Importance of Pus Infections in Ohio. The presence of a high rate of furunculosis and wound infections among certain classes of workers in Ohio has repeatedly come to the attention of the Division of Industrial Hygiene and has assumed such proportions in certain establishments as to present an important economic problem. It has been observed that these afflictions are unusually prevalent in operatives of lathes and cutting and milling machines, who come in contact with cutting compounds and cutting oils, where these lubricants are caused, by gravity or force, to flow in a steady stream on a job at the point of application of the tool. It has been observed, also, that these infections are more prevalent during the summer

ence of pus-forming bacteria in the oil but to decreased resistance offered to the growth of bacteria already present in the skin. It is maintained that this lowered resistance is more pronounced in the case of wax-distillates than with the lighter oils, due to the presence of highly cracked bodies such as the aromatic compounds, which, by dissolving out fat from the skin, caused chapping and cracking, often followed by dermatitis. This may be the case with workers in wax plants where paraffin is separated from lubricating oils, but if it is true that oils and cutting compounds as used in automatic machines are contaminated with pus-forming organisms, and that, in some cases, these oils and compounds are of such composi

bacterial life, then it must be concluded that such oils and compounds in themselves act as direct vehicles of infection. This surmise is further supported when the different types of skin afflictions are scrutinized as to their relations with the different substances. Thus in the distillation or handling of petroleum and petroleum products, the different distillates cause varying grades of dermatitis, the character depending, in a general way, on the types

a

of distillates given off at different temperatures. Benzine, or petrol naphtha, with a boiling point of 150° C. (and under) causes superficial inflammation of the skin, with dry, scaly conditions, resembling somewhat a dry eczema. Lighting oil with a boiling point of 150° C. to 300° C. causes, in the main, papular and pustular eczema and the development of typical acne ("oil" pimples). Residium, with a boiling point above 300° C. causes an erythema and the formation of ulcers and warts with a tendency to changes.

cancerous

Types of Afflictions. The, afflictions observed among the machinists under discussion here, present a far different far different picture. Multiple abscesses, sometimes of a very severe type, are encountered and wound infections are un-. usually frequent. As expressed by Shie1, "a pin-prick if left unattended, developed into a severe lymphangitis; a slight scratch in twelve hours into a linear mass of pus; a slight abrasion into a suppurating ulcer, and a laceration into a mass of necrotic tissue and pus." It is, therefore, evident that the skin abrasions found among operatives of cutting and screw machines are followed by pus infections all too frequently. Hence it would seem that attention should be turned especially to these substances as the potent agents in the dissemination of these infections throughout a department or an entire plant.

Conditions at the Plant. The case records as kept at the company's dispensary were not indexed in such a way as to show the number of cases treated of any

1

particular kind nor their distribution in the plant. Nurses at the dispensary, however, went back over the records and listed for us all cases of furunculosis and wound infection for a three months' period. Records of forty-one cases of furunculosis and twenty-six cases of wound infection occurring in twenty-six departments employing 1,365 men resulted. However, inquiry in the plant soon showed that many more cases actually occurred than appeared at the company's dispensary (self-treated, treated by outside physicians, etc.). Of the cases of furunculosis on file, 37 were detailed enough to be of value in the inquiry. A rather intensive study. was made in connection with each case, including the dispensary and employment records and a personal inquiry of the departmental foremen and each of the victims.

Although it is to be expected that a certain rate of furunculosis will be encountered normally in any group of persons, yet it is evident that the occurrences in certain establishments are much too frequent for such explanation. It is significant, also, that but few of the cases observed had ever experienced this trouble before becoming employed in a capacity that brought them in contact with cutting compounds and cutting oils. It was observed that the furunculosis rate was much higher in some departments than in others. and two departments having rates of 10.8 per cent and 16 per cent were the only departments using, to any extent, automatic machines with continuous-flow lubricating systems. Not only were the rates higher in these departments, but

the types of furunculosis for the number of cases encountered were found to be much more severe.

There were 84.5 days lost because of furunculosis during the three months' period, representing a wage loss to the men estimated at $303.40. Of the 84.5 days lost, 80.5 days were lost by employes in the two departments in which cutting compounds and oils were used in large quantities. It was observed, also, that the total duration of all cases of furunculosis was 557 days, 84.5 days being lost time, the remainder representing 472.5 days of more or less impaired efficiency, accompanied by the constant menace of spread of the infection in the individual himself as well as to his fellow workers. Practically all of the other departments showing furunculosis used oils or compounds to some extent, and many of the departments handled parts that had been machined in other departments using oils and compounds. It is evident that infection might be transmitted from one department to another in this manner and investigation tended to show that such is sometimes the

case.

