Microsoft PowerPoint - PH2120_Occupational Health

Occupational and Environmental

Health

Arch “Chip” Carson, MD, PhD

University of Texas School of Public Health

Man’s Impact on the Environment

Environmental Health is clearly about the
environment’s impact on man.

Specifically, it is the field dealing with the
physiological and psychological effects of
spending time and performing routine
tasks within a particular environment.

Occupational Health

Occupational health deals specifically with
the workplace, a subset of the general
environment.

It encompasses further practical
subdivisions, such as:

Occupational Health Nursing

Aerospace Medicine

Industrial Chronobiology

Categories of Hazards

Chemical irritants

Physical irritants

Metabolic poisons

Mutagens/carcinogens

Infectious agents

Ergonomic stressors

Accidents/unsafe practices

Psychological stressors

Environmental Contaminant
Concerns

•

Organic solvents

•

Metals

•

Pesticides

•

Persistent substances

•

New materials

•

Mixed exposures

•

Ionizing and non-ionizing radiation

•

Infectious agents

Types of Biological Responses

Structural disruptions

Biochemical derangements

Genetic mutations

leading to

Cellular, tissue or organ dysfunctions

Deficiency or excess accumulation of normal
materials

Developmental failures of reproduction

Cancers

Injury to Critical Organs

Central nervous system - (toluene, heavy
metals, organophosphates, heat, etc.)

Liver - (halogenated solvents, some metals,
etc.)

Heart - (cyano compounds, nitriles, carbon
monoxide, etc.)

Kidney - (cadmium, lead, ethylene glycol,
ionizing radiation, etc.)

Bone marrow - (lead, benzene, etc.)

Adverse Reproductive Outcomes

•

Infertility

•

Spontaneous Abortions

•

Congenital Malformations (birth defects)

•

Other (low birth weight, central
nervous system dysfunction,
immunoincompetence, "failure to thrive“)

Biomarkers

Biological markers are indicators
signaling events in biological
systems or samples - NRC

They can be probes of:

Exposure

Effect

Susceptibility

29 y/o lab technician received spill of
hydrofluoric acid to the right hand, forearm,
and thigh.

Reagent bottle (Conc. HF) shattered on lab bench.

Wearing lab coat, chemical goggles, jeans, tennis
shoes (no gloves or respiratory protection).

Felt liquid contact the areas above and smelled
acrid fumes of the acid.

Evacuated laboratory immediately, called for
assistance, removed clothing and showered 5
minutes (beginning within two minutes of the
exposure).

Total volume released - 150ml.

73 y/o widow is discovered by a neighbor in a
semi-comatose state, slumped in a chair in her
home.

She is drooling from the mouth,and tearing from
the eyes, and has soiled herself with both urine
and feces.

She responds dully to strong stimuli but sinks
back into her previous state in seconds.

She appears to have been there since the
previous evening.

She is an active church member and lives
independently, caring for herself, two large
dogs, five cats, and a goat.

32 y/o commercial flooring installer develops
jaundice, dark urine, slate-colored stools,
fever.

Two-week history of heavy workload,
severe headaches, poor appetite.

Has been using “solvents” to prepare
concrete floors for tile adhesives.

Minimal ethanol use past 7-10 days.

Taking Tylenol for the headaches.

No infectious hepatitis exposures.

45 y/o attorney has a 2 month history of early
fatigue, abdominal cramping, joint pains,
malaise.

She has curtailed her practice of law and remains in bed
much of the day.

She has also reduced her hobby and her cardiovascular
exercise program.

She appears weak, pale, and concerned.

She has no contributory past medical history, allergy, or
family history.

She had recent international travel to Sweden in
conjunction with her hobby.

Exam is normal, except for marked oral and conjunctival
pallor. Stool is guaiac negative.

A 51 y/o truck driver has a six month history of
worsening shortness of breath and exercise
intolerance.

Was well until present at a terminal during an
accidental release of phosgene gas. Smelled a
sweet cut-grass odor.

Within 10-15 minutes felt irritation of the eyes,
nose and chest, and developed a severe
headache.

Went to the emergency room within hours at the
request of his supervisor.

