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have been developed for use in drilling for foundations in New York City which promise to be useful in more extended fields. Where wet methods are used, they have not been fully sufficient to keep the air entirely free from dust.
General ventilation is as important, if not more important, a preventive measure. If the dusty air can be placed by clean air, or the dusty air sufficiently diluted by clean air, the opportunity for the development of silicosis can be greatly reduced.
The United States Public Health Service finds that a safe limit lies somewhere between nine million and twenty million particles per cubic foot of air when samples are collected by the Greenburg-Smith impinger method and counted with about 110 diameters magnification, light steel illumination. The dust referred to is granite dust with about 25 to 35 percent of free silica and 60 to 70 percent of total silica. Oklahoma has included a limit of 300 particles per cubic centimeter in its law, and 10 million particles per cubic foot has been included in the regulations of the Department of Labor of New York State.
A similar standard is being used in Wisconsin and in Ontario, and is in agreement with the standard fixed some years ago in South Africa.
Respiratory diseases probably predispose to silicosis. Individuals with tuberculosis are a menace to others working in silica dust, as the silicotic individual is very much more susceptible to tuberculosis than is the normal man. Physical examination before employment and of all workers at regular intervals has been required by law in Australia, South Africa, Great Britain, and Ontario, Canada. Any man suffering with silicosis should not be employed where he will have to breathe dust, especially silica dust. If he has tuberculosis, he should not be permitted to work where he will be in contact with those exposed to silica dust.
In some countries the physical examinations are made by a national medical bureau constituted for the purpose. In other countries the men best qualified in various districts are appointed by the Government to make the examinations. In still others, a board consists of a medical man appointed by the state, one selected by the industry, and a third by the employees. The men selected to make these physical examinations should be experienced in respiratory diseases, especially those caused by dust, should be acquainted with the industry and the conditions under which the men might work, and should be neutral, that is, should favor neither the employers nor the employee. However experienced and fair-minded they may be, occasionally either the employer or the worker wants an appeal, which can usually be made by another member of the board without the examiner being acquainted with the fact that the appeal has been made. The findings of the two physicians are then received by conference of the entire board.
Physical examination is believed to be very important for prevention of silicosis, as well as tuberculosis; but it must be remembered that no one measure is successful. A combination of all preventive measures—methods of control of dust and its source, good ventilation or dilution, and initial and periodical physical examination-are needed to prevent silicosis.
Most of the men suffering from silicosis do not die as a result of it. They usually die of other infections, especially tuberculosis.
The tuberculosis incidence rate among the workers exposed to silica dust is many times the incidence rate among the male age groups not so exposed. As an example, the incidence rate, according to Dr. Chadwick, of Massachusetts, is about 2 per thousand. In some of the silicous-producing industries, where the men are exposed to the dust, it will be as much as 50 per thousand for an incidence rate.
The Public Health Service, as stated in the beginning, has cooperated with other bureaus of the Government for a number of years in dealing with silicosis. The Bureau of Mines asked quite early that medical personnel be assigned to that Bureau to carry on the studies, and it included a statement in its appropriation bill that persons could be assigned from the Public Health Service. Later the Congress passed an act known as the Parker Act authorizing the Secretary of the Treasury to detail officers and other employees of the Public Health Service to the different departments and independent establishments of the Government in connection with problems having to do with public health. That has been done in a number of instances.
There are officers of the Public Health Service detailed to the Bureau of Standards, the Department of Labor, the United States Employees' Compensation Commission, the Bureau of Indian Affairs, and probably elsewhere that I do not recall.
In the course of these studies that have been carried on by the Public Health Service in cooperation with other agencies of the Government, more than 80 publications on the subject of silicosis and allied diseases have been issued. The earliest one was published as a report on the Joplin, Mo., situation, which work was done in cooperation with the Bureau of Mines. The Bureau of Mines did the engineering work and the Public Health Service did the medical work.
I have here [indicating] a number of publications on the subject of silicosis that will probably interest you.
Mr. RANDOLPH. If it is convenient for you to leave all of these [indicating] publications with us, we should be glad to have you do so, Doctor. We do not want to include them as part of the record, but they could go along with the record to members of the committee to help the committee in its work.
