be found in workshops where electrical meters are made, and they can only be satisfactorily met by the adoption of the precautions mentioned in the last section of this chapter.

Gold and Silver Extraction.—Both gold and silver are occasionally separated from the ores in which they are found by amalgamation with mercury, the latter subsequently being removed by distillation.

Water-gilding.—In the gilding and silvering of ornaments, the use of mercury has fortunately been almost entirely replaced by the much less harmful electroplating. The gilding, however, produced by the amalgam with mercury and subsequent firing (water-gilding) is more durable than that obtained by electroplating, but such articles as military buttons are still prepared in the old dangerous way, although greater precautions are taken to see that the fumes are carried away. The object to be gilt is treated with a solution of nitrate of mercury, and the amalgam (previously prepared by heating an alloy of gold with silver and copper to redness, adding an eighth part by weight of mercury, subsequently cooling in water and expressing any excess of mercury) is applied with a brush. Formerly the article was heated over a charcoal fire, with, necessarily, escape of fumes both of carbonic oxide and mercury into the room. Now it is done either in a closed stove or on a gas jet with a good draught.

Silvering of Mirrors.—The process of silvering of mirrors, which formerly caused so much suffering, was to spread out on a perfectly horizontal table of marble or glass a sheet of tinfoil. On to this a small quantity of mercury was poured to form an amalgam. A large quantity of the metal was then added, and the carefully polished plate of glass was slid over it, pushing some of the excess[441] of mercury in front, which was collected in small channels, but abundance remained in the cracks and crevices of the tables. Heavy weights were placed on the glass to press out the mercury, and in a few days the combination of mercury and tin was found to have adhered firmly to the glass.

It may be well to refer here to the process which has taken its place. The method is a wet one, and consists in pouring over the cleaned and dried glass plate a solution of nitrate of silver, containing an alkaline reducing agent, such as a tartrate, or more commonly ammonia. A reddish or black precipitate at first falls down, and later on a shining surface of metallic silver holds close to the glass. The glass is then carefully wiped dry and backed with a coat of varnish or red lead. Cases of lead poisoning have occurred from the use of red lead in this way.

Statistics of Dr Wollner[98] show that in 1885, on an average, 160 persons were engaged in the silvering of mirrors in Fürth. Among these there were 165 illnesses (103 per cent.) for which sickness insurance money was paid, and of these 60.6 per cent. were on account of mercurial poisoning. The percentage among males and females was practically the same, but the number of sick days was greater in the case of men than in that of the women—66.7 days as compared with 50.5.

In 21 per cent. symptoms became prominent in from one to two years, in 61 per cent. in two to six years, in 15 per cent. in six to ten years, and in 3 per cent. in ten to seventeen years.

In 1898 the Factory Inspector for the district of Fürth states in his report that only seven persons were engaged in the process, and that their employment was intermittent. As the process has thus become practically extinct, it is hardly necessary to give the regulations enforced in Germany since 1889, but they are well worth reading by those who are anxious to bring to an end particularly dangerous industries, especially when they are carried on in the homes of the workers.

Hatters Furriers’ Processes.—Mercury in the form of a dilute solution of the nitrate is used in the preliminary process of felt hat making to increase the felting properties of the rabbit fur. The industry employs in the mercurial process alone between two and three hundred men and women. After the longer hairs have been removed by fur pullers, the rabbit skins are subjected to a process known as “carotting,” in which they are brushed with[442] the above solution. When dried they are brushed by machinery to loosen the fur, and then each rabbit skin is passed through an ingenious machine with rotating knives so arranged as to cause the skin to be shaved off in strips, leaving the fur intact.[99]

Few combinations can be imagined more likely to affect detrimentally the health and more particularly the teeth of workers than that of mercury and nitric acid. As might be expected, those engaged in “carotting” show in most marked degree injury to the teeth from the nitric acid fumes, the typical condition of which has already been described, while tremor and erythism predominate in those engaged in the later processes as the result of the inhalation of particles of fur impregnated with the nitrate of mercury.

The following figures make this clear, giving the result of an examination made by me of 111 persons in eight different factories, who had worked for one year and upwards—

A “fur” as received from the cutting machine, analysed in the Government Laboratory, was found to contain 1.34 per cent. of nitrate of mercury. The mercury forms a very insoluble combination with the keratine in the hair which is not removed in the subsequent processes of felt hat making. Jungfleish[100] found in a layer of felt which had been deposited on the revolving cone used in making hats nearly 0.5 per cent of metallic mercury, and in a felt hat which had been worn for a long time 0.7 per cent. Nevertheless, mercurial poisoning even of slight degree does not occur, or at any rate only very exceptionally, in the later processes of felt hat making.[101]

Preparation of Mercurial Compounds.—In factories where mercurial compounds are made, such as calomel, corrosive sublimate,[443] the red oxide (largely used as an anti-fouling paint for ships’ bottoms), and vermilion, there is considerable evidence of mercurial poisoning among the workers. For instance, of 27 men so employed, I found in four (15 per cent.) more or less salivation, and in ten (37 per cent.) tremor, besides such other symptoms as anæmia and gastric derangement. Danger arises from the volatilisation of the metal in the subliming operations, and also to some extent from the dust which, though very heavy, can become scattered, if such processes as mixing, sifting, and grinding are not carried out with care in closed-in vessels.

Calomel, subchloride of mercury (HgCl), is made either by intimately mixing corrosive sublimate with metallic mercury and subsequent sublimation, or by mixing definite proportions of mercuric sulphate, metallic mercury, and common salt. The mixture is then heated so that the calomel may pass off as vapour and be condensed in the cool subliming chamber. Finally, it is ground wet, dried, and sifted. All these later stages in the preparation must be carried on in a closed apparatus, and with observance of great care.

Corrosive sublimate, the bichloride of mercury (HgCl₂), is made by heating two parts by weight of mercury with three parts of strong sulphuric acid. To the mercuric sulphate so formed when dry, one and a half parts of common salt are added. The corrosive sublimate is converted into vapour by heat, and condenses on the upper cooler portion of the vessel in lustrous colourless masses, leaving a cake of sulphate of soda below. The sublimate is then scraped out, and usually undergoes no further treatment such as grinding. The operation of sublimation requires very constant attention on the part of the worker to prevent the vessels in which the vapour sublimes being overheated, and so allowing its escape.

In the preparation of red oxide of mercury, nitrate of mercury is first made, in which care has to be taken that the fumes so developed are carried away by ventilating shafts in connection with each vessel. The crystals formed after evaporation are ground with addition of metallic mercury, and then heated in an oven. Nitrous fumes are evolved, and the oxide, black when hot, turns to a brilliant red crystalline powder on cooling. Finally, it is ground wet, dried, and sifted.

Vermilion, sulphide of mercury (HgS), is made by mixing excess of sulphur with metallic mercury in closed rotating[444] wooden drums. Black amorphous sulphide of mercury results,[102] which on heating to 150° C. becomes converted into a dark violet powder. From this vermilion is obtained by sublimation, a process attended with risk from escape of vapour. Finally, it is ground wet, and according to the fineness of the grinding so is the particular shade of colour obtained.

The manufacture of calomel, corrosive sublimate, and vermilion can be made by a wet method throughout without danger, provided reasonable care is taken.

Preventive Measures.—The conditions to be aimed at in places where metallic mercury is handled (and for the most part also in places where salts of mercury are used), are as follows:—

1. The flooring and benches should be smooth, impermeable, and free from cracks or crevices in which mercury can lodge. Preferably the floor should be of some kind of asphalt or cement, laid in such a way that channels all converge towards a receptacle where the scattered mercury may collect. Wood, although at present in common use, is not well adapted for the purpose. The receptacles should be covered over, leaving only a narrow opening for the mercury to run in.

2. There should be ample light, and the windows of all rooms where mercury vapour may be produced should preferably face the north.

3. Mercurial processes should be carried on in rooms separate and distinct from the other workrooms.

4. Any unnecessary raising of the temperature above 60° F. is to be avoided, and consequently there should be no direct heating of the rooms by open fires or stoves.

5. Mechanical ventilation should be provided, and reliance not be placed merely on differences of temperature between the outside and inside air. Inlets for air should be above the level of the heads of the workers, and the draught of the fan should be a downward suction one.

6. Workers should wear overalls and head coverings.

7. Shortness of the hair, shortness and cleanliness of the nails, a proper hygiene of the mouth, and baths, would do much to protect the workers. Ample washing convenience, including soap, nail brushes, and towels, should be provided.

8. Meals should be prohibited in any room where mercury is handled.

[445]

9. Periodical medical examination, with power to the surgeon appointed to suspend temporarily or permanently from work.

In two of the largest factories in which mercurial preparations are made, in addition to the carrying out of all dusty processes such as mixing and sieving, as far as possible, in a closed-in apparatus, the following measures have been taken:—

In hatters furriers’ processes the remedial measures required are rather different, although suggestions (6), (8), (9), and part of (7) equally apply. It is necessary in this industry to remove the fumes arising from the solution of nitrate of mercury in carotting, and to secure the absence of dust at the cutting machines, either by perfecting the machinery and fittings of the receptacles into which the bulk of the dust is carried by the revolving knives, or by increasing this draught by means of a fan. This latter mode has been adopted with success both as regards removal of dust and economy of work. It is desirable, too, that the primitive stoves at present in use for drying the “carotted” skins should be replaced by the kind now commonly to be found in steam laundries, of “horses” sliding in and out of the heated chamber on rails.

By the French law of 13th May 1893, the treatment of the skins and fur of hare and rabbit skins with nitrate of mercury is scheduled, with others, as an industry in which neither children nor females may be employed.

T. M. Legge.

Peculiar lesions—erosion of the septum of the nose and the production of ulcers on the skin—are caused by bichromate of potassium or sodium. Erosion of the septum is found only among persons engaged in the manufacture of the salts, but ulceration of the skin of exposed parts, principally the hands, although most severe and most frequently met with among the same class of operatives, may be detected among persons engaged in the many industries in which the salts are used in solution.

Bichromate of potassium and sodium, commercially known as “bichromes,” are used largely—

1. In the manufacture of colours, such as the various chrome yellows, by the interaction of lead acetate and bichromate of potassium.

2. In dyeing and calico-printing. In dying cotton yarn the material is soaked in lime water, and, after wringing, is transferred to a vat containing lead acetate. It then passes through a solution of bichromate which develops the yellow colour on the fibre.

In calico printing potassium bichromate is used in the indigo blue discharge style, when it may be printed from a paste containing 40 per cent. of bichromate, which will discharge the colour from the blue material after suitable treatment. Or it may be used for the production of chrome lead colours by first printing the desired pattern on the calico with a paste containing acetate of lead, and subsequently passing this through a 2 to 5 per cent. solution of bichromate.