Had evidence of fluid or localized collapse within
lungs, was treated, observed overnight, and
discharged to follow-up with pulmonologist.

Toxin-Hazard-Exposure-Risk-Safety

A 3 ½ year-old girl is admitted to the
regional hospital for chelation therapy

She was picked up in a temporary lead
exposure screening program.

Her blood lead level was 57 mcg/dL.

Effects of inorganic lead in children and adults -
LOAEL’s

100

120

140

Children

Adults

Hypertension

EPP increase in

EPP increase in men

Peripheral neuropathy, male infertility, nephropathy

Decreased hemoglobin synthesis

Decreased longevity

Anemia

Encephalopathy

Death

Encephalopathy

Nephropathy

Anemia

Colic

Decreased hemoglobin synthesis

Decreased Vitamin D metabolism

Decreased nerve conduction velocity

EPP increase, ? decrease Vitamin D metabolism

Developmental toxicity

Decreased IQ, hearing and growth

Placental transfer occurs

Increased blood pressure (men), decreased hearing

Toxic Effects of Lead

•

Anemia

•

Kidney damage

•

High blood pressure

•

Digestive cramping

•

Neurotoxicity (peripheral neuropathy)

•

Neurotoxicity (reduced intelligence,
sensory/perceptual disturbances)

•

Multiple enzyme inhibitions

Multidimensional approach

Characteristics of the agent

Critical organs

Physical and chemical properties

Characteristics of the exposure

Intensity and duration

Route of entry

Characteristics of the exposed

Susceptibility

Co-exposures

Human Knowledge of
Occupational Illness is Very Old

Flint Knappers

Lead Smelters

Soldiers

etc.

Lead Levels in the Greenland
Icecap

-10000

-4000

1000

1930

2000

Industrial Revolution

New science

Development of factories

Machines and energy sources

The same old dangerous substances

Large work force

Epidemics of occupational disease

Georgius Agricola (1494-1555)

De Re Metallica.

Basel: J. Froben and N. Episopius, 1556

De Re Metallica is Agricola's best known
work. It is a systematic examination of
mining and metallurgy as practiced in a
sixteenth-century mining center.

I have omitted all those things which I have not

myself seen, or have not read or heard of from

persons upon whom I can rely. That which I have

neither seen, nor carefully considered after reading

or hearing of, I have not written about. The same

rule must be understood with regard to all my

instruction, whether I enjoin things which ought

to be done, or describe things which are usual, or

condemn things which are done.

Agricola, Preface to De Re Metallica, 1556

De Re Metallica

Agricola described all mining operations
in great detail including prospecting,
administration, the use of water power
and the transport of ores. He described
for the first time the preparation of nitric
acid and saltpeter.

Paracelsus (

1493-1541)

Paracelsus, Theophrastus Philippus
Aureolus Bombastus von Hohenheim

Born: 1493 (C.E.)Einsiedeln,
Switzerland,
Died: Sep 24

, 1541 (C.E.)

Salzburg, Austria
Lifespan: 48

Father

Occupation: Physician
Career: no fixed place, worked in
Germany and German- speaking
countries
Mother ?

"The universities do not teach all

things,“ , "so a doctor must seek out

old wives, gipsies, sorcerers,

wandering tribes, old robbers, and

such outlaws and take lessons from

them. A doctor must be a traveller, . . .

Knowledge is experience."

Education

Biography

1526 settled in Strasbourg, but not
enrolled in the physicians but in the grain
merchants guild. Indication that he
probably did not actually hold the degree
that he claimed ?

Wolfgang Thalhauser, in his laudatory

preface to Paracelsus's Grosse

Wundartzney (1536), calls Paracelsus a

"doctor of both medicines."