Dr. SAYERS. I shall be glad to leave these publications with you.
The latest report came off the press at 4:30 p. m. yesterday. It covers a study made in Pennsylvania among the anthractite coal workers. That report gives the preventive measures that may be employed. The interesting part of these reports is that there is a control method available in connection with the disease. We have had the active cooperation of the operators in these studies, fortu. nately. Again, the employees have cooperated with us 100 percent in making these studies. It is only by such hearty cooperation that we may confidently hope to obtain the real facts. We are having excellent cooperation from the different States also.
We are very much interested in the matter of silicosis, just as we are interested in all matters affecting the public health. We are ready and willing to cooperate with any group or groups that care to cooperate in connection with this important work. Our plans seem to be working very satisfactorily at this time.
In this work we have trained personnel, but it is of limited quantity and not enough to do all that needs to be done or to answer all the requests in anything like a complete way. While the authority is already available for the cooperation and for us to do these things, yet, unfortunately, the funds with which to do the work are not available. The funds have been limited and curtailed at times when we have been doing work of real importance.
Mr. RANDOLPH. The third deficiency appropriation bill, which has passed the House and now awaits action of the Senate, provides, as I understand, for the Public Health Service a certain amount that may be applied to all the States in the studies and surveys of diseases incident to industries. Is that true?
Dr. SAYERS. That money is not exclusively for surveys and studies in connection with diseases incident to industries. It is to be used in connection with all public health problems; and industrial diseases, of course, come under that heading. That money will be allocated for work in the various States in accordance with a sound formula.
Mr. MARCANTONIO. That fund, as I remember, amounts to about $10,000,000 ?
Dr. SAYERS. It amounts to about $8,000,000.
Mr. RANDOLPH. And of that amount about $125,000 will be made available for work in the State of West Virginia; is that true?
Dr. SAYERS. That is true.
Mr. RANDOLPH. Already, as I understand, even before the failure to provide this money, certain funds were available for use in the States whereby the United States Public Health Service could undertake limited studies and surveys in certain States. I believe that you have already started such work in North Carolina and West Virginia. Is that true?
Dr. SAYERS. Yes. We have begun work there at the request of the industrial commission, or the State departments of health. I believe I should include the departments of labor, because it, too, is cooperating with us. As I have suggested, our funds to do this work are very limited. We are doing such work in North Carolina, and recently we began such work in West Virginia. The requests from both of these States are, however, many months old. Last September we were asked by the State of West Virginia to start this work, but we could not do so on account of a lack of money.
Mr. RANDOLPH. I believe that at that time I personally urged upon you the carrying on of this work in West Virginia.
Dr. SAYERS. Yes.
Mr. RANDOLPH. Can you give use the name of the doctor of the United States Public Health Service who is now engaged in this work in the State of West Virginia ?
Dr. SAYERS. He is an engineer. The first part of the studies and surveys are from an engineering standpoint, and they are made by an industrial hygienist or industrial engineer. The gentleman to whom you refer is Mr. J.J. Bloomfield. The State of West Virginia is employing an engineer to be instructed by our engineer. He is Mr. Page.
Mr. RANDOLPH. I do not mean to dwell upon the West Virginia situation so much, but since this matter hinges upon the tragedy at Gauley Bridge, is it not a fact that the West Virginia Department of Compensation, through Mr. Matthews, and the West Virginia Commissioner of Labor, Mr. Jarrett, and the State department of health, through Dr. McClure, have assisted and aided you in every cooperative method to bring about these studies!
Dr. SAYERS. Yes; they have urged me to come there and arrange to help out with the studies. Their cooperation is splendid.
Mr. DUNN of Pennsylvania. Is it necessary for the States to render some assistance before the United States Public Health Service gives assistance ?
Dr. SAYERS. If the Public Health Service has the money, it is not necessary; but we are, as I have suggested before, quite limited in personnel.
Mr. MARCANTONIO. As a matter of fact, that fund of $8,000,000 for this type of work is to cover all health studies, as I understand, therefore it is a most inadequate sum. Doctor, I do not ask that you comment on that observation. I myself will say that it is grossly inadequate for the high purpose for which it is intended.
