Occupational Disease and Economic Waste

EXPERIENCE teaches most effectively when it comes in vivid and dramatic form. The loss of 350 lives in coal-mine accidents a year ago, in a period of three weeks, was so startling as to awaken the public conscience. Many, who never gave the matter thought before, know to-day that our annual tribute to carelessness in mining is 2000 lives a year. The stain -which rests upon the operation of our railroads is recognized as blacker still; for the annual toll paid on train and track amounts to 10,000 lives. Most of this slaughter is preventable, — is prevented, by other nations. It was no overzealous reformer, but the Governor of the State of New York, who recently said, “ The shocking number of preventable casualties in our industrial employments, . . , in the light of comparative statistics, constitutes a disgrace to the country.” These are signs of an awakening. The day is coming when we shall no longer remain “ the scandal of the elder earth ” in our indifference to the wraste of human life.

It is important to realize, however, that there are other dangers of industrial life, less obvious than exploding firedamp or colliding locomotives, but even more sinister in their end results. These are the occupational diseases. When a mine explosion occurs, it is telegraphed over half the world. When, here and there, hundreds and thousands of workers grow pale and listless, and one by one drop out, and pass from the factory to the hospital, the tragedy is unnoted. Yet, year by year, disease causes ten times as many deaths as accidents.

Let us take tuberculosis as an example. In many discussions of this much discussed disease its relation to industry is scarcely mentioned. Yet a study of vital statistics shows that its prevalence is correlated with occupation to a significant degree. Among the stone-cutters at Barre, Vermont, and at Quincy, Massachusetts, the death-rate from tuberculosis is double that of workers at other trades; and the cutlers at Northampton, Massachusetts, die from tuberculosis at four times the normal rate. Statistics give a pale and meagre picture of what this means. The following letter, written five years ago by a physician in a New England town, is more vivid than pages of figures: —

“ I have been in practice in East Douglas since 1863, with the exception of some thirteen years following 1873. I have seen quite a number of cases of so-called grinders’ consumption. I have examined one case post mortem. I found the smaller bronchial tubes thoroughly filled with the grindstone grit; the lung in the lower part looked and felt like the liver after cooking. The symptoms are excessive dyspnoea on slight exertion, dry cough, and great prostration. The grinders are from the Polanders and Finns for the past dozen years. The disease takes hold of them more frequently, and is more rapidly fatal than among the grinders of former years and of other nationalities. When I came here forty years ago, I found the victims among the Yankees who had ground some twenty years before. Those would grind eighteen or twenty years before having to give up work. The French Canadians were then grinding. They could work twelve to sixteen years. They became frightened off, and the Swedes took up the work. They would get the disease in eight or ten years. Now the Finns and Polanders are at it, and they last only three to five years, and the disease is more common among them.”

The normal, healthy body has its “ fighting edge; ” and, if given a fair chance, is able to protect itself against such foes as the tubercle germ. The successful cure, even of advanced consumption, by fresh air and good food, exercise, and rest, shows how well the healing force of nature plays its part. In the East Douglas axe factory these defensive agents had no chance. The delicate lungtissue in which bacilli and body-cells were contending, wTas lacerated by sharp particles of steel, and aid and comfort were thus given to the invaders, rather than to the defending garrison. Metallic dust, which forms a scarcely perceptible cloud in the air, threatens sickness and death, by injuring the lung-tissue and favoring consumption, as surely as the unguarded railroad track invites damage to life and limb.

The injury to the lungs, and the consequent high death-rate from consumption, are most marked in industries which are associated with the production of sharp particles of mineral or metallic nature. Cutlery and stone-cutting, potteryand earthenware-making, file-cutting, glassmaking, hornand celluloid-working, pearl-button-making, emeryand corundum-working, are examples of this sort; and they show tuberculosis death-rates from two to four times as high as the normal. Other dusts of non-metallic kinds are less injurious, but are serious enough. Among the felt-hat-makers of Orange, New Jersey, the pointed shreds of hair produce sufficient damage to double the amount of consumption that would occur under normal conditions. Shoddymakers, rope-makers, rag-pickers, brushmakers, cigar-makers, workers in some parts of the cotton and woolen industries and of paper-making, carpet-makers, flaxand hemp-pickers and carders, operatives in liorse-hair factories, and many more, suffer in varying degrees.

