TO GENERAL GEORGE M. STERNBERG,

WASHINGTON, D. C.

February 4, 1908.

Surgeon-General U. S. A. (Retired),

Chairman of the President's Homes Commission,

Washington, D. C.

SIR-The Committee on Social Betterment finds it difficult, if not impossible, to elaborate plans for the amelioration of present standards of living among the least resourceful people without a full consideration of the relations of certain occupations to the health of those engaged therein. The question of health is intimately connected with the physical, social and moral welfare of the human race and plays an important role in the prosperity of countless numbers of our fellow beings, whose only income is the product of their daily labor. It will be readily conceded that health is the chief asset of the workingman, and that no greater calamity can befall him than when his earning capacity is impaired, or arrested, by reason of sickness or disability. It means, in many instances, the utter financial ruin of the family and is doubtless one of the most potent causes of want and poverty. The truth of this statement is being more and more appreciated, and well directed efforts are being made everywhere to prevent, as far as possible, the fundamental causes of poverty and distress. In this the medical profession has been a helpmate to religion. Men who come in daily contact with sickness and distress can not fail to experience deep sympathy for their fellow men, which is all the more profound when they realize that many of the diseases are preventable, and much of this terrible suffering cruelly unnecessary. These tender feelings inspired by a desire to render a service to humanity have stimulated into existence a science which has for its object not only the promotion and preservation of health, but also the prevention of disease.

In the search for the causes and prevention of diseases the interests of the wage-earners have not been neglected; indeed, it may be truly said that a special department has been created, known as Industrial Hygiene or Social Medicine, with a most complete and satisfactory literature of its own. German authors, in 1897, issued a volume of over 1,200 pages, and English authors, under the editorship of Dr. Thomas Oliver, devoted 891 pages to "Dangerous Trades”—“The Historical, Social and Legal Aspects of Industrial Occupations as

Affecting Health." The writer, during his visit to Berlin in September, 1907, met Dr. E. J. Neisser, who had just completed an "International Review of Industrial Hygiene," covering a volume of 352 printed pages. Dr. Neisser deplored his inability to present a general review of the work accomplished in the United States for the promotion of the welfare of the wage-earners, since, with the exception of the reports of the Inspector of New Jersey, no recent data concerning factory sanitation were available for publication. Realizing the importance of the subject, not only to wage-earners, but to all interested in the conditions under which our fellow men and women live and work, an effort has been made in the succeeding pages to supply this information.

It is, indeed, a feeble attempt towards amelioration of existing conditions, when compared with the monumental volumes of German and English authors. The writer acknowledges his indebtedness to Dr. Neisser for the inspiration given him by his own good and unselfish work, and also to all authors consulted by him, and to whom credit is given in the text.

It is hoped that this study of the causes of sickness and the means of promoting industrial efficiency and earning power, will fill one of the obligations which your Committee assumed to discharge.

Respectfully submitted,

GEORGE M. KOBER.

INDUSTRIAL AND PERSONAL HYGIENE.

BY GEORGE M. KOBER, M. D.

Part I-INDUSTRIAL HYGIENE.

INTRODUCTION.

One of the most interesting and beneficent subdivisions of hygiene is a study of the relations of occupations to health and longevity. The necessity for devoting special attention to this subject was shown long ago by observations that certain occupations and trades are dangerous to health, and hence in the interest of wage-earners and the public at large it is clearly desirable to study these relations, to determine the sources and significance of the dangers, and the possible means for the prevention or the mitigation of the injurious effects.

A pioneer study was made by Professor Ramazzini, of Padua, as early as 1700, and his monograph was translated into English in 1705, and also into French in 1777.

In 1810 the French Government issued a decree relating to "etablissements dangereaux, insalubres et incommodes," and in 1815 the English Parliament instituted a commission to inquire into the condition of factories, etc. In 1822 Mr. C. Turner Thackrah, of Leeds, wrote a monograph "On the Effects of the Arts, Trades, and Professions, and of Civic States and Habits of Living on Health and Longevity." In 1833 and 1865 the English Parliament again appointed commissioners, and in 1839 the "Academie des sciences morales et politiques de France," and subsequently Bavaria, Prussia, and the German Empire directed similar investigations. As a result of these efforts and numerous independent investigations, it is known today that persons habitually engaged in hard work, especially in factories and indoors, present a greater amount of sickness and higher mortality than persons more favorably situated, and that the character of the occupations influences to a great extent not only the average expectation of life, but also the prevalence of certain diseases.

