May I call your attention to a new subject that has come into the field of industrial hygiene, or perhaps I should say, to an old subject that has come to be newly regarded and promises to ocupy a place of unusual importance in the problems of industry and in the problem of public health, namely, the question of fatigue? It has long been very well known that accidents in railway transportation increase almost in proportion as the working hours of the trainmen increase beyond a reasonable length and it is very well known that accidents multiply in industries as the overstrain of the workers is increased. But we have not yet given much attention o the all-pervading presence of fatigue and its significance for the general health of the industrial class or for the general virility and physical vigor of the class. But all these questions are now coming prominently into the field of preventive medicine.

Mr. Oliver, in his "Disease and Occupations," says that "fatigue or tiredness is a sensation, the outcome of a particular state of the nervous system, the result of work carried on beyond the capability of the organism." Describing fatigue a little more in detail, he said: "The waste products added to the blood act upon the nerve endings in muscle and upon the gray matter of the brain and create a sense of fatigue. Although the sensation of tiredness is referred by us to the overworked muscles, the location of the cause is less in the peripheral than in the central nervous system. On the one hand waste products act upon the muscles, diminish their contractility and render them less responsive to nerve stimuli; and on the other hand they poison the large nerve cells in the gray matter of the brain, render them less receptive to sensory stimuli, and in this way reduce their power of emitting volitional impulses. There is, therefore, in fatigue an element that is mental as well as physical."

The fact and effects of fatigue have in the last few years been made an additional basis for the justification of the shorter working day for women. It was recently argued conclusively and successfully before the Supreme Court of the State of Oregon that the regulation of the hours of labor for women was justifiable on the ground of the injurious effect of the fatigue of long hours. The same arguments, somewhat modified, prevailed in one of the superior courts of the State of Illinois.

If it is difficult to estimate the extent of occupational diseases how much more difficult is it to estimate their cost. It is true that attempts have recently been made to measure the economic loss due to tuberculosis. These figures might be reproduced if there were more time for their presentation. But their magnitude is almost beyond our understanding and I think would give us no basis for the determination of the economic loss from other and all occupational diseases. Moreover, I refuse to believe that we can express in dollars and cents the loss of a husband and father. The measure of human life cannot be expressed in money. If it be the life of one of our own family we do not think of counting the cost of the efforts it takes to preserve that life. Everything that a man has will he give in exchange for his own life or for the life of his own family.

eases.

The cause of the diseases of occupation suggest ways in which we may reduce the amount of sickness and the number of deaths from occupational disThe reduction of sickness and death from phosphorous poisoning is chiefly a matter of substituting sesqui-sulphide of phosphorous for the yellow phosphorous in the making of matches. This substitution has been made in France with the result that in almost ten years of its use there was not re

ported a single case of phosphorous poisoning. Similar results have attended its gradual substitution in the match factories in England. Recent legislation in our own country should promote this desirable end here also.

In the compressed air illness the difficulty is the unequal air pressure upon the men as they are being locked in and locked out of the caisson. The chief means of prevention is therefore a properly timed compression and decompression of the air. In addition to the inequalities of pressure, the poisoning of the air by the use of lamps and by waste products of the body is a cause of aggravating the caisson disease. Therefore, lamps that do not vitiate the atmosphere and improve ventilation are essentials, and it is extremely important that the working shifts be properly timed, but always short.

The reduction of lead poisoning requires especially that every precaution shall be taken to prevent inhalation of dust particles of lead, whether in the process of making white lead or in the handling of lead in any of its forms. No pains can be too great to insure cleanliness on the part of the worker and on the part of the shop, in order that lead may not find its way into the system. Minute regulations for many of the workmen are absolutely necessary. For those engaged regularly in some of the lead processes, ideally, at least three suits of clothes are required while about the factory. There should be an abundance of wash basins and provisions for hot baths. There should be moist respirators for the persons working at dusty points in the process and arrangements for constantly spraying the dry material. The installation of machinery at every point possible in the process is also greatly to be desired. The labor of children and women in lead processes should be prohibited, for it has been conclusively shown that young persons of both sexes are highly liable to plumbism and I do not need to elaborate as to the serious effects of plumbism in women.