Outstanding medical
achievements

“The Dose

makes the

poison”

Bernardino Ramazzini (1633-

1714)

Italian physician,
acknowledged as ‘the father of
industrial hygiene and
occupational medicine’

The first to recognize the social
significance of occupational
diseases

Methodically collected material
relating to diseases of manual
workers and the relation to
their occupations

Showed how worksites can
serve as schools for
practitioners, how learning
about the whole patient helps,
how asking the right questions
leads to the root cause of
disease and better outcomes

Health Problems in the XVII Century

Wars determined
the evolution of
states and affected
the lives of people

It is not clear what
people considered
as good health at
that time

Disease was ever
present: Measles,
typhus, typhoid,
tuberculosis,
syphilis, malaria,
small pox and
plague

Ramazzini’s Work…..
The link between occupation and health

“dangerous materials
such as mineral dusts for
miners and stonecutters,
vegetable particles for
tobacco and carding
workers, and vapors for
vintners and
confectioners, could be
inhaled or absorbed
through the lungs or (like
mercury ointment) could
penetrate the skin”

Ramazzini’s Work…..

The link between occupation and health

On posture, repetitive

movements, lifting weights,

and particular work-related

musculoskeletal disorders:

“certain morbid affections . . .

from other causes, some

particular posture of the limbs

or unnatural movements of the

body”

Ramazzini’s Work…..

The link between occupation and health

On a chemical laboratory that

produced sublimate and gave off

fumes of vitriol in the neighborhood

"it appeared that many more persons

died in that quarter and in the

immediate neighborhood of the

laboratory than in other localities”

On excess noise affecting

coppersmiths….. “the ears are

injured by that perpetual din”

On word processing: "The maladies

that affect the clerks arise from three

causes: first, constant sitting;

secondly, incessant movement of the

hand and always in the same

direction; and thirdly, the strain on

the mind . ."

Ramazzini’s Work….

Risk prevention and workers' health

protection…

Mine Workers: “to purify that imprisoned air . . .
emitted from the minerals and the bodies of the
miners, also by the fumes of lighted lamps,
superintendents of mines regularly expel the thick
stale air and force in fresh and purer air”

Manual Laborers who need severe muscular effort
e.g., bricklayers, woodworkers, and printers: “in work
so taxing, moderation would be the best safeguard
against these maladies, for men and women alike; for
the common maxim "Nothing in excess" is one of
which I excessively approve”

Ramazzini’s Work….

Risk prevention and workers' health

protection…

Sewage workers: "to fasten
transparent bladders over
the face”

Starch-makers: “to carry on
this sort of work in spacious
places, not in confined
quarters”

Bakers and millers: “their
habit of covering the mouth
with a linen bandage is a
good one, but it is not
enough to prevent . . . flour
making its way into the
innermost recesses of the

De Morbis Artificum Diatriba

Modena, 1700 AD

The first systematic
treatise on workers
health and occupational
diseases by the father
of industrial hygiene

Translated into English
in 1705 under the title “
A Treatise of the
Diseases of
Tradesmen.”

Percival Pott

(1713-1788)

Short Treatise of the Chimney-Sweepers

Cancer

Pott's Short Treatise of the Chimney-
Sweepers Cancer appears to be the first
publication implying the carcinogenic
effects of high concentrations of soot in
the scrotal folds. Although he did not use
the word 'carcinogenesis' Pott has
reasonably come to be regarded as the
father of preventive oncology.

An account of a case by J. Earl (Pott’s

son-in-law)

James Chard was a chimney boy who
received treatment in St Bartholomew's
Hospital during Pott's time there. It
appears that he, too, may have been
aware of the detrimental effects of soot,
for 'he described his life as a chimney boy
when he was washed once every 5-6
years. Later he washed himself once a
week and recently he washed every night.'

TRIANGLE SHIRTWAIST

FACTORY FIRE

March 25, 1911

Triangle Shirtwaist Factory

Lower Manhattan

Located on top 3 stories of 10 story Asch
Building

Built 1901, next to NYU and Washington
Square

Make of brick and stone with wooden
frame interiors.

Thought to be ‘fireproof’

Events leading up to fire

No fire drills ever conducted although 3 small
fires there in 1909

2 narrow staircases from top 3 floors and all but
one door to stairway kept closed

Doors sometimes bolted to prevent employee
loitering or stealing of fabric

Single fire escape went to second floor and not
to street

2 small freight elevators-5 feet square

Events leading up to fire

Bags of cloth, tissue paper, rags and
cuttings covered the tables, shelves and
floors.

