Occupational Diseases

OCCUPATIONAL DISEASES, diseases that have exclusively or predominantly occupational etiology, i.e., those caused by occupational hazards and dangers of the work process or unhealthy sanitary-technical conditions of the surrounding work premises (see Occupational Hazards). Examples of O.D. with exclusively occupational etiology are, first of all, certain occupational poisonings, for example, aniline poisoning, which does not occur in ordinary circumstances, outside of occupational work. Predominantly occupational etiology is found, for example, in lead poisoning (food lead poisonings or poisonings from taking lead preparations internally for therapeutic purposes are also possible), writer's cramp, pneumoconiosis, etc. Along with this, in addition to specific O.D., there are a number of diseases that are usually not occupational, but among which individual cases of disease undoubtedly have an occupational origin. This follows that it is impossible to compile an exhaustive list of O.D. by the very nature of the matter, since almost every disease can in one or another cases have an occupational character. However, in some cases, certain types of diseases occur in particular professions so frequently, while the same non-occupational diseases are such a rarity for this group of workers, that with a significant degree of probability (bordering on certainty) each case of such a disease in this profession can be considered occupational. Examples can serve as acute tenosynovitis in professions requiring frequent small and rapid movements; cataract of glassblowers and generally cataract in professions associated with intense exposure to thermal radiation with a large number of so-called Focht infrared rays; nystagmus of coal miners; occupational eczema of an allergic nature upon contact with certain substances, etc. Finally, there are also O.D. which for a given profession are by no means typically occupational, and then in each individual case the physician must, on the basis of careful clinical and pathological analysis (localization of the disease, its form, nature of the course, detailed occupational anamnesis of the victim, etc.), establish its connection with working conditions, and thereby determine the presence or absence of occupational etiology. Examples can serve as varicose veins in spinners, damage to the heart muscle in a worker engaged in heavy physical labor, dermatitis from the action of irritating substances. The influence of occupational hazards or unhealthy general sanitary working conditions can also manifest itself in a significant increase in the prevalence of a certain type of disease in a given professional group, clearly detectable statistically, but without it being possible to determine in each specific case the occupational or non-occupational nature of this disease in each individual person. In such cases, we no longer speak of O.D., but of occupational morbidity characteristic of this profession. An example can serve as rheumatism in a number of professions associated with work in conditions of increased air humidity or dampness, tuberculosis in some dusty professions, infectious diseases among certain groups of medical personnel, veterinary personnel, agricultural workers, etc. The study of occupational diseases and O.D. from the point of view of their etiology, peculiarities of course, mass and individual prevention is carried out by occupational hygiene and more specifically its differentiated section - occupational pathology (see). The study of occupational morbidity is carried out by the section of occupational hygiene - sanitary statistics of labor. Bourgeois science studies almost exclusively only the clearly expressed specific occupational diseases because the study of this issue is closely connected with the corresponding legislation of bourgeois states and with the special interest of entrepreneurial circles, in particular of insurance associations and sick funds, in which, as is known, entrepreneurs actively participate in most countries. The fact is that in a number of countries among those in which social insurance exists in general, in relation to O.D. the direct responsibility of the employer is established, i.e., social insurance for this type of 'insurance risk' is built on the principle of social insurance for accidents (they are usually not paid by sick funds, but by insurance associations, or at any rate from those insurance funds in which the workers themselves do not participate or participate to a much lesser degree than from the sickness insurance fund). The usual norms and conditions of provision here are somewhat better than in sickness insurance. This leads to the desire of both employers and bourgeois scientists to narrow the concept of O.D. as much as possible, reducing it to a narrow circle of such nosological forms that undoubtedly or predominantly always have an occupational character. It goes without saying that such a point of view is absolutely unacceptable in the conditions of the USSR neither from the