Moreover, it is known beyond a peradventure that users of alcoholic liquors engaged in lead processes are more prone to lead poisoning than are non-users of alcohol. Therefore, men employed in lead processes should abstain from drink; or, by putting it another way, men who are alcoholics should not be employed in lead processes.

Just as there is a substitute for the yellow phosphorous, so there is, in a measure, a substitute for the white lead, now so generally used in painting. Such a substitute, called "zinc white," has been tried with very satisfactory results, both as to its covering power and its durability. For inside work the evidence has been conclusive in favor of the zinc white, while extended experiments as to its use in outside work have thus far given very favorable evidence.

The prevention of tuberculosis, so far as it is an occupation disease, is chiefly a question of removing dust and of providing adequate light and ventilation. It is exceedingly important that the dust of industries be carefully removed from the shop and factory, since it is true not only that the dust particles and fumes lower the resistance to disease, but also because tuberculosis is transmitted from prson to person almost entirely by means of dust. The dried sputum which contains the tubercule bacilli is a chief means by which tuberculosis is carried from one person to another, therefore it is exceedingly important that wherever people congregate, as in places of occupation, every precaution must be taken to prevent the accumulation and scattering of dust.

It at the same time an abundance of clean, pure air and a high degree of sunlight can flow about the workers there should follow among wage earners a positive and marked reduction in the deaths from tuberculosis.

Industrial Insurance and Charitable Aid.

It will take a long time to greatly reduce the death rate among wage earners from diseases of occupation, and when all has been done there will doubtless remain an irreducible minimum rate. To protect the families of wage earners from want occasioned by the diseases of occupation it is desirable that some form of insurance or compensation shall be at hand. We put the cost of the wear and tear on machinery upon the industry itself. We shall in part at least put the cost of the wear and tear of human life upon the industries themselves.

There are, to be sure, already some sick benefits available for some of our wage earners. Many of the trade unions have sick benefits for their members, but only a small proportion of the wage earners are members of trade unions having sick benefits and usually these benefits are inadequate in amount. It is true that many large employers of labor have sick benefit funds. These are good also as far as they go, but they do not go far enough. A few life insurance companies write a working man's insurance, but these policies are little more than death benefits and are a very expensive and not very satisfactory form of protection for the wage earner and his family.

Certain of the European States, notably Germany, have worked out sickness insurance for wage earners in which usually the State itself, the employer and the employee share in the cost. There is no doubt in my mind that an adequate system of insurance is an essential to the welfare of our wage earners and in an obligation that the State should assume at least in part. Time forbids my going into the question of what constitutes an adequate insurance of this sort and what proportion of the cost ought to be borne by the various parties in interest.

Whether insurance against industrial diseases involves a principle different from that involved in a system of compensation for industrial accidents is a debatable question. There are those who believe that no new principle is involved and that the practical method of securing insurance against occupational diseases is to extend by appropriate legislation or by court interpretation the definition and list of what is included under industrial accidents.

There are others who believe that you cannot trace the illness of the wage earner directly to the work ist elf or to the conditions under which it is performed as you can do in the case of an accident. They argue that the industry is responsible for the accident and that the industry alone should bear the cost, but that the industry is only partially responsible for the illness and that the cost of such sickness should be shared in part by the wage earners themselves. I find myself more in sympathy with the latter view and believe that independent of the system of compensation for industrial accidents we need to provide additional insurance against occupational diseases.

While we are reducing the sickness and deaths due to industries and while we are establishing an adequate system of insurance, there will exist the problem of charitable help when wage earners fall sick and their income is interrupted for any considerable period of time. To meet the needs of these families by charitable assistance, whether from public or private sources, is the least

satisfactory way, but in the tardiness of these preferred forms of social justice, as they may be called, charitable aid must be at hand, be adequate and be more intelligently given.

Approximately one-third of the families applying to our charitable societies for help apply because of sickness, and the large proportion of these are wage earners' families. The absence of adequate compensation for industrial accidents and of insurance against industrial diseases not only creates a large part of the problem of relief that the charitable societies have to deal with but substitutes alms for social justice.