Potassium bichromate is the most important mordant for wool. The mordanting bath is prepared with 2 to 4 per cent. potassium bichromate (of the weight of the wool) and the necessary quantity of water, amounting to from 50 to 100 times the weight of wool.[103]

[448]

3. In photography. The carbon process depends on the fact that gelatine and potassium bichromate combine under the influence of light to form a compound which is insoluble in hot water. The strength of the bichromate solution for this process does not exceed 5 per cent.

4. As an oxidising agent for the manufacture of coal tar colours, for the bleaching of oils, etc.

The first full account of the lesions arising in the course of the manufacture of bichromate was given by Bécourt and Chevallier in 1863.[104] In 1854 Heathcote published in the Lancet[105] an account of obstinate ulceration of the tonsils and pharynx observed in a worker in a bichromate factory. No such extensive ulceration as he describes has been recorded since.

A very complete description of the processes and of the clinical symptoms shown by the persons employed, together with suggestions for improving the conditions of working, was given in a joint paper by Delpech and Hillairet[106] in the years 1869 and 1876. They believed that any part of the skin might become ulcerated if exposed long enough to the action of the dust. In no case did they find that the ulcers penetrated into the joints, or that the bones of the nose were attacked. They believed that the action of the dust set up in some cases bronchitis and asthma.

In 1893 the effect of bichromate on the health of the workers was referred to in the Report of a Departmental Committee of the Home Office on the conditions of labour in chemical works, and, as a result, special rules prescribing protection of vessels containing bichromate in solution, respirators, due means for the removal of dust, waterproof gloves, and lavatory accommodation, were drawn up.[107]

In 1895 the conditions found in the German bichromate factories was made the subject of an interesting official report by Dr Wutzdorff,[108] assisted in the chemical part by Dr Heise.[449] Following upon the recommendations made by Dr Wutzdorff, stringent regulations were drawn up to govern the industry in Germany.

In 1899 considerable stir was created in Glasgow by the publication by the Labour Leader of a series of pamphlets directed to show, among other things, that in certain factories in Scotland the conditions of work were still unhealthy. In that year I visited all the factories in this country, and a code of special rules printed elsewhere in this volume now governs the industry.

Potassium bichromate is made by roasting a mixture of chrome ironstone, potash and lime, lixiviating the fused mass with water, and adding enough sulphuric acid to convert the neutral chromate into bichromate. The reaction may be represented as follows:—

Sodium bichromate is made in practically the same way, sodium carbonate taking naturally the place of potassium carbonate. In the crushing and grinding of the chrome ironstone much dust permeates the air, but this mineral dust does not give rise to the peculiar lesions associated with the bichromate.

After having been ground to a fine impalpable powder the chrome ironstone, mixed with lime and potash, is introduced into a furnace and roasted for about three hours. When withdrawn from here the fused mass or “batch,” as it is called, consisting of neutral chromate of calcium and potassium, after being allowed to cool, is broken up and shovelled with evolution of much dust into large vats or “keaves.” Water and potassium sulphate in solution are added, and at this stage, owing to the slaking of the uncombined lime, much steam, carrying with it particles of chromate dust, arises. The solution, when concentrated by passing through successive keaves, is pumped into evaporating pans, which are almost invariably entirely covered in and communicate with the outside air by means of a shaft running through the roof. Sulphuric acid is next added, forming potassium sulphate and potassium bichromate. The former is withdrawn, and the latter, when sufficiently concentrated, is pumped into lead-lined tanks, where crystallisation is usually completed within three weeks. The crystals form beautiful large adherent masses on the sides and floor of the tanks. They are broken up by a pick, removed on barrows to be washed, dried in open stoves by hot-air or steam-pipes, and finally packed in barrels.

[450]

Sodium bichromate does not usually crystallise, but forms a solid cake which requires to be broken up.

The particular lesions associated with the manufacture are found among all classes of men employed, from the moment the fused mass is removed from the furnace, until the crystals are headed up in the barrels. Inasmuch, however, as all the processes are carried out in one large common shed, it is a little difficult to determine the relative degree of danger attaching to each operation.

The rafters immediately above the keaves are coloured a canary yellow, from the neutral potassium chromate carried up by the steam; a sheet of cardboard suspended at a height of 2 feet above an evaporating pan becomes covered in a short time on its upper surface with innumerable small brown specks of bichromate—a precipitation which must result from the cooling of the steam; a stranger present for only a few minutes while the packing is being done has the mucous membrane of his nose acutely inflamed for hours or even days afterwards. These facts show how permeated the atmosphere in the shed can become from the dust and fumes from the bichromate. Breaking the crystals is the source par excellence for the development of chrome sores.

Dr Heise, in the paper already referred to, estimated quantitatively the amount of bichromate dust in the air where the different processes were carried on. Thus he found 1 cubic metre of air near to the place where three men were breaking up a cake of sodium bichromate contained 6.30 milligrammes. One cubic metre taken during the fifteen minutes during which packing was done contained 1.57 milligrammes. As regards the steam, he found 1 cubic metre taken at a height of 45 centimetres above the level of the evaporating pan contained 0.736 milligrammes of sodium bichromate. In general, considerably less bichromate was found in the air over the evaporating pan than where the dusty processes were carried on.

The following is the result of an examination I made of 176 men exposed to work at one time or another in the chrome house:

In most of the cases where the septum was found ulcerated[451] but not perforated, the duration of employment had not been sufficiently long for the ulceration to proceed to perforation.

In none of the 30 men in whom the septum was found to be normal was the immunity attributable to shortness of employment. Six were connected with the management, 6 were blacksmiths or coopers, 10 were furnacemen, 4 were engaged at the keaves, and 4 in the crystal house. One-half of them had been employed for upwards of ten years.

There can be no doubt that the mucous membrane covering the septum is attacked more readily in some persons than in others, and I incline to the view that an immunity may be acquired if the first few months are passed without ulceration taking place.

The rapidity of its onset is remarkable, as is shown by the following table:—

Duration of Employment where the Ulceration had not progressed to Perforation.

Perforation was noted as having already occurred in one instance where the duration of employment had been seven weeks, and in two others it had been less than three months. Usually, it appears to take place between the sixth and twelfth month after commencing work. Most of the men examined worked in the crystal house, and all except the four mentioned had either ulceration or perforation of the septum. The majority of the furnacemen also had perforation, but in them the septum was found normal more frequently than was the case with the men employed in the crystal house.

Nature of the Perforation.—The cartilaginous framework of the nose consists of five pieces, the two upper and the two lower lateral cartilages, and the cartilage of the septum. The two upper and the two lower lateral cartilages give the nose much of its shape, and form the alæ nasi. The ulcerative process due to bichromate dust never attacks them. The cartilage of the septum is somewhat triangular in form, and thicker at its margin than at its centre. Its anterior margin, thickest above, is connected from above downwards with[452] the nasal bones, the front part of the two upper lateral cartilages, and the inner portion of the two lower cartilages. Its posterior margin is connected with the perpendicular lamella of the ethmoid; its inferior margin with the vomer and the palate processes of the superior maxillary bones. The seat of election for the ulceration to commence is a point about a quarter of an inch from the lower and anterior margin of the septum, and it extends in a direction upwards and backwards.

The limitation of the perforation to the cartilage of the septum is accounted for by the fact that the mucous membrane covering it is adherent, forming the perichondrium, and is far less vascular than the mucous membrane lining the rest of the nasal fossa. Once the mucous membrane is destroyed, the blood supply to the cartilage is cut off, and necrosis ensues. The ulceration having progressed upwards as far as the junction of the septum with the ethmoid and backwards to the vomer, becomes arrested. Healing then takes place, the bone not being attacked, and the cicatrix usually becomes covered with an ecthymatous crust of mucus.

In no instance was the anterior or lower border of the septum destroyed. Consequently, the rigidity of the parts is maintained, and deformity, so prominent in other ulcerative processes attacking the nose, absent.

The onset of the morbid process is ushered in by sneezing and the ordinary symptoms of nasal catarrh. The pain accompanying the ulceration appears to be insignificant. It had never been severe enough to necessitate absence from work or to call for medical treatment.

Once the perforation is established, the only inconvenience which results is the formation of plugs of mucus in the nasal passages. The general health is in no way detrimentally affected by the condition. Considering the extent of the lesion, the number found with marked impairment of the sense of smell is not large. Mucous deposits and white patches were occasionally noted on the pharynx, but definite ulceration, such as has been described in bichromate workers, was in no case detected. Asthma, noted by the French writers on the subject, Delpech and Hillairet, was found in one instance—that of a partner in one of the works. In his case there was a family predisposition to it, but the first definite attack dated from contact with bichromate.

Ulceration of the Skin.—In 39 out of the 176 men engaged in chrome processes, one or more unhealed ulcers or “chrome[453] holes” were observed. In these and in several others, numerous scars marking the site of bygone ulcers were noted.

A chrome hole is a sluggish ulcer. It results from a cut or abrasion of the skin coming into contact with bichromate in the form of crystals or solution. The seat of election is either on the knuckles or at the base of the nail, but they may occur on any part of the hands or forearm. In two cases they were observed on the neck, once in the groin, and once on the foot. The tissues around are raised, thickened, and indurated; the centre is filled by a slough, usually covered by a scab, and the whole resembles a large boil. When the slough has been removed the floor of the ulcer is seen to consist of greenish-yellow granulation tissue. In the majority of cases the central scab is not more than ⅛ inch in diameter, in a few it is ¼ inch, and the largest that I have seen measured, ¾ by ½ inch. Chrome holes occur principally among men engaged in the crystal house and at the keaves, and only rarely among the furnacemen. The amount of pain and inconvenience they cause is considerable. Sometimes they necessitate absence from work, but they are never a menace to life. At one works six men were absent during 1898 for periods varying from three to nine weeks, on account of chrome holes. Even when their severity is not such as to necessitate absence from work, months may elapse before they heal.

The treatment adopted by the men is of the most elementary description, and naturally under these circumstances they prove intractable.

The conditions found by Dr Wutzdorff in the German bichromate factories were very similar. Ulcers of the external skin were found most frequently on the fingers, hands, and arms, then on the feet and legs; once an ulcer was found in the external auditory meatus and three times on the eyelids. The ulcers penetrated deeply into the soft parts, and required, in consequence, a long time to heal. In no case had they penetrated as far as the tendons, or into the joints. Ulceration and perforation of the septum was found in workers in several factories, and ulceration of the gums and pharynx of slight extent was observed twice. The general condition of the workpeople was apparently good—at all events no worse than that of chemical workers generally.

