tlifornia 
 
 ional 
 
 lity 
 
 U. S. DEPARTMENT OF LABOR 
 WORKING CONDITIONS SERVICE 
 
 GRANT HAMILTON, Director General 
 
 PRELIMINARY REPORT 
 
 OF 
 
 OMMITTEE ON MORTALITY 
 FROM TUBERCULOSIS IN 
 DUSTY TRADES 
 
 ?N BRANCH, 
 ALI 
 
 CALIF. 
 
 WASHINGTON 
 
 GOVERNMENT PRINTING OFFICE 
 1919
 
 U. S. DEPARTMENT OF LABOR 
 WORKING CONDITIONS SERVICE 
 
 GRANT HAMILTON, Director General 
 
 PRELIMINARY REPORT 
 
 OF 
 
 COMMITTEE ON MORTALITY 
 
 FROM TUBERCULOSIS IN 
 
 DUSTY TRADES 
 
 WASHINGTON 
 
 GOVERNMENT PRINTING OFFICE 
 1919
 
 INTRODUCTION. 
 
 This preliminary report of the Committee of the National Tuber- 
 culosis Association on the Mortality in Dusty Trades affords students 
 a rare opportunity to gain a real insight into the methods of the 
 committee. It announces the formation of a committee and its pro- 
 gram of investigation in a field that has long been recognized as of 
 primary importance in industrial hygiene. The immediate investi- 
 gations will deal with trades in which inorganic dusts have been found 
 to be harmful to workers the marble and granite industries and 
 work in quarries. From time to time additional reports will be pub- 
 lished giving the progress of the committee's work. The committee 
 consists of the following: 
 
 Dr. Frederick L. Hoffman, chairman, third vice president, and 
 
 statistician, Prudential Insurance Co., Newark, N. J. 
 Dr. Edward R. Baldwin, Trudeau Sanatorium, Saranac Lake, 
 
 N. Y. 
 Dr. Alice Hamilton, expert, Bureau of Labor Statistics, U. S. 
 
 Department of Labor, Washington, D. C. 
 Dr. H. R. M. Landis, Henry Phipps Institute, Lombard and 
 
 Seventh Streets, Philadelphia, Pa. 
 Dr. A. J. Lanza, chief, Industrial Hygiene and Medicine, 
 
 Working Conditions Service, U. S. Department of Labor, 
 
 Washington, D. C. 
 
 Dr. O. W. McMichael, Asheville, N. C. 
 Dr. Alfred Stengel, professor of medicine, Medical School, 
 
 University of Pennsylvania, Philadelphia, Pa. 
 
 The report is published by the Working Conditions Service as part 
 of its work of giving information of scientific studies made to better 
 working conditions. The work of the committee will be of practical 
 assistance to the service. 
 
 GRANT HAMILTON, 
 
 Director General.
 
 SUMMARY REPORT OF THE COMMITTEE ON THE MORTALITY FROM 
 TUBERCULOSIS IN DUSTY TRADES OF THE NATIONAL TUBERCULOSIS 
 ASSOCIATION. 
 
 SUBMITTED TO THE EXECUTIVE COMMITTEE, PITTSBURGH, DECEMBER 5, 1918. 
 
 The following rather extended report has been arranged in a sum- 
 marized form as a matter of convenience, not only for the member- 
 ship of the committee but also for the information of the executive 
 committee and the board of directors. It is a record of the com- 
 mittee's activity and the meetings held. 
 
 The Committee on Mortality from Tuberculosis in Dusty Trades 
 was appointed by the president of the National Tuberculosis Asso- 
 ciation, in response to a resolution which was unanimously adopted 
 by the board of directors. Under date of December 21, 1917, the 
 following letter was addressed by the chairman to the members of 
 the committee, outlining briefly the proposed plan and scope of 
 the contemplated investigation, although necessarily in a rather 
 tentative form: 
 
 It affords me much pleasure to acknowledge your acceptance of membership on 
 the Committee on Tuberculosis in Dusty Trades. It requires no argument of mine 
 to emphasize to you the practical and far-reaching importance of more qualified 
 technical consideration of this heretofore neglected aspect of the tuberculosis problem 
 in this country. Your cooperation can be made of real value to the association which 
 has extended to us this opportunity to give the matter official consideration. I 
 would therefore welcome an early intimation of your viewpoint regarding the trades 
 or occupations which in your opinion should receive prior consideration. It has been 
 suggested that we might take up at the outset the question of tuberculosis frequency 
 in the stone industry, selecting two or three recognized centers of its most important 
 branches, such as granite cutting, marble cutting, and sandstone cutting. The slate 
 industry in eastern Pennsylvania would seem to offer a very promising field. From 
 another point of view it might be of real value to examine into the facts of actual 
 tuberculosis frequency in the cement industry, which is comparatively free from the 
 disease if the available statistical data and the special research work of Dr. Tucker 
 can be relied upon. From much the same point of view a tentative inquiry might 
 be made into the occurrence of tuberculosis among coal miners, say in the Scranton 
 district, of which original investigations were undertaken by Wainwright and Nichols 
 eome years ago. Possibly after Dr. White's return from France he might help us 
 with laboratory research in Pittsburgh, with special reference to the soft-coal mines of 
 western Pennsylvania. The investigations which have been made by the Bureau of 
 Mines and the United States Public Health Service in the zinc and lead mining 
 districts of southwestern Missouri are suggestive of further study and analysis of 
 mortality statistics and possibly the collective records of practicing physicians, 
 hospitals, etc. 
 
 5
 
 6 MORTALITY FROM TUBERCULOSIS IN DUSTY TRADES. 
 
 In the case of each and every one of these specialized studies it would seem neces- 
 sary as a basic consideration that a thorough analysis should be made of the deaths 
 from tuberculosis and respiratory diseases of persons aged 15 and over in the sections 
 selected. This, of course, would require the cooperation of the local or State boards 
 of health. Such experience as the writer has had is suggestive of the most hearty 
 cooperation if the officials in charge are properly approached. 
 
 Aside from the occupations with exposure to inorganic dust, it would seem well 
 at the outset to take up at least one occupation or industry with exposure to organic 
 dust. Perhaps the most important of these is the cotton industry, and a comparative 
 study might be made of the mortality of a representative mill town in New England 
 and the South. The mortality analysis should be amplified by dust sampling, 
 observations on temperature and humidity, and an individual as well aa collective 
 expression of qualified local medical opinion. The information which has become 
 available with reference to the occurrence of tuberculosis in cotton spinning and 
 weaving in this country as well as abroad suggests a much more thorough and 
 . impartial scientific study of the facts than has been made thus far. 
 
 The foregoing observations are merely tentative and an indication of the lines of 
 research that suggest themselves to the undersigned as practical and promising of 
 early results. It may be interesting in this connection that the United States Bureau 
 of Labor Statistics expects to issue during the early part of 1918 an extensive bulletin 
 by the undersigned on the mortality from respiratory diseases in trades with exposure 
 to inorganic dust, 1 which it is hoped will prove of substantial value in the further- 
 ance of the research herein indicated and officially approved by the national asso- 
 ciation in the appointment of our committee. There is a possibility that we can 
 interest the Census Office in our work and secure much valuable technical aid and 
 assistance may also be forthcoming from the United States Public Health Service 
 and from the State boards of health, at least from Pennsylvania and Massachusetts, 
 and possibly the Industrial Commission of Ohio. To the extent that such cooperation 
 is secured our own work will, of course, be materially reduced in important matters 
 of detail. 
 
 Preliminary to the sending out of this letter there had been a 
 fairly extended correspondence with Dr. E. R. Baldwin, of the 
 Edward L. Trudeau Foundation, with particular reference to a 
 proposed investigation in the State of Vermont, and under date of 
 November 7, 1917, Dr. Baldwin wrote to Dr. Hoffman as follows: 
 
 In view of the favorable attitude of the Vermont Marble Co.'s representative, Mr. 
 Frank C. Partridge, and Dr. Caverly, of the State Board of Health, the investigation 
 which I proposed to them would seem to be quite well received. I therefore am 
 inclosing a preliminary outline of the kind of study that seems to me worth while 
 for your criticism and suggestions. I hesitate to trespass upon your time for this, 
 but knowing your interest and the number of things that from your standpoint 
 you would like to see covered, I am sure you can be of great assistance in sug- 
 gesting further inquiries or the elimination of those that seem hardly worth while. 
 The work might be done largely at the Vermont Sanatorium at Pittsford, where 
 Dr. E. J. Rogers is resident physician. In conversation with one of the trustees 
 (Dr. James) I find him quite favorable toward a grant from the Trudeau Founda- 
 tion for this purpose, and we could probably furnish an assistant under the fellow- 
 ship plan for the carrying on of the work at the sanatorium as a center. The 
 permission of the granite industry would have to be obtained, although I think it 
 could be secured without great difficulty. I would welcome any criticism or sugges- 
 tion you might make before making the final plan for this work. 
 
 i Hoffman, Frederick L.: Mortality from respiratory diseases in dusty trades (organic dusts). Bull. 
 231, Bureau of Labor Statistics, U. S. Department of Labor. Washington, 1918.
 
 MORTALITY FROM TUBERCULOSIS IN DUSTY TRADES. 7 
 
 This letter made it clear that Dr. Baldwin had anticipated the 
 work of the committee by taking the initial steps of an original 
 investigation which had, in fact, been quite fully discussed at the 
 meeting of the board of directors of the association when the reso- 
 lution for the appointment of the committee was adopted. The plan 
 proposed by Dr. Baldwin is restated in its entirety below: 
 
 INVESTIGATION OP THE EFFECT OF THE MARBLE AND GRANITE INDUSTRIES ON 
 
 TUBERCULOSIS. 
 
 HISTORY AND STATISTICAL INQUIRY FROM THE VERMONT BOARD OF HEALTH AND THE 
 UNITED STATES MORTALITY TABLES. 
 