Mr. DUNN of Pennsylvania. And I will say right here and now that I agree with you, Mr. Marcantonio.
Mr. RANDOLPH. Do I understand that your sanitary engineer, Mr. Bloomfield, is already working in the State of West Virginia ?
Dr. SAYERS. Yes.
Mr. RANDOLPH. And perhaps his going into the State a little sooner than he would ordinarily go under the program, and the making of slight funds available, have been brought about to a certain degree by the study which this committee is making in connection with silicosis.
Dr. SAYERS. That is probably true, but I have nothing to support my statement.
It would seem, then, that if funds could be made available, that we can go ahead and develop means and give information to the State authorities as to the best methods of control in connection with this disease. We can also give information to the employees, which will be helpful.
In one group of men, not in the United States where there are more than 80,000, the incidence rate of tuberculosis which, as I told you, is closely associated with the incidence rate of silicosis, in 1923 was 7.33 percent per thousand men employed, and in 1933, 11 years later, the incidence rate among that same large group of men was 2.72 percent, which is very close to the incidence rate among the average general population.
We feel very definitely that this disease can be controlled, so that it is no longer a problem to industry or the States of the Union. One important consideration is the proper application of methods of control that are known and available. We think that methods are already available in most of the industries, if those methods are properly applied.
Mr. RANDOLPH. I am happy to hear that. We have had testimony here which would tend to make the committee believe that silicosis is incurable.
Mr. Dunn of Pennsylvania. It is at least preventable, is it not, Doctor?
Dr. SAYERS. It certainly is.
Mr. MARCANTONIO. In talking about cure, do you mean that it may be arrested?
Dr. SAYERS. Yes. Mr. MARCANTONIO. That is not necessarily curing it, though. Dr. SAYERS. It is according to what one means by the word “cure.” We should have to define it. If we mean that a man can go along and do his normal work, yes, it can be cured. If he has no subjective symptoms, yes, it can be cured. We have had individuals who have not had exposure for 18 or 20 years and who have had the disease. I have known a number of individuals who have had the disease 18 or 20 years. Men examined by Dr. Lanza in 1933 and found to have the disease then are still living and working.
Mr. MARCANTONIO. I know of some cases in New York City of men who contracted this disease while digging in the subways and they are still living but in those cases exposure was slight. It all depends upon the degree of exposure; is not that true, Doctor?
Dr. SAYERS. It depends upon the percentage of free silica, upon the concentration of dust in the air, and the length of exposure.
Mr. MARCANTONIO. Even in the case of a person whom we would describe as cured, according to this definition, that person is more susceptible to infections than is a person who never had silicosis, a silicotic condition of the lung?
Dr. SAYERS. That is probably true, but we are not certain. We are not certain but what the increased susceptibility may be overcome after awhile.
Mr. MARCANTONIO. A study has been carried on by Dr. Coldwater, of Bellevue Hospital, in which, as I understand, they have gone into the effect of silica, the poison created by it, its getting into the organs of the body and complicating the disease. That explains many times the quick deaths that take place, does it not?
Dr. SAYERS. In most cases death is not sudden. It is slow. This is a progressive disease.
Mr. MARCANTONIO. Sudden death is brought about by complications such as pneumonia, tuberculosis, and kindred diseases, is it?
Dr. SAYERS. Usually that is true, when death does occur.
As to the toxicity of silica, there has been some argument. There has been some argument as to how silica dust is a particular hazard, compared with other dusts.
Mr. DUNN of Pennsylvania. It was testified before the committee that three boys named Jones died within 13 months because of silicosis. When these boys first went to work they were healthy. Is that possible?
Dr. SAYERS. It is possible, but that does not usually occur.
Mr. MARCANTONIO. When a man works daily in a tunnel which has a high percentage of silica, as high as 97 percent, and he is kept exposed to that silica for months about 10 hours each day, it is very possible that death will occur soon, is it not?
Dr. SAYERS. That depends upon the concentration.
Mr. MARCANTONIO. When the concentration is very heavy, it will bring death quickly, will it not?