point of view of our legislation nor from scientific and practical preventive considerations. Since Soviet social insurance no longer knows division into different branches depending on the type of event requiring payment from insurance organizations (illness, accident, etc.), but distinguishes only temporary and permanent disability, the need for special insurance of O.D. also falls away. At the same time, from the point of view of the interests of improving working conditions and reducing morbidity, the limitation of the material of study and practical impact only to specific diseases is completely unacceptable. Clarification of the etiology of both specific occupational diseases and other types of O.D. to the same extent contributes to identifying special professions, types of work, and particularly threatened 'points' in the organization of labor and production processes as objects for intensified work in the field of occupational hygiene, and also to a certain extent of therapeutic medicine. The same significance is also attached to the analysis of occupational morbidity, with the only difference that here the results cannot be of such a concrete character in relation to working conditions and various health-improving and therapeutic-prophylactic measures in relation to each worker, but they make it possible to direct the thought and efforts of the corresponding medical or sanitary-technical competence to the search, and then to the elimination of harmful etiological factors both in the general conditions of this profession and in the specific working conditions of certain collectives, enterprises, etc. The broad development of the study of O.D. in the USSR has led to the special development of issues of their early diagnosis, and as this issue deepened, to the study of various shifts in the state and functions of the organism that are still only on the border between physiology and pathology and can therefore serve as signals for the adoption of necessary hygienic and individual therapeutic-prophylactic measures and for the assessment from the point of view of occupational hygiene of the physical state of health and occupational risk of one or another collectives. Mass medical examinations of the health status of workers in the USSR, first of so-called harmful productions, and then of increasingly wide circles of enterprises in the order of so-called dispensarization in the first years of the restoration period, led to the creation of the special concept of 'pathological involvement' (Bogoslavsky). In this case, a number of serious methodological errors were made, leading to completely unscientific and politically harmful conclusions. For example, the school of the Leningrad Institute for the Study of Occupational Diseases (Prof. Vigdorchik) on the basis of statistical processing of mass material and as a result of in-depth studies of various indicators (anthropometric data, blood tests, study of metabolism, various functional reactions, etc.) compared the results obtained with some artificial 'average', purely formal 'norm', for which either a healthy profession or a control group (for example, Red Army men) was taken, and then any, even insignificant, deviations from this norm were interpreted as pre-pathology and in any case as an indicator of sanitary unfavorable conditions of this group. As a result, it turned out that there is not a single professional group without one or another shifts and deviations. And from this it was naturally already to come to the conclusion that every labor in all conditions is always harmful. The school of the Institute named after Ookh, using the 'methodology' of Bogoslavsky's pathological involvement, made even grosser errors, since it mechanically added together various signs of this pathological involvement, mechanically replacing the state of the organism as a whole with individual lesions ('pathological signs'), then formally summed them up without a qualitative assessment of their real significance for health, and on this basis came to the conclusion that there is in fact almost not a single worker without pathological involvement. As a result, an impression was created of significant sanitary unfavorable conditions of the proletariat of the USSR, and the enormous shifts in the matter of actual improvement in the health of the broad working masses and reduction of O.D. remained completely unnoticed.

