Occupational Hazards

OCCUPATIONAL HAZARDS, specific factors or accompaniments of the labor or production process that adversely affect the worker's body. Since they usually cause prolonged, gradually occurring changes in the body (most often chronic diseases), they should be distinguished from professional hazards that cause traumatic injuries. Only in two cases can occupational hazards also be the cause of accidents (in the social insurance interpretation of this term): 1. When poisons, due to sudden exposure in unusually large quantities or in strong concentration (mostly due to unforeseen accidents - like ruptures of storage facilities, bursts of pipelines, etc.), cause acute poisoning of workers. 2. In the case of acute professional infections. Occupational hazards are primarily the main source of both specific occupational diseases (see) and changes in the general pattern of morbidity of one or another professional group. In addition, they often cause pathological changes both localized-anatomical and biological-functional in nature, sometimes not even associated with loss of work capacity, often having only a pre-pathological character and lying as it were on the borderline between physiology and pathology. In these cases, they often cause the appearance of so-called professional stigmata. Occupational hazards can be not only an etiological factor directly causing the occurrence of one or another disease, but also affect the general state of health of individual professional groups, changing the frequency of occurrence, intensity and duration of various diseases arising under the influence of various etiological factors by no means of a professional nature. Working conditions, acting on the human body for at least one third of its entire working life, naturally leave very deep traces on it, manifesting themselves much more often not exclusively in the form of exotic cases of specific professional diseases, but affecting its usual morbidity. The disease itself as a nosological form in these cases is not professional, but its frequency, and sometimes also the peculiarities of its course, already represent a phenomenon of professional-pathological character. The influence of occupational hazards is also manifested in the fact that diseases that occur under ordinary conditions, under the influence of certain professional conditions, can proceed in more acute or in special, unique forms, affect certain selected systems and organs, give a larger number of unfavorably ending cases than is the case in the norm. According to the well-known Edinger "theory of wear" (Aufbrauchstheorie), both intoxications and infections and other diseases most often and most severely affect those organs that are in a state of constant overstrain or chronic fatigue. Furthermore, occupational hazards can contribute to the emergence or, more correctly speaking, the manifestation of such diseases or pathological conditions that are associated with congenital or acquired weakness, lower resistance or other defects of individual organs or systems, although under other working conditions these, often genotypic, characteristics would not have phenotypically manifested themselves at all. The most striking example of this group of cases are various professional skin diseases, when the effect of external factors of a production nature (poisons, irritants, moisture, etc.) only reveals a special pathological sensitivity of the skin to various external factors (allergy). Myopia likewise requires for its development a special, relatively unstable state of the lens. However, far from all persons predisposed to the development of myopia actually develop it in life. Statistics prove a close connection between the relative number of myopes in various professions, on the one hand, and the need to strain vision intensively under conditions of professional work, as well as the state of illumination of the workplace - on the other. Occupational hazards, in turn, can also significantly weaken the resistance of various organs both to direct external influences and to infections. Thus, e.g., rheumatic or cold diseases are particularly widespread among persons working under conditions of high temperature with sharp fluctuations, in an atmosphere of increased humidity, dampness, etc.; conjunctivitis occurs particularly frequently among those working in a dusty atmosphere, and work at high temperature, weakening the cardiovascular system, contributes to the appearance and unfavorable course of corresponding diseases, predisposes to complications in infections, etc. Recently, in a number of works published in the USSR, it has also been clarified that persons engaged in heavy physical labor give serious complications of the gonorrheal process (both in men and women) much more frequently than the norm. The proper assessment by physicians of the role of occupational hazards has serious significance also in that the very assessment of the state of health as a result of an apparently completed disease process ('practically healthy') will be far from the same even in completely identical, from the point of view of pure clinical science, cases for representatives of different categories of professional labor. And if previously clinical science set before itself only questions of prognosis 'quo ad vitam' and 'quo ad valetudinem', now it cannot limit itself in questions of prediction to only these factors, but must constantly set before itself also the question of the outcome 'quo ad functionem'. Indeed, that state of health which gives the right to consider the average 'abstract' person healthy is by no means such for representatives of various professions, who, even with a favorable outcome in the ordinary clinical sense of the disease, retain a certain functional insufficiency, hindering the previous intensity and quality of work, or for whom there remains a constantly real threat of the resumption of one or another pathological condition or the disease as a whole, provided the previous work is maintained. Occupational hazards, being one of the most powerful ways of the influence of the external environment on the body, of course, act very rarely in complete isolation. Usually they are closely intertwined with other influences of the social environment (level of wages, housing, nutrition, living conditions, sexual life, etc.). In some cases, the profession entails certain peculiarities of a purely social nature from those mentioned above (acute housing need among seasonal workers, alcoholism in certain professions, unregulated sexual life among sailors, etc.). However, not only for the purpose of theoretical systematic consistency, but also for the purpose of proper organization of preventive measures, social conditions ('domestic hazards') and occupational hazards should not be confused. The latter concept should be limited exclusively to the circle of harmful effects on the body directly dependent on labor and production processes. Proceeding from such a limitation of the concept of occupational hazards, one can build the classification given below (Kaplun). Depending on the nature of their occurrence, occupational hazards should be divided into 3 main groups: a) related to the labor process, b) related to the production process (object, instruments and product of labor), c) related to the external environment of labor and production. I. To the hazards related directly to the labor process (Group I) belong: 1) excessive duration of labor (working time), 2) excessive intensity of labor (excessive load or excessive speed), 3) prolonged forced monotonous position of the body (standing, sitting, incorrect), 4) strain of the locomotor apparatus (ligaments, joints, tendons, etc.), as well as isolated muscle groups (for example, excessive load on individual muscles in porters and blacksmiths, enhanced walking, rapid small and monotonous movements of the hands or fingers in the work of packers, packers, etc.), 5) strain of the central nervous system and higher mental functions, 6) strong emotional influences (telephone operators, stenographers, representatives of higher intellectual professions, drivers, locomotive engineers, pilots), 7) strain of respiratory organs (glassblowers, wind instrument musicians, orators, etc.), 8) strain of sense organs. II. To the second group of occupational hazards, related to the production process, belong primarily various mechanical effects on the worker by instruments, objects or products of labor: 1) friction or pressure on the surface of the body, 2) vibration of the body, caused either by the tools used (e.g., work with a pneumatic hammer, drill, etc.), or by the vibration of the floors of work premises (e.g., in weaving workshops), or by the movement of the workplace (e.g., in drivers, tram drivers, locomotive engineers, etc.), 3) effect on the body of various types of dust, e.g., on the skin coverings, mucous membranes, etc.; dust can be more specifically classified: by origin, by size, by shape of particles, by chemical composition, by nature of effect, etc. (see.

