above disease requires that there should be, as far as possible, absolute and complete isolation of all such cases, especially of scarlet fever

In many cases that there is criminal negligence, if not absolute indifference, is beyond question. The cases should be placed in large, well ventilated apartments, if possible in an upper story. Ventilation should be as complete as may be compatible with the safety of the patients; that is, while the rooms should be well ventilated the patients should not be subjected to draughts. The utmost cleanliness should be observed. While the room should be well ventilated, it should be sufficiently warm. All children of the family should at once be prohibited from going to school, church or to other public places; indeed, they should be kept at home. Other children and people, except necessary nurses, should be kept away. General visiting of sick people, that in some places, prevails as a matter of curiosity, or from mistaken kindness, to get a good dinner, to gossip or from whatever motive, is an unmitigated nuisance and should be abated. None but those who go to nurse should visit people who are seriously sick, while a complete isolation, cleanliness and thorough ventilation will always constitute our chief reliance in a sanitary point of view, still the liberal use of disinfectants is most essential. First, the patients should be "freely and frequently anointed with lard or vaseline containing a small quantity of carbolic acid. This tends to destroy the poison or to prevent its dissemination; by preventing the detachment and spread of the epidemic, carbolic acid, one drachm to the pint of water, should be used about the room, and may be added to water in which clothing is washed. Sulphate of iron (copperas) may be dissolved in water and placed in shallow vessels about the room." The throat and mouth may be washed with a weak solution of chloride of soda. The agency of heat should be sought when we desire to destroy the germs of the disease in clothing. The bed linen and wearing apparel should be soaked in boiling water, baked in an oven or burnt. Fumigation as previously described, should be used after convalescence, one pound of sulphur to 1,000 feet of cubic space is said to be sufficient. Clothing should not be sent off the premises to be washed. The vessels in the room should contain some disinfectant, such as chloride of soda or carbolic acid. The above directions apply chiefly to scarlet fever and measles; they would doubtless be just as applicable to diphtheria and typhoid fever. So far as whooping cough is concerned, isolation is perhaps, the only safe precaution, and if complete all that is required.

"NAILERS' CONSUMPTION," AND OTHER DISEASES PECULIAR TO WORKERS IN IRON AND GLASS.

BY JOHN L. DICKEY, A. M. M. D., WHEELING.

In Wheeling and the immediate vicinity there are ten large iron and nail concerns, employing in all the departments about five thousand seven hundred men and boys. In the same locality are twelve glass works, in

which are employed about two thousand six hundred and fifty persons. Like those who follow other trades and occupations these iron and glass. workers are liable to certain diseases and injuries. To briefly mention some of these is the purpose of this paper.

The "boilers" and their "helpers," some of them stripped to the waist, are exposed to the intense heat of the puddling furnaces as they stir the molten metal. Perspiring from every pore they will gulp down large draughts of ice-water, or step outside and stand for a few minutes in the open air, or in a stiff river breeze. As they are quitting work, preparatory to going home, they are accustomed to bathe their arms and bodies in the convenient tanks of constantly running water. Such sudden coolings are, of course, liable to cause congestions, which may be followed by some of their manifold consequences.

The "rollers" and "hookers," from the nature of their work, are more liable to strains, of muscles as well as joints. . Muscular rheumatism, myalgia, (cramps in the muscles), and thecitis (inflammation of the sheaths of tendons), are not infrequent among them. Over-heating and sudden cooling, of course, lend their share in causing these troubles.

The nail feeders, sitting for hours at a time on their hard, backless stools, become, more or less, stoop-shouldered, and many of them are, naturally, troubled with hemorrhoids.

Surgical injuries are not so common as one would expect, considering the numerous opportunities afforded for accidents. Burns are probably more frequent than any other surgical cases. A serious injury of this kind occasionally happens to an unfortunate fellow who steps on the crust of slag that has not fully hardened over the refuse metal from the blast furnace. Before he can extricate his foot it is horribly burned. In the nail factories particles of steel or stone frequently fly into the eye. When not too deeply imbedded in the tissues, one of the older workmen, with a long experience in such matters, skillfully removes the foreign body. Sometimes an inflammation of the cornea or iris follows such injuries, and occasionally an eye is lost by a general inflammation, involving all the structures.

