Occupational Diseases

OCCUPATIONAL DISEASES, diseases having an exclusively or predominantly occupational etiology, i.e., caused by the hazards and dangers of labor and the production process or by unhealthy sanitary-technical conditions of the surrounding workplace (see Occupational hazards). Examples of occupational diseases having an exclusively occupational etiology are, first of all, certain occupational poisonings, e.g., aniline poisoning, which is not encountered in ordinary circumstances, regardless of occupational labor. Predominantly occupational etiology is found in, e.g., lead poisoning (food-borne lead poisoning or poisoning resulting from the ingestion of lead preparations for medicinal purposes is also possible), writer's cramp, pneumoconiosis, etc. Along with this, besides specific occupational diseases, there is a number of diseases that are usually not occupational, but in the series of which individual cases of the disease have an indisputably occupational origin. From this it follows that it is impossible to compile an exhaustive list of occupational diseases by the very nature of the matter, since almost every disease can in one case or another have an occupational character. At the same time, however, in some cases, certain types of diseases are encountered in individual professions so frequently, and the same diseases of a non-occupational character are such a rarity in relation to this group of workers, that with a significant degree of probability (bordering on certainty), every case of such a disease in a given profession can be considered occupational. Examples can serve as acute tendovaginitis in professions requiring frequent small and rapid movements; glassblower's cataract and, in general, cataract in professions associated with sharp exposure to thermal radiation with a large amount of so-called Vogt's infrared rays; miner's nystagmus; occupational eczema of an allergic character upon contact with certain substances, etc. Finally, there are also occupational diseases which are by no means typically occupational for a given profession, and then in each individual case, the physician must, on the basis of a thorough clinical and occupational pathological analysis (localization of the disease, its form, character of the course, detailed occupational history of the victim, etc.), establish its connection with working conditions, and therefore also determine the presence or absence of occupational etiology. Examples can serve as varicose veins in spinners, damage to the heart muscle in a worker of heavy physical labor, dermatitis from the action of irritating substances. The influence of occupational hazards or unhealthy general sanitary conditions of labor can also manifest itself in a significant increase in the prevalence of a certain type of disease in a given occupational group, clearly detectable statistically, but without it being possible in each specific case to determine the occupational or non-occupational character of the given disease in each individual person. In such cases, we are no longer speaking of occupational diseases, but of occupational morbidity characteristic of a given profession. Examples 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 some groups of medical personnel, veterinary personnel, agricultural workers, etc. The study of occupational diseases and occupational diseases from the point of view of their etiology, peculiarities of the course, mass and individual prophylaxis is conducted by occupational hygiene and, more specifically, its differentiated section—occupational pathology (see). The study of occupational morbidity is conducted by a section of occupational hygiene—labor sanitary statistics. Bourgeois science studies almost exclusively only clearly expressed specific occupational diseases, in view of the fact that 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 insurance societies and sick funds, in which, as is known, entrepreneurs also actively participate in most countries. The fact is that in a number of countries from among those in which social insurance exists at all, direct responsibility of the entrepreneur has been established in relation to occupational diseases, i.e., social insurance for this type of 'insurance risk' is built on the principle of social insurance for accidents (they are also usually paid not by sick funds, but by insurance societies, or in any case from those insurance funds in the creation of which the workers themselves do not participate or participate to a much lesser extent than in the fund for insurance against illness). The usual norms and conditions of provision here are somewhat better than with insurance against illness. Hence follows the desire of both entrepreneurs and bourgeois scientists to narrow the concept of occupational disease in every possible way, reducing it to a narrow circle of such nosological forms that indisputably 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 for scientific and practical prophylactic considerations. Since Soviet social insurance does not know of a division into different branches depending on the type of event requiring payment at the expense of insurance organizations (illness, accident, etc.), but distinguishes only temporary and permanent disability, the need for special insurance for occupational diseases also disappears. At the same time, from the point of view of the interests of improving working conditions and reducing morbidity, limiting the material of study and practical influence to only specific diseases is completely unacceptable. Clarifying the etiology of both specific occupational diseases and other types of occupational diseases equally contributes to identifying special professions, types of labor, and particularly threatened 'points' in the field of labor organization and production processes as objects for intensified work in the field of occupational hygiene, as well as to a certain extent, curative medicine. The analysis of occupational morbidity has the same significance, with the only difference that here the results cannot have such a concrete character in relation to working conditions and various health-improving and curative-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 for, and therefore subsequently to the elimination of, harmful etiological factors both in the general conditions of a given profession and in the concrete conditions of labor of certain collectives, enterprises, etc. The wide development of the study of occupational diseases in the USSR 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, which are still only on the border between physiology and pathology and can therefore serve as signals for taking necessary hygienic and individual curative-prophylactic measures and for assessing, from the point of view of occupational hygiene, the physical state of health and occupational risk of one or another collective. Mass medical examinations of the state of health of workers in the USSR, first of so-called harmful industries, and then of increasingly wider circles of enterprises in the order of so-called dispensary screening in the first years of the reconstruction period, led to the creation of the special concept of 'pathological prevalence' (Bogoslovsky). At the same time, a whole series of serious methodological errors were made, leading to completely unscientific and politically harmful conclusions. Thus, 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 obtained results with some artificial 'average', purely formal 'norm', for which either a healthy profession or a control group (e.g., Red Army soldiers) was taken, and then interpreted any, even insignificant, deviations from this norm as pre-pathology and, in any case, as an indicator of the sanitary disadvantage of a given group. As a result, it turned out that there was not a single occupational group without one or another shift and deviation. And from this, it was natural to come to the conclusion that all labor in all conditions is always harmful. The school of the Obukh Institute, using the 'methodology' of pathological prevalence of Bogoslovsky, committed even grosser errors, since it purely mechanically added up various signs of this pathological prevalence, mechanically substituting the state of the organism as a whole with individual lesions ('pathological signs'), then completely 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 essentially almost not a single worker without pathological prevalence. As a result, an impression was created of significant sanitary disadvantage of the proletariat of the USSR, and the enormous shifts in the cause of the actual improvement of the health of the broad working masses and the reduction of occupational diseases remained completely unnoted.

It goes without saying that occupational diseases can be studied and analyzed not as a result of some artificial isolation of occupational pathological incidence, but only on the basis of studying the general dynamics of worker morbidity and additional in-depth analysis of certain morbid forms and states of health that are truly pre-pathological (with the caveat that the selection of each such state must be scientifically justified, physiologically and clinically grounded, and rely on factual proof of its role and place in the further development of an indisputable disease). The study of occupational diseases must, of course, be simultaneously closely linked with the analysis of domestic influences, since these closely intersect with occupational ones in terms of both negative and positive effects on health. The decline of occupational diseases in the USSR under the influence of the successes of socialist construction, and primarily the fundamental reconstruction of our entire industry