The preventive measures necessary in the manufacture of potassium or sodium bichromate will be found stated in the regulations printed elsewhere in this volume. They resolve themselves generally into removal of dust and fumes, cleanliness, and[454] medical supervision periodically of the workers, and the covering up of cuts and abrasions with suitable dressings. When in solution the salt does not attack the unbroken skin. Indiarubber gloves are sometimes worn by the men in dye-works who are constantly engaged in processes in which bichromate is used in dilute solution, but in view of the difficulty of enforcing their use, and the fact already stated, that unless there is an abrasion of the skin a chrome hole will not be developed, the wearing of indiarubber gloves, while a thing to be recommended, can hardly be made compulsory. It is advisable that in all dye-works the foreman should be made responsible to report all men suffering from abrasions of the skin, or from chrome holes, to the manager, in order that they may have proper treatment, and be put to other work until such time as healing has taken place.

In photographic processes involving the use of bichromate, if there is any tendency to the development of eruptions on the hands, careful washing and subsequent treatment, when thoroughly dried, with lanolin or glycerine should be tried. If this fails, rubber gloves must be worn.

T. M. Legge.

The two substances, the dangers to health attendant on the working of which form the subject of this chapter, present widely different features, both as regards their essential natures, their treatment during the processes of manufacture, and the treatment they subsequently receive. The one being a metal and the other an alloy, the primary processes in the first case are those of mining and of reducing the ore; while in the second, the admixture of metals in such proportions as the particular alloy requires is the first detail of treatment. A similar process of casting into ingots follows with both substances, but the malleable and ductile qualities of copper render its subsequent treatment, in the various processes of manufacture, dissimilar to that of brass and its kindred alloys.

There are, moreover, marked features of dissimilarity in the constituents of brass and of copper ore of especial importance in any consideration of unhealthy conditions attendant upon working in these substances. The form of copper ore which is most largely smelted in England is copper pyrites, an ore which is largely composed of sulphur, while in various ores arsenic is found. Brass and similar alloys, on the other hand, are composed of copper and zinc; and as we shall see later in this chapter, it is to the presence of the latter ingredient that in our opinion may be attributed the illness known as “brassfounders’ ague,” or at all events the abnormal amount of ill health found to exist amongst brass mixers and casters.

Although it might be more natural to discuss the metal in the first place, and the alloy of which it forms a very important part in the second, we will reverse that order, owing to the much greater degree of importance, from a sanitary point of view, which attaches to the working of brass than to that of copper. Prefacing, therefore, our remarks on the dangers attending the working in brass by an outline of the processes involved, it will be sufficient for our purpose to quote from a Report of a Committee of the Home[456] Office appointed in 1894 to inquire into the conditions of labour in the manufacture of brass and of kindred amalgams, and of which we had the honour of being members. It is explained that, in the first instance, an alloy is made at a very high temperature in crucibles which are plunged into sunken furnaces, the principal components of the alloy being copper and zinc (commonly called spelter) mixed in proportions varying in accordance with the quality of brass required. An example of a deposit resulting from the pouring of common or yellow brass taken by the Committee is as follows:—

Other amalgams, such as gun metal, phosphor bronze, and bell metal, yield different proportions, while in some cases it is found that old copper and brass scrap, such as discarded locomotive and marine boiler tubes, are thrown into the mixture. The alloy thus mixed is poured into iron moulds or ingots, to be remelted when required; or it is at once poured into moulds which have been already prepared by patterns to receive the metal, and in which the formation of the castings takes place. Previously to receiving the metal the mould has been dusted over with fine dust either of burnt loam, sand, burnt red brick, charcoal, French chalk, or bean flour, according to the requirements of the work. The moulds are, roughly speaking, iron rims clamped together, and filled with very fine sand in which the patterns have left impressions for the reception of the metal, hence the name of sand-casting possessed by this process. Should the metal be required for sheets, tubes, or wire, it is poured into iron moulds or ingots, to be subsequently rolled or drawn as required, and this process is called sheet or strip casting. Having procured its shape, the brass article or casting is subjected to further processes on its way to completion, such as (1) that of dipping in aqua fortis and in acid solutions of various strengths for the purpose of removing oxidation and impurities; (2) that of burnishing or of polishing at a lathe to acquire a smooth surface; (3) that of finishing or dressing; and finally (4) that of lacquering, which is an application of a solution[457] of shellac and other ingredients to the work (specially heated for its reception on a stove) with a view of securing the colour desired; also (5) a process of bronzing is also undergone when a particular effect is required in the appearance of the article. In either of these processes, which involves the pouring of the molten alloy, the zinc deflagrates during the pouring, and a dense white smoke is formed, which almost instantaneously fills the atmosphere of the casting shop. This smoke is rapidly converted into snow-white flakes and white powder, consisting of the oxide of zinc, which remains for some time diffused through the atmosphere of the shop, and in ill-ventilated casting shops collects upon the rafters and ceiling in the form of a dense white incrustation. The quantity of these fumes depends, firstly, upon the amount of zinc employed; secondly, upon the ventilation of the shop; thirdly, upon the weather—a dull, foggy day preventing their escape. It may be readily imagined that persons exposed to the alternations of heat and cold in the casting shop, to the deflagrated zinc inhaled as well as imbibed with food and drink, and the intense thirst induced by the nature of the work, would suffer in health. That such is the case the evidence submitted to the Home Office Committee was ample and conclusive. It must not, however, be assumed that nothing was previously known upon the subject, or that no steps had been already taken in the endeavour to improve the shops or in other ways to ameliorate the condition of the workers.

The recognition of working in and making brass as causative of disease is due to Dr Headlam Greenhow, who, in 1862, read before the Royal Medical and Chirurgical Society a paper on “Brassfounders’ Ague.” This was based on his experience while paying a brief holiday visit to Birmingham in 1858, in connection with his investigation of trades injurious to health. It is curious that he should have selected for his title the name of a disorder which undoubtedly occurs, but which, as we shall endeavour to show, is only an acute expression of a chronic malady, and one which rarely or never comes within the range or experience of practising physicians. In the out-patient department of the Birmingham hospitals one meets with an enormous number of brass-workers complaining of various pulmonary and gastric disorders; but an experience of many years has never yet produced to us a case of this so-called ague, although questions will very frequently elicit the statement of its occurrence. The literature of the subject is very scanty, but Greenhow quotes[458] Thackrah’s essay on the “Effects of Arts, Trades, and Professions on Health and Longevity,” published about 1830, as well as the writings of a few Frenchmen, which have not, however, materially advanced our knowledge of the disease. Thackrah’s observations were clearly inaccurate and imperfect, for he mentions only “ague,” which he speaks of as an intermittent fever, attacking brass-workers from once a month to once a year, and leaving them in a state of great debility. Dr Hogben, Physician to out-patients at the Queen’s Hospital, Birmingham, published a very interesting paper on this subject in the Birmingham Medical Review in May 1887. Dr Greenhow refers only to ague and bronchial disorders, and very cursorily to nervous troubles, as resulting from brass casting; but Dr Hogben mentions also colic, constipation, and dyspeptic troubles which result from this occupation. Dr Greenhow, on the one hand, refers all the symptoms to intoxication by zinc, while Dr Hogben thinks they should be rather referred to chronic copper poisoning. These two metals are the principal ingredients in the making of brass, as already mentioned.

That Thackrah was in error in speaking of brass ague as an intermittent affection, occurring once a month or once a year, is clearly proved by the following positive observation, which is supported by all brass-workers. Ague never occurs among the regular workers, but always affects those who are new to the work, or who resume work after an absence of even a month or a fortnight. If a man resumes work, that is melting or casting, after even so brief an interval, he is sure to have an attack of ague, but he will have only one attack, and remain free until after his next holiday. There is most certainly no kind of regular intermission, and according to brass-workers themselves, they only suffer till they are inured to the poison. The following are the symptoms of this so-called ague. After working a few hours, a man becomes languid, depressed, and feels very cold. He is very pale and almost in a state of collapse, his face is covered with a cold perspiration, he shivers, his teeth chatter, and he is restless and anxious. His head aches, there is much nausea and complaint of muscular pains. As a rule he goes or is led home, where he drinks freely of milk and goes to bed. The symptoms continue until he has vomited, either as the result of taking an emetic or independently of it. Vomiting is usually followed by sleep or recovery, with more or less of debility and lassitude on waking. Drs Greenhow and Hogben[459] speak of a more or less marked hot stage succeeding the cold, while following the hot stage they mention profuse sweating. The hot stage may be absent, but the sweating, according to these writers, invariably occurs. Our own observations, based on inquiry amongst those who have suffered from this ague, have never elicited a statement of these hot and sweating stages. Even direct questions as to their occurrence have always been met with positive negation, though some have spoken of free perspiration in the stage of collapse. How to reconcile these statements we do not know. The cycle of events as recorded by Greenhow is just that of ordinary ague, from which this disease differs, otherwise than in the suggested sequence, in toto. The inquiries we have made do not support such a sequence, and certainly not a relationship to malarial ague. The symptoms are just such as would be caused by the ingestion of a quantity of irritant metal, sufficiently large to cause vomiting, and its attendant depression. Such, indeed, is our opinion of the causation of the symptoms, and therefore the name “ague” should not be continued, as being wrongly suggestive and misleading. It will be remembered that it is only when fresh to the work that brass-workers suffer from “ague,” but, though they do not suffer from acute metallic poisoning, they do suffer from its chronic effects, and it is extremely probable that, as with arsenic and opium eaters, they may become inured to the use of the metals.

As it is not very common for brass-workers to use tooth brushes, the accumulating tartar is usually found coloured green. Even when an attempt is made to cleanse the teeth, they still show signs of green discoloration. This has been proved to be due to the presence of copper. The white hair of the workmen is often coloured green, and the underclothing is stained green by the perspiration. The gums may be slightly blackened at the edges, but there is nothing distinctive as in the case of the blue line of lead poisoning; nor, indeed, beyond the green colouring of the hair and teeth, do brass-workers present any unequivocal evidence of their calling.