 1. Incidence and mortality from tuberculosis among workers: 
 
 (a) Dry cutting. 
 (6) Moist cutting. 
 
 2. Personal inquiry from employees in industries, with family histories: 
 
 (a) Dry cutters. 
 (6) Wet cutters. 
 
 3. House to house census by medical inspectors of present and past illnesses among 
 families of cutters: 
 
 (a) Age. 
 (6) Race. 
 
 (c) Residences. 
 
 (d) Various employments, past and present, of tuberculous. 
 
 (e) Various employments, past and present, of nontuberculous, especially other 
 
 chest diseases. 
 
 (f) Duration of employment. 
 
 (</) Present condition of employees: 
 
 (1) Apparently well. 
 
 (2) Those suffering from ailments, especially chest or throat affections. 
 
 MEDICAL EXAMINATIONS. 
 
 1. All who show symptoms or a history of chest disease: 
 
 (a) Chest examination. 
 
 (6) Sputum examination (if present). 
 
 (c) Families of those who have tuberculosis. 
 
 2. Rontgenograms of all who have chest affections: 
 
 (a) Rontgenograms of 25 dry cutters who are apparently well. 
 (6) Rontgenograms of 25 wet cutters who are apparently well. 
 
 3. Calcium determinations in urine of 10 healthy dry cutters in marble industry. 
 
 (a) Calcium determinations in urine of 10 healthy wet cutters or any other 
 
 nondusty employment. 
 
 (6) Calcium determinations in sputum of 5 dry cutters who have bronchitis. 
 Inspection and description of working conditions. 
 
 Determination of amount (weight and bulk) of dust in terms of cubic feet of air in dry 
 cutting rooms in 
 (a) Winter. 
 (6) Summer. 
 Methods of ventilation. 
 Respirator devices described. 
 Habits of workers. 
 Use of exhaust devices. 
 11045919 2
 
 8 MORTALITY FROM TUBERCULOSIS IN DUSTY TRADES. 
 
 Under date of December 26, 1917, Dr. E. R. Baldwin amplified 
 his previous communication in part as follows : 
 
 Your suggestions about the scope of the investigation are certainly very interesting 
 and valuable. The bearing of this problem upon organic dust is of course so wide- 
 spread, and I have so little knowledge on it, that I think I could be of very little use 
 in that particular in my situation. There is one point that occurred to me in con- 
 nection with the investigation of industries, and that is the possibility that the United 
 States Public Health Service would be engaged in the same thing and possibly at 
 the same time, or if not, would have plans for this work. 
 
 I have no doubt that your forthcoming statistical study would be the best starting 
 point of any investigation, and until this is available I presume there will be little 
 done. I was assured by Dr. Caverly in Vermont of the cooperation of the State 
 board of health, including some clerical aid. Dr. Rogers, superintendent of the 
 sanatorium in Pittsford, was the man I had in mind to take charge of the medical and 
 X-ray work. He is a good diagnostician, but would need assistance and guidance 
 in planning out a survey. The Vermont Marble Co. has indicated its willingness 
 to give us every facility, but the granite industry is less easy to deal with, from what 
 I have heard. 
 
 In his reply to this letter, under date of January 3, 1918, Dr. Hoff- 
 man enlarged upon certain practical aspects of the proposed investi- 
 gation, in part, as follows: 
 
 I am obliged to you for your favor of December 26 and the fairly extended expression 
 of your views regarding the plan of procedure on the part of the committee on dusty 
 trades most likely to prove productive of practical and early results. It seems to me 
 that the work that you have in mind is most promising and in accordance with my 
 own ideas regarding the prior importance which should be given to the stone industry. 
 I feel with you that a limited but thorough investigation of a few typical dusty trades 
 would be more acceptable to the association than a rather superficial study of a larger 
 number of trades and occupations, however attractive the latter might be from other 
 points of view. A considerable amount of new material will be forthcoming as soon 
 as my bulletin on The Mortality from Respiratory Diseases in Dusty Trades with 
 Exposure to Inorganic Dusts is published. 
 
 In your letter of November 7 you referred to the favorable attitude of the Vermont 
 Marble Co. and the anticipated active cooperation of the Vermont State Board of 
 Health. This seems to me a most auspicious indication of the assistance which will 
 be forthcoming in the furtherance of our plans when presented in the proper way to 
 those directly concerned. It has always been my own method to utilize such agencies 
 as could be made use of to secure the information desired and to give full credit for 
 such cooperation in the conclusions arrived at. In Vermont we would have both 
 the marble and the granite industries, and possibly some attention could be given to 
 slate quarrying, cutting, etc., which is of some importance in that State. Of the slate 
 sold in the United States during 1915, out of a total value of about $5,000,000, 
 $1,250,000 was derived from Vermont. The production, however, has been declining 
 in that State during recent years. Vermont in 1915 was the fourth most important 
 stone producing State, being slightly exceeded by New York and Ohio but con- 
 siderably by the State of Pennsylvania. There were 49 active plants in operation, 
 indicating that the number employed to a given quarry, mill, etc., was larger than 
 in most of the other States. In granite production, however, Vermont was the leading 
 State in 1915; in marble it was also the leading State, in fact, far exceeding in the 
 value of the product any other State. It would therefore seem entirely safe to assume 
 that conclusions based upon an investigation in Vermont with reference to the granite 
 and marble industries and possibly with reference to the slate industry should be
 
 MORTALITY FROM TUBERCULOSIS IN DUSTY TRADES. 9 s 
 
 sufficiently representative for the country at large, and I would be pleased to join 
 with you in an active effort to subject the local conditions to a thorough investigation, 
 in so far as our own office can be of assistance to you. In other words, I would be 
 inclined to agree that at the outset at least, or say for the present year, most of the 
 work of the committee should be limited to the State of Vermont, more or less in 
 conformity to the admirable outline attached to your letter of November 7, and which 
 bears the title "Investigation of the effect of the marble and granite industries in 
 tuberculosis." 
 
 First in the order of logical procedure, it would seem to me, a thorough study should 
 be made of working methods or processes and labor conditions. How far present 
 methods have been made a matter of descriptive accounts in trade journals, etc., 
 I am not aware, but I feel reasonably sure that there would be no serious difficulties 
 in obtaining at least at the outset a fairly comprehensive account, amplified by the 
 required illustrations of the principal machines used in dry cutting, moist cutting, 
 etc. In this connection we have available the results of a personal investigation 
 made by myself some years ago into the conditions in Vermont and of which we will 
 make an effort to secure a duplicate copy for your information. As regards personal 
 inquiry among employees in the industries referred to and with special reference to 
 family histories, it would be advisable to proceed with extreme caution, upon the 
 basis of an exceptionally carefully considered blank. Many such investigations have 
 failed in the past in that either the blanks themselves were improperly worked out 
 or that the inquiry was not made with the required persistency. We had some ex- 
 perience in this connection with an investigation made by Miss Janice Reed in 
 behalf of the Phipps Institute in the clothing industries in Philadelphia. The blanks 
 and forms used by her at the time should prove useful in connection with the Vermont 
 investigation, and copies thereof will be obtained and forwarded later on, together 
 with a copy of the report itself, with reference to which I may explain that the 
 analysis was made in my office and that the blanks were printed at our expense and 
 the work itself in a general way was done under my direction. 
 
 The same observations apply to house-to-house censuses by medical inspectors with 
 reference to the present and past illnesses among the families of cutters. I, however, 
 feel that the entire industry should be included in this investigation, for as possibly 
 to be emphasized later, occupational changes make it exceedingly desirable to include 
 those who are now perhaps following harmless pursuits, but who formerly followed 
 occupations of a harmful nature. Collis, in the Milroy lectures on dust phthisis, 
 gives as an illustration the case of a lung of an insurance agent who for eight years 
 before, however, had been a miner in the Transvaal, etc. If the autopsy had not 
 been made, or if the previous occupation had not been ascertained, the conclusions 
 in either event, or both, would have been misleading. 
 
 I construe the term "race" (under letter "6") to mean racial origin, or, rather, 
 parent nativity. The blank should show the birthplace of the father and the mother 
 as well as the birthplace of the person questioned. This section should be revised 
 and if possible made more specific, so as to admit of categorical answers more suitable 
 for statistical analysis. 
 
 As regards the medical examination, I am emphatically of the opinion that if any 
 way possible all employees should be examined, whether they show symptoms of 
 past history of chest diseases or not. The method pursued by the miners' phthisis 
 commission of South Africa should, if possible, be followed in matters of detail, so- 
 that if practicable the results may be comparable. A copy of the report of the 
 commission, if not available to you, can be loaned to you by the library of the United 
 States Commissioner of Labor Statistics. 
 
 The same observation applies to the determination of the amount (weight and 
 bulk) of the dust in terms of cubic feet of air in dry cutting rooms, but I would 
 broaden this to include all cutting rooms, and, furthermore, that the determination
 
 10 MORTALITY FROM TUBERCULOSIS IN DUSTY TRADES. 
 
 be in conformity to the more or less standardized method of the South African inves- 
 tigation or the Australian investigation, or those made in England in behalf of the 
 Royal Commission on Metalliferous Mines 
 
 The methods of ventilation, dust-exhaust devices, respirators, of different types, 
 habits of the workers, with special reference to dust removal, cleanliness of the plant, 
 sweeping, etc., would indicate highly differentiated lines of inquiry, which it would 
 be best to develop with increasing experience in the gathering of this kind of infor- 
 mation. It is possible that the American Museum of Safety could be utilized with 
 reference to securing a complete list of respirators, of which, unfortunately, a large 
 number have been found impracticable in actual use or otherwise objectionable on 
 the part of the workmen. 
 