It is self-evident that occupational diseases (P. z.) can be studied and analyzed not as a result of some artificial isolation of professional pathological morbidity, but only on the basis of studying the general dynamics of workers' morbidity and an additional special in-depth analysis of certain pathological forms and health conditions that are truly pre-pathological (with the selection of each such condition being scientifically justified, physiologically and clinically substantiated, and based on the factual evidence of its role and place in the further development of an indisputable disease). The study of occupational diseases must of course be closely linked with the analysis of domestic influences, since such influences closely intersect with professional ones in terms of both negative and positive effects on health. The reduction of occupational diseases (prof. b-ney) in the USSR under the influence of the successes of socialist construction and, above all, the fundamental reconstruction of our entire industry is evidenced, at least, by data on the reduction of general workers' morbidity in recent years (the number of days of temporary disability per 10.0 'full' insured persons according to Tsustrakh data for the USSR was: in 1928 - 841.21, in 1929 - 875.31, in 1930 - 868.22, in 1931 - 839.6, in 1932 - 750.4). In reality, the reduction in morbidity was even greater, since these average figures are influenced by the different composition of workers in different years. A more accurate picture is given by figures for individual industries. For example, in metallurgy we have the following picture: the number of days of disability per 100 'full' insured persons was: in 1928 - 1193, in 1929 - 1233, for 1930 there are no exact data, in 1931 - 1021 and in 1932 - 972. According to the legislation of the USSR, special registration of occupational diseases has been established. By the Resolution of the NKT USSR and NKZdr. RSFSR of 1/III 1924 (with amendments of 11/II 1928), mandatory registration was introduced: a) professional poisonings (caused by lead, mercury, arsenic, phosphorus and their compounds, chlorine and its derivatives, hydrochloric, nitric, nitrous and hydrofluoric acids, oxides of nitrogen, sulfur and sulfur dioxide, hydrogen sulfide, carbon disulfide, carbon monoxide, gasoline and benzene and its homologs, nitro compounds of aromatic hydrocarbons, aniline, phenol and their derivatives, and all other professional poisons); b) anthrax; c) glanders; d) cataracts in work related to high temperature and bright light; e) cancer of the bladder in work with aniline compounds; f) occupational diseases of the skin (eczema, ulcers, burns, etc.), caused by the distillation of coal tar, turpentine, chlorine, chromium and other substances). Under this resolution, all medical institutions and all without exception physicians, both salaried and private practitioners, must send notifications of these occupational diseases to the sanitary inspector in the Labor Department and to the health authority at the place of work of the patient. In addition, the administration of enterprises and institutions in all cases of mass professional poisonings, if there are more than three victims or fatal cases, is obliged to immediately notify the sanitary labor inspector by telegraph or telephone. Moreover, the most careful registration of all poisonings is carried out by the method of signal statistics of all health posts. In the first years after the introduction of this registration, statistics showed a steady increase in the number of registered occupational diseases, especially professional poisonings, and here there was less an increase in diseases than an improvement in the barely beginning to be established registration. In the future, we observe a picture of their reduction despite the growth of industry. The following tables give an idea of the distribution of professional poisonings and occupational diseases in the RSFSR (according to NKT RSFSR data) for recent years. Table 1. Distribution of occupational diseases by industry. Industry 1927-1928 1928-1929 1929-1930 + special quarter 1931 Leather and mechanical. Extraction and processing of materials..... Chemical...... Mining and metallurgical. Textile ..... Metal processing and machine building. . Food industry . . . Wood processing . . Construction ..... Sewing........ Paper....... Processing of animal products ...... Other........ Total 1 343 221 1 469 2 227 3 181 1 928 Table 2. Distribution of professional poisonings by industry. Industry 1929-1927-1928-1930 1928 1929 + special quarter Chemical...... Mining and mining ..... Metalworking and machine building . Textile ..... Polygraphic . . Mining and processing industry...... Food industry . . . Sewing........ Woodworking . Paper....... Comm, business ...... Leather-mechanical . . . Other production...... Total 5S8 2 682"» 467 i - 2 093 1 719 4 190 1931 1 818 41 2 10 0 0 2 335 From these tables, which by no means claim to be an exhaustive list of poisonings for the reasons mentioned above, it follows a certain decrease even in absolute numbers of occupational diseases - professional poisonings, starting from 1931. Without exact data on the number of workers by industry by year, it is impossible to derive exact relative indicators, but it can still be unequivocally stated that there is a clear decrease in the corresponding coefficients in recent years, since the growth of workers during these years was incomparably greater than even the increase in absolute numbers in the table from 1927/28 to 1929/30. Even more characteristic are the data for Leningrad, where as a result of special active work in the field of combating professional poisonings, it was possible to achieve very tangible results, as can be seen from the following table: Table 3. Number of professional poisonings. Date Abs. Per 100 workers 1/X-1926....... 