More distinctive and more formidable, however, than all the other diseases and injuries to which these workers in iron are subjected is the socalled "nailers' consumption," which in technical language might be termed phthisis fabrum clavorum. Accepting the division of the causation of phthisis into the two classes of general and local, nailers' consumption comes under the latter. It is the mechanical or irritative form of this dread disease, and resembles anthracosis, or miners' consumption; millstone makers' consumption; cotton consumption, to which the operatives in cotton mills are liable; stonemasons' consumption; and knife-grinders' consumption. The last named is probably identical with nailers' consumption, as it is due to the irritation set up by particles of steel and stone-dust. Ten or twelve hours a day the nailer and nail feeder are breathing in an atmosphere laden with minute particles of iron and steel. The nailer has charge of three or four machines, and much of his time is spent in the grinding room sharpening the knives of the nail machines on large, rapidly revolving sand-stones, the dust from which is an additional source of irritation to his air passages and lungs. The feeder is not exposed to this dust of the grindstones, but this danger is partially balanced by his sitting con

stantly on his stool in a cramped position, inspiring the metallic dust. The great bulk of the danger, however, falls on the nailer, and no matter how broad-shouldered and full-chested he may be, nor how robust in health, he must succumb sooner or later. Besides grinding the knives he finds it necessary to use, three or four times a day, the "patent scraper" for leveling the face of the stone, which becomes worn in grooves and grows smooth and glazed on the surface with the particles of steel. The scraper is attached to the frame, and a white, choking cloud of coarse stone dust fills the air, which, in the words of a workman, is "very hard on the lungs." In order to obviate the danger from grinding, to some extent, Eastern nail mills formerly used, as a rule, wet stones, but this method is too slow and is not much in vogue at present. Two of the mills here, the LaBelle and the Benwood, have introduced large and powerful fans for removing the dust. The stones are encircled half way round by troughs, which lead into a larger conduit, through which is passing a strong draught from the fan. By this means at least half of the refuse is removed. It is claimed that the good results can already be seen in the improved looks of the nailers of these two mills, and that they lose less time from work on account of sick

ness.

Various forms of inspirators for excluding these irritating particles have been devised, but no one of them has ever come into general use, either because they were found inefficient, or on account of a false pride among these men that prevents many of them from using such things. A handkerchief is sometimes worn over the nose and mouth; a sponge is tied in front of the face; or more complicated apparatus in the shape of inhalers is occasionally used. One of the simplest and most ingenious devices of this kind, which is used to some extent, was originated by a very intelligent nailer a few years ago, and consists of a large artificial moustache, which affords considerable protection both to the nose and mouth. The most perfect inspirator is a small frame of wire gauze fitted to the nose. Inside of the frame is a bunch of cotton, which catches all the finer particles that escape the outer screen. The cotton can be frequently changed, which is an advantage over inspirators that are more costly and more complicated, for they soon become foul and worthless.

Following is a single illustrative case of nailers' consumption, so far as an exact diagnosis can be made without a post mortem. The patient is under the care of Dr. Charles M. Frissell, through whose kindness I obtained the history : A—. S—., Æt. 43, born in Montreal, Canada, where he lived till 21 years old. His father died at 48 of an acute disease; his mother lived to be 72 years old. He has two brothers and two sisters older than himself, and two brothers younger, all still living. There was never any consumption in the family, so far as he knows. The patient has been a nail-feeder and nailer since he was 16 years old, and has never worked at anything else. Has always been of regular habits, and has never exposed himself much. Three years ago he contracted a cold and has been coughing and expectorating more or less ever since. Has not worked any for sixteen months on account of shortness of breath. At present he is much emaciated, suffers from dyspnoea and has a hacking cough, with some expectoration. The chest-walls are much contracted, especially on the right side, where there is also a deep infra-clavicular depression and

marked flattening. In the right lung there is absence of vesicular murmur and signs of a large cavity in the upper part. There is dullness over the entire left lung, and lessened vesicular sounds, with some bronchial breathing. In short, the physical signs are those of fibroid phthisis.

The following facts in regard to post mortem appearances of the lungs in nailers' consumption were kindly furnished me by Dr. T. O. Edwards, being the result of three examinations he had made: There was marked discoloration of the lung tissue, being much darker than that of an average person living in a manufacturing city where soft coal is used. There was induration of the tissue, and numerous deposits of hard, fibroid material, varying in size from small nodules to masses larger than a walnut. These masses were more like accumulations of heavy material than the results of caseous degeneration, and would sink instantly in water. In one case there were several plates of brittle, calcareous accumulations on the pleural surfaces of the lungs. Numerous cavities were found in all the cases, and were lined with a pus-secreting membrane, the broken down tissue having been expectorated. Generally there are pleural, and sometimes pericardia, adhesions, which may account for the extreme dyspnoea which is generally noticeable in these cases.