Ague is not a disorder for which brass-workers consult a medical man; they know how to treat it themselves, and also that it is transitory in its effects; but they come to hospitals in large numbers to be treated for bronchitis. As regards this there is nothing special. The men suffer from it in common with all workers in dusty trades, and so far as we can learn from the[460] Secretary of the Brass-workers’ Organisation, they usually die from chronic bronchitis or fibroid phthisis, unless they succumb to some acute malady. The existence of nervous disorders, especially paralysis agitans, has been said to be common among them, but we cannot find that a larger percentage of brass-workers than of the rest of the community suffers from diseases of the nervous system. It is common, however, to meet with complaints of disturbance of the digestive function. Brass-casters suffer from dyspepsia, loss of appetite, gastro-intestinal catarrh, nausea, vomiting, metallic taste, thirst, colic, constipation, and diarrhœa. They are often nervous and hypochondriacal, and complain of headache as well as muscular pains. There is nothing distinctive about any of these disorders, except the obstinacy with which they resist ordinary methods of treatment, and the readiness with which they yield to the administration of iodide of potassium in combination with the other drugs indicated by the various conditions of ill-health. All the symptoms bear a remarkable resemblance to those produced by chronic copper poisoning. In Guy and Ferrier’s Forensic Medicine, an outbreak of copper poisoning from the use of copper vessels in cooking is recorded, in which the symptoms were almost identical with those here mentioned. The inmates of a convent suffered severely from obstinate and severe colic, retching, and bilious vomiting, costiveness, and flatulence, burning pain in the pit of the stomach and extremities, and paralytic weakness in the arm. According to Stephenson it is impossible to distinguish between the symptoms produced by zinc and copper poisoning. These are just such as brass-workers suffer from, and it is, therefore, impossible to say which metal—copper or zinc—is most concerned in the production of these symptoms. Dr Greenhow attributes them all to the inhalation of the deflagrating zinc. This forms oxide of zinc, which is only sparingly if at all soluble, and, therefore, is not likely to be freely absorbed into the stomach. Greenhow pays little or no attention to the common and chronic gastric and intestinal troubles to which brass-workers are liable. These affect all who work in the various processes by which, either in vapour or in minute particles, copper and zinc—that is, brass—are distributed in the atmosphere. Dr Hogben, on the other hand, considers copper alone to be the efficient cause of the symptoms, and advances the following arguments:—

1. We have no evidence that the internal administration of zinc ever produces the symptoms of brass ague. Enormous[461] doses of the oxide have been administered without apparently producing the characteristic febrile reaction of brass ague.

2. The malady is observed in individuals whose work is other than casting.

3. The malady is not observed in operatives, such as galvanised iron workers, who work with zinc, and are exposed to its fumes.

4. Zinc is rapidly excreted, and does not, like lead, mercury, or copper, become fixed in the body, and produce chronic affections.

It seems more probable that, accepting Stephenson’s statement of the impossibility of distinguishing between the effects of acute copper or zinc poisoning, the symptoms of ague are due to an admixture of the two metals; whereas, for the chronic complaints, the copper is responsible. How the practice of taking milk during an attack of so-called ague has arisen is not clear; but its wisdom is proved by the fact that in cases of both copper and zinc poisoning milk is one of the best antidotes, since it precipitates both these metals into insoluble albuminates. It is abundantly evident that brass-workers are especially liable to diseases from the use of the metals employed in its manufacture, but these are not new disorders; they are either proofs of chronic poisoning by zinc or copper, or, as in the so-called ague, are due to intoxication by them. If more proof were wanting of the unhealthiness of brass-casters, it would be afforded by the fact that a few years ago, though there were 1200 casters in Birmingham, there were not more than ten over sixty years of age, and in connection with a superannuation fund of the Amalgamated Brass-workers’ Association from which casters could at the age of fifty-five derive benefit, it is an appalling fact that there were only three men—two in Birmingham and one in Sheffield—enjoying this benefit.

That such a condition of affairs should be allowed to remain unremedied, if remedy was possible, was improbable after special power was vested in the Home Secretary by the Factory Act of 1891 to deal with processes which he deemed dangerous or even injurious to health.

The desirability of observance of certain general principles, such as temperance, cleanliness, and care in the matter of taking food, was obvious not less in the case of brass-workers than of other operatives. These need not be enlarged upon by us, although their importance towards securing health and[462] happiness in a man’s declining years are sadly overlooked among the working classes. But it was felt that there should be some definite rules officially published for the healthy conduct of brass-working.

A series of rules designed to that end were tentatively issued with the approval of the Secretary of State by Mr R. E. Sprague Oram, C.B., then Chief Inspector of Factories in 1894, but although possessing features of stringency which appear not unwarrantable under certain conditions of brass-working, they were generally felt to be unnecessary in the case of working in alloys in which the percentage of zinc was either relatively small, or indeed from which it was entirely absent.

Official attention had, however, been thoroughly aroused to the necessity of action, and in November 1894 a Departmental Committee was appointed by Mr Asquith, Secretary of State, to report upon conditions of work, so far as they affected the health of operatives in the various processes connected with the working of brass, gun metal, bell metal, and other kindred amalgams. Subsequently too at Birmingham, which may be regarded as the home of the brass trade, the Committee held sittings and made inquiries in various parts of London, in Willenhall, Wolverhampton, Edinburgh, Glasgow, Sheffield, and Rotherham, and were assisted by the evidence of a large number of manufacturers, artisans, factory inspectors, physicians, and others, on which their report to the Home Secretary of State was based. The report largely deals with matter already given in this chapter, but drawn as it was immediately after the accumulation of the best evidence on the subject which could be procured, and for the elicitation of which no further opportunity is likely to arise for the present, it is desirable that the conclusions arrived at should be given. Having stated that during the inquiry the Committee had met with ample evidence of the existence of such symptoms as have been described above, the report adds that the attention of the Committee had been, by personal observation and experience, especially drawn to the causes and symptoms of the so-called “ague,” of which the members had no reason to doubt zinc fumes were the efficient cause; that it considered the danger of working in the several alloys was proportionate to the amount of zinc contained; that the danger was increased by the use of such ingredients as discarded locomotive and boiler tubes, and such-like scrap; also that the symptoms were caused by the inhalation of the zinc fumes, and by the introduction[463] of the particles of zinc into the digestive tract with such food as might be eaten in the casting shop. The conclusion arrived at was that, “Although in brass-casting, as in all other occupations, the practice of personal cleanliness may serve to reduce the ill effects incident to the workers’ employment, yet if a brass-caster is constantly exposed to the influence of these fumes, it remains almost an impossibility that he should pass unscathed by them. The most serious efforts, therefore, should be directed by manufacturers and artisans alike towards the minimising of the ill effects which must of necessity be caused in the process of casting by these fumes; and the Committee are convinced, both from personal experience and from evidence which they have acquired from witnesses of all classes, that the direction of these efforts should lie towards securing a proper construction of casting shops, supplemented by a system of ventilation conducted on scientific principles.”

Shops properly constructed, scientifically ventilated, adequately provided with washing arrangements for the casters, and licensed by a competent authority, were the requirements suggested by the Committee as being absolutely necessary for the casters. The compulsory wearing of mouth coverings during the process of pouring the metal was felt, owing to hostile evidence given by the workers themselves, to be impossible for recommendation. Finding that “a great many witnesses considered milk to be a desirable thing to take when ill, but as a rule they preferred to take it at night, finding that it did not agree with them so well when taken in the shop, and in many cases witnesses did not think milk suited them personally,” the Committee did not consider it desirable to recommend the retention of the tentative rule requiring manufacturers to provide a supply of milk or other sanitary drink. The drinking of milk, however, as well as the wearing of a covering to the mouth and nostrils, was recommended for the casters. Further recommendations were, leaving the shop for the purpose of taking food, frequent ablution, care in the avoidance of taking cold, and of a regular and moderate diet.

Apart from the recommendations for optional courses of conduct were suggestions for specific rules. It was a matter of sincere regret to the Committee to learn that these were in some instances—such, for example, as the desired requirement that casting shops should be licensed—beyond the powers of enforcement vested in the Secretary of State. The special rules[464] which were issued subsequently to the report of the Committee underwent a slight modification more recently, and are now as follows:—

Form 271.

Factory and Workshop Acts, 1878 to 1895.

MIXING AND CASTING OF BRASS AND OF CERTAIN OTHER ALLOYS.

SPECIAL RULES.

Under Section 8 of the Factory and Workshop Act, 1891, and Section 28 of the Factory and Workshop Act, 1895, for the processes in the mixing and casting of Brass, Gun Metal, Bell Metal, White Metal, Delta Metal, Phosphor Bronze, and Manilla Mixture.

DUTIES OF OCCUPIERS.

1. They shall provide adequate means for facilitating, as far as possible, the emission or escape from the shop of any noxious fumes or dust arising from the above-named processes. Such means shall include the provision of traps or of louvre gratings in the roof or ceiling of any shop in which such processes, or either of them, is or are carried on; or in case of a mixing or casting shop which is situated under any other shop, there shall be provided an adequate flue or shaft (other than any flue or shaft in connection with a furnace or fireplace) to carry any fumes from the mixing or casting shop, by or through any such shop that may be situated above it.

2. They shall cause all such mixing or casting shops, whether defined as Factories or as Workshops under the Factory and Workshop Act, 1878, to be cleaned down and limewashed once at least within every twelve months, or once within every six months if so required, by notice in writing from H.M. Inspector of Factories and Workshops, dating from the time when these were last thus cleaned down and limewashed; and they shall record the dates of such cleaning down and lime-washing in a prescribed form of register.

3. They shall provide a sufficient supply of metal basins, water, and soap, for the use of all persons employed in such mixing or casting shops.

4. They shall not employ, or allow within their Factory or Workshop the employment of, any Woman or Female Young Person, in any process whatever, in any such mixing or casting shop, or in any portion thereof which is not entirely separated by a partition extending from the floor to the ceiling.

DUTIES OF PERSONS EMPLOYED.

5. They shall not partake of, or cook any food in any such mixing or casting shop, within a period of at least Ten Minutes after the completion of the last pouring of metal in that shop.

B. A. WHITELEGGE,

H.M. Chief Inspector of Factories.

July 10, 1896.

These Rules are required to be posted up in conspicuous places in the Factory or Workshop to which they apply, where they may be conveniently read by the persons employed. Any person who wilfully injures or defaces them is liable to a penalty not exceeding five pounds (Factory and Workshop Act, 1891, section 11). Occupiers of factories and workshop, and persons employed therein, who are bound to observe any special rules, are liable to penalties for non-compliance with the same (Factory and Workshop Act, 1891, sections 9 and 11).

