Showing papers in "American Journal of Public Health in 1948"

Q Fever in Los Angeles County. Description of some of its Epidemiological Features.

Abstract: QFEVER has been found to occur in Los Angeles County, California, in an apparently endemic fashion, and this paper describes certain characteristics of the disease in that area. Two naturally occurring outbreaks of Q fever are known to have taken place in the United States. The first appeared in Amarillo, Tex., in March, 1946,' and the second in Chicago, Ill., in August, 1946.2 These two epidemics were alike in many respects; both were sharp outbreaks arising from occupational exposure of susceptible persons to stock being slaughtered or moving to slaughter. The attack rates were high in both instances, being over 50 per cent in the most heavily exposed groups, and the dates of onset of the cases were distributed over a 2 to 3 week period, the variation being chiefly accounted for by the spread in incubation period of the human disease. It seemed clear from studies of the two outbreaks that infected cattle in Amarillo and infected calves or sheep in Chicago had been the source of human infection, and that transmission to slaughter-house workers had come from infected tissues and body fluids either by direct contact or by means of droplets of splattered fluids. Ticks had been very rarely seen on animals in either of these locations, and, in Chicago, cases did not tend to develop in persons associated with operations on hides, but instead were concentrated in personnel handling viscera. Although the means by which the human beings had become infected was somewhat clarified by these studies, the manner of infection of the animals was not obvious, and it was not possible to gain a clear picture of the natural reservoirs of the disease in this country. For one reason the infectious source had long since been removed when the outbreaks occurred, and the epidemiological investigations were necessarily retrospective. The endemic area now found in Los Angeles County appears to provide suitable material for investigation of the natural reservoir problem. The apparent lack of an insect vector in the two American outbreaks and their explosive and isolated nature seems to be different from the picture in Australia.3

History of Factory and Mine Hygiene

Abstract: I SHALL ATTEMPT TO MAKE A survey of the history of factory hygiene, that is, of the hygiene of the plant and its installations as well as that of the work itself, especially of health safeguards in dangerous occupations, and also of the protection of miners. I realize fully that some other aspects of working conditions, such as the protection of women and children, the regulation of working hours and wages, have always been of much greater importance for public health and labor protection, because they protect the greatest number of working people in the most effective way. However, being a physician and industrial hygienist, I wish to confine myself to my own field, the hygiene of work… . Accident prevention will also be treated, but since it is rather the concern of engineers it will be dealt with less thoroughly and without technical details… . The methods developed for the control of health hazards (except accidents) may be divided in the following groups: the elimination of dangerous substances, the exclusion of especially endangered groups (women and children, and other groups by pre-examination and periodical examination), work turnover, shorter working hours (hygienic working day), personal precautions, and technical devices. The elimination of dangerous substances and their replacement by others may be accomplished by laws and regulations or by voluntary action on the part of manufacturers. The supposition of both is that science has discovered substitutes adequate for the special purposes of the dangerous processes… . Mercury seems to have been introduced in the production of mirrors in about 1500 in Venice… . In the middle of the 19th century there were many complaints, considerable research, and numerous regulations concerning the quick-silvering of mirrors… . The production of silver mirrors became cheaper than that of mercury mirrors when the price of silver went down. In the year 1889 the German government issued far-reaching rules for the use of mercury which made that process even more expensive… . The desire to exclude from work persons who are especially sensitive to the hazards of that work is at the root of all the laws that protect women and children and also prevent their employment in dangerous trades. When an English law of 1833 prohibited employment of children under 9 years of age in textile factories and permitted children from 9 to thirteen to work no more than 9 hours a day, it became necessary—since reliable birth certificates were lacking—for a physician to testify that the individual was “of the ordinary strength and appearance” of a child that age. This was, I think, the first medical pre-examination for factory work required by law… . The law presumes that in certain kinds of work all women and children, by their peculiarities, are more endangered than are male or adult persons. Consequently women and children are forbidden to engage in such work. The British Mines and Collieries Act of 1842 prohibited the employment underground of all females and of males under ten years of age. The British Factory and Workshop Act of 1878 prohibited the cleaning of moving machines by children, the employment of children and young persons in mercury mirror and white lead factories, and the work of young girls in certain parts of glassworks and brickworks. The regulation of May 7, 1898, prohibited the work of persons below the age of fifteen years in some divisions of the manufacture and decoration of earthenware and china. Sections 76 and 77 of the Factory and Workshop Act of 1901 likewise excluded women, young persons, or children from certain work… . Other Persons Suspected of Being Especially Endangered. Exclusion from work—or from some types of work—also is indicated in the case of persons particularly sensitive to a substance because of certain bodily peculiarities and of persons who already have absorbed so much of a specific substance that curtailing the exposure seems necessary. The first group must be protected by medical pre-examination, the second group by periodical examination. These methods also have long been in use. A regulation concerning factories making phosphorus matches, issued by the government of Lower Austria in 1846, made the following provision: “Such a factory must be visited by the health officer monthly and the workers, male and female, have to be examined, and, if one of them shows the slightest trace of a symptom attributable to the harmful influence of phosphorus, he must be eliminated from the work.” … A German rule of 1892 stated that young workers may be employed in glassworks only if they obtain a certificate of fitness from a physician. The German regulation concerning lead paint factories (1903) orders examinations to be made twice a month by a physician, whose name is communicated to the factory inspector and the health officer. The management of the factory must keep a control book which contains the names, ages, and other such data on all workers, the beginning and termination of their employment, and a record of every illness… . Thus we see that the trend of the development is to put the examinations as far as possible under governmental supervision. The reason is the same as that which caused the introduction of certifying surgeons in England: the impossibility of getting exact examinations and reports from physicians dependent on the manufacturer–or on the worker. I may add from my own experience that such examinations are reliably carried out only if efficient governmental supervision is exercised–perhaps with the exception of a few very large factories… . The periodic examination not only offers the possibility of protecting men from serious illness by excluding them from dangerous work at the appearance of certain signs. It also permits the discovery of the dangerous spots by observing the frequency or the quick development of the first signs among workers at a given place or work. Thus it controls the efficiency of prophylactic measures and indicates the necessity for their improvement. Finally such examinations, in conjunction with examinations of the air, provide us with the time of true “allowable limits.”