 A collateral study should be pneumatic tool processes, which, of course, as you 
 know, have been even more extensively developed in connection with underground 
 mining than with cutting and polishing in the stone industries. The cooperation of 
 manufacturers could, no doubt, be secured later on, as the facts would develop, for 
 of course we must keep in mind throughout the importance of practical results. It 
 would be of small use to emphasize an evil or condemn existing processes or practices 
 unless an alternative could be suggested, but if possible one acceptable to the theo- 
 retical as well as eminently practical point of view. 
 
 On the basis of the foregoing, I shall proceed with our own preliminary office inves- 
 tigation. All that we have on the subject of the granite and marble industries will be 
 brought together and subjected to critical consideration. When available a prelimi- 
 nary report will be sent to each member of the committee. 
 
 Referring now to your letter of December 26, it seems to me that the strictly tech- 
 nical work should be entirely under your personal direction, and subsequently we 
 might so organize our committee as to make you the chairman of a subcommittee of 
 one on medical examinations and laboratory analysis. I would personally be willing 
 to take charge of the general industrial conditions, working processes, and sickness and 
 mortality statistics. After you have worked out your own plans somewhat further 
 and mine has been developed a meeting could be arranged for either at Saranac or 
 perhaps at Burlington, at the office of the State Board of Health, to be followed by a 
 joint interview with the managers of the industries whose cooperation has been prom- 
 ised. I should judge that during March or April such a conference could be arranged 
 for in Vermont, to be followed later by others as occasion may require. 
 
 In the meantime the fact had developed that an exceptionally 
 thorough investigation was being made in the State of Indiana, 
 jointly, by State and Federal health authorities, etc., in cooperation 
 with employers of labor in the limestone industry of southern Indi- 
 ana. Under date of January 8, 1918, the following letter had been 
 received by the chairman from Mr. R. M. Richter, the secretary of 
 the Bedford Stone Club Auxiliary: 
 
 Please advise us whether the rate you make stonecutters differs substantially from 
 rates in other vocations. If there is a difference, we would be glad to have you say, 
 if consistent, why. Are there any reasons other than the prevalence of dust in some 
 stone-working establishments which perhaps cause you to discriminate in rates or 
 otherwise against this class of labor? A prompt reply will be very much appreciated. 
 
 To this letter, under date of January 15, 1918, the following reply 
 had been made, though limited, of course, to the injurious conse-
 
 MORTALITY FROM TUBERCULOSIS IN DUSTY TRADES. 11 
 
 quences of dust inhalation, which in the investigation under way 
 was a matter of minor consideration: 1 
 
 This occupation has been investigated by us from time to time with reasonable 
 thoroughness, but not sufficiently so to justify final scientific conclusions. The writer 
 is chairman of the committee on the Scientific Investigation of the Mortality from Res- 
 piratory Diseases in Dusty Trades appointed by the president of the National Tubercu- 
 losis Association, which has in contemplation an original investigation along strictly 
 scientific lines, and as far as practicable in conformity to the method of procedure fol- 
 lowed by the Phthisis Commission of South Africa. The writer's earlier observations 
 and statistical data are contained in Bulletin No. 79 of the United States Bureau of 
 Labor, of which a copy may possibly be obtained through the Superintendent of Public 
 Documents, since the general issue has long been exhausted. A revised issue is now 
 in course of preparation and will be available in perhaps six months in proof form 
 through the courtesy of the Commissioner of Labor Statistics. This volume is exclu- 
 sively devoted to mineral dust. The data and observations, however, are rather 
 general, since an opportunity did not present itself to go into the details by means of 
 field investigations, which would have required visits to the principal centers of the 
 etone industry and a reexamination of death certificates with practicing physicians 
 familiar with the facts of local disease incidence and its relation to highly specialized 
 industrial processes. For your information we give below our rating practice withi 
 regard to stone and marble workers, as published in our latest rate book (August, 1917) : 
 
 Paving-stone cutters '. Endowment plans, medium. 
 
 Quarrymen, open or surface work Medium. 
 
 Quarrymen working underground Endowment plans, medi um. 
 
 Stonecutters not using pneumatic tools Endowment plans, medium. 
 
 Stonecutters using pneumatic tools Endowment plans, hazardous. 
 
 Stone sawyers, and lathe workers, polishers, and finishers. Endowment plans, medium. 
 Tool sharpeners Medium. 
 
 These ratings, however, are not conclusive concerning the point of view in which you 
 are likely to be most interested, in that for practical reasons we can not differentiate- 
 the minor employments which would be most exposed from the major branches of 
 the industry with a relatively small degree of dust exposure. We give below the 
 premium charge at age 30 for the different classes as well as the normal charge in 
 or-cupations without exceptional hazards: 
 
 Annual premium, $1,000 insurance; age SO; twenty-year endowment. 
 
 Regular rate $42. 35 
 
 Paving-stone cutters 
 
 Qtiarrymen workin (r underground . 
 Stonecutters, not using pneumatic tools. 
 
 Stone sawyers, lathe workers, polishers, finishers, and tool sharpeners 
 
 Stone cutters, using pneumatic tools 47. 16 
 
 From a letter received from Mr. Richter under date of January 19 r 
 1918, in reply to Dr. Hoffman's letter of January 15, the following 
 extract is quoted, as an illustration of views pie\ ailing at the present 
 
 i The results of the Indiana investigation have since been published as Reprint No. 460 of the United 
 States Public Health Service. The reprint contains three reports, respectively, by i assed Asst. Burg. 
 J. P. Leake, on "Health hazards from the use of the air hammer in cutting Indiana hmestone"; one by 
 Dr. David L. Edsall, on "The supposed physical effects of the pneumatic hammer on workers in Indiana 
 limestone": and one by Dr. Alice Hamilton, on "The effect of the air hammer on the bands of stone- 
 cutters."
 
 12 MORTALITY FROM TUBERCULOSIS IN DUSTY TRADES. 
 
 time concerning the apparent harmlessness of dust inhalation in 
 consequence of the use of pneumatic tools in the limestone industry 
 
 ^x-r cis\tt 4- V rt*f\ I ~n r\ t a Y\ o 
 
 of southern Indiana: 
 
 Drs. Barnes, Leake, and Edsall are unanimous in their finding that the prevalence 
 of dust in the mills of the Indiana limestone district is a negligible factor. This 
 because the stone as worked here is drenched with water at various stages of fabrication, 
 which water is not evaporated to any extent until the stone is practically ready for 
 loading. These doctors are further agreed that the general health of all the stone- 
 cutters examined and interviewed here is exceptionally good and that without question 
 or doubt they rate much higher in that regard than stonecutters generally. 
 
 It seems to us, therefore, that the matter to which we refer hereinbefore must be of 
 yital interest to you. Our interest in it is twofold. We want to show in all fairness that 
 the effects of the pneumatic tool are not such as to warrant discrimination. We want 
 further to create for our workmen a condition which will give them every benefit so far 
 as insurance, among other things, is concerned, which may rightly accrue from the 
 fact, first, that the pneumatic tool does not imply hazard and, second, that in our 
 operations in Indiana tuberculosis owing to dust is practically, if not entirely, an 
 unknown experience. 
 
 With further reference to this exceptionally favorable view regard- 
 ing the local situation, the following extract from a letter of Mr. 
 Richter's dated January 25, 1918, is also included: 
 
 When you come to Bedford, you will find the mills are almost altogether of a strictly 
 up-to-date character, so far as equipment in general and working conditions are con- 
 cerned. As a matter of fact, we believe we can show with some force that in the 
 absence of a personal examination of the facilities here no true conclusion can be 
 reached regarding our particular situation. In passing, we want to refer to the fact 
 that tuberculosis unquestionably is far more prevalent in the granite and sandstone 
 industries than in the Indiana limestone industry. Not only are our accommodations 
 more modern than generally found elsewhere, but the nature of the stone itself is such 
 as to preclude most of the detrimental elements which are a source of objection in other 
 sections of the business. Indiana limestone, as commonly worked, is moist, in fact, 
 one may say, wet. Furthermore, its physical make-up is such as to cause an almost 
 total absence of sharp, gritty particles which, according to my understanding, are the 
 chief objection in granite and sandstone. I have in mind, upon the occasion of your 
 visit here, whenever it is, to call a meeting of all the cut-stone firms, so that if you care 
 to you can give them a talk on the whole proposition, or at least as far as you may wish 
 to go into it. 
 
 In the meantime correspondence had been had with the general 
 secretary and treasurer of the Journeymen Stonecutters' Association 
 of North America, Mr. Walter W. Drayer, of Indianapolis, under 
 date of February 2, 1918, reading as follows: 
 
 Replying to your favor of the 29th ultimo, will say that I have no special reports as 
 to the health and to the injuries suffered by our members from the use of the pneumatic 
 hammer. It is true that our members do suffer a partial paralysis of the hands in the 
 use of the pneumatic hammer, and this condition has brought forth a determined 
 complaint by our membership. However, 'we have no data to submit at this time, but 
 within the course of the next few weeks the Department of Labor will issue a special 
 bulletin upon the subject, the department at this time being engaged in conducting a 
 rigid examination to determine just the effect of the use of this tool upon the man 
 who uses it.
 
 MORTALITY FEOM TUBERCULOSIS IN DUSTY TRADES. 13 
 
 To the foregoing letter the following reply was made under date of 
 February 6, 1918: 
 
 We are obliged to you for your favor of February 2, and the information contained 
 therein regarding the forthcoming report of the Bureau of Labor Statistics on the effects 
 of the use of the pneumatic hammer on certain bodily functions, especially the use of 
 the hands and the arms. We hope to have an opportunity to examine this report in the 
 near future at Dr. Meeker's office in Washington. I have arranged for an interview 
 with Dr. Hamilton, with whose work we are thoroughly familiar. 
 