These rules will be found to strike at the three principal causes of illness in the workers, viz.: (1) shops either structurally unfit for the processes of mixing or casting metal, or equally unfit on account of their dirty and zinc-coated condition; (2) the want of opportunity afforded to the casters of washing themselves before taking meals; and (3) the most pernicious habit, too common hitherto with the workers, of taking food in an atmosphere of deflagrated zinc. It will be noticed also that a prohibition is laid upon the employment of females in casting-shops. Their labour in connection with such work is limited to the making of cores, small blocks of sand which are used in the formation of hollow castings. The evidence of the witnesses examined before the Committee was in favour of this prohibition, also of core-making being carried on in a separate shop.

With regard to the other processes met with in brass-working, and which have been enumerated in an earlier part of this chapter, it cannot be said that they present any causes of illness differing from like processes in connection with other metals. Workers in the dipping-shop, and to a less extent in the bronzing process, are exposed to inhalation of acid fumes, and further, in the former occupation to exposure to the weather and to being obliged to stand on very wet floors. In a case brought to our notice, the powder used in bronzing contained lead to an extent of 7 per cent., a condition which might induce plumbism in the worker in the absence of due precaution. The dust which is given off during polishing is partly metallic in character, partly composed of a mixture of sand and lime, and partly textile fluff worn off the calico polishing discs by the process of work. Without doubt such dust should, as in all factories, be removed by fans or other[466] ventilating methods from the shop. The shops used for lacquering should similarly be freed from the unpleasant fumes of the lacquer, which cannot, however, be considered in any particular degree injurious to health. A most interesting paper read before the Midland Medical Society by Dr William Murray (subsequently printed in the British Medical Journal, 2nd June 1900) on Chronic Brass Poisoning, draws attention to another rather common form of plumbism caused by the process of “putting together” gas fittings, it being customary to solder the joints of these fittings with white lead, and then having closed one end of the bracket, to suck at the other to ascertain that the work is perfectly sound. We have recently met with a case of advanced paralysis in a man of forty-five apparently induced by this branch of brass-work. Dr Murray deals in detail with his method of treatment of cases of chronic brass poisoning, of which as Resident Surgeon of the Birmingham General Dispensary he has had considerable experience.

We hope we have shown that, firstly, the conditions of brass-working in all its branches require that the shops in which it is carried on should be well ventilated in order to secure the escape of the “smother” from the casting-shops, and of the conglomerated dusts from the polishing rooms; and secondly, these conditions require or rather demand habits of personal cleanliness and of self-respect on the part of the workers, habits which prescribe temperance, avoidance of taking food in the shop, and frequency and regularity of ablution. Such are now possible of attainment by the persons whose health is concerned, and it rests with themselves alone to make full use of the improvements placed within their reach.

Passing from the consideration of brass to that of copper, we find that there is little to be said regarding the working of that metal descriptive of any injury to health among its workers. Indeed it may be doubted whether any traces of such injury can be found. Having been mined in many quarters of the globe, the ore is subjected to the process of smelting, which, so far as Great Britain is concerned, takes place chiefly at Swansea, and also at St Helens and at Newcastle-on-Tyne. The qualities of the ores from different mining districts vary greatly, and the reducing processes of the ores vary correspondingly. Speaking generally, it may be said that the process consists of six operations conducted in reverbatory furnaces,[467] termed calcining and melting furnaces. At the conclusion of these processes the metal, freed from the arsenic, sulphur, and other accessories of the ore, is melted and cast into ingots, to be sent in that shape to various centres for manufacturing purposes.

During the smelting processes the sulphurous fumes either are collected in leaden chambers for purposes of condensation into sulphuric acid, or escape through the flues into the outside air. In neither case does the worker at the furnace suffer from these fumes, except, perhaps, when drawing the furnace he may experience some back draft of sulphur, an evil which may readily be met by the wearing of a handkerchief over the mouth while engaged in the operation. During recent years it may be mentioned that the first of the reducing processes is more commonly carried on in the vicinity of the mines, and as a consequence the ore on reaching S. Wales is now usually in the form of regulus. The denuded state of the country in the neighbourhood of the smelting furnaces bears witness to the unhealthy character of sulphur fumes. Dr Arlidge, however, notes an analysis of sickness in the Swansea district which tends to prove that though the fumes were very productive of acute pulmonary disease, yet the death-rate in parts of the country subject to their influence was lower than that in adjacent districts. We are told by Mr Lewis, who for many years has been the Factory Inspector in charge of the Swansea district, that although there is a prevalent impression that the furnacemen suffer exceptionally from chest mischief owing to the great heat and the fumes, he does not consider that they suffer in any degree more than the furnacemen in other metal processes. He forms the same opinion as that held by us in respect of the brass-workers, namely, that the workers are not sufficiently careful of themselves between shifts. He reports that the flue and chamber cleaners, as at other smelting works, rarely wear respirators; they will not ventilate the flues nor water the dust before commencing cleaning operations, and consequently the respiratory organs are more or less affected; he cannot find direct evidence of specific illness traceable to copper smelting. Mr Lewis attaches considerable importance to the provision of high and well-constructed stacks and flues, and to the due preparation of the chambers by ventilation and watering before the process of their cleaning takes[468] place. No special inquiry having been ordered concerning this subject, particular importance attaches to Mr Lewis’ opinion.

On the whole we do not consider that copper-working is in any way as dangerous an occupation as brass-working, for the pouring of metal is not accompanied by the same abundant vapours as in brass pouring, besides such vapour as does arise is mainly due to the presence of a small quantity of spelter in the mixture. The same precautions as advised for brass pourers should be taken, but the need is less; we have seen a pouring shop with a perfectly clear atmosphere five minutes after the pouring has taken place. A muffler or respirator should be worn during the operation, and, as far as we have seen, this is generally done. Apart from the pouring we have been struck by the excellent health of copper-workers, and as the dust is heavy, and does not float in the air, there are none of those respiratory troubles which, as we have seen, are the bane of brass-workers. There is one danger to which apparently they might be subjected, but we found no evidence of its having arisen, and that is from the accumulation of the heavy copper dust on the tables or boards at which the men are working. It seemed not unreasonable to expect that want of cleanliness on the part of the workers would entail digestive troubles from the mixing of copper dust with the food. As we have stated, no evidence of this is forthcoming. It will be seen that we are unable to confirm Dr Arlidge’s view of the dangers to copper-workers from the inhalation of copper dust, nor are we able, though contrary to our expectations, to assert that men employed in the trade are particularly liable to suffer from colic. According to Blaudet, this colic is attended by complete prostration, by vomiting and purging, and it is very probable that such results would follow, if the men were dirty in their work and habits, the introduction of copper dust by food taken into the stomach. Opinions are much divided on this subject, and it is possible that working in old copper and brass, which are covered with a carbonate of copper, may be responsible for the ill effects noticed. According to M. Perron of Besançon, clockmakers, who have to handle copper freely, suffer from a slow intoxication from it, exhibited by gastric derangements, diarrhœa, oppression, and some feverishness, but our own experience among copper-workers and other persons does not confirm these observations.

The conditions of improvement suggested both for brass[469] and copper working are those that should be applied to all manufacturing processes. Shops of good construction, well ventilated, and amply furnished with lavatory and other sanitary arrangements; these are desiderata for the workmen.

Indiarubber is used in the manufacture of waterproof garments, door-mats, toys for children, insulators of electric wires, tobacco pouches, etc. In the production of these articles large numbers of people find employment. During my visits to indiarubber works in Manchester and London I had several opportunities of observing some of the dangers incidental to the trade.

On entering a waterproof garment manufactory one encounters an extremely pungent vapour, which dries and heats the nose and throat, and is apt to make the eyes run water. This is the fume that comes from naphtha, which is used to dissolve the rubber and to form the dough that is spread as a thin layer by means of a roller machine upon the cloth about to be waterproofed. Both coal tar and mineral naphtha are employed. The vapour of naphtha is extremely irritating, and can be detected over the whole of the factory. The colour of the waterproofed material depends upon the pigment that is employed. If, for example, black is wanted, all that has to be added to the dough, composed of indiarubber and naphtha, is lamp black. The men who feed the roller machines, and who regulate the distribution of the dough upon the cloth, are constantly breathing the irritating atmosphere, but I did not find any special complaint in regard to it from them. It is the girls who work in the overheated and often overcrowded rooms of the factory that suffer most. They are usually very anæmic and complain much of headache. So saturated are they with the fumes of naphtha that even after they have left the factory they still feel the taste of naphtha in their food. In the workrooms these girls are employed rolling and pressing the garments; joining the seams, etc., by rubber dissolved in naphtha. On a winter’s night, when the gas is full ablaze, the air of the workroom is extremely pungent, so that girls are often obliged to leave the room and go into the open air for a short period. The[471] fumes of naphtha are more unpleasant than really dangerous; still there is no doubt that the constant inhalation of these fumes during working hours and the distaste for food thereby created cannot but in time undermine the health of the female worker, and render her more or less unfit for duty.

The dangerous process in the manufacture of indiarubber goods is not that in which naphtha is used, but bisulphide of carbon. In order to render rubber goods capable of withstanding alternations of heat and cold, and of retaining their elasticity in all kinds of weather, they must be vulcanised. The vulcanising agent is either the common flowers of sulphur or a compound of sulphur. When 50 to 60 per cent. of sulphur is added to rubber there is obtained a very hard product known as ebonite. Considerable care has to be taken in using sulphur. If, for example, too much sulphur is added to rubber, the goods become hard; 5 per cent. gives good elasticity. There are various ways of bringing indiarubber goods under the influence of sulphur. It may be done in the primary mixing of the dough, so that all that is subsequently required in the treatment of the waterproofed materials is exposure to a great heat, say 260° F. in a closed oven. Another method is to hang up non-vulcanised waterproofed goods for several hours in a hot stove in which there is a basin containing chloride of sulphur heated over a flame. These processes can scarcely be called dangerous, for they are conducted in closed chambers. The real danger lies in using as the vulcanising agent bisulphide of carbon, to which is often added a small quantity of chloride of sulphur. The bisulphide of carbon has an extremely offensive odour: it is very volatile and highly inflammable, but it is an excellent solvent for caoutchouc. To vulcanise indiarubber goods by means of bisulphide of carbon, the materials are passed through a solution containing about one thousand parts of bisulphide of carbon and from two to ten of chloride of sulphur. The indiarubber is dissolved by the carbon bisulphide and becomes incorporated with the sulphur given up by the chloride.