Flint regards these irritative forms of phthisis as chronic interstitial pneumonitis, accompanied by signs and symptoms which render it difficult to be differentiated from tuberculosis. But Niemeyer and others hold that the tuberculous product is often dependent on bronchitis, and this is generally the original trouble in nailers' consumption. The most recent views on the pathology of this form of fibroid phthisis are found in Coats' Pathology, published a short time since. The author says that these foreign particles irritate more or less according to their mechanical qualities, particles like steel dust, hard, heavy and angular, being more irritating than the light and rounded pieces of carbon in the miner's lung. Referring to the particles of sandstone, he says, "They irritate the bronchial mucous membrane. When they pass into the interstitial tissue of the lung they irritate it, and in this case there is frequently a very marked induration of the connective tissue. This induration, along with the bronchitis, may go on to the formation of cavities by bronchiectasis (dilatation of the bronchia.) The indurations often have special centres of greatest intensity in form of hard nodules, in the centre of which a collection of glistening particles may be found.”

Dr. Edwards, who has been the City Health Officer during the past eight years, informs me that the death record during this period shows that fortythree nailers and four feeders have died in that time; forty died of so-called nailers' consumption, the remaining seven from other causes. These, of course, were only of the four factories within the city limits. This record is not entirely reliable from the fact that, very often, the physician filling out the death certificate neglects to give the occupation; but, on the other hand, the occupation of nailer and nail feeder is more generally given than any others. The average age of these forty men was found to be less than thirty-nine years. By a rough estimate, made from the above mentioned record, the number of nailers that die of consumption is about eighty out of every one hundred. From Lawson on Phthisis, we learn that the number of people not exposed to special causes, who die of consumption,

is about fourteen out of one hundred; the highest average he gives is among those exposed to the inhalation of mineral particles, seventeen out of one hundred. Niemeyer gives the general average of fourteen to twenty in every one hundred.

Dr. J. E. Reeves tells me that he carefully examined one hundred and thirty-six nailers, a few years ago, and found only one out of the whole number whom he regarded as sound, and whom he would have recommended to a life insurance company as a good risk. In all of the others he heard bronchial respiration and discovered other signs of consolidation in different degrees.

The Ohio Valley Protective Union and at least one of the old line life insurance companies, will not insure nailers, no matter what would be the result of a thorough examination, for the occupation is regarded as too hazardous.

There can be no doubt that an important factor in the high mortality of nailers' consumption is the dissipation to which many of these men are addicted. They make big wages and spend money freely. Their wages run from seventy-five to one hundred and seventy-five dollars every two weeks, an average of sixty-two and a half dollars a week. With so much spare money at command they are exposed to many temptations, and, as a consequence, alcoholic excesses and late hours make such serious drains on their health that they are the less able to fight their common enemy, and drop out of the ranks much sooner than their more temperate comrades. There are exceptional cases of nailers who are over sixty years of age, have been working at the trade more than thirty years, and are still in apparently strong health. They are mostly sober, temperate men, who take good care of themselves, morally and physically. If a nailer, who is free from an inherited tendency to phthisis, and has no natural or acquired predisposition to the disease, wear a good inspirator while working, and take other precautions to guard against the dangers of his trade, at the same time living temperately and giving intelligent attention to his hygienic surroundings, he would contribute a material share toward lengthening the short average of a nailer's life.

WORKERS IN GLASS

Are liable to certain diseases and injuries, peculiar to their work and surroundings. In many factories most of the workmen are not exposed very long at a stretch, their time being divided into "turns" of five hours each, an industrious workman making ten or eleven turns in a week.

All are exposed, more or less, to a high degree of heat, but this has been much modified in late years by improvements in ventilation. A strong draught of air is driven by fans through large pipes which run to different parts of the factory and around the furnaces. These pipes have vent holes at short intervals which allow the cool air to blow on the workmen near the furnaces, or from which rubber hose conducts it to the presses for cooling the moulds. The "finishers" are generally exposed to the heat of the room on the one hand, or the cool air from a door or window near which they sit, on the other. The "snappers" are exposed to the intense heat of the "glory holes" at which they stand to melt the ware.