The accident rate varied from 53.6 per cent to 265.2 per cent for the three months' period in the different departments or an annual rate of from 214.4 per cent to 1060.8 per cent - an average of from two to ten reported accidents per man per year. The highest wound infection rate for any department was 6.7 per cent occurring in a department using cutting compounds and oils in large amounts. This department also had a high furunculosis rate. The infection rate for all accidents in all departments was only 1.6 per cent and demonstrates the value of

prompt medical care of all accidents, however unimportant they may seem. In one department with or accidents among 50 men during the three months' period there were no reported infections, despite the fact that this department used large amounts of cutting compounds and oils, and had the highest furunculosis rate of any department. It can, therefore, be safely concluded that where wounds occur, even under conditions most favorable for infection, infections can be kept at a minimum by prompt preventive treatment.

Distinctions in Mixtures. Cutting oils, consisting of lard oil or mineral oil, or both, are to be distinguished from cutting or drilling compounds which are usually mixtures of fat-oils, fatty acids, soaps and mineral oils which are mixed in varying proportions with water. to form emulsions. Sometimes the addition of a small amount of salsoda is necessary to produce a good emulsion.

Relations to Germ Growth. It is maintained by some observers that oils used in automatic machines tend to be sterile, — that they possess some bactericidal action. On this point the following experiments were made:

Experiment I. To Determine Whether Fresh Samples Are Infected. Eight samples of oils and cutting compounds were procured from machines and cultures made immediately as follows: Slants of glycerin-agar and bloodserum were treated with a loop of each sample, as were plates of glycerin-agar. At the end of twenty-four hours all of the cultures had visible bacterial growths. These were found to be the usual pus-forming organisms. One sample showed as many as 110,000 micro-organisms per gram of oil (estimated from colonies in petri plates after incubation for thirty-six hours), the organisms being practically pure

cultures of staphylococcus aureus, an organism causing boils, abscesses and other pus conditions.

was

Experiment II. The Bactericidal Action of Oils and Cutting Compounds. One cc. of a twenty-four hour broth culture of staphylococcus aureus added to ten cc. of each of twenty-two samples of oils and cutting compounds which had been previously sterilized for fifteen minutes at fifteen pounds' pressure in the autoclave. The results of this series of tests indicated that neither mineral oils nor cutting compounds are germicidal. At the same time they probably have little in the way of nutrient properties for bacterial growth. However, as growth did not disappear in many of the test mixtures in a period of twelve hours, the indication is strong that these mixtures may be capable of action as "carriers" of infection. In this connection there did not seem to be any difference between cutting oils and cutting compounds.

Sources of Pollution. There appear to be many sources of pollution for the oils and compounds. It was found that all workers interrogated denied spitting into the reservoirs, but several men denying this practice were observed to do so in spite of instructions by

foremen and officials to the contrary. As the operatives' hands and arms are in almost constant contact with these substances, the filthiness of this practice can be readily appreciated. Cuspidors should be supplied to all employes and insistence on their use is essential. In general, it is better to replace "Don't Spit" signs with cuspidors and signs calling attention to them, as "Use the Cuspidor."

Mode of Spread. Due to these exposures, pollution is almost certain to follow, especially in those cases where employes have acne or where they have pus infection of the skin, or mouth and respiratory tract. This is more serious where machines are equipped with individual oiling systems and where

cuttings and shavings are collected from the different machines and the oil drained off and filtered. The oil is usually heated slightly to facilitate the filtering process. It will be seen that if the oil from one machine is polluted with organisms and is mixed with oil having slight or no antiseptic properties and coming from many other 'machines, and later redistributed, infection is certain to be carried to any number of men. This is also true of machined parts which are covered with the oil and subsequently handled by men in other departments. Cutting compounds, on the other hand, are not usually recovered from cuttings and there is, therefore, less posibility of infection spreading from machine to machine, except by the small amount which adheres to machined parts. Here the effects of rapid drying and light probably cause the death of the great majority of pus-forming organisms within a few hours at most. But if the cutting compound becomes polluted in a given machine (as it usually is), the man working on the machine may be re-infected indefinitely.

Wound Infections. Repeated minor injuries by steel splinters, etc., offer many opportunities for bacteria to enter the skin. These

steel splinters are present in oils and compounds in great numbers as has been demonstrated by microscopical examinations as well as by magnet withdrawal (Shie).

Conclusions. It is, therefore, concluded that oils and compounds are important factors in transmitting organisms which cause furunculosis and which infect wounds. It is concluded, also, that the mechanical action of these substances is an important factor in