It is difficult to prevent the nauseating, offensive, and repellent vapour given off by carbon bisulphide penetrating the atmosphere of a workroom even when the room is provided with fans. Fortunately, in some respects, the work is carried on in the top storey of the factory. Here the long webs of cloth coated with indiarubber are vulcanised by being passed through a trough of bisulphide of carbon placed in front of rollers. Escaping at the distal end of the machine the cloth is afterwards hung up to dry. All the time[472] the men are at work in this room they are exposed to the vapour of the bisulphide. Inhalation of the vapour is liable to induce a subacute inflammatory condition of the nerves of the limbs known as peripheral neuritis, in consequence of which men lose the power in their arms and legs. Some of the men whom I examined had been paralysed in their lower extremities, had been off work for several months, and had only slowly regained the use of their limbs. Occasionally men may work as long as three or four years in the bisulphide department without becoming paralysed. Before actually losing the power in their legs the men suffer from inco-ordination; they stagger when walking. The workmen complain of the carbon bisulphide vapour making them drowsy and of their sleep being heavy. After working for a few hours in the vulcanising department, they feel tired and sleepy. Thick or foggy weather rather tends to favour the development of these unpleasant symptoms.

The pernicious effects of bisulphide of carbon are by no means confined to the men. The women and girls who dip very fine indiarubber goods—for example, children’s balloons, tobacco pouches, etc.—into the bisulphide, suffer even more severely than the men. The poisoning shows itself under two forms. In one the symptoms which are slowly developed are dizziness, headache, vomiting, lassitude, and not infrequently paralysis of the arms or legs. Many of the female workers complain of tasting the nauseous bisulphide in their food. The appetite thus becomes impaired. In the other form of poisoning, which may be spoken of as acute, the individual is really intoxicated. Girls have told me that on leaving the factory at night they have simply staggered home, they have even fallen as if drunk, or at the end of a day’s work they have had a splitting headache, and on reaching home have sat down, tired out, and fallen asleep before touching their evening meal. This sleep is heavy and non-refreshing. In the morning they drag themselves to the factory feeling ill and headachy, and, like people who are accustomed to the intemperate use of alcohol, they only get relief and recover their nervous equilibrium by renewed inhalation of the vapour of the bisulphide of carbon. Sad as this state of things is, it is nothing to the extremely violent maniacal condition into which some of the workers, both male and female, are known to have been thrown. Some of them have become the victims of acute insanity, and in their frenzy have precipitated themselves from the top rooms of the factory to the ground. In consequence of bisulphide of carbon being extremely explosive, vulcanisation by[473] means of it has generally to be carried on in rooms, one side of which is perfectly open. This open front is usually protected by iron bars.

Bisulphide of carbon, in addition to causing paralysis of the limbs and an exalted condition of the brain, induces a temporary form of amblyopia, or blindness. Women often suffer from excessive menstruation, and, if pregnant, they may abort. Girls sometimes become hysterical and excited. This form of toxic hysteria, like that in plumbism, often masks a deeper form of bisulphide of carbon poisoning. The individual becomes extremely loquacious; she shouts or sings, becomes very irritable, and may, when in this mood, perpetrate acts that are beyond her control and even beyond her consciousness. Just as in some people, after the excitement of alcoholic intoxication has passed off, there comes a stage of depression, physical and mental, so too after intoxication by bisulphide of carbon there is a period marked by great weakness of mind and body. Prolonged exposure to the vapour of bisulphide induces an enfeeblement of the intelligence that recalls the mental weakness of chronic alcoholic inebriety.

In addition to the risks from naphtha and bisulphide of carbon, indiarubber workers are said to be liable to consumption. Dr Philip of Edinburgh states that within a period of eight years he had under his care in the Hospital for Consumption 70 indiarubber workers, and that 85 per cent. of these suffered from respiratory diseases, the bulk of which was phthisis. His experience as to pulmonary phthisis has not been altogether confirmed by that of medical men elsewhere.

Prevention of Poisoning.—Ventilation of the workrooms is of the first importance. This cannot be secured by open windows alone. Owing to the inflammability of carbon bisulphide no fires and no naked lights are allowed in the workroom. The workpeople complain, therefore, of the cold, and as a consequence cannot but have their vital resistance reduced thereby. The air of this particular part of the factory is redolent of the offensive odour coming from the open troughs and basins. As carbon bisulphide is heavier than the ordinary atmosphere, the artificial means of ventilation that are required are such as shall draw the air of the workroom downwards away from the worker. No young person should be allowed to work in the vulcanisation of indiarubber by means of carbon bisulphide, nor should any adult be allowed to work more than five hours a day—two and a half at a stretch—separated by at least an hour’s interval, which should be spent in the open air, if possible, and away from the factory.

[474]

This is a kind of work in which there ought to be alternation of employment. All receptacles containing carbon bisulphide when not in use should be covered. The machines should be provided with down-draught suction fans. During the drying of the vulcanised waterproof goods no person should be allowed to enter the room where these products are hanging unless on business that is absolutely necessary. Naphtha receptacles should, when not in use, be kept covered. No food should be eaten in the bisulphide department, and it should be discouraged also where naphtha is used. Girls say that they sometimes can only eat food in the workrooms, because they do not taste the naphtha there. In the open air the food tastes as though it contained naphtha. Workers in the bisulphide process should be medically examined once a month, and the slightest indication of commencing paralysis or other nervous manifestation should be followed by suspension from work. Five hundred cubic feet of air space should be allowed to each worker.

Poisoning by bisulphide of carbon in its minor form generally disappears on removing the individual from his employment. By many of the workers, particularly girls who are extremely poor and ill-fed, suspension from work would be keenly felt, for to them the loss of the weekly wage is a serious matter. When peripheral neuritis has been induced and causes paralysis, recovery is usually tedious. The patient under these circumstances should be taken to a hospital, where under the influence of good food, rest, electricity, and tonic treatment, health will in most instances be regained.

In the Allgm. Medic. Central Zeitung, 22nd December 1900, Lazarus, a surgeon-dentist, draws attention to a new malady to which workers in gutta-percha are liable. In one year he observed twenty cases of dental caries and necrosis of the jawbone not unlike that met with in lucifer matchmakers, and known as phosphorus necrosis. Those workers, who on entering the factory were already the subjects of decayed teeth and carious stumps, are the most predisposed. With the exception of a young woman, aged 19 years, and who had worked in the factory for only two years all the other females who suffered were from 25 to 35 years of age. While Lazarus recommends a dental examination of the teeth of all the workers before entering a gutta-percha factory, he offers no suggestion as to the probable causes of the necrosis of the jaw in the patients who came under his care for treatment.

Thomas Oliver.

There are about fourteen authorised explosives in use in the United Kingdom, all of which contain, more or less, naphthalene and the aromatic nuclei, benzine, toluene, either singly or combined. These nuclei, when nitrated, form the usual combustible elements in high explosives.

The dinitro compounds of benzine exist in three varieties, ortho, meta, and para. The ordinary commercial form consists almost entirely of metadinitrobenzine, and is generally used in the manufacture of high explosives. This is in some cases mixed with a chlorinated hydrocarbon. The metadinitrobenzine is usually commercially pure, it rarely contains a trace of mononitrobenzine, or the lower oxides of nitrogen. A little free acid is generally found which colours the crystals yellow, and stains the hands of the workmen. It is very sensibly volatile at a temperature of 48° C. At ordinary temperatures it is solid, as are also its isomerides, para and orthonitrobenzine.

The proportions used in the various explosives differ very largely, ranging from 5 to 20 per cent. in the finished explosives. In a smaller number the mono, di, and tri nitrobenzine, toluene, and naphthalene are employed either alone or in combination.

When comparing the poisonous nature of these substances, naphthalene is probably not poisonous, whilst some of the toluene compounds are more poisonous than the benzine.

There is evidence that, generally speaking, the higher the nitration of the aromatic series, the more dangerous these substances are to manipulate.

This is borne out by the following investigations, which we communicated to the Lancet, August 31, 1901:—

“We found that mononitrobenzine when given by the mouth[476] to cats was quite harmless, they seemed rather to thrive and grow fat upon it. Dinitrobenzine is exceedingly poisonous both to men and animals. 1.2 grammes given to a cat by the mouth proved fatal in about three hours. The smallest lethal dose for a cat of 6 lb. in weight, given by the mouth in one dose, was .08 gramme. In another instance .06 gramme given in the same manner was almost fatal. A lethal dose of .09 gramme of dinitrobenzine, when given over a consecutive number of days in divided doses of .04, .02, .01, and .02 gramme, did not cause death.”

“Hypodermically, .04 gramme did not prove fatal to a cat.

“In experimenting upon animals with trinitrobenzine, we found that it was distinctly but not much more poisonous than dinitrobenzine.

“Coming to the toluene group, the administration of mononitrotoluene proved, like its homologue mononitrobenzine, quite inert.

“There is great difference of opinion amongst manufacturers as to whether dinitrotoluene has lethal properties or not. The weight of evidence rather supports the latter view. We are investigating this point (Lancet, August 31, 1901).

“Trinitrotoluene is not poisonous under ordinary use.

“For comparative purposes we injected 50 minims of a 1 per cent. solution of dinitrobenzine into a cat, with a fatal result. We then injected 60 minims of a 1 per cent. solution of trinitrotoluene into another cat, with the result that the only effect appeared to be some slight cyanosis.

“Again, 90 minims of a 1 per cent. solution of dinitrobenzine given hypodermically was quickly fatal to a cat, whilst 90 minims of a 1 per cent. trinitrotoluene proved perfectly innocuous.”

This is a very important practical point, as the susceptibility of man and animals seems closely allied. In some factories the trinitrotoluene has been substituted for dinitrobenzine, with great advantage to the health of the workmen employed.

The oxidising bodies used are the nitrates of ammonium, potassium, and barium. These do not appear to affect the workmen injuriously.

The gases produced by the complete detonation of these high explosives, when well diluted with air, are for all practical purposes harmless.

During the process of the manufacture of these high explosives an intimate mixture of the organic compound with the oxidising body results. This is effected in the case of chlorinated metadinitrobenzine[477] (of which this article chiefly treats), by the processes of grinding, melting at a temperature of 98.9° C., cooling, mixing in a closed, heated, jacketed pan at a temperature of 80° C., and finally filling in air-tight cartridges.

Poisonous Dose.—Dinitrobenzine is a potent poison, whether introduced into the stomach, injected into the circulation, absorbed as it readily is by the skin, or inhaled in the form of vapour.

The poisonous dose of dinitrobenzine for an animal, cat, or dog of six pounds in weight averages about .08 gramme; in the same proportion for a man of ten stones weight, it will be about 1.84 grammes.

Dixon Mann (Forensic Medicine, 2nd edition) and T. Oliver (article in Allbutt’s System of Medicine, vol. ii.) do not mention the poisonous dose, but in all probability a dose of under 1 gramme by the mouth will be lethal.

In fatal cases death takes place within twenty-four hours from a single dose. If animals live beyond that time, there is a strong probability of their ultimate recovery.