Even where there is no special dust, the ordinary vitiation of air must be reckoned with, as contributing its share to occupational disease. In the large cities of the East thousands of men and women -work at cigar-making, in small and large establishments. Some are in excellent sanitary condition; others are very bad; and the Cigar-makers’ Union, though a strong and intelligent labor organization, does little to improve them. In the summer, if the air be not too dry, windows may be opened and natural ventilation secured; but tobacco must be kept moist in order to mould cigars efficiently, and if the outer air be dry, open windows are not permissible.

I visited, one afternoon in November, a hand-room in which 50 men were exhaling impurities, and eighteen gas-jets vitiating the air, in a space of less than 12,000 cubic feet. The temperature was 72 degrees, the relative humidity 78 degrees of saturation, and the air contained 35 parts of carbon dioxide per 100,000, ten times the value for good air. To the bad effect of such an abominable atmosphere was added the noxious irritation of the fumes of dry tobacco. The spitting habit is common in cigar factories; and, as the Massachusetts State Board of Health in a recent report points out, this “ is particularly to be deprecated, in viewof the fact that in the processes of manufacture considerable tobacco falls to the floor, and these fragments, if not gathered up and used on the premises, are very commonly swept up writh all the dirt, dried sputum, and other matter, and sold as fillings for cheap cigars.” It is not surprising that the Association for the Prevention and Control of Tuberculosis reports the tuberculosis death-rate among cigar-makers as 4.8 per 1000, — about twice the normal figure. I was once told by a cigar-maker that he could always recognize his fellow craftsmen by the ** cough.”

The actual amount of damage wrought by occupational disease is not known with any certainty. Vital statistics in the United States are deplorably faulty. There is no state or city in the Union which publishes accurate records of the death-rates in various industries from particular causes. Many records of death give no information as to occupation, and what information is given is often incomplete. It is possible, however, to make approximate estimates of the economic cost of dust and bad ventilation by a study of the ratio between the deaths from tuberculosis and those from all other causes. If, among grinders in a certain town, for example, the ratio of tuberculosis deaths to total deaths is twice or thrice that which obtains for the general adult population, it is fair to assume that the actual tuberculosis death-rate is at least twice or thrice the normal.

We know that ten out of every thousand adult persons in the United States die every year from all causes; and of these ten deaths, two or three are due to tuberculosis. Among grinders and cutlers and stone-cutters, the ratio of tuberculosis deaths rises from one-quarter to three-quarters of the deaths from all causes. Therefore it is fair to assume that at least five in every thousand workers at these industries die every year from tuberculosis as the direct result of their occupation.

The same line of reasoning enables us to gauge the economic waste in the larger industries, where the danger to the individual is less, but the number of individuals exposed to risk is vastly greater. I had occasion, a few years ago, to make a careful study of the statistics of operatives in the textile city of Fall River, Massachusetts. I found the ratio of tuberculosis deaths to total deaths, among all classes of operatives, to be 33 per cent, instead of 23 per cent for the corresponding general population. In certain branches of the industry it is less; among spinners and card-room hands, it is more. The records of a leading insurance company, to which I have recently had access, have confirmed my conclusion that the ratio of tuberculosis deaths to total deaths among textile workers of New England is fairly represented by that figure, 33 per cent. If that be the case, it implies that three or four of every thousand of these textile workers die of tuberculosis every year, against two or three of the population as a whole. The over-hot and over-moist and badly ventilated rooms of the cotton and woolen mills cost one life a year for every thousand operatives employed.