 It has occurred to the writer that perhaps you would be willing to discuss this 
 matter with the undersigned, not only as regards the rather limited aspects of the 
 particular question just referred to, but as to the broader questions involved, such as 
 the general mortality of stonecutters in Indiana, the apparent excess from 
 pulmonary tuberculosis and other respiratory diseases, etc. The general subject of 
 stoneworkers' mortality will be discussed in a forthcoming bulletin of mine on The 
 Mortality from Respiratory Diseases in Dusty Trades, limited for the present to dust 
 of mineral origin. 
 
 Does your association transact life insurance or does it grant sick benefits, and, if 
 so, are the mortality or morbidity data available in a form for statistical analysis? 
 If your association should have a considerable amount of information on the subject 
 it might be feasible for the committee and our company to cooperate so as to bring to 
 light much useful information on the health of the men in this industry or rather the 
 possible health-injurious aspects of the work in which they are engaged. The com- 
 mittee on the scientific study of the dusty trades with special reference to tuberculosis 
 recently appointed by the National Association for the Study and Prevention of 
 Tuberculosis, and of which I have the honor to be the chairman, is most anxious to 
 secure the cooperation of your association, aside from the cooperation which is likely 
 to be extended to us by the State board of health and the leading stone producing 
 industries. 
 
 In connection with our investigation I expect to visit Indiana and I could, of 
 course, easily arrange to see you and discuss this matter in more detail. I rather 
 regret to learn that you have as yet made no special investigation on your own part 
 as to the health and the injuries suffered by your own employees from the use of 
 pneumatic tools, but possibly this reference does not cover the broader question of 
 health-injurious conditions in the stone industry of Indiana in general. 
 
 To this letter Mr. Drayer, February 9, 1918, replied at consider- 
 able length. His letter is a notable contribution to the scientific 
 study of industrial diseases from the labor point of view, and the 
 letter is given in its entirety, even though some of the observations 
 relate to the physical effects of the use of the pneumatic hammer on 
 the health of the workers in Indiana limestone as a problem sepa- 
 rate and distinct from the broader questions involved in the present 
 discussion : 
 
 Your valued favor of the 6th instant at hand this morning and contents very care- 
 fully noted. In reply will say that I will cheerfully favor you with any information 
 we have relative to the use of the air or pneumatic hammer and the physical injuries 
 suffered by our members who use it, also any data you may desire as to the mortality 
 of our membership. 
 
 With reference to the air hammer, it has been a momentous question with our 
 membership for the past five years, owing to its almost universal installation in many 
 localities throughout the country. We have not conducted any specific investigations 
 in regard to this tool for several reasons, namely, that the employers maintain that
 
 14 MORTALITY FROM TUBERCULOSIS IN DUSTY TRADES. 
 
 our opposition to the tool is solely because it has proved efficient and that we are 
 afraid it will displace a number of our mechanics; that no matter how unprejudiced 
 an investigation we might conduct, the employers would go to extremes to discredit it; 
 that the subject to us is one that needs no specific investigation, inasmuch as fully 
 90 per cent of our members who have been using this tool for a year or more show the 
 visible effects which can not be denied, inasmuch as the circulation in their hands 
 and arms becomes stagnant and as a result on a cold and damp morning their hands 
 and fingers seem absolutely lifeless, turning a pale white color, best illustrated by 
 comparing it to the hands of a corpse. We have therefore prevailed upon the United 
 States Government to make an investigation of this general complaint, knowing that 
 such report could not be discredited by the employers, which would be the case 
 should we conduct an investigation. I am by this mail forwarding you copies of 
 our 1917 Journals in which I have marked several articles bearing upon our observa- 
 tion of the use of this tool, also containing general summary of Dr. Charles Cottingham, 
 of this city, whom we employed to make an examination of some seven or eight of our 
 members. In these Journals you will also find extracts of items appearing in the 
 "Minutes," a pamphlet published by the International Cut-Stone Contractors and 
 Quarrymen's Association. By writing to Mr. Win. A. Guthrie, secretary of the 
 International Cut-Stone Contractors and Quarrymen's Association, 1 East Forty- 
 second Street, New York City, you might be able to get the back numbers of this 
 publication and thus obtain a clear understanding of the attitude of the employers 
 upon this tool. 
 
 As to the susceptibility of our members to tuberculosis, I may advise you that a 
 few years back, when a great deal of the work was in sandstone, the death rate of our 
 members from tuberculosis was alarming. However, of late years sandstone has not 
 been so extensively used, Indian oolitic limestone in a great measure supplanting 
 the use of sandstone, and as the bulk of the work in Indiana limestone is done with 
 machines and the analysis shows limestone to be composed of about 98 per cent lime, 
 we find that our death rate of tuberculosis is steadily decreasing. I might add, though, 
 that the use of the pneumatic hammer subjects our members to more danger in the 
 contracting of tuberculosis than do the tools of our trade the mallet and hammer 
 inasmuch as the vibration or stroke of this hammer is constant, thus emitting a 
 steady stream of this fine dust into the face and nostrils of the operator, while with 
 the tools of the trade there was, of course, an interval between the blows which gave 
 the dust some opportunity of being carried away in the air. 
 
 We have since the organization of our association paid our members a death bene- 
 fit, and of course a record has been kept of all such claims. I am sorry to say, how- 
 ever, that this record was not in the past kept in the complete manner it should have 
 been kept, as a great number of deaths recorded do not show causs of death and age 
 of deceased. However, a majority of the deaths show a complete record and it is, 
 of course, possible to obtain statistics on the percentage thus reported. 
 
 I note that you are contemplating a visit to Indiana, and if you will visit this city 
 during your investigation in the State I will be only too pleased to meet you and 
 give you all information possible. In the meantime it is possible that I will be in 
 New York some time during the month and if agreeable I would be pleased to call 
 at your office and talk over these subjects with you, as it is evident that we must 
 obtain some relief from the present inhuman manner in which a number of the em- 
 ployers would force our members to use thesa tools. I feel satisfied that should you 
 see Dr. Meeker and Dr. Hamilton they will be in a position to supply you with much 
 valuable information relative to the air hammer and we are very much in hope that 
 the medical examination of several of our members now being conducted in Chicago 
 by Dr. Rothstein will be shortly completed so that we may get the complete report 
 of the Bureau of Labor Statistics upon this subject. 
 
 Assuring you that I am only too pleased to assist you in any way possible in your 
 investigation of health conditions in the stone trade in Indiana, I am, etc.
 
 MORTALITY FROM TUBERCULOSIS IN DUSTY TRADES. 15 
 
 The reply to the foregoing communication, under date of February 
 15, 1918, reads in part as follows: 
 
 It was very good of you to write to me at length regarding the subject matter referred 
 to in my letter to you of February 6. Your presentation of the matter in controversy 
 is an admirable indication of your sense of fairness and your desire to have the true 
 state of affairs ascertained by means of an impartial inquiry. You have certainly 
 adopted probably the only course open to you by making use of the expert services 
 available through the Bureau of Labor Statistics. There is not a more qualified 
 person in this country in connection with such matters than Dr. Alice Hamilton and 
 her report will unquestionably set forth the facts in the case with scrupulous accuracy 
 and scientific collusiveness. Of course, in every question of this kind there are 
 matters in controversy which permit of more than one well-considered point of view, 
 so that it is most desirable indeed that the manufacturers, on their own account, 
 should have initiated similar inquiries, which ought to prove productive of good 
 results. I understand that they have retained Dr. Edsall, who is one of the foremost 
 authorities on occupational diseases and whose judgment and conclusions should be 
 of real value. 
 
 Mr. Drayer made anwser to the preceding communication under 
 date of February 23, 1918, but on account of urgent office matters 
 the proposed conference could not be arranged for, nor could the 
 contemplated investigation in Indiana be carried out at the tune, 
 although additional assurances of local cooperation had been re- 
 ceived from Dr. J. N. Hurty, the secretary of the Indiana State 
 Board of Health: 
 
 Your valued favor of the 15th instant at hand and contents carefully noted. In 
 reply will say that just as soon as I have the opportunity of being in New York City 
 I will call you over the phone and make arrangements to meet you either in New 
 York or at your office in Newark. 
 
 I fully expected to be in New York prior to the end of this month. My mission 
 there was in connection with a matter in the Federal court, but I believe there has 
 been some postponement of the case, and I can not predict just when the matter will 
 again come up. 
 
 However, just as soon as I have occasion to visit New York I will get in touch with 
 you and will be pleased to bring along such records of our association as will enable 
 you to draw conclusions as to the percentage of our members who have died of tuber- 
 culosis as a result of the dust connected with the cutting of stone. 
 
 (Useful references but particularly with regard to the effect of the air hammer on 
 the hands of stonecutters, but with some observations on pulmonary tuberculosis, 
 occur in the January, March, May, June, August, and September, 1917, issues of The 
 Stonecutters' Journal.) 
 
 The preliminary work having been completed the first meeting of 
 the committee was called to be held at Saranac Lake, following the 
 executive committee of the National Tuberculosis Association, 
 called for July 13, 1918. In a communication to the members of 
 the committee, dated June 25, 1918, the proposed plan of investiga- 
 tion was briefly outlined as follows: 
 
 This is to inform you that, if in any way possible, a meeting of the committee on 
 dusty trades will be held at Saranac Lake either before or after the meeting of the 
 executive committee. Since at this time the date is somewhat uncertain, but tenta- 
 tively assumed to be July 13, the meeting could probably be held Sunday after-
 
 16 MORTALITY FROM TUBERCULOSIS IN PUSTY TRADES. 
 
 noon or perhaps Saturday evening. Dr. B. R. Baldwin has been at work on experi- 
 mental research, in cooperation with the State Board of Health of Vermont, and 
 no doubt definite recommendations could be made as to the .nature of the work to be 
 taken up by the committee. Dr. Lanza, of the Public Health Service, in cooperation 
 with associates of the Bureau of Mines, has just published a report on Silicious Dust in 
 Relation to Pulmonary Disease, which should be useful. Much to my regret my own 
 rather extended report on Occupations with Exposure to Inorganic Dusts and Their 
 Relation to Pulmonary Diseases is not yet available, but the final page proof has been 
 released for the Public Printer. 
 The main questions to be taken up are, briefly, as follows: 
 
 1. What occupations or industries should be taken up at the outset? Would it not 
 be possible to limit the work of the committee at this time to certain well-defined 
 employments in the stone industries, such as the marble and granite quarries of Ver- 
 mont, the limestone industries of southern Indiana, the zinc and lead mines of south- 
 western Missouri, and possibly the cement industries and perhaps the slate industries 
 of Pennsylvania? 
 