A marked characteristic of dinitrobenzine is the ease and rapidity with which, when mixed with fat, it passes through the skin into the system. We found that a 25 per cent. ointment in lanoline, rubbed into the skin of a cat, caused death in twenty-four hours, and 400 milligrammes of lanoline containing .1 gramme of dinitrobenzine, when rubbed into the groins of a man, produced lividity, cyanosis, and other pathognomonic symptoms in a few hours. No doubt the secretions of the cutaneous glands facilitate absorption when the powder settles on the skin. It is probable that all the nitro derivatives of the aromatic series pass readily through the skin. In most works, handling any of these crude compounds for any length of time without gloves is prohibited, being considered dangerous.

The concentrated vapour is dangerous in small doses, and fatal in large. A workman breathing for ten minutes the air in a flue through which pure dinitrobenzine had passed from the mixing pans, died from the effects eighteen hours later.

Judging from experiments upon animals, the poisonous dose, if injected hypodermically, is about half that taken by the mouth.

Poisoning divides itself naturally into acute, subacute, and chronic.

Acute Poisoning.—Fatal acute cases are rare, and have been noted chiefly on account of their interest from a medico-legal point of view. The symptoms are nausea and vomiting, intense[478] congestive headache, faintness and giddiness, loss of control over the limbs, numbness, tingling in tongue and lips, and other subjective sensations. A characteristic symptom is deep cyanosis; lips, fingers, and tongue are deeply cyanosed, nearly black in the early stage. The skin becomes cold and clammy, the pulse quick and weak, often over 120 a minute. It is small, thready, and feeble, and shows a very low condition of arterial tension. The capillaries are freely dilated, and cause the line of descent in sphygmographic tracings to be very rapid. In all severe cases the pulse is fully dicrotic, and displays well the loss of vasomotor tone, which is one of the most marked features in these cases. The heart’s action is easily excited by exertion, the breathing is laboured, and the urine darkened. The eyes become bright and glassy, the features pale and ghastly, and coma supervenes, which lasts for many hours. Exceptional symptoms are noises in the head, or dark specks floating before the eyes. When larger doses of the poison have been absorbed, unconsciousness may become complete. The eyes then roll slowly from side to side, the pupils are widely dilated, and the conjunctivæ are insensitive to touch. Both the deep and superficial reflexes are in abeyance. The respirations are increased to even double the normal number, become irregular, and Cheyne-Stokes in character. The limbs become quite flaccid, or one or more of the joints remain stiff, and when this is the case it is usually those of the upper limbs. Eventually this stiffness entirely disappears. The hands, feet, and face become remarkably bloodless. Occasionally there is œdema of the lips and eyelids, or dropsy of the lower extremities. The temperature ranges from 99° F. to 102° F. (Lancet, November 1, 1902, p. 89).

Subacute Poisoning.—Subacute attacks may supervene upon chronic poisoning, in which, besides the usual chronic conditions to be mentioned later, we find a distinct distaste for food, especially breakfast. Sometimes there is nausea, or there may be slight vomiting. This should always be a warning sign, for, if neglected, coma may follow.

The attacks vary in severity according to the amount of the poison absorbed. The symptoms noticed are:—Headache, with throbbing of the temples and forehead, great langour and depression, the urine becomes darkened in colour, the hands moist; there is drowsiness, with great tendency to sleep; the men say it is impossible to keep awake. During the night they sleep soundly unless prevented by an incessant headache. In the morning they[479] awake unrefreshed and heavy. The tongue is fairly clean though dark in colour, and develops a yellowish fur; dull, heavy pains are felt in the back. Breathing is quick and short, and fatigue follows upon the least exertion. Pricking, tingling, and numbness in the extremities are complained of when walking; workmen when so affected may take three hours to cover as many miles; they stagger, do not know where their legs are, frequently fall, and are unable to pick themselves up readily. When asked to walk backwards with their eyes closed, their movements are very unsteady. These symptoms practically disappear if the men leave work a few days; after such rest they say they feel in excellent health and spirits.

Chronic Poisoning.—The more common manifestations may be denominated chronic, as they are found after prolonged absorption of small doses of the poison, and many of them persist for a long time, at least many months, even after the workmen have left this special occupation. All workers who are brought into intimate contact with this poison show more or less the following:—

Upon careful examination of the cases, it is found that those employed suffer from a very severe form of anæmia. The ruddy hue of health disappears; the skin becomes dirty yellow-greyish in colour. This duskiness gradually deepens with the amount of poison absorbed, and decreases as it becomes eliminated. This objective symptom is especially marked in the mucous membrane. The men appear to be suffering from partial asphyxia. The conjunctivæ show a jaundiced tinge.

Muscular System.—The effects of the poison are shown in a marked manner upon the muscular system. The men have not the appearance of being employed in manual labour. When stripped the muscles are seen to be flaccid and the skin loose. The body lacks fullness and firmness. All movements lose tone and precision. Fatigue quickly follows muscular exertion.

In long-continued cases the objective symptoms are occasionally remarkable, such as wasting of the muscles, especially those of the extremities. This has been particularly pointed out by Dr Ross (Medical Chronicle, May 1889). “The muscles of the hands are seen to be very much atrophied. The spaces between the metacarpal bones are more distinctly marked than is normal, and the grooves between them very noticeable. The muscles of the thenar and hypo-thenar eminences are soft and distinctly wasted, especially the abductor indices. Patients cannot, without[480] considerable trouble and difficulty, cause the tips of the thumb and little finger to meet. Sometimes this is more observable in one hand than the other. The phalangeal joints must be bent, otherwise there is inability to flex the thumb strongly into the palm, and at the same time the power of adduction is feeble.

“All the finer and more delicate movements of the hands are greatly restricted in severe cases. Small objects such as pins and needles cannot be readily felt or held. The act of walking loses much of its elasticity and spring, and in consequence the balance of the body is with difficulty maintained. The big toe in the advancing foot does not manifestly drop; it is only slightly flexed into the sole. There is usually no ankle drop, and the power of raising the toes whilst the foot is flat on the ground is not lost. The symptoms of weakness and paresis observed in the muscles of the foot are not so well-marked as those seen in the hand.”

Nervous Symptoms.—Pains of a shooting, stabbing, or darting character are of very frequent occurrence. They are felt in all parts of the body, a common position being under the heart or in the armpit, neck, or jaws. The legs are rarely affected. When the pains are in the locality of the stomach they are of a griping nature. Sometimes a smarting or burning sensation is described, which is felt in the cheeks, forehead, and eyes, or restricted to the soles of the feet. These sensations are not accompanied by tenderness to the touch.

More or less irritation of the peripheral nerves is always present. It shows itself by tingling and itching of the skin of the fingers, palms, and backs of the hands, sometimes extending to the wrists. In a certain proportion of cases they are felt in the feet as well as the hands. They may be restricted to the feet, and only noticed when the men have their boots on, or their legs crossed. Whilst sitting, or at rest in bed, the pains are often acute. They are invariably confined to the dorsum of the foot, never being felt in the soles, and disappear upon standing or walking. Occasionally these symptoms are more severe in the extremity or extremities of one side of the body.

Hyperæsthesia is a most characteristic feature in all these chronic cases of poisoning. In all cases it is present, but it varies both in intensity and in the part of the body affected. It may be felt in one or both feet, restricted to the upper or under surfaces of the toes. Striking the outside, or dorsum of the foot, causes severe electric-like pains to run all over the leg. In a[481] well-marked case there will be exceeding tenderness upon the slightest pressure on any part of the foot. Drawing the finger very gently over these sensitive areas sends shooting pains about four inches up the legs. The soles of the feet are not affected by a light touch, but a sharp blow, tap, or jar, or a false step in walking causes painful sensations as high as the knees. These symptoms are usually more acute in the left than the right leg. The upper extremity is in like manner affected; a gentle rub on a small part of the cutaneous distribution of the ulnar nerve will produce general formication and tingling all over the arm. Partial hemianæsthesia, with a small patch excessively tender, may be present. This is probably hysterical. Dr Dreschfeld points out that Charcot, Balmskz, and Marie have found this same symptom in bisulphide of carbon poisoning, viz., hemianæsthesia with small circumscribed hyperæsthetic areas. The nerve trunks of the legs or arms are sensitive to pressure where superficial; and great pain is caused all over the area of distribution of the occipital nerve by pressure on the nerve trunk.

The muscles are often very tender, especially those of the upper arm. Touch is often impaired in the fingers and toes. Patients almost invariably complain that the skin of the hands and soles of the feet is less sensitive than is usual in the healthy state. The fingers are numb and act clumsily, while the hands feel as if they were gloved. The impression of sand or snow is conveyed to the feet when standing or walking. Heat and cold are with difficulty differentiated. In one sufferer two test-tubes containing water, differing 10 degrees in temperature, being applied to the arms and trunk, were readily distinguished, but from the hips downwards the patient was utterly unable to discover which of the two tubes was the hotter. If applied simultaneously about three inches apart, both were experienced as cold. Generally speaking the skin of the body is more sensitive than that of the limbs, but in all parts variations occur. Upon using a Faradic current of a given strength, which was with difficulty borne by the thighs, arms, and trunk, there was no perceptible impression produced in the calves or legs. In these situations the compasses must be separated three inches, to be distinguished as two points. The transmission of touch and pain are slower than normal, or at any rate are not as readily responded to as in health. The extremities become very quickly chilled. On the slightest exposure to a low temperature the fingers look pale, bloodless, and feel as if they were dead, and the feet are[482] always cold. Hearing and taste are unaffected. There is great loss of energy. Feebleness, lassitude, and depression are invariable concomitants. The sexual appetite is notoriously weakened, or lost, and erections of the penis rare. The reflexes, superficial and deep, are very variable; sometimes they are exaggerated; this, however, is not usual. Generally speaking, they are enfeebled. Dr Reynolds mentions a case where the patient was comatose and the knee-jerk persistent. Cremasteric and plantar reflexes are those most commonly absent. The muscles react readily to a moderate Faradic current, but different groups of muscles vary in their sensitiveness to the same strength of current.

Eye Affections.—Dinitrobenzine produces a distinct toxic defect of vision similar in many respects to that caused by tobacco, iodoform, bisulphide of carbon, etc. This amblyopia will be found in a varying degree in all those who suffer periodically from subacute attacks of poisoning, or who develop other symptoms due to the continued absorption of the poison. Susceptibility may aggravate the symptoms, but no worker can claim perfect immunity. Comparatively few complain of any impairment to their sight, but probably about one in ten are unknowingly affected. Dr Neiden (Edinburgh Medical Journal, 1889) and Mr Simeon Snell (British Medical Journal, 1894) have described the eye affections. The latter summarises his conclusions as follows:—“Failure of sight, often to a considerable degree in both eyes, concentric contraction of the visual field, with in many cases a central colour scotoma, some blurring, never extensive, of the edges of the disc, and a varying degree of pallor of its surface.”