The textile industry does not stand alone. In the report on the sanitary condition of factories and workshops made by the Massachusetts State Board of Health in 1907, is the following comment upon the boot and shoe industry: —

“In the majority of factories visited, the ventilation was found to be poor, and in many of them distinctly bad. Of the rooms not especially dusty, 102 were badly ventilated and 20 were overcrowded. In the rooms in which large amounts of dust are evolved, the number of machines with means for efficient or fairly efficient removal of dust was found to be 1630; the number either inefficiently equipped or devoid of equipment was 2769.

“ Of 84 of the many dusty rooms reported, 40 were also overcrowded, 35 were dark, 21 were overheated, and 18 were overcrowded, dark, and overheated. In more than one-third of the factories visited, the conditions of water-closets were not commendable; most of them were dark and dirty to very dirty. In 50 establishments no spitting was noticed, in 173 there was some, in 115 considerable, and in 35 much.”

Translate these bald facts into the experience of the individual worker. Figure him passing from the dark, overcrowded, overheated workroom into the chill night air of winter, with his throat and lungs filled with rasping dust. Imagine the facility with which the tubercle germs enter those lungs and grow in them and rot them away. Picture the infection of the wife and child which is so apt to follow.

The death-roll from occupational tuberculosis accounts, of course, for only a portion of the total industrial disease. Various of the lesser industries are subject to their own peculiar disorders. Specific poisonings supplement the general effect of poor ventilation and unsanitary conditions. Workers in lead, and those who make use of the metal in filemaking, plumbing, painting, pottery, glass-making, and type-setting, assimilate minute quantities of this poisonous substance, which gradually accumulates in the body until serious results ensue. Painters’ colic and wrist-drop are among the early symptoms; serious nervous derangements follow7, and death may be the final result. Workers in mercury and in arsenic, handlers of bichromate, and operatives who deal with other poisonous substances, suffer in definite and specific ways.

In some trades it is noxious fumes which threaten the worker instead of metallic poisons. Carbon bisulphide and naphtha, as used in certain processes for treating india-rubber and gutta-percha, produce serious disorders of the nerves anti the digestive system. A joint committee of the Massachusetts State Federation of Women’s Clubs and the Women’s Educational and Industrial Union made, in 1904, a study of the conditions under which women were working in the rubber factories of New England. Their agent reported that most of the women handled compounds containing oxide of lead, many eating their lunch at the same work-bench, and some habitually putting the material in their mouths. Fumes of naphtha pervaded the air of most of the rooms. The women who made light rubber goods inhaled also a fine talc dust. Finally, in making rubber shoes the forms were pressed against the pit of the stomach in such a fashion as to produce serious internal derangements. The prevalence of anaemia, dyspepsia, and acute hysteria among rubber-workers was found to be a familiar fact to physicians who had come in contact with them.

It is unnecessary to dwell further on the dark side of this picture. Industrial disease exists. The important practical point is that its continuance is needless. All this waste of life and health is preventable. Dust in certain industries can be reduced to a minimum by substituting moist for dry processes. In others, it can be drawn off by special ventilation through hoods placed over the machines which produce it. In extreme cases, where these measures fail, the individual may be protected by the wearing of respirators designed for the purpose; and this should not be left to the whim of ignorant operatives, but enforced by the employer and the State. Fresh air can be supplied to any workroom, and its temperature and moisture adjusted so that the industry in question may be carried on without undue damage to the workers. Against leadpoisoning, and naphtha fumes, and every other industrial danger, there are remedies which may be practically and efficiently applied.

It is no matter of theory that sanitary factories are possible. In the Massachusetts examination of industrial establishments, to which reference has been made, satisfactory conditions were found in certain factories in almost every industry. England and Germany, where these problems are older, and hence nearer to solution, teach us that factory sanitation is an attainable ideal.