2.9 » » 1927 ...... 1.9 » » 1928 ...... 1.97 » » 1929 ...... 1.77 » » 1930 ...... 1.23 » 1/1-1932...... 0.7 For orientation as to which occupational diseases are most common in the USSR at present, a breakdown of data on occupational diseases and professional poisonings by their individual types according to the statistics of NKT RSFSR for recent years is provided. Table 4. Distribution of occupational diseases by type of disease. Name of occupational diseases 1927-1928 1928-1929 1929-1930 + special quarter 1931 Dermatitis and eczema from acids and alkalis Dermatitis and eczema from other causes . . Overheating of the body . . Tenosynovitis .... Chrome ulcers.... Anthrax.... Folliculitis and furunculitis...... Inflammation of the cornea, ophthalmias...... Conjunctivitis.... Other diseases 655 46 30 112 82 177 79 1 000 1 561 4 0 1 138 Total .... 1 469 2 227 3 181 ! 1 9:8 Table 5. Distribution of professional poisonings by poisons. Name of poison 1929-1927-1928-1930 1928 1929 + special quarter 1931 Carbon monoxide .... Lead ......... Gasoline ......... Carbon dioxide ...... Aniline ........ Zinc oxide ..... Mercury ......... Nitro compounds . . . Carbon disulfide ...... Sulfur dioxide..... Phosphorus......... Alcohols (amyl and methyl)..... Turpentine ....... Formaldehyde ....... Acrolein ....... Hydrogen sulfide ...... Kerosene vapors .... Bisulfite ...... Other poisons...... Unknown poisons . . . 1 008 1 931 47 1 617 84 8 17 20 3 17 56 0 0 8 11 0 0 o 21 0 All-Union statistics of professional poisonings cannot be carried out in relative indicators, e.g. per 1,000 insured, as is done in relation to general morbidity or professional injuries, since it reflects rather random processes - the occurrence of acute poisonings only in individual enterprises, and they often have a mass character and quickly disappear when appropriate measures are taken or unexpectedly reappear, as for example when new substances are introduced into production. This explains why, for example, poisonings by individual less common toxic doses of poisons sometimes appear and disappear in individual years. At the same time, certain conclusions can still be drawn from these tables. Thus, from them it follows that tenosynovitis, which are characteristic of very intense fast work, have disappeared completely in 1931, which should be attributed to the mechanization of production; lead, gasoline, and aniline poisonings are sharply reduced, to which special attention was paid to labor protection, but on the other hand, the importance of carbon monoxide (metallurgy!) and cataracts (the effect of radiant energy in various types of furnaces!) is growing. The legislation of the USSR also deals with occupational diseases in connection with the fact that, as the text of the instruction of the All-Union Council of Social Insurance of January 31, 1929 states, disabled persons who became so from 'so-called specific occupational diseases, i.e. diseases that are exclusively characteristic of work with certain professional harmfulness or at least occur in work with these harmfulness many times more often than under other conditions', are granted a pension in an increased amount along with disabled persons from accidents. According to the resolutions of the Union Council of Social Insurance of January 4, 1929 and January 20, 1931, a special list of occupational diseases is in effect in the USSR to which this resolution applies. In view of its practical importance, it is given in full (Table 6).

In addition, according to the relevant notes: a) medical personnel of psychiatric institutions who directly care for the mentally ill and have lost their capacity for work due to severe neurosis with intellectual degradation and change of character, or from early arteriosclerotic dementia, or from clinically expressed mental illnesses that occur at an age not corresponding to this disease, are entitled to benefits on the same basis as persons who have lost their capacity for work from the P. z. listed in this present list; b) syphilis may be recognized as an occupational disease in case the localization of the primary lesion is characteristic of the performance of professional duties, for example, in obstetricians, syphilitic lesions of the hands, in wet nurses of the breast, in glassblowers--in the area of the mouth. For the purpose of detecting occupational injuries and P. z. in chronic conditions or in their early stages, etc., the legislation of the USSR establishes mandatory medical examinations of workers in harmful industries. By resolutions of the NKT and NKZdr. of the RSFSR of September 24 and December 5, 1928 (on the basis of Art. 143 of the Labor Code), mandatory medical examinations have been introduced for workers dealing with lead, mercury, arsenic and their compounds, for workers in industries k-t, chlorine, be- €25 Tab l . 