 2. How far would it be possible to secure the active cooperation of the State Boards 
 of Health of Vermont, Pennsylvania, Indiana, and Missouri? Some gratifying assur- 
 ances have been received, especially from Vermont and Indiana. 
 
 3. What field investigations should be undertaken at this time and how far would 
 it be possible or practicable to secure the active cooperation of the Federal Health 
 Department, the Bureau of Labor Statistics, the Bureau of Mines, etc.? 
 
 4. How far would it be possible for the Trudeau Foundation to cooperate, or con- 
 versely, in what direction could the work of the committee be best coordinated to the 
 admirable work which is being done by Dr. Baldwin and his associates? 
 
 5. Would it be feasible and if so, would it be advisable to undertake a special 
 analysis of death certificates in certain centers of the stone or cement industries for 
 the purpose of subjecting the data to a qualified examination, especially as regards 
 accuracy in occupational returns and accuracy in the clinical diagnosis and correctness 
 in death certification? 
 
 6. How far would it ba possible to take up the question of autopsies, especially 
 with the cooperation of the Henry Phipps Institute and possibly the Mellen Institute 
 of Pittsburgh? The occupational disease clinic of the University of Pennsylvania 
 might also be utilized. A question which might be taken up would be as to how far 
 a thoroughly complete series of autopsies of stone and cement workers, including 
 miners, could be brought together, amplified by a complete chemical analysis of the 
 lungs, in conformity to the procedure of the miners' phthisis commission of South 
 Africa, etc. If a descriptive account of even only a score of such lungs could be 
 secured with full occupational details, dust exposure, occupational processes, etc., 
 much new knowledge might be gained. 
 
 7. How far would it be possible and if so, desirable to take into special account 
 the question of the degree of fineness or minuteness 01 size of the dust particles inhaled 
 under different occupational conditions as different and distinct from the quantative 
 determination of the dust contents both of the air and the lungs, as has usually hereto- 
 fore been the case in investigations of this kind? The work of the South Africa Com- 
 mission seems to have proved conclusively that the degree of fineness or minuteness 
 of the dust particles is of far greater importance than the mere quantity of the dust 
 inhaled during different occupational processes. 
 
 These are merely tentative suggestions so as to provide an orderly basis of procedure 
 for the deliberations of the committee. Any other questions could of course be brought 
 up at the meeting. 
 
 At the meeting the following brief report, which was originally 
 communicated to the executive committee under date of March 
 15, 1918, summarized what had thus far been done:
 
 MORTALITY FROM TUBERCULOSIS IN DUSTY TRADES. 17 
 
 REPORT OP THE CHAIRMAN OP THB COMMITTEE ON THE SCIENTIFIC INVESTIGATION 
 OP THE MORTALITY PROM TUBERCULOSIS IN DUSTY TRADES. 
 
 There has thus far been no meeting of the committee, but a rather extended corre- 
 spondence has been carried on with the members, who, one and all, are showing an 
 active interest in the proposed investigation. Dr. Alice Hamilton has accepted 
 membership and her cooperation will be most useful. She has agreed to include a 
 study of the question of tuberculosis in its relation to the use of pneumatic tools in 
 her general investigation of the stone industry in Vermont. For the time being atten- 
 tion is concentrated upon the limestone industry in southern Indiana. Most gratifying 
 assurances of cooperation have reached us from manufacturers and labor unions, as 
 well as from the United States Bureau of Labor Statistics and the United States 
 Public Health Service, which are at present engaged in a thorough scientific study 
 of the mechanical effects of pneumatic tools. The investigations will be enlarged in 
 certain directions, in accordance with our suggestion, to include the subject of tuber- 
 culosis. It had been the intention of the chairman to make a personal investigation 
 in southern Indiana before this, but it is doubtful whether this can be done before 
 May or June. Among other conferences was one recently held with Dr. Leake, of 
 the United States Public Health Service, whose investigations in southern Indiana 
 included the question of tuberculosis and whose preliminary report will be published 
 in the near future. 
 
 The outlook is therefore encouraging that really useful work will be done by the 
 committee during the summer months. In the meantime the chairman's rather 
 extended report on the Mortality from Respiratory Diseases in the Dusty Trades, 
 with special reference to Inorganic Dusts, in course of publication by the United 
 States Bureau of Labor Statistics, is reaching completion, and should be available 
 before June 1. 
 
 Respectfully submitted. 
 
 FREDERICK L. HOFFMAN, 
 Chairman Committee on Mortality from Tuberculosis in Dusty Trades, 
 
 National Association for Study and Prevention of Tuberculosis. 
 
 Under date of July 17, 1918, the minutes of the meeting and the 
 results of the conference were communicated to the president of the 
 association, as well as to the members of the committee, for future 
 reference and as a basis for future deliberations, as follows: 
 
 Dr. DAVID R. LYMAN, 
 
 President, National Tuberculosis Association, 
 
 Wallingford, Conn. 
 
 MY DEAR DOCTOR LYMAN: The following is a brief statement of the conclusions and 
 recommendations arrived at by the Committee on the Scientific Investigation of the 
 Mortality from Tuberculosis in Dusty Trades, at their recent meeting at Saranac Lake, 
 with such observations concerning matters of detail as may prove useful as a matter 
 of record. 
 
 The meeting was participated in by Dr. A. J. Lanza, of the United States Public 
 Health Service; Dr. Edward R. Baldwin, of Saranac Lake; Dr. Alice Hamilton, of 
 Hull House, Chicago; Dr. O. W. McMichael, of Asheville, N. C.; and by invitation, 
 Dr. Charles S. Caverly, president of the Vermont State Board of Health; and Dr. 
 Gardner, of the Research Department of the Trudeau Foundation, Saranac Lake. 
 
 In a general way, the committee considered first the question as to what occupations 
 or industries should be taken up; second, what special aspects of the problem should 
 be given priority; third, what special methods of investigation, if any, should be fol- 
 lowed; and, fourth, what official or private assistance or cooperation should be secured.
 
 18 MORTALITY FROM TUBERCULOSIS IN DUSTY TRADES. 
 
 The committee took cognizance of an investigation contemplated by Dr. E. R. 
 Baldwin and his associates in hehalf of the Trudeau Foundation into the relation of 
 the marhle and granite industries to tuberculosis, with special reference to the State 
 of Vermont. In the furtherance of this plan, presented in some detail and placed 
 before the committee for its consideration, the active cooperation of the State Board 
 of Health of Vermont had been secured, as well as that of the Vermont Marble Co., 
 and particularly that of its representative, Mr. Frank C. Partridge. 
 
 The importance of the stone industries in their relation to the tuberculosis problem 
 was emphasized by the chairman, who directed attention to a forthcoming and rather 
 extended publication of the United States Bureau of Labor Statistics, on the mortality 
 from respiratory diseases in their relation to the dusty trades, limited, however, to 
 inorganic dust. The evidence brought together in this work fully sustains the view- 
 point of Dr. Baldwin and others, that if at all practicable, the stone industries, and 
 particularly the marble and granite industries, should be given priority in the delib- 
 erations of the committee. 
 
 Dr. Caverly presented a statistical statement regarding the stone industries of the 
 State of Vermont, pointing out in detail that the number of granite cutters in the 
 Barre district, including helpers, and men employed in quarries, was approximately 
 5,000. In the city of Barre, with a population in 1910 of 10,784, there had been 135 
 deaths from all causes, and that of this number 28, or 20.7 per cent, had been caused 
 by tuberculosis of the lungs; and 33, or 24.4 per cent, by some form of tuberculosis. 
 This excessive proportion of deaths from tuberculosis was fully sustained by the evi- 
 dence in detail, and for a period of years regarding the frequency of tuberculosis 
 among the general population of the granite-cutting industries, not only of Vermont, 
 but of the country at large. It was agreed as a tentative conclusion that mechanical 
 and other operations necessary in the conduct of the stone-cutting industry were in 
 some way and in some measure, and possibly in a large measure, responsible for the 
 excess in the frequency of tuberculosis occurrence in the stone-cutting sections of the 
 State of Vermont. 
 
 Regardless of the frequency of tuberculosis in the .stone-cutting sections, counties 
 or towns, of the total number of admissions to the State sanatorium for incipient tuber- 
 culosis during a period of about ten and a half years, and numbering 963 patients, 
 only 56, or 5.8 per cent, have been granite cutters, granite workers, or quarrymen. 
 In addition thereto, the number of marble tracers, graders, polishers, cutters, and 
 workers admitted to the institution since its opening has been only 10. In view of 
 the fact that these two stone industries are probably the most important industrial 
 enterprises in the State, it is self-evident that the institution is not being utilized as 
 much as it should be, and most of all not on the part of those afflicted workers suffering 
 from the disease in the incipient and curable stages. 
 
 Dr. Caverly, in conclusion, stated that the outlook was encouraging that the manu- 
 facturers, especially those engaged in the marble industries, would welcome a scientific 
 investigation, and that a similar amount of support would probably be forthcoming 
 with the Granite Manufacturers' Association, and especially its secretary, Mr. Hinman, 
 of Barre City. 
 