In conclusion let me gather up in a sen.ence the general argument of this paper. Although we cannot measure precisely the extent of industrial accidents and occupational diseases in this country, we do know that the numbers are altogether too high and experience elsewhere has shown that the numbers can be greatly reduced. Although we cannot measure in dollars and cents or in any other terms the cost of industrial accidents and occupational diseases, we need no figures to convince us that the burden is too grievous to be borne.

Although it will take a long time we must set our faces like flint toward the reduction and prevention of accidents and sickness through all means of safety and industrial hygiene that investigations and science can devise. For the irreducible minimum we must provide adequate compensation and insurance. In the meantime and for those not otherwise cared for the arm of sympathy must reach out and the hand of plenty must provide.

THE NEW DIVISION OF INDUSTRIAL HYGIENE.

The Department of Health is about to establish a Division of Industrial Hygiene, which will be under the general supervision of the Director of the Bureau of Infectious Diseases, and which will be closely associated with the Bureau of Public Health Education.

The Chief of the Division of Industrial Hygiene will be expected to coordinate all of the resources and activities of the Bureaus of Public Health Education, Laboratories, and Sanitation, as have any bearing on occupational diseases.

The Committee on Public Health Education of the Advisory Council, which was recently requested by the Commissioner of Health to consider the advisability of establishing a Division of Industrial Hygiene, has endorsed the following report prepared by a sub-committee consisting of Dr. George M. Price, Chairman, Miss Frances Perkins and Alderman Jacob Weil. Report on the Advisability of Establishing a Bureau of Industrial. Hygiene in the Health Department of New York City.

There are nearly two million persons engaged in gainful occupations in New York City. According to the United States Census of 1910, there were in New York City 57.7 per cent. of all the industrial establishments in the state, in which there worked 55.2 per cent. of the wage earners in the state.

Statistics are lacking as to the percentage of occupational diseases and industrial poisoning in the city but it is evident that the largest number of such cases in the state occur in this city.

The general mortality and morbidity of the population of a city are profoundly influenced by the conditions of the industrial establishments in the

city and by the hazards of industry and by the health conditions of the industrial population.

Private organizations, like the Museum of Safety, the Association for Labor Legislation, the Metropolitan Life Insurance Company, etc., are not able to safeguard the industrial population by their official functions.

The State Labor Department, with its present organization, with its attention given to the whole state and with its activities mostly centered upon the safeguarding of machinery and the enforcement of legislation as to child and woman labor, cannot devote much of its attention to industrial hygiene and to educational propaganda.

Investigation and research of occupational diseases, the prevention of industrial poisoning and the spread of knowledge of industrial hygiene among the industrial population should be the legitimate functions of a progressive Health Department of a great city like New York, the function of the department being the preservation of the health of the citizens of the city in the prevention of disease.

It is therefore within the functions of the Health Department to establish a Bureau of Industrial Hygiene.

The functions of such Bureau should be:

I. The establishment of a central occupational disease clinic for research investigation of industrial diseases on the lines of the clinic of Professor Devoto at Milan, Italy.

Such a clinic should be separate from the tuberculosis clinics although acting in harmony with them and in co-operation with the university and hospital clinics throughout the city.

Such a clinic should be the central clearing house of all specific occupational diseases and industrial poisonings, should have ample means for research and investigation and should also study the prophylaxis of the various industrial diseases with which it comes in contact.

2. The establishment of an industrial hygiene educational division which should endeavor by all means to spread the knowledge of the causes of industrial poisoning, the preventive measure to be taken in various industries, and the right modes of work and living for the industrial population throughout the city.

Such an industrial hygiene educational division should also, in co-operation with the various manufacturers associations and other existing bodies, as well as with the Department of Education, endeavor to conduct a general campaign of education among the manufacturers and workers as to the prevention of occupational diseases and the preservation of the health of the workers.

A Bureau of Industrial Hygiene organized on the lines indicated would be a potent factor in the reduction of mortality and morbidity in the city and would add prestige and credit to the municipality and to its Health Department. (Signed) GEO. M. PRICE, M. D.

In the preparation of a program for the Division of Industrial Hygiene, the Department will be assisted by Prof. W. Gilman Thompson, of Cornell University Medical College, who is perhaps New York's most authoritative medical investigator and writer in the field of occupational diseases. Dr. Thompson has consented to join the Advisory Council of the Department, and has been named as Chairman of a Committee of Industrial Hygiene. The following