Dust), 4) intense sound effects, i.e., the influence of noises acting purely mechanically on the organ of hearing through both air and bone conduction (this should be distinguished from the much less harmful active strain of the organ of hearing, which type of hazard falls into the above-mentioned category of strain of the sense organs). Next follows a group of hazards united together on a purely hygienic principle under the common name of the so-called meteorological factor. This includes: 1) abnormal air temperature (extremely high, unusually low, unevenly distributed, sharply fluctuating), 2) abnormal state of air currents (excessive movement of air, complete stagnant immobility, frequent changes in it), 3) excessive humidity or dryness of the air, 4) unfavorable combinations of temperature, humidity, and air movement. Such a classification of meteorological hazards seems most expedient, as it systematically classifies individual, most harmful moments regardless of the place where work is carried out. Indeed, it is hardly reasonable to consider, as many authors do, work in the open air or underground or over water as an occupational hazard, since each workplace is a source of a number of basic hazards listed above. Following this is a group of hazards related to the effect on the body of other types of energy—electric current and rays—infrared, or thermal, affecting the body in this case not by preliminary heating of the air (heat conduction), but by direct radiation (heat radiation from melting furnaces, steam hammers, etc.), rays of the visible part of the spectrum, or light (here we are talking about their direct impact in direct connection with the production process, as, for example, in the melting and casting of metal, at glass furnaces, etc., and not as a result of irrational lighting), ultraviolet (during film shooting, during acetylene and electric welding, etc.), X-rays, radium, etc. This also includes the main mass of occupational hazards acting on the body chemically: a) caustic and irritating substances acting on tissues directly at the point of contact (acids, alkalis, various solvents, etc.) and b) causing a general poisoning effect on the body after their penetration into the bloodstream, the so-called occupational, or more correctly, industrial poisons. Finally, some hazards are characterized by their biological method of action. These include: a) the danger of bites and injuries inflicted by animals and humans (for workers in slaughterhouses, shepherds, attendants of laboratories and zoos, veterinarians, staff of psychiatric hospitals, etc.), b) anthrax infection when working with rags and wool, c) the danger of skin diseases when collecting and sorting rags, in sewing workshops, etc., d) infections in persons in contact with cadaveric material, e) helminthic diseases in miners (see Ankylostoma), f) infection with syphilis among doctors, glassblowers, wet nurses. III. Finally, the last, third group of hazards is the effect of the general sanitary conditions of labor, related to the arrangement of the workplace or the peculiarities of the place of work (even if the peculiarities of the latter are closely connected with one or another labor process). This includes: 1) insufficient air volume (excessive crowding of workers), 2) lack of natural light and defects in the lighting area, 3) defects in heating, 4) other defects in the arrangement and maintenance of the premises. Finally, this should also include such occupational hazards as the unfavorable influence of atmospheric conditions when working in the open air (the influence of rain, wind, bad weather, etc.) and abnormal atmospheric pressure—both reduced (when working in high layers of the atmosphere, during flights) and increased (when working in caissons). Thorough clarification of occupational hazards makes it possible to compile accurate sanitary characteristics of detailed professions and to rationally organize measures for improving labor and preventing occupational diseases. Labor sanitary statistics knows a number of attempts to compare individual sanitary indicators of professions with occupational hazards. Thus, for example, Sommerfeld, based on materials from Berlin hospital funds (1899-1901), provides the following table: Mortality from tuberculosis of the lungs depending on the inhalation of various types of dust. Types of dust: Metallic dust... Copper............. Iron............. Containing lead....... Organic dust... Leather and fur..... Textile........... Wood and paper..... Tobacco............. Mineral dust... Per 1,000 insured persons of the corresponding group: 8.4 5.5 5.5 7.9 4.2 To characterize the possible accounting of the action not only of dust, but also of other occupational hazards, the following table is provided (borrowed from the statistics of professional mortality in Holland for 1908-11):