 Dr. Baldwin said in this connection that much valuable assistance could be rendered 
 through the Vermont Sanatorium at Pittsford, and particularly its resident physician, 
 Dr. E. J. Rogers, whose services might be made available through the cooperation of 
 the Trudeau Foundation in the direction of certain highly specialized phases of field 
 research. 
 
 Dr. Lanza raised the general question as to the use of pneumatic tools and the best 
 possible means of reducing or controlling the health-injurious consequences of their 
 extensive employment in the stone industry. Dr. Caverly called attention to a safety 
 device which, a few years ago, had been offered but had been rejected on the ground 
 that it materially increased the weight of the tools and was therefore objectionable
 
 MORTALITY FROM TUBERCULOSIS IN DUSTY TRADES. 19 
 
 to the employees. He agreed to furnish a photograph of the proposed device, with a 
 view to a further consideration of this question, particularly on the part of the manu- 
 facturers, especially the Ingersoll-Rand Co. Dr. Caverly also recalled that at the 
 time a fairly extensive correspondence had been had with those directly interested 
 in the problem and possibly some of this correspondence might later be made available 
 to the committee. 
 
 Dr. Hamilton referred briefly to her investigations in the Barre district, limited, 
 however, largely to the mechanical injuries resulting from the use of pneumatic tools 
 and made only incidentally with reference to the dust hazard and its relation to the 
 occurrence of pulmonary tuberculosis. She gave expression to the view that the labor 
 unions would be favorable to an investigation if approved of by the president of the 
 International Union, with headquarters at Quincy, Mass. It was felt by all those 
 present that the fullest cooperation of both employers and employees could be had 
 from the outset in any possible field investigation. 
 
 The question was then taken up as to the first section of Dr. Baldwin's proposed 
 plan of investigation, having chiefly to do with external or environmental factors, 
 including housing conditions, age, race, duration of employment, etc. It was agreed 
 that such a field investigation should be made more or less in conformity to the plan 
 of inquiry followed by Dr. Forrest B. Ames in his "A tuberculosis survey of the resi- 
 dents of Saranac Lake, New York," made available to the members as a reprint from 
 the American Review of Tuberculosis for June, 1918. It was agreed, however, that 
 the blank utilized for the purpose would require to be materially modified, and it was 
 further agreed that the chairman would have such a blank prepared, based upon 
 similar inquiries in this and other countries arid forward tentative copies to every 
 member of the committee previous to the next meeting. Dr. Lanza suggested in this 
 connection that possibly the blanks used by him in the joint investigation of the 
 United States Bureau of Mines and the United States Public Health Service, in south- 
 west Missouri, and at Butte, Mont., might be utilized. He was requested to forward 
 -copies of such blanks to the chairman. 
 
 Dr. Caverly then suggested that possibly the State health inspectors could be made 
 use of in securing the required information by a house-to-house survey; if not of an 
 entire district or town, at least of a typical portion thereof. He thought further that 
 the State Tuberculosis Department, through its educational division, might render 
 useful personal assistance, and he agreed to give this matter further consideration. 
 Dr. Lanza said that on the basis of his experience woman field investigators had been 
 iound particularly useful, and his view was sustained by the chairman and others 
 present participating in the discussion. Exceptional care, however, would be required 
 in the employment of a field worker, aside from the question as to compensation and 
 other expenses. Dr. Caverly suggested the preparation by the chairman of a brief 
 memorandum for his use in presenting a proposed plan of cooperation to the Vermont 
 State Board of Health for its official approval. This was agreed to by the chairman, 
 and copies of such a memorandum were subsequently to be sent to every member of 
 the committee. 
 
 It having been agreed that a field investigation would be necessary to ascertain the 
 general facts of the industry and the general effects of the employment upon the 
 physical, social, and economic condition of the people, the committee proceeded with 
 a, consideration of the second portion of Dr. Baldwin's outline, concerning chiefly the 
 medical or physical examination of the employees. It was agreed that such an exami- 
 nation should be made of as large a number of employees as could possibly be induced 
 to submit to a thorough examination. Dr. Hamilton felt that if the cooperation of 
 the Granite Cutters' Union and of other labor unions was secured the difficulties would 
 not be as serious as anticipated. Dr. Lanza said that in the light of his experience 
 much would be gained if the physical examinations were conducted under the direct 
 authority of some member of a department, like the United States Public Health
 
 20 MORTALITY FROM TUBERCULOSIS IN DUSTY TRADES. 
 
 Service, the United States Bureau of Mines, or the United States Bureau of Labor 
 Statistics, rather than to be made to rest entirely upon the basis of a private and 
 unofficial initiative. 
 
 Dr. Baldwin enlarged upon the practical side of the required Rontgen-ray examina- 
 tions, which all of those present considered absolutely essential. Reference was made 
 to the elaborate study of this phase of the problem by Drs. Pancost and Miller, and 
 by Dr. Landis, the latter being a member of the committee, but unfortunately unable 
 to be present. The Trudeau Sanatorium, or the Trudeau Foundation, would be 
 willing to undertake much if not most of this work and materially share in the expense. 
 It was agreed, however, that the physical examination of the employees should follow 
 the field investigation, but in the meantime the technical details of such an investi- 
 gation, with special relation to the required blank, etc., would receive consideration. 
 As to the best possible blank for the purpose, it was agreed that the chairman should 
 have such a blank prepared on the basis of previous investigations in this country 
 and abroad, and Dr. Lanza promised to furnish copies of the blanks used by him in 
 the examination of some 1,500 miners in the Butte (Mont.) district. 
 
 Dr. McMichael agreed to report possible individual cases of lung fibrosis and pul- 
 monary tuberculosis obviously in consequence of dust exposure, although he felt 
 somewhat doubtful as to the amount of material likely to present itself in his section 
 of North Carolina in view of the limited extent of the dusty trades in that portion of 
 the country. He, however, further agreed to undertake whatever duties might be 
 assigned to him in connection with the more highly involved technical aspects of the 
 inquiry, particularly as to pathological phases, and perhaps autopsy records, etc. 
 
 Dr. Baldwin then directed attention to the fact that a limited amount of animal 
 experimentation was being carried on at his laboratory, limited for the time being 
 to exposure, under control, of guinea pigs to finely comminuted granite dust. He 
 hopes later to carry on similar experiments with marble dust, and the chairman agreed 
 to obtain for him a sufficient quantity of limestone dust for the same purpose. He 
 explained that three forms of experiments were carried on first, with animals in 
 thorough health and not heretofore exposed to tuberculosis; second, with animals 
 suffering from slight tuberculosis infection; and third, with animals infected with 
 tuberculosis subsequent to prolonged dust exposure. 
 
 The order of procedure in the proposed investigation was then agreed upon more or 
 less as follows: 
 
 1. The preparation of a brief outline of the general subject, limited to the stone 
 industries of the State of Vermont, by the chairman, possibly amplified by a pre- 
 liminary personal investigation of the conditions in the territory, with conclusions 
 useful for the guidance of the field workers. 
 
 2. A qualified preliminary technical investigation of industrial conditions and 
 industrial processes in the granite and marble industries of the State of Vermont by 
 the chairman and one of his office assistants through the cooperation of the Prudential. 
 This study would include a descriptive account of the most injurious or dust-producing 
 industrial processes, with illustrations of the tools used, etc. This investigation 
 would probably be made by Mr. Edwin E. A. Fisher. 
 
 3. The chairman agreed to take steps to ascertain, through the cooperation of the 
 State Board of Health, the best method by which a transcript might be had or a 
 reanalysis might be made, of the death certificates of stoneworkers in certain selected 
 towns of the State of Vermont. If it should be found impossible for the State Board 
 of Health on account of limited office force to assist in the required statistical work, 
 the chairman intimated the probability that the Prudential would assume the expense 
 of such an investigation, aside from the company's willingness to assume the expense 
 of printing the required blanks for the general conduct of the field investigations and 
 the physical examinations subsequent thereto. 
 
 4. The so-called house-to-house investigation should, as far as practicable, be under 
 the direction and control of the State Board of Health of Vermont. It should proceed
 
 MORTALITY FROM TUBERCULOSIS IN DUSTY TRADES. 21 
 
 in conformity to the best examples of corresponding investigations in this country 
 and abroad, and the data, as far as practicable, should be made comparable with other 
 investigations so as to enhance their value for future use. 
 
 5. The more involved technical investigation of the industry should be jointly 
 under the direction of the United States Public Health Service and the United States 
 Bureau of Mines, corresponding, as far as practicable, to the investigations made by 
 these two Government departments into the relation of siliceous dust to pulmonary 
 disease among miners in the Joplin district in Missouri. It was agreed that the chair- 
 man should frame a resolution for adoption by the executive committee of the National 
 Tuberculosis Association suggesting the official cooperation of the director of the 
 United States Bureau of Mines and the Surgeon General of the United States Public 
 Health Service, corresponding to a similar resolution transmitted under date of May, 
 1911, and which resulted in the undertaking of the investigation previously referred to. 
 
 6. The physical examination of employees, and possibly members of their families, 
 should, if any way practicable, be under at least the direction of the United States 
 Public Health Service, in affiliation, however, with such other official and voluntary 
 agencies as might be secured to enlarge the field of inquiry and to improve the quality 
 of the results. 
 
 7. The X-ray examinations should be made locally but in cooperation with the 
 Trudeau Foundation, the State sanatorium, and the local hospitals in the districts 
 concerned. 
 
 8. Post-mortem examinations should be obtained in a sufficiently large number, 
 possibly on the basis of a ruling of the State Board of Health, concerning the modifica- 
 tion of doubtful death certificates. 
 
 9. The problem of domestic infection, or more precisely, the incidence of tubercu- 
 losis among the wives and children of stoneworkers, should be made a matter of separate 
 inquiry, so as to avoid confusion with the main purpose of the investigation, having 
 primarily and practically exclusively to do with the health-injurious consequences 
 of continuous and considerable dust inhalation in the stone industries of the State. 
 It was agreed, however, that, as far as practicable, the entire family should be included 
 in the personal examination. 
 