In all cases absence from the work removes these symptoms in a varying length of time: and usually a restricted exposure will alleviate them.

Urinary Affection.—In cases of long-continued chronic poisoning, dinitrobenzine will always be found free in the urine (Dixon Mann). In the urine of animals, tube casts, brown flakes, and hæmoglobin have been isolated, and in the kidneys much cloudy swelling of the epithelium lining the tubules can be seen (Strassmann and Strecker).

We tested the blood, lungs, liver, spleen, and urine from several cats poisoned by dinitrobenzine. In only one sample, the urine from a cat which died from chronic poisoning, could any indication be found. Both sugar and albumen are generally[483] absent. The source of the bile pigments is the hæmoglobin of the blood, and the excretion of these pigments points to the existence of some cause at work in the blood leading to the destruction of hæmoglobin. The large deposit of urates, high specific gravity and presence of biliary pigments found in the urine, is strong corroborative evidence of an active destruction of blood corpuscles.

No experimental evidence has yet proved that reduction takes place in the body in case of the nitro-compounds of benzine to aniline, or phenylene-diamine.

In several samples of urine tested, both nitrates and nitrites were present, so that in the case of phenylene-diamine being present, the pigment Bismarck brown would be formed, and would give the urine a brown tint.

The samples of urine were tested for free dinitrobenzine by the following method: The urine is treated with zinc and hydrochloric acid for some hours. Any dinitrobenzine that may be present is reduced by the nascent hydrogen into phenylene-diamine. The urine is then alkalised with caustic soda, and well shaken up with ether. The ether is then separated, filtered, and evaporated. The residue is treated with dilute acetic acid and nitrite of soda, when a yellow or brown coloration shows the presence of dinitrobenzine in the original sample. In three cases a slight indication was found.

By ordinary reducing agents in the laboratory, such as nascent hydrogen, the nitro-substitution compounds of benzine can easily be reduced as follows:—

Mononitrobenzine to aniline.

Dinitrobenzine to phenylene-diamine.

Trinitrobenzine to triamidobenzine.

The amount of urea is generally high, due to increased metabolism of the tissues.

The exact chemical changes which take place in the body are extremely difficult to follow. The nitro-compounds probably pass through the body without suffering any change, or they may be reduced in the body.

It will be noticed in the subsequent table that all the samples are acid, many being strongly so. Nearly all are dark-brown in colour and generally precipitate a red deposit, principally urates. In most of these urobilin is present, and can be easily recognised by the following test: 100 c.c. of the urine are acidified with 10 drops of strong hydrochloric acid, and then shaken with 20 c.c.[484] of chloroform. The chloroform which falls to the bottom is separated by means of a separating funnel, and filtered into a test-tube, .4 c.c. of a solution of 1 gramme of crystallised acetate of zinc dissolved in a litre of 95 per cent. alcohol is then poured gently down the side of the test-tube, and at the junction where the liquids meet, a green fluorescent ring, characteristic of urobilin, will appear; the solution on shaking will become fluorescent, being green by transmitted, and rose-coloured by reflected light. This pigment can also be detected by means of the spectroscope.

Urine.—In severe cases of dinitrobenzine poisoning, the urine becomes of a dark, tawny, port-wine colour. There is no irritation or frequency in making water.

The following table represents the examination of the urine from very mild cases, such as can any day be found amongst men handling, or breathing the fumes of dinitrobenzine.

Pathology: The Blood.—Active metabolism takes place at once upon contact of the blood tissue with dinitrobenzine, and this may induce a febrile rise of temperature. The blood becomes thin and dark in colour, varying from chocolate-brown to black. The number of blood corpuscles is greatly diminished, in some cases less than half the normal number. The amount of hæmoglobin averages 35 per cent. MacMunn describes the presence of large coloured megalocytes, 12 µ in diameter; the ordinary red corpuscles are smaller than normal, about 5 µ or 6 µ in diameter; many are crenated and broken up.

Haldane (Journal of Physiology, vol. xxi., 1897), in carefully conducted experiments on mice, “finds spectroscopically a feebly-marked band in the red besides the oxyhæmoglobin bands; but it was not methæmoglobin. Methæmoglobin is contained in the blood, but some other pigment is probably present.” In men we were able to obtain the oxyhæmoglobin band, but it was always blurred. Whether there is a special dinitro band in the blood is a disputed point; it has been investigated in animals by Huber and Röhl (Über akute u. chron. Intox durch Nitrokorp d. Benzolreihe, 1890).

[485]

URINARY ANALYSIS

Dinitrobenzine is a powerful narcotic poison. Death in acute cases is due to coma in man. Convulsions are frequently and generally observed in animals. It is a powerful disintegrator of the blood, and in dogs, cats, and rabbits causes oligocythemia, poikilocytosis, and hæmoglobinæmia. So great is the destruction of the blood corpuscles that Haldane attributes all the symptoms to the want of oxygen consequent on changes in the blood. In[486] chronic poisoning men exhibit the features of a peripheral neuritis, although this point has not been confirmed by pathological investigation. Strassmann and Strecker (Friedreich’s Blätter für gerichtliche Medizin, 1896), in dogs, have obtained, by staining, degeneration of the lateral columns of the cord. They also found irritation and catarrh of the stomach and intestines, and after large doses small extravasations of broken-down blood-clot, with swelling and cloudiness of the mucous membrane of the stomach. There is also evidence of much tissue degeneration in the organs, probably fatty. In men, post-mortem, we find that the lividity entirely disappears, the skin becomes pale, and all the internal organs, such as the heart, lungs, and liver, are of a pale yellowish cast, and more friable than usual. The brain is of a dull pink colour, and the veins of the body, and especially the meninges, are filled with a thin, characteristically-fluid, black blood.

Prognosis.—Prognosis in cases of poisoning by dinitrobenzine depends upon the amount absorbed, the time the men have been exposed to it, and their previous health. The headache and general malaise caused by small doses are usually recovered from in the course of a few days. A week’s absence from work enables the men to regain their usual energy, the appetite and urine becoming normal. Anæmia is a very persistent trouble. If the number of blood corpuscles becomes greatly decreased, it takes months to restore them. The peculiar dusky colour of the skin can be detected by those who are conversant with this symptom, even weeks after ceasing work. In cases of coma hours may elapse before consciousness returns. Recovery has taken place after insensibility lasting eight to twelve hours. In one fatal case consciousness returned after nearly sixteen hours’ insensibility, but death suddenly occurred half-an-hour afterwards, when the man was being raised quickly and carelessly from the recumbent position. Cases which are going to terminate fatally usually do so within twenty-four hours. Some months may elapse before muscular power is fully restored. The profound anæmia does not leave its mark permanently, it is eventually entirely recovered from when the workers are removed to other occupations. Workmen often affirm that after a time they become accustomed to the effect of the poison. This is not so, any more than individuals can become habituated to taking alcohol without being affected by it. In the early stages of employment the workers notice and complain of the effects of the poison, as it is new and strange to[487] them; eventually they come to regard the symptoms as necessary to the work, and if slight, know from their own experience that, by more care in the manipulation, or absence from work, the symptoms will pass away. Any natural weakness is liable to be aggravated, and pre-existing anæmia will be made worse.

Precautions.—With ordinary care the work is but slightly harmful, but without care it becomes immediately dangerous. The higher the percentage of dinitrobenzine used the greater the risk and the necessity for care. The dinitrobenzine used should be, as far as possible, chemically pure. We find a small admixture of mononitrobenzine makes it more dangerous to manipulate (Lancet, August 31, 1901). Commercial dinitrobenzine is a deadly poison, however introduced into the system. All precautions have for their object the prevention of poisonous quantities gaining access to the system, by the dilution of the poison, and the avoidance of personal contact. Works should be situated in the country. At the erection of the different houses, much attention should be given to their construction and arrangement. Each should be well isolated; not opening one into the other, nor contiguous to another building. Each should be surrounded by a plentiful air space, and have ample ventilation. Every house should be provided with a lantern roof, containing rain-proof windows easily opened and closed. The window space must be ample, and all windows capable of being freely opened or entirely taken out. It is often necessary to regulate the draught, and on windy days removing the windows on the lee side will permit a free current of air, and ample exit of the fumes, dust, and heat generated. No house should be overcrowded with machinery, and the different processes should be conducted as far as possible in separate buildings. All vessels, melting pots, cooling trays, or pans containing a heated compound must be provided with efficient and well-fitting covers, with flues leading from them to the outside air. The floors, tables, covers of pans, ledges, canisters, etc., in all the houses are to be kept clean and free from dust, the powdered compound, and manufactured explosive; and no utensils or useless articles are to be allowed in the houses. Canisters containing the powder must be kept closed with a well-fitting lid. No flue through which heated vapour has passed may be entered by any person. The cleaning of such flues must be done automatically, or from the outside of the building. Cooling trays should be in a shed open on all sides to the external air. A house, or other shelter from the weather, should be provided for[488] the workmen to retire from the vitiated atmosphere of the house whilst watching the operations.

Wherever possible, the processes of grinding, filling, and emptying utensils, hoppers, pans, and cartridges should be done automatically. If done by hand, respirators should be used, and the men should be careful to stand on the windward side of the pans when the covers are off. Washing appliances should be freely supplied, preferably near each house. Towels inside the houses are objectionable; even if covered up they remain wet. Frequent washing of the hands with soap and nail-brushes is most desirable. The face, beard, and head should be kept clean, frequently washed, and free from dust. The beard, hair, and nails should be cut short. The air in the houses should be kept as dry as possible. Moisture in the atmosphere is always followed by an increase in sickness. Low temperature and dry atmosphere cause a proportionate decrease in the sick-rate. This is accounted for by the fact, that moisture makes the powder cling to the exposed parts of the body; perspiration has the same effect, as also some of the deliquescent salts used. In winter the number of invalids is very small, but during the hot summer months is greatly increased. In all houses where there is much dust, respirators are essential. They are of no use against the vaporised fumes. Cotton respirators fitting over the nose and mouth, kept very clean and frequently renewed, are least objected to by the workmen. Dr Snell has suggested a diving-bell apparatus. Gloves are necessary when handling the material. The importance of keeping the interior of the gloves scrupulously clean and tight at the wristbands is self-evident.