Floors and machine were covered with oil
and barrels of machine oil lined the walls

March 25, 1911

4:30 pm- 8

floor

Employees left by one open door at end of day

Company guard checked women’s handbags for
cloth fragments

Fire reported on 8

floor-attempted to extinguish

it with buckets of water.

225 employees on 8

floor began to evacuate

but panic and confusion caused difficulties

Ninth and Tenth Floors

Flames spread to 10

floor through windows

and ignited the cloth buckets.

On 9

floor over 150 workers tried to go through

a 20 inch passageway that led to open stairway.

On 10

floor workers tried to get on freight

elevators and jumped on top of elevators as they
descended

This jammed 1 elevator. 19 bodies found
wedged in elevator shaft. Other elevator broke
down when power circuit became waterlogged
by fire hose spray.

Asch Building Burns

At 4:45pm building engulfed in flames and
no escape possible

Since it was a Sat afternoon, police
thought no one was in building

Then bale of dress material dropped from
8

floor with person wrapped inside it- she

died in the fall

Fire Department Failures

Failure to enforce safety laws

Inadequate equipment for city’s loft bldg-
tallest ladders only reached to 6

floor(half

of city’s factory workers worked above this
floor)

Safety nets too weak to hold falling
bodies.

City Building Dept Failures

Asch bldg lacked adequate safety features

Factory inspector had warned owners of
bldg several months prior to fire of
violations including inadequate exits,
locked stairway doors. Dept did not
followup to see if corrections made

Trial

Isaac Harris and Mac Blanck indicted by
grand jury and charged with manslaughter

Testimony centered on 3 questions:

-Was 9

floor door kept locked regularly

- Was it locked at time of fire

-Did defendants know it was locked

Aftermath

State legislature pressured by public to create
New York Factory Investigating Commission in
June 1911 to study working conditions in state.

Held public hearings and heard from 222
people.

1836 factories were inspected in 20 industries

Over 4 years it collected material for 13 volumes
of reports

Between 1911 and 1915, 60 bills were
introduced and 56 of these passed.

Radium dial painters

The Triumvirate of the Defense

Assumption of Risk

Fault of Fellow Worker

Contributory Negligence

The Radium Dial
A. Loudermilk

……..like the clock's her hands daintied time itself

with the all-American convenience of glowing

in the dark. It took radium

and a skeptical brush to spook the clock's expression,

to give 3 a.m. the whisper of 3 a.m. without a light on.

……With every second hand iota,

every speck of afternoon, the girls twirled as trained

"Nor a finer point"

dwarf brushes in their mouths. …..

The Theory

Radium salts are mixed with phosphorescent
zinc sulphide and this mixture was applied to the
dial to be illuminated. This luminescence
depends on the phenomenon called
“scintillation”.

The Facts

The paint used by the girls contained chiefly
zinc sulfide rendered luminous by activation
with 20-30% of radium and 70-80% of
mesothorium containing radiothorium. For
economic reasons the radium was substituted
with radiothorium, whose decayed products
have a greater velocity and penetrance than
those of radium , and therefore are
physiologically more active.

The Story

Between 1917-1928, about 4000 girls were
employed in various watch dial painting
companies, in New Jersey, Illinois, Connecticut.

It was no easy task to trace the tiny numbers on
the watches, made popular by their use in World
War I. So the women were encouraged to make
a fine point on their brushes by rolling the tips on
their tongues before dipping them in the radium-
laced paint.

"Not to worry," their bosses told them. "If you

swallow any radium, it'll make your cheeks
rosy.“

“It was a little strange,” (one of the victims),

said. When she blew her nose, her
handkerchief glowed in the dark. But
everyone knew the stuff was harmless. The
women even painted their nails and their
teeth to surprise their boyfriends when the
lights went out.

Extent of Exposure

If a girl licked her brush 14 times per dial,
(as per data collected), she would ingest
15-215 micrograms of radiothorium a
week.

Samples tested for radioactivity from skin,
dresses, chandeliers and wall beams in
the rooms were positive.

Sequence of Events

1920-22: About fifty girls in the NJ area were being
treated for jaw necrosis by dentists.

Blum was the 1

to report a possible occupational

exposure in Sept. 1924 in a case of osteomyelitis
of the mandible.