6. by por. Name of the disease Occupational harm causing the disease Professions in which this disease occurs predominantly or exclusively Ankylostomiasis Progressive myopia Work underground Prolonged visual strain when working close Varicose veins of the legs--expansion \ Prolonged standing or prolonged walking with edema or ulcers Voice loss due to paralysis of the vocal cords, chronic laryngitis or "singer's nodules" Cataract Caisson disease Chronic inflammations of the skin, ulcers Systematic strain on the vocal cords Systematic exposure to radiant energy of significant intensity Increased atmospheric pressure Work with irritating and caustic substances Dupuytren's contracture Systematic traumatic injury of the palmar fascia Neuralgia and neuritis of the limbs Professional coordinator neuroses (type of writer's cramp) Nystagmus Poisoning Pneumoconiosis Skin cancer Inflammation of the retina Chronic inflammation of the mucous bags of the knee, elbow and radial joint Hearing loss, due to lesions of the inner ear Chronic changes in the joints of the limbs (flat feet, baker's legs, etc.) Chronic tendovaginites Severe lesions of tissues (dermatitis, ulcers, cancer, atrophy) Overexertion of the corresponding limbs or pressure on nerve trunks Overexertion of the corresponding muscle groups Work underground Professional poisons Prolonged inhalation of large amounts of dust Work with tar, pitch, soot, paraffin, anthracite and similar substances Systematic exposure to radiant energy of significant intensity Systematic pressure or friction in the area of the corresponding joints Systematic exposure to loud sounds Increased load on the joints Intensified work of the corresponding muscles X-rays and radium rays Ulcers of the mucous membranes of the nose and mouth, ) Work with irritating and caustic substances cornea, "

Miners, coal miners, tunnel workers, quarry workers, tailors, watchmakers, engravers, proofreaders, typesetters, loaders, machine operators, mail carriers, waiters, dentists, salespeople, singers, teachers, glassblowers, welders, workers at metallurgical and roasting furnaces, autogenous welders, caisson workers, divers, workers in chemical plants dealing with chromium, alkalis, acids and other similar substances, etchers, attendants and female attendants of mud baths, tram conductors, locksmiths, stampers of postal correspondence, blacksmiths, laundresses, loaders, telegraphists, stenographers, typists, pianists, violinists, turners, clerks, draftsmen, miners, coal miners, Professions in which one has to deal with these poisons, coal miners, miners, workers in the silicate industry, grinders, sharpeners, chimney sweeps, coal workers, workers in corresponding industries, glassblowers, welders, workers at metallurgical and roasting furnaces, autogenous welders, masons, roofers, parquet layers, bridge builders, haulers and sled drivers (miners), weavers, boilermakers, blacksmiths, nail makers, typesetters, loaders, machine operators, mail carriers, waiters, dentists, salespeople, laundresses, ironers, box makers, packers, labelers, personnel of X-ray departments, workers manufacturing X-ray tubes; persons in contact with radium, workers in chemical plants dealing with chromium, alkalis, acids and other similar substances, etchers, attendants and female attendants of mud baths, lime, sodium sulfide, chrome salts, for workers in aniline dye production, in fur dyeing with ursole dyes, workers in aromatic nitro compounds and ammunition production, coal gas and water gas, tobacco and makhorka, in smelting and casting of copper and zinc ores, radio telegraphists and aviators. Examination periods are set annually or once every 6 months. Prevention of occupational diseases covers a whole system of diverse measures. First and foremost are the issues of complete improvement of the production environment by eliminating the very cause of occupational diseases (replacement of poisonous substances with harmless ones, full mechanization of the production process, etc.). This is followed by improvement of the production environment through measures for the hygienic rationalization of technological and labor processes (isolation of harmful processes and master's workshops, hermetic sealing of production processes, etc.). Finally comes the system of sanitary-technical measures (industrial ventilation, local removal of gases, dust, etc.). Following this should come the organization of labor and production (rational division of labor, reduction of muscle strains, frequent small and rapid movements, provision of rational work furniture, etc., establishment of a rational work regime based on appropriate alternation of work and rest periods). Last should be the use of individual protective devices, which in general have only a palliative significance. Not directly, but indirectly, measures for the sanitary-technical equipment of workplaces and enterprise territories also influence the reduction of occupational diseases (see Industrial Sanitation). A number of general and special resolutions of the USSR People's