 10. The problem of prevention obviously could not receive consideration until 
 the entire new material had been properly assembled and made the subject matter 
 of qualified discussions and of definite recommendations. 
 
 11. Finally, the proper care of incipient cases, and possibly the still more involved 
 question of workmen's compensation for fibroid lung diseases contracted in the course 
 and in consequence of the employment were left open for future consideration. 
 
 Aside from the foregoing, it was agreed that, as far as practicable, the slate and talc 
 industries of Vermont should be brought within the plan and scope of the investiga- 
 tion, although apparently limited to the health-injurious consequences of granite 
 and marble dusts. 
 
 The question of the pottery industry, and that of dust exposure in flint mills, was 
 left for consideration at a subsequent meeting, but the chairman agreed to make 
 tentative inquiries into the subject. 
 
 Dr. Caverly directed special attention to dust-producing processes in the slate 
 industry in Rutland County, and the generation of vast quantities of dust, sufficient 
 to prove at least obnoxious to the surrounding country, and resulting in lawsuits on 
 the ground of damage done to vegetation, etc. 
 
 The committee then closed the discussion concerning the granite and marble indus- 
 tries and took up the question of the limestone industries of Southern Indiana, which 
 will be dealt with in a subsequent report. t 
 
 Very truly, yours, 
 
 FREDERICK L. HOFFMAN, 
 Chairman Committee on Mortality from Tuberculosis in Dusty Trades.
 
 22 MORTALITY FROM TUBERCULOSIS ITS DUSTY TRADES. 
 
 In a second communication dated July 25, 1918, the report upon 
 the conference to the president of the association was completed. 
 
 Dr. DAVID R. LYMAN, 
 
 President National Tuberculosis Association, Wallingford, Conn. 
 
 DEAR DR. LYMAN: After having fully agreed upon the details of the proposed in- 
 vestigation of the stone industry in the State of Vermont, the committee took up the 
 question of a corresponding though possibly less extensive investigation into the dust 
 problem of the limestone industries of southern Indiana. The chairman presented 
 the results of a fairly extended correspondence with the secretary of the Bedford 
 Stone Club Auxiliary of Bedford, Ind., and some statistical data conveying an 
 urgent suggestion for a thorough inquiry into local Conditions, briefly set forth as 
 follows: 
 
 In consequence of a controversy involving the usj of the pneumatic tools in stone- 
 cutting, etc., and the alleged mechanical injuries to the hands and arms, all of which 
 has been made the subject of exhaustive investigations by representatives of the 
 industry, the labor union, the Federal Bureau of Labor Statistics, the United States 
 Public Health Service, etc., the question had incidentally been raised as to the possi- 
 ble injuriousness of pneumatic tools on account of the large quantities of fine dust 
 raised during the mechanical operations. The viewpoint, however, had been ad- 
 vanced by the secretary of the Bedford Stone Club Auxiliary that "Tuberculosis 
 unquestionably is far more prevalent in the granite and sandstone industries than in 
 the Indiana limestone industry. Not only are our accommodations more modern 
 than generally found elsewhere, but the nature of the stone itself is such as to preclude 
 most of the detrimental elements which are a source of objection in other sections 
 of the business. Indiana limestone, as commonly worked, is moist, in fact, one may 
 say, wet. Furthermore, its physical make-up is such as to cause an almost total ab- 
 sence of sharp, gritty particles which, according to my (Dr. Richter's) understanding, 
 are the chief objection in granite and sandstone." 
 
 Dr. Richter referred also to the report of Dr. Barnes, of St. Louis, and subsequent 
 investigations by Dr. Leake, of the Public Health Service, and Dr. Edsall, the well- 
 known authority on occupational diseases, to the effect that "They are unanimous 
 in their finding that the prevalence of dust in the mills of the Indiana limestone 
 district is negligible factor. This because the stone as worked here is drenched with 
 water at various stages of fabrication, which water is not evaporated to any extent 
 until the stone is practically ready for loading." 
 
 "These doctors have further agreed that the general health of all the stonecutters 
 examined and interviewed here is exceptionally good and that without question 
 or .doubt they rate much higher in that regard than stonecutters generally." 
 
 Assuming for the time being that these conclusions are correct, it would neverthe- 
 less be of the first importance to ascertain with the required degree of thoroughness 
 and scientific accuracy the facts, more or less in the manner as has been done so ad- 
 mirably by the United States Bureau of Mines in their recent report on Siliceous 
 Dusts in Relation to Pulmonary Diseases among Miners in the Joplin District, Mis- 
 souri. The committee therefore agree that in view of the most hearty and unqualified 
 assurances of active cooperation on the part of the Bedford stone industry the entire 
 subject matter should be taken up with reference to the limestone industry of 
 southern Indiana. It, however, was clearly recognized that the strictly technical 
 phases of the investigation would probably have to be taken care of by the United 
 States Bureau of Mines and the United States Public Health Service. 
 
 As a matter of record the chairman read from a letter addressed to him by the secre- 
 tary of the Bedford Stone Club Auxiliary, dated January 19, 1918, reading in part: 
 
 "It seems to us, therefore, that the matter to which we refer hereinbefore must be 
 of vital interest to you. Our interest in it is twofold. We want to show in all fairness
 
 MORTALITY FROM TUBERCULOSIS IN DUSTY TRADES. 23 
 
 that the effects of the pneumatic tool are not such as to warrant discrimination. We 
 want further to create for our workmen a condition which will give them every benefit 
 ao far as insurance, among other things, is concerned, which may rightly accrue 
 from the fact, first, that the pneumatic tool does not imply hazard, and, second, 
 that in our operations in Indiana tuberculosis owing to dust is practically, if not 
 entirely, an unknown experience." 
 
 It having been agreed that such an investigation should be undertaken, it was 
 thought best, however, to postpone the work in Indiana until the plan of inquiry 
 had been thoroughly worked out for Vermont. The chairman was able to inform 
 the committee that assurances had come to him from the State health officer of Indi- 
 ana that the Board of Health of that State would most heartily cooperate, and that 
 in addition a corresponding offer of cooperation had also been forthcoming from the 
 general office of the Journeymen Stonecutters' Association, Mr. Walter W. Drayer, 
 general secretary, Indianapolis. Mr. Drayer's letter concludes with the statement 
 which is here incorporated as a matter of record, that he is "only too pleased to assist 
 you in any way possible in your investigation of health conditions in the stone trade 
 of Indiana." 
 
 Dr. Alice Hamilton reported briefly upon her own investigations in Indiana, almost 
 exclusively, however, with reference to the alleged injurious mechanical effects of 
 pneumatic tools, with which, of course, the committee on dusty trades has no direct 
 concern. She gave the assurance of her entire willingness to cooperate to the fullest 
 extent and it is to be hoped that this may be feasible through the United States Bureau 
 of Labor Statistics. Dr. Hamilton's experience, it was clearly recognized, would be 
 invaluable to the committee, more so in view of the fact that she had also made personal 
 investigations in connection with these matters in Vermont. 
 
 Before concluding its session the committee considered, briefly, the problem of 
 metallic dust, as observed in connection with the military industries of the Govern- 
 ment. Dr. Lanza intimated that some useful information would probably be forth- 
 coming in consequence of his investigations of conditions at the plants of the Winchester 
 Arms Co. 
 
 Dr. Baldwin explained briefly his laboratory experiments with guinea pigs exposed 
 intermittently to the inhalation of granite dust, which, however, had not proceeded 
 sufficiently far to justify definite conclusions. The committee were shown over the 
 laboratory and gained much useful knowledge. Dr. Baldwin incidentally brought up 
 the question of the health injuriousuess of the dust inhaled by the workmen employed 
 in the carborundum plants at Niagara Falls. When he had first visited this plant some 
 years ago, he had been assured of the practically noninjuriousness of the dust, regard- 
 less of the obvious and perceptible evidence to the contrary. Subsequently a number 
 of the employees from this plant had come to Saranac Lake suffering from tuberculosis, 
 and, although the evidence, of course, was not final as to whether the disease had been 
 contracted in consequence of the exposure to carborundum, a general conclusion to 
 this effect seems justified in view of the conditions observed. It was therefore agreed 
 that if the executive committee of the National Tuberculosis Committee should meet 
 as intended at Buffalo, in August, the committee on dusty trades would meet jointly 
 and perhaps take up a brief investigation into the conditions at Niagara Falls in the 
 plants referred to. Dr. Baldwin assured the committee that Dr. Bowman, in charge 
 of the welfare work and himself a sufferer from tuberculosis in the incipient stage of the 
 disease, would no doubt cooperate in the fullest extent. 
 
 The committee thereupon adjourned subject to the call of the chairman. 
 Very truly, yours, 
 
 FREDERICK L. HOFFMAN, 
 Chairman Committee on Mortality from Tuberculosis in Dusty Trades, 
 
 National Tuberculosis Association.
 
 24 MORTALITY FROM TUBERCULOSIS IN DUSTY TRADES. 
 
 On the occasion of the meeting of the executive committee preced- 
 ing the meeting of the special committee a resolution had been intro- 
 duced by the chairman of the committee, and had been unanimously 
 approved, as follows: 
 
 RESOLUTION UNANIMOUSLY ADOPTED AT THE MEETING OF THE EXECUTIVE COMMITTEE 
 OF THE NATIONAL TUBERCULOSIS ASSOCIATION. 
 