Hoffman report – 1925: 5 deaths and 12 cases
among girls who had developed a resistant
infection of the jaw with marked anemia – he
thought mesothorium was responsible.

Sequence of Events (cont.)

Castle and Drinker report: Extent of exposure
assessed. Recommendations made for future
protection of workers. First report by factory
executives.

1928: first reported case of a worker who
developed osteogenic sarcoma. Sarcoma
arose in an area of previous radiation osteitis.
A total of two such cases found among 15
patients dead – coincidence?

1928, Nov: Death of Dr.von Sochocky,
technical director of the NJ company – he
made the formula for the paint. Death due to
aplastic anemia.

Litigation

1926: 2 deaths settled out of court.

1927: Suit started in supreme court. “The case
of the Five Women Doomed to Die”

Each asked for $250,000 in compensation for
medical expenses and pain. The five eventually
became known in newspaper articles carried in
papers throughout the U.S. and Europe as "the
Radium Girls."

When the first court hearing came up January
11, 1928, the women could not raise their
arms to take the oath. All five of the "Radium
Girls" were dying.

In early June, a federal judge volunteered to
mediate the dispute and help reach an out-of-
court settlement. Days before the case was to
go to trial, the five "Radium Girls" agreed that
each would receive $10,000 and a $600 per
year annuity while they lived, and that all
medical and legal expenses incurred would
also be paid by the company.

Conclusion

The five "Radium Girls" died in the 1920s and
1930s. Their sad fate was sealed when they
dipped paintbrushes into radium paint and
sharpened the bristles with their mouths. There
was a resistance to warnings about the dangers
of radium in society -- highlighting the
importance in the relationship between ideas
and social structure. In addition, radium was
seen as part of the arena of science and
medicine and as such enjoyed a certain
legitimacy that made it almost beyond criticism.

History of the Gauley Bridge Disaster

Union Carbide wanted to harvest the
rich natural resources in Southern
West Virginia

Construction of a hydroelectric power
plant that would generate 100,000
kilowatts of electricity

History of the Gauley Bridge Disaster

Designed a tunnel to divert the New
River from Hawks Nest to a power
station near Gauley Bridge

This tunnel and power station was of
singular importance to the expanding
new world of alloyed metals, chemicals
and plastics

History of the Gauley Bridge Disaster

The tunnel was excavated through pure quartz
sandstone.

Drilling took place at the height of the Great
Depression (1930-31).

Workers with the most dangerous jobs were
commonly migrant Blacks from the South.

Hawks Nest Tunnel Incident or Gauley
Bridge Disaster is considered the first
American industrial disaster.

Silicosis

Silicosis is a chronic fibrous disease of the
lungs produced by prolonged and extensive
exposure to free crystalline silica dust.

The most common form of crystalline silica is
quartz.

Quartz is considered to be chemically inert,
but it does react in the lungs to initiate fibrous
tissue growth.

Silicosis has been a recognized disease
process for over 4000 years. Agricola
detailed it in his Treatise on Mining.

Common Names for Silicosis

Ganister Disease

Grinders Asthma

Grinders Rot

Grit Consumption

Masons’ Disease

Miner’s Asthma

Potters Rot

Sewer Disease

Stonemason’s
Disease

Tunnelitis

Working Conditions at Gauley

Bridge

Conditions where deplorable

Most excavation was completed in 18 months
(June ‘30-Dec. ‘31)

Workplace safety regulations and workers’
compensation laws were in their infancy.

An estimate that, within 5 years of tunnel
completion, at least 764 of the 1213 workers
at risk died of silicosis or other lung disease
(63%).

Controls Methods

Dust Suppression

(engineering)

Moisture, mists, fogs

Ventilation (engineering)

local exhaust ventilation and collection system

Respirators for workers (PPE)

Changing Facilities (PPE, administrative)

Tunnel evacuation during and after blasting
to let dust settle (administrative)

Significance of Gauley Bridge

Disaster

Catapulted workplace safety into main
stream politics

Gave a basis of a need for occupational
exposure guidelines

Designation of silicosis as an occupational
disease with compensation for workers.

OSH Act of 1970