It is known, for example, that bronchitis, pneumonia, and tuberculosis are much more frequent in dust-inhaling occupations, and that the sharp angular particles of iron and stone dust are more liable to produce injury of the respiratory passages than coal, flour, grain, and

other kinds of dust. It is also known that workers in lead, mercury, arsenic, phosphorus, poisonous dyes, etc., suffer especially from the injurious effects, and that other occupations, such as mining, railroading, and those which necessitate working with or around moving machinery involve special danger to life and limb.

For these reasons workers in many industries need special protection, and in order to render this efficient it must be provided for by the enactment and enforcement of suitable laws. In 1833, 1864, 1867, and 1870, England enacted the so-called "factory laws." France provided a child labor law in 1841 and in 1874 a more satisfactory labor code. Germany and other continental governments enacted suitable legislation between 1859 and 1886.

According to Miss S. S. Whittelsey's "Essay on Massachusetts Labor Legislation," child labor received attention in Massachusetts as early as 1836. The first law as regards safety and sanitation was enacted in that State in 1877, since which time all the States and Ferritories have enacted some form of labor or factory laws.

OCCUPATIONS AND MORTALITY.

According to the United States Census for 1900, of 360,739 males, ten years of age and over, dying in the United States during the census year, 278,147, or 77%, were reported as having a gainful occupation. Of females, ten years of age and over, there were 324,075 deaths and 45,491, or 14%, were reported as having a gainful occupation. In the aggregate the table on page cclx gives information as to the mortality by occupations for 5,575,745 males and 1,587,874 females. The death rates by occupation groups are as follows:

Each of the eight large groups of occupations is subdivided, and detailed information is given in sixty specified groups of employment

for males, and in fourteen groups for females, of which we have produced only two for females, on account of their high death rate.

Unfortunately we have no reliable occupation mortality statistics and never will have, until greater attention is given this subject by health officials and the Census Bureau.

I

In view of the importance of the subject and the tendency elsewhere towards a more detailed classification and information for industries and trades, Mr. Frederick L. Hoffman says: "It was reasonably to be expected that the Census report of 1900 would materially increase the number of specific occupations dealt with in the section discussing the relation of occupation to mortality, but instead of 89 employments discussed in the Census of 1890, only 60 are dealt with in detail in the Census of 1900. To make this matter worse, the details are not given in the fundamental tables, but a vast majority of heterogeneous employments are grouped in a purely arbitrary manner, filling space to no advantage, and resulting in conclusions of no practical value."

He very properly objects to grouping together miners and quarrymen, because according to the Census of 1890 the comparative mortality figure of quarrymen was 469, while that for miners was given as 1,127; "and to combine two such unlike occupations is the mere production of a figure which has absolutely no determining value, but the use of which must lead to false and mischievous conclusions." For like reason he objects to the grouping together of fishermen, oystermen, sailors and pilots, which he very properly regards as three welldefined groups of employment. The mortality figure in the Census of 1890 for fishermen and oystermen was 543, for pilots it was 630 and for sailors 2,276. Many other combinations of employments, such as hotel keepers and boarding-house keepers, or saloon keepers with restaurant keepers are objectionable, as it does not enable the student of social questions to determine the effects of alcohol upon longevity. If, for example, restaurant keepers, who very generally do not engage in the liquor traffic, had not been combined with saloon keepers, bartenders, etc., the death rate of this group might not be so favorable but be more in accordance with the excessive mortality rates observed in this class in other countries. Mr. Hoffman points out that during the five years 1891-1895, during a condition of peace, the death rate of the U. S. Army was 6.6 per 1,000, and for the Navy 8.3 per 1,000, and concludes from this, that soldiers and sailors should not have been combined. We quite agree with him, as there is reason to believe that the factor of environment, such as close sleeping quarters and damp

'Quarterly Publication of the American Statistical Association, December, 1902, p. 172.