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or any county, city or township" are directed to enforce all State health regulations.

Nurses' Organizations The attention of public health nurses and of to Meet in Cleveland other persons interested in public health nursing work is directed to the announcement of the meetings of several nursing organizations in Cleveland the second week in May.

The annual meetings of the American Nurses' Association, the American League of Nursing Education and the National Organization for Public Health Nursing will be held at the Hotel Hollenden May 7, 8 and 9. The State Graduate Nurses' Association will meet at the Hotel Winton May 6.

These meetings will afford an excellent opportunity for interested persons to obtain the latest and best information on subjects pertaining to the nursing profession. Attendance will be well repaid in knowledge gained.

Physicians' Committee
Enters Cancer Fight

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As chairman of the Ohio Medical Association's committee on control of cancer, Dr. Andred Crotti of Columbus is leading a movement which has as its object to check and reduce the increasing cancer mortality. The Ohio State Medical Journal says:

"Dr. Crotti will endeavor, by a series of monthly treatises on the subject, to impress upon the profession, a realization of our responsibilities in more thorough and prompt cancer diagnosis and the benefits to be derived therefrom. To obtain results in a campaign to control the cancer problem, two things must be done the medical profession of the state must be brought to improved methods of diagnosis through which incipient cancers may be detected, and the general public must. be educated to the need of directing early attention to conditions that may result in cancer. Dr. Crotti has mapped out a comprehensive campaign, to the end that the profession may not merit in the future the severe criticism which it has received in the past because of increasing cancer mortality, and the movement deserves the earnest co-operation of every Ohio physician."

THE OHIO PUBLIC HEALTH JOURNAL would add to this last sentence the words: "and every Ohio public health worker." Cancer is an everincreasing menace to the public health. The sooner effective measures to prevent it are put into operation, the greater will be the good that these measures can accomplish.

The Ohio Medical Association and its committee are to be congratulated for the public spirit they are displaying in this new enterprise.

Depreciation of Water Purification Plant is Dangerous

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The Bellaire water purification plant has been in use in that city since 1915 and has produced very satisfactory results insofar as the quality of the filtered water is concerned. The equipment of the plant and of the water works pumping station operated in connection with it has never been entirely satisfactory and there has always existed an uncertainty in regard to the ability of the system to continue in service.

On February 6, 1918, through failure of low service pumping equipment, it became necessary to stop the operation of the filter plant and in order to maintain a water supply for the city unfiltered Ohio River water was pumped to the distributing system. These conditions continued until February 23, 1918, when repairs were completed and the operation of the filter plant was resumed. During these 18 days the citizens of the city, who had become accustomed to the use of filtered water, were forced to depend upon a turbid and contaminated supply. This instance serves well to illustrate the value of duplicate equipment and the necessity of maintaining all equipment connected with a water works system in a high state of efficiency. Serious depreciation of water works equipment cannot occur without a serious detriment to the community.

Local Health Organization in Ohio

From a southern Ohio village comes this news item:

"At a recent meeting council hired Marshal Tom D. Jones as health officer and gave him a salary of $5 a month. Health officers have in the past received no salary other than certain fees for work actually done.

"The health officer will earn the regular stipend by doing work that has been outlined for him. He has been instructed to lay the town out in districts and to visit each district at least once each month and see that the health laws of the state and the village are obeyed. He has authority to cause citizens to remove trash, rubbish and other unhealthy things from streets, alleys and their own premises."

It would hardly be cause for surprise if under his authority to remove "other unhealthy things from streets, alleys and their own premises" the new health officer-marshal should find it necessary to order the population out of town.

Cause and Prevention of Furunculosis and Wound Infections Among Machinists

Abstract of a Report of an Investigation by the Division of Industrial Hygiene, State Department of Health, R. P. Albaugh, Director

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 months, the exact reasons being

unknown.

Theories as to Cause. Various explanations have been advanced for the unusual incidence of these afflictions. It is a well known fact that pus-forming bacteria are usually present in large numbers even in normal conditions of health on the surface and beneath the surface of the skin, and, because of this fact, many observers are of the opinion that furunculosis, as reported among the workers described, is due not to the pres

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 composition as to sustain and promote 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.

of distillates given off at different temperatures. Benzine, or petrol naphtha, with a boiling point of 150° C. (and under) causes a 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 picture. Multiple abscesses, sometimes of a very severe type, are encountered and wound infections are unusually 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

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 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 persona! 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

1 Shie, M. D.: Wound Infections Among Lathe Workers. J. A. M. A., Dec. 8, 1917, pp. 1927-1930.

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 It was obin large quantities. served, 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 10 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 treat

ment.

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

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