which enters every home in which a person has been blinded or has lost part of his sight permanently-a tragedy which often spells disaster. Close students of industrial conditions are now convinced that 98 per cent of all industrial accidents are preventable. If this applies also to the eye hazards of industry, this joint effort of the American Federation of Labor and the Society for the Prevention of Blindness and the society's program within the industries themselves and among employer groups should result in the saving of many men's and women's eyes. Endemic Pellagra in Cotton-Mill Villages of South Carolina 1 OME of the conclusions reached from a study of pellagra by the United States Public Health Service which extended over a period of about five and a half years were published in Public Health Reports of October 12, 1928. The study, which began in the spring of 1916 and ended in October, 1921, covered several textile-mill communities in South Carolina, the number studied varying at different periods from 1 to 24 villages. Only one of the villages was under observation throughout the entire period and it is the findings of this study, much delayed for various reasons, which are now summarized. The study is regarded as important from the fact that it shows the fluctuations in the incidence of the disease from year to year and also because it brought out the more important factors in these fluctuations. During 1917, the period when the largest number of persons were under observation, in an aggregate population of 22,653 individuals there were 1,147 cases of pellagra reported, giving an incidence rate of 50.6 cases per 1,000. It was shown by the study that pellagra in an endemic locality is from two to six times more prevalent than the experience of the local physicians would seem to indicate, and that the fatality rate when definitely marked cases of all grades of severity are considered does not appear to exceed 3 per cent. The data show that endemic pellagra is preponderatingly a disease of children of from 2 to 15 years of age, a fact which does not seem to have been recognized before. It was found, also, that the single women, as compared with the married, widowed, or divorced, were relatively exempt from the disease. This was explained by the fact that in the population group under consideration, the single woman was usually a wage earner which would, in general, place her in a somewhat more advantageous position in regard to diet than the women who had other responsibilities. The incidence of the disease was found to be markedly seasonal, from 80 to 90 per cent of the cases beginning within the period from April to July, inclusive. In view of the fact that diet has been proved to be an important factor in the incidence of the disease, the reason for seasonal variation in the development of cases is found in the variation in the diet brought about by the seasonal modification of the food supply. It was found that the disease had a marked and very sharply limited season of prevalence, the curve of which, with a slight lag, paralleled that of incidence. As marked seasonal variations in the food supply were shown in the village longest under observation, the relation of this variation in food supply to the striking seasonal incidence and prevalence of the disease is suggested. 1 See Labor Review, February, 1919 (pp. 221-226), and November, 1927 (p. 39). No consistent correlation between sanitary conditions and pellagra incidence was demonstrated by the study, but such association as was at times observed was regarded as accidental and due to the intimate relation of the endemic disease to economic status, of which the sanitary condition is often an index. There was a striking inverse correlation shown between the incidence of the disease and family income, the study of the selected village for nearly six years demonstrating that income shortage was a fundamental, though indirect, controlling factor in the year-to-year fluctuation in the occurrence of the disease. It seems evident, therefore, that the fluctuations from year to year are largely the effect of economic conditions that influence the ability of a certain section of the population to procure an adequate diet. Fifth International Congress on Industrial Accidents and HE Fifth International Congress on Industrial Accidents and tember 2-8, with approximately 2,400 delegates present, representing countries in all parts of the world. The conference represents an earnest effort to establish a clearing house in order more effectually to combat industrial accidents and occupational diseases, and national committees appointed by the congress are active in most of the civilized countries. About 40 delegates were registered from the United States, 18 of whom formed a study group and, traveling together, visited clinics in Berlin, Vienna, Munich, southern France, and Spain, either before or after the congress. Two hundred and six papers were read in one or another of the four official languages of the conference-English, French, German, and Italian-12 of these papers being presented by the American group. The papers read by the American delegates dealt with methods of treatment of traumatic conditions or diseases, with the effects of various poisonous vapors, the periodic health examination in industry, the medicolegal aspects of occupational diseases, the determination of permanent disability following head injuries, and occupational ear, nose, and throat diseases among American factory workers. Three