 Whereas the special committee on the scientific study of the dusty trades in their 
 relation to the relative frequency of tuberculous diseases have unanimously agreed to 
 concentrate their efforts for the time being upon the morbidity and mortality of men 
 employed in the stone industry of the State of Vermont and the limestone industry 
 of the State of Indiana; and 
 
 Whereas, in the furtherance of their work, the committee are most urgently in need 
 of governmental cooperation in certain highly specialized matters of field inquiries and 
 laboratory research; be it therefore 
 
 Resolved, That the United States Public Health Service and the United States 
 Bureau of Mines be requested to undertake jointly a thorough investigation of the dust 
 problem in the stone industry of Vermont and Indiana, with a view to the ascertain- 
 ment of all the facts having a bearing upon the excessive incidence of tuberculous and 
 nontuberculous respiratory diseases in the several branches of the industries referred 
 to, and the determination of the best possible methods and means whereby the mor- 
 bidity and mortality of the men employed therein may be materially reduced by the 
 adoption of more effective safeguards and improved methods of sanitation than those 
 in use at the present time. 
 
 Assured of the hearty cooperation of the Vermont State Board of 
 Health, the efforts of the chairman were concentrated upon the 
 Vermont stone industry as the most promising line of research during 
 the summer and early fall. Of interest and value is therefore a letter 
 from the secretary of the board, Dr. Charles F. Dalton, dated July 22, 
 1918, reading as follows: 
 
 Under separate cover, I am sending you a rough model of a granite cutter's hand 
 tool for combining pneumatic suction with compressed air. The principle of this tool 
 is that a circular jacket is placed around the shaft of the tool which is either square 
 or several sided, leaving a space through which the granite dust can be withdrawn. 
 The working of this tool would require a hose for suction as well as the pressure hose 
 and, as this would materially add to the weight, it has been objected to on this ground 
 by some granite workers who have seen it. However, I am informed that this tool 
 which I am sending you has actually been used and demonstrated that it will do the 
 work if some difficulties can be overcome. This model was made by Mr. Allan 
 Calhoun, formerly factory inspector for the State of Vermont, but he has turned it 
 over to the State Board of Health for such use as can be made of it. 
 
 I have personally gone over the matter of the use of a hand tool with representatives 
 of the granite manufacturers in Barre and also with the granite cutters. They are 
 apparently ready and willing to adopt any feasible plan for the elimination of granite 
 dust from hand tools, but at my last conference with them they did not know of any 
 practical method of accomplishing this result. 
 
 All this is at the suggestion of Dr. Caverly, who tells me that you are likely to come 
 to Vermont some time in the near future to visit the Barre granite industries. I 
 shall be glad to accompany you on the trip and am much gratified that this work is 
 being taken up.
 
 MORTALITY FROM TUBERCULOSIS IN DUSTY TRADES. 25 
 
 This letter was amplified by a subsequent communication dated 
 July 27, 1918, which is also given in its entirety: 
 
 Your letter addressed to nie in Montpelier has just reached me via Burlington. 
 You speak in your letter of the desirability of our board assisting at least in the house- 
 to-house inquiry that' will be made into the stonecutting industries of Vermont, 
 as a result of our conference at Saranac Lake. I know that our board will be in entire 
 sympathy with this work. However, at the present time, by reason of resignations, 
 due to war work and other things, we are crippled. We have no inspector just now, 
 but I have no doubt the executive secretary of the State Tuberculosis Association, 
 who works under the auspices of our board part of the time, may be utilized for some 
 inquiries in this work. We shall have, I hope, an inspector soon. If you can defer 
 the investigation for a month or two I think we should be able to give you more assist- 
 ance. The matter will be brought to the attention of the board at its next monthly 
 meeting, which occurs August 8, and you will be notified more .specifically of the 
 extent of cooperation which may be expected from us. You are perfectly right in 
 thinking that the board will furnish you every assistance possible in this work, in 
 which we are all very much interested, the importance of which has been recognized 
 by us for a great while. 
 
 There is included also a statement presented by Dr. Caverly 
 at the Saranao Lake meeting of the committee, which will be found 
 useful for future reference : 
 
 Number of granite cutters in the Barre district (comprising about 6 towns), 3,000. 
 
 Number of helpers, 1,000. 
 
 Number of men in quarries, 1,000. 
 
 Barre City, with a population in 1910 of 10,784, had 135 deaths from all causes; 
 28, or 20.7 per cent, were from tuberculosis of the lungs; 33, or 24.4 per cent of these 
 deaths were from tuberculosis in some form. 
 
 Number of deaths from tuberculosis of the lungs in the State runs in recent years 
 from 250 to 300, hence the number of deaths in the city of Barre is approximately 10 
 per cent of all that occurred in the State. 
 
 Number of admissions at the State sanatorium for incipient tuberculosis since it 
 was opened, 10J years ago. of granite cutters, quarrymen, and granite workers has 
 been 56 out of a total number of admissions of 963, or 5.8 per cent. 
 
 Barre Town, which is a township surrounding the city, with a population of 419, 
 had 4 deaths from tuberculosis in 1917, out of a total number of deaths of 51. 
 
 Montpelier City, with a population of 7,856, had 13 deaths from tuberculosis of the 
 lungs in 1917, with total deaths of 121 . Pulmonary tuberculosis rate is 10.7 of the total 
 deaths. 
 
 Number of admissions to the sanatorium among marble tracers, graders, polishers, 
 cutters, and workers since institution opened, 10. Number of slate quarrymen 
 and cutters, 7. 
 
 The marble and slate industries are centered in Rutland County. 
 
 The secretary of the Granite Manufacturer's Association is Mr. Hinmaii, of Barre 
 City. Dr. Alice Hamilton, of Chicago, has recently made an investigation of the 
 granite indutry for the Department of Labor at Washington. 
 
 As bearing upon the more general work of the committee, there 
 is included here a letter from the director and chief engineer of the 
 division of sanitary engineering of the State Department of Health 
 of West Virginia, Mr. Mayo Tolman, dated August 2, 1918:
 
 26 MORTALITY FROM TUBERCULOSIS IN DUSTY TRADES. 
 
 FREDERICK L. HOFFMAN, 
 
 Third Vice President and Statistician, Prudential Insurance Co., 
 
 Newark, N. J. 
 
 DEAR SIR: I was deeply appreciative to receive your kind letter of recent date in 
 reference to my "Sanitary survey of Charleston." This was particularly the case as 
 not only has the report not received any comment in this city but has failed to awaken 
 the slightest interest, so deeply set has Charleston become in the rut she has traveled 
 for years. 
 
 I am sorry that I can not report more definitely upon the tuberculosis condition at 
 the Kelly Ax Works. The works have been investigated on six different occasions 
 by the State Department of Health, on several other occasions by Miss Erma Slack, the 
 nurse of the Anti-Tuberculosis League, and all investigators report that the deaths 
 among ax grinders have accurred among those men who are known to have been 
 infected before the installation of dust removal machines. However, Dr. Holt Barks- 
 dale, one of the leading younger physicians in Charleston and a man who has made 
 a special study of tuberculosis in Charleston, is of the opinion that the ax plant is still 
 responsible for much tuberculosis in Charleston. Living conditions in the vicinity 
 of the ax works are as noted in the report, deplorable, and there are well authenti- 
 cated cases where men who appeared perfectly well have used the same bed with 
 advanced cases of tuberculosis and it would seem possible that the disease has been 
 spread in this fashion. My own experience with the ax plant shows that the dust 
 removers are not given sufficient attention to make them fully effective at all times. 
 I think the illustration in the report will prove this for sparks can be seen flying well 
 towards the ceiling. 
 
 Again thanking you for your kindness in commenting on this report, I remain, 
 Most sincerely, yours, 
 
 MAYO TOLMAN, 
 Chief Engineer, State Department of Health. 
 
 There is also included a letter from Dr. H. R. M. Landis, of the 
 Henry Phipps Institute, bearing more directly upon the question 
 of proper blanks and forms to be used in connection with the pro- 
 posed investigation .in the State of Vermont. 
 
 I quite agree with you that many of the blanks used in these investigations are 
 too much overloaded with detail. I have Lanza's report and I think you might as 
 well follow that. I do feel, however, that much more extensive study of the outside 
 life of the men is needed than is contained in this industrial investigation with the 
 one exception of the study made by Mrs. Lit and myself. For example, I saw a 
 potter yesterday who acquired a slight tubercular infection in addition to his dust 
 disease and made a perfect recovery and returned to his trade as a potter. He re- 
 mained perfectly well for a year and a half and then broke down as a result of starting 
 drinking. I cite this simply to draw attention to the fact that it is necessary to know 
 how and where these men live before I am convinced that their method of living has 
 as much influence, if not more influence, as has the evils of their employment. I feel 
 that any investigation such as you are about to make should result in a very incom- 
 plete study if it fails to cover this phase of the subject. It should not be very diffi- 
 cult to get a good family history, seeing the presence or absence of tuberculosis in 
 the family, the general hygienic condition of the home and the neighborhood, and the 
 present habits as to food, hours of sleep, and indulgence in alcohol. 
 
 On account of prolonged absence from office in connection with 
 an extended western trip, the chairman found it impossible to under- 
 take the proposed investigation in Vermont, but assigned the sub-
 
 MORTALITY FROM TUBERCULOSIS IN DUSTY TRADES. 27 
 
 ject to one of his office assistants, Mr. Sylvester Schattschneider, 
 with extended experience in field investigations of this kind. 
 
 The outbreak of the influenza epidemic occurred at just about 
 the time when the field investigation was to have been commenced, 
 and the same had therefore to be abandoned for the time being. 
 
 Still more lamentable was the untimely death of Dr. Caverly, 
 president of the State Board of Health of Vermont, to whose active 
 cooperation, high scientific attainments, and always hopeful attitude 
 of mind, the chairman and the committee are under lasting obligation. 
 
 Partly, as stated, on account of prolonged absence from office, 
 but also on account of the influenza epidemic, etc., no subsequent 
 meetings of the committee were held. It is hoped, however, that a 
 meeting can be arranged for in the near future; but frequent con- 
 ferences have been had on the part of the chairman with members 
 of the committee concerning matters of detail. 
 
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