Commissariat of Labor and union republics concern the arrangement and maintenance of individual harmful and hazardous industries, as well as measures to prevent specific occupational diseases. Among the latter, mention should first be made of the resolution of the USSR People's Commissariat of Labor of December 16, 1924, prohibiting the production of white lead. Further resolutions have been issued by the People's Commissariat of Labor: of January 28, 1929, prohibiting the use of lead gaskets when filing files; of May 10, 1928, on measures to prevent infection with anthrax in enterprises where raw leather is processed, etc. Of great importance for the prevention of occupational diseases are also a number of resolutions of the USSR People's Commissariat of Labor on reducing working hours for workers in hazardous occupations, on additional leave for a number of professions due to the harmfulness of work, and on supplying them with special clothing and footwear, on issuing soap for hazardous and dirty work, on issuing milk or other fats as additional food to a large number of professions associated with the danger of occupational poisoning, etc. Finally, attention should be drawn to the great importance of maintaining particularly careful cleanliness and other requirements of personal hygiene, and in this connection, the great importance of sanitary-educational work in the field of occupational hygiene. In essence, occupational accidents are one type of occupational disease. However, since the etiology of occupational trauma is quite specific (mainly various types of acute mechanical, chemical or thermal injuries), and the system of combating it and its prevention has a number of features, this problem is considered separately (see Trauma). Lit.; Bogolepova L. and Kurdinovsky E., Professional Pathology in Obstetrics and Gynecology (Health Protection of Labor and Revolutionary Way of Life, Works of the Institute for the Study of Occupational Diseases named after Obukh, vol. 28, M., 1929); Bogolevsky S., Statistics of Professional Morbidity, M., 1924; ibid., Statistics of Professional Incidence, pt. 1-Method of Research, M., 1926; Golyanitsky I., Introduction to the Social Pathology of Surgical Diseases, M., 1925; ibid., Surgical Occupational Diseases of the Organs of Movement, M., 1927; Davidenkov F., Professional Pathology of the Nervous System (Health Protection of Labor and Revolutionary Way of Life, Works of the Institute for the Study of Occupational Diseases named after Obukh, vol. 26, M., 1919); Danilova E., Current Labor Legislation, ed. 3, vol. II, M., 19^1; Kaplun S., Prevention of Occupational Diseases (Fundamentals of Prevention in Medicine, ed. by A. Malkov, N. Semashko and A. Sysin, M., 1927); Kolsch F. and Misch S., Occupational Diseases of the Teeth and Oral Cavity, M., 1927; Litkens V., Anthrax and Measures to Combat It, M., 1926; ibid., Occupational Diseases of the Teeth and Oral Cavity, M., 1927; Metsatunyan A., Occupational Poisonings and Occupational Diseases in the RSFSR for 1928-29, Hyg., Path. and Occup. Safety, 1931, no. 7; Oppenheim, Rille u. Ullmann, Occupational Diseases of the Skin, M., 1925-26; Samoilov A., Professional Pathology of the Eye (Health Protection of Labor and Revolutionary Way of Life, Works of the Institute for the Study of Occupational Diseases named after Obukh, vol. 23, M., 1929); Stroganov V., Combating Trauma in Leningrad Industry, Bull. of the Leningrad Institute of Labor Organization and Health Protection, 1932, no. 19-20; Temkin Ya., Occupational Deafness, Moscow, 1931; Uait P., Occupational Lesions of the Skin, Their Prevention and Treatment, M., 1925; Shneider B., Occupational Diseases of the Throat, Ear and Nose, L., 1926; Shneider N., Occupational Pathology of the Organs of Hearing and Upper Respiratory Tracts (Health Protection of Labor and Revolutionary Way of Life, Works of the Institute for the Study of Occupational Diseases named after Obukh, vols. 18 and 25, M., 1929); Yakimchik P., Legislation on Safety Engineering and Industrial Sanitation, M., 1926; Biebergel E., Occupational and Accidental Diseases of the Organs of Movement, Stuttgart, 1913; Borgmann u. Fischer, The Combat of Anthrax in Industrial Enterprises, B., 1914; Brezina E., Industrial Poisonings and Their Combat, Stuttgart, 1932; Dalche P., Gynecologie et accidents du travail, P., 1922; Handbook of Occupational Diseases, ed. by Th. Weyl, Jena, 1908; Methods of Occupational Medicine (Handbook of Biological Work Methods, ed. by E. Abderhalden, Pt. 4, Vol. 16, H. 3 u. 4, B.-Vienna, 1932); Lowy J., Clinic of Occupational Diseases, B.-Vienna, 1924; Oppenheim, Rille, Ullmann, The Damage to the Skin by Occupational and Industrial Work, Vols. I-III, Lpz., 1922-26; Peyser u. Майе, Industrial Ear Injuries and Their Combat, B., 1928; Telekyu. Bresine, International Survey of Occupational Diseases, B., 1929; Thies O., Industrial Eye Injury and Its Combat, B., 1928. See also lit. to articles Poisonings, Occupational Hygiene, Occupational Pathology and Occupational Neuroses.