Good factories cannot of course be had for nothing. Pure water costs, clean milk costs, and so does good air. Yet in each of these cases the investment yields ample returns. The worker in a ventilated factory gains in health and vigor and happiness, as well as in prolonged life. The employer gains, too, and not merely in mox*al satisfaction. I have heard of a rubber factory which was forced to close on half a dozen hot days in summer, because the women workers were fainting right and left; but this is poor policy. Human machines of low vitality mean a poor product. The increased efficiency obtained with healthy workers pays back in dollars and cents more than the outlay for fans and ventilators. Finally, the community gains, — in productive capacity and in physical soundness, for the present and the future. In the 1000 census the capital invested in cotton manufactures was estimated at $400,000,000. The annual payment in wages, corresponding, was $85,000,000. At 3^ per cent, this ’would represent a capital of more than $2,400,000,000. The investment of “Life Capital ” is then by far the largest investment in the cotton industry, and in most other industries as well. If this capital is being squandered needlessly it behooves us to check the waste.

The community, the employer, and the employee are alike concerned in the betterment of factory conditions. All three must play their part if progress is to be assured. The State must be equipped with an efficient force of experts to discover where existing evils lie, and how they may be remedied. A few progressive states have advanced along this path already. In Massachusetts, a corps of fifteen medical inspectors was created for the task of factory inspection in 1907. A year ago a sani tary expert of high grade was added to the factory-inspection department in New York. The ideal board, with both medical and engineering knowledge at its disposal, is, however, yet to be created in most states.

The State cannot do everything. In this as in other reforms, it can, and should, furnish the best expert knowledge of evils and of remedies. If can, and should, establish a minimum of sanitary decency, and compel the reformation of the worst conditions. Beyond this, progress must come from private initiative. State inspectors can modify the worst conditions; only manufacturers can improve the best. A score or more of large establishments could be mentioned in which this opportunity has been generously realized. Far-sighted employers of labor have made it a point to go beyond law and custom, and have vied with each other in reforms which seem almost Utopian. Light and ventilation, the removal of dust and gases, guarding of machinery, provision of wash-rooms and locker-rooms with sanitary plumbing, establishment of lunch-rooms and emergency-rooms, are among the features of such model factories. More purely social enterprises, recreation-halls, classes for apprentices, dwellings for the workers, and insurance systems, supplement the direct physical provisions of “ welfare work.” The important point about it all is that the employers who have tried this policy find that it pays. According to “ American Industries,” in one notable case in which new ventilation was introduced, “ the cost of installation Avas sis thousand dollars, but the reduction thereafter of the percentage of absences because of illness was so great that the employer Avas compensated for the outlay.” Care of the living machine pays, — in the enthusiasm, the cooperation, the soundness of body, the efficiency of hand and eye, and the alertness of mind, which make a better workman.

Finally, a large share of responsibility for factory conditions must rest upon the worker himself. He alone is always on the spot. He alone knows, or ought to knoAV, what actual conditions are. Unorganized, he may not be able to make his legitimate needs felt. With the growth of organization and the general recognition of the right to organize, the labor unions have a growing responsibility for industrial conditions. They have done much that is important in improving the lives of their members by shorter hours and higher wages. They have as yet done little in the intelligent reform of factory conditions in regard to sanitation. They have almost wholly failed to grasp the magnificent opportunity, which should be theirs, of bringing to the individual worker that knowledge of sanitary science which will enable him, in the factory and out of it, to maintain a maximum of health and efficiency.

The betterment of factory conditions is a cause which should enlist the publicist, the employer, and the labor unionist, in a zealous and intelligent cooperation. Sanitary work-rooms injure none, and benefit all. Ignorance of the dangers which exist, and of their simple remedies, is what stands in the way of progress. As with so many e\fils, it is not a case for denunciation, but for education. It is not grasping selfishness of the capitalist which is generally responsible for bad conditions. Nor is it willful carelessness of the workers. It is lack of knowledge on both sides. As knowledge of the real conditions grows, the waste of life-capital through occupational disease wall cease. What are Ave doing as a nation to spread that knowledge? A year’s budget of the United States Navy amounts to more than a hundred million dollars. The combined expenditure of all the States of the Union for the campaign against occupational disease amounts to perhaps a tenth of one per cent as much. We know that ill-ventilated factories Avil! cost the lives of many thousand workers in 190!) and 1910. Is the danger of war more imminent?