of the papers represented the work of the Reconstruction Hospital in New York. A resolution adopted by the conference dealt with the question of first aid and of after-treatment in cases of accident caused by electric currents, it being the opinion of the congress that the care given to electrical injuries is insufficient in all countries. The resolution states that there is "much to be desired in the field of electropathology and electric accidents as regards the treatment by doctors; likewise, as to knowledge by engineers in most countries of the dangers of electricity and protection against them." The members of the congress put forward the request to the Government of every country that they should give every attention to the treatment of electric accidents just as the teaching of their prevention and practical instruction in a 1 Journal of the American Medical Association, Chicago, Nov. 24, 1928, p. 1652. corresponding degree should be given in the universities and technical schools, and that there should be a sufficient supply of instruments so that in future any accidents caused by electricity may be prevented and, if this is not altogether possible, that they should at least insure immediate help for the injured person for the saving of his life or for the easing of the serious consequences of the accident. International cooperation for the establishment of electropathology and electrohygiene is likewise greatly to be desired and the earliest possible foundation of it insured. In the first place, these international workers must find out what the conditions are in each country for the prevention of electric accidents, what may be the educational equipment of doctors and technicians, likewise the necessary instruction of the people, after which it should be made compulsory in every country or State where electricity is employed and where electric accidents are likely to occur so certain insurance instructions should be maintained. But in the first place an endeavor should be made that the course of instruction in universities and technical schools should be essentially better than it is at present in most countries. Every medical and technical student should be compelled to attend lectures and pass examinations on electropathology and therapy as well as on electrohygiene. In this respect every doctor and engineer should prove his practical and theoretical ability before the health and security of workers with and consumers of electricity be intrusted to them. French Experience Regarding Occupational Diseases Caused by X rays and Radioactive Substances1 TH HE effects of occupational exposure to X rays, radium, and the various radioactive substances and the recent decision of the French Superior Commission on Occupational Diseases to include diseases resulting from exposure to radiations from these elements among the reportable diseases are discussed in an article in a recent issue of the Paris Médical. The early and late effects of radioactive substances or emanations are said by the writer to be now sufficiently well established to constitute a symptom-complex or syndrome the cause of which is certain, so that it can be said positively that radiations from these substances cause a typical occupational disease. The first signs of exposure to the radiations are blood changes, affecting first the white blood corpuscles and then the red. There is a reduction of the leucocytes in the peripheral blood below the normal standard or more rarely either a myeloid or lymphatic leucæmia, that is, a condition of the blood and the blood-making organs characterized by a permanent increase in the large white blood corpuscles and by enlargement of the spleen, the lymphatic glands, and the marrow of the bones, together or separately. There is also a deficiency in the number of red blood corpuscles, with abnormal inequality or irregularity in their size. Blood changes occur very early and have been demonstrated following a single exposure to the gamma rays of radium, while there is also lowering of the arterial pressure but with a maintenance of the cardiovascular equilibrium. Radiations have a direct effect on the reproduction cells, causing sterility and disordered menstruation and they cause troubles of nutrition, characterized by more or less marked loss of weight and showing various depressive symptoms, such as fatigue, drowsiness, headache, etc. However, the latter symptoms are Paris Médical (Paris, France): November, 1928, pp. 422-424 "Les accidents causés par les diverses radiations," par le Dr. F. Dervieux. purely subjective and consequently susceptible of considerable individual variation and there is reason to question whether there is not some correlation between these symptoms and the blood changes. In addition to these pathologic conditions the radiations have a traumatic effect resulting in radiodermatitis, burns, lesions of the skin and underlying tissues, and malignant growths, while the special action of the ultra-violet rays should not be forgotten. The methods of protecting workers subject to the hazards from radioactive substances have been considered in France by different interested organizations. In a report to the industrial hygiene commission the radioactive substances which are actually used in greater or less quantity were given as radium, radium emanation, radioactivity induced by radium or radon, polonium, actinium, thorium, mesothorium, and radiothorium, thorium X, emanation of thorium or thoron, and radioactivity induced by