Cave Sickness. A New Disease Entity

Abstract: D URING the past year we had the opportunity to investigate in Arkansas an outbreak of a peculiar pulmonary disease, mention of which appears only once to our knowledge in medical literature. Cain 1 and his coworkers published a report on just such an episode which occurred in the neighboring state of Oklahoma in 1943. Later a personal communication noted another similar instance happening in Mexico.2 In none of the investigations including our own, was an etiologic diagnosis established. We have dubbed the condition "cave sickness " because of the feature common to all three outbreaks and have concluded that this is a new or at least inadequately described disease entity. Our study was conducted on 21 white male patients who represented the greater part of the 25 persons engaged in a treasure hunt in an old abandoned chalk mine in southwestern Arkansas. Excavation was started September 12, 1947. At intervals beginning with the 4th and ending with the 13th day of operations, all of those who had spent any time in the cave became ill in varying degrees of severity. Data in Table 1 give the ages, incubation periods, calculated from patient's first visit to the cave to date of onset, length of exposure, which could not be defined in terms of hours and minutes, and type of disease. Only individuals who had entered the diggings were involved in the outbreak. Among them the disease took the form of a febrile illness with pulmonary manifestations. Onset was sudden after a short prodrome of coryza and malaise followed by chills and fever. The rest of the symptom complex was composed of headache, in some cases with retro-orbital pain, nuchal tension, nervous irritability, slight cough, chest pain, weight loss, and certain general complaints. There was a dearth of physical findings. Aside from increase in temperature and pulse, all signs were confined to the chest where sonorous inspiratory and expiratory rales were heard early in the illness. These later became moist and sticky and disappeared after coughing. Clinical laboratory studies were not revealing. Chest radiographs were spectacular and in keeping with the prostration of the patients. The report on these is as follows 3:

Rheumatic heart disease and crowding; a survey of rural and urban Connecticut school children.

Abstract: ATTEMPTS have been made for over 50 years to relate the prevalence of rheumatic fever and rheumatic heart disease to climate and special types of living conditions. From an epidemiological standpoint these two environmental influences are closely associated, in that temperature, rainfall, and altitude, or so-called macro-climate,t are important factors in influencing the extent to which people spend their time indoors, and these in turn influence crowding and spread of droplet infection. On the other hand, the living conditions in which we are interested here refer to the immediate surroundings of the individual, whether urban or rural, the environment within his home including dampness, crowding, food, and clothing. The previous studies which have attempted to relate urban living conditions with the prevalence of rheumatic fever are many and variable. They include those of Perry and Roberts in Bristol,

Sex Variants: A Study of Homosexual Patterns

Abstract: these sources Mr. Griffith has collected an enchanting anthology which should appeal to all lovers of humanity. From its nature this is essentially a book to be dipped into, and for the bedside table or the odd leisure hour it will join the select few. Fingerprints, Scotland Yard and Henry Faulds. By GE'ORGE WILTON, B.L. (Edin.). Edinburgh: Green & Son, 1951. Pp.29. Price 7s. 6d. This is a collection of the writings of a well-known authority on the subject. Some have appeared in the Juridical Review for August, 1950, and others are biographical notes and descriptions of outstanding cases. The History of Capital Punishment. By GEORGE RYLEY SCOTT, F.Z.S., F.R.A.I., F.Ph.S. (Eng.). London: Torchstream Books, 1951. Pp. 312. Price 21S. The thorny and pertinent problem of the capital sentence is fully dealt with in this book. The title does not invite the reader to the fuller study of the question of how society should deal with its major criminals, but the book in fact goes on from its historical survey to discuss and place before the reader the pros and cons for abolition and expounds dispassionately the views held by leading thinkers. Whatever view the reader himself may hold, this book is of absorbing and at times repelling interest for the author spares few details of the horrors man has at times devised for his fellows. A book of this kind was needed to offset the not inconsiderable volume of uninformed vaporings on the subject. Law Relating to Hospitals and Kindred Institutions. Supplement to 1949 (Second) edition. By S. R. SPELLER, LL.B. London: Lewis, 1951. Pp.' 80. Price 12S. 6d. Mr. Speller has brought his unique volume right up to date with this latest supplement. It is a must for all hospital administrators and their advisors. Selected Decisions of the Minister on Questions of Classification and Insurability. Pamphlet M.3. H.M. Stationery Office, Kingsway, London, W.C.2. . Price 4d. Five leading decisions by the Minister of National Insurance on classification and insurability under the National Insurance Acts, affecting a variety artiste; a student chiropodist; a disabled person who worked at home making rugs; a school meals service helper and a student physiotherapist.