thorium. These elements act in three different ways: Through the direct rays which penetrate into the organs of the body, through the inhalation of radioactive emanations (radon or thoron), and through the absorption of solid or dissolved radioactive substances. The protective measures recommended by the French Academy of Medicine are adequate ventilation of workplaces, use of rubber gloves and of forceps for handling materials, protection from the rays by the use of lead plates of adequate thickness, and periodic medical examination and blood examinations of all workers exposed to the radiations. There should also be similar protection against X rays, the industries or industrial operations which expose the workers to ultra-violet rays including the manufacture of mercury quartz lamps, taking moving pictures with electric arc lights, electric welding, autogenous welding, and numerous others. A report upon the occupational diseases due to radiation presented to the Superior Commission on Occupational Diseases at a recent meeting listed uranium, and its salts, uranium X, and ionium among the elements presenting an industrial hazard in addition to those enumerated above. In this report it was recommended that the diseases which should be included among the reportable industrial diseases were skin affections, either acute or chronic, cancer, anemia with leucopenia, pernicious anemia and leucemia, and radium necrosis, all of which were the direct effects of radiation, while certain other diseases such as degeneration of the bone marrow, atrophy of the spleen, and troubles of gestation were not included as it is not always possible to determine positively that they are solely the result of exposure to radiation. The commission decided that the following types of industrial or commercial enterprises were potential sources of poisoning from these substances: Plants for the extraction of radioactive elements from minerals, manufacture of derivative radioactive substances; plants making medical appliances for radium therapy, or X-ray appliances; laboratories for research or measurement of radioactive substances and X rays; plants making radioactive chemical or pharmaceutical products, and factories making radioactive luminous products or workshops in which these paints are applied; clinics and sanitariums, centers for the treatment of cancer; enterprises for the sale of radium and radioactive substances; and manufacturing establishments using X rays. The commission fixed the limit of responsibility for the development of these diseases at one year with the exception of cancer, which it was considered might develop at any time within five years. Ο Compulsory Insurance Against Tuberculosis in Italy N JULY 1, 1928, regulations for the purpose of administering the law instituting compulsory insurance against tuberculosis in Italy went into effect. The new law applies automatically to all persons liable to compulsory insurance against invalidity and old age. It applies to workers in industries, commerce, and agriculture, and also to those who are beneficiaries of the mercantile marine invalidity fund. A number of institutions cooperate in administering this insurance, among them the National Social Insurance Fund (Cassa Nazionale per le Assicurazione Sociali), a special committee, and the provincial societies for combating tuberculosis. Below are given some of the important regulations, as digested from the decree issued on October 27, 1928, published in the Bolletino del Lavoro of July 31, 1928. Collection of contributions.-The National Social Insurance Fund is charged with the financial management of the insurance against tuberculosis. Contributions are collected at the same time as the contributions for old-age, invalidity, and unemployment insurance. For agricultural workers employed by the day the contributions are fixed at 0.10 lira (0.526 cent) daily, 0.50 lira (2.63 cents) weekly, or 1 lira (5.26 cents) biweekly. The National Insurance Fund, within the limits and conditions established for compulsory insurance, is authorized to permit voluntary insurance under conditions to be determined by a special committee and to be approved by the Minister of Economic Affairs. Benefits. Applications must be submitted to the fund by registered letter by the insured, his family, or his legal adviser, or by the local authority of his place of residence. Medical examination is made at the hospitals connected with the fund or at dispensaries operated by the provincial antituberculosis societies with the aid of a physician of the fund. If the condition of the patient does not permit of an examination at these places, the examination is made by the traveling dispensary of the provincial antituberculosis society with the collaboration of a physician of the national fund. Papers and documents relating to benefits must be transmitted by the provincial societies to the national fund within 10 days. Where a favorable decision has been made, the insured is so advised by the fund by registered mail, indicating the day and place the insured is to present himself for treatment. Treatment at home is provided by the National Social Insurance Fund only in case there is no room in any of the tuberculosis hospitals, or when the condition of the patient makes this necessary. Home treatment, however, must cease as soon as space is available in one of the tuberculosis hospitals and in any case the cost of medical treatment administered in the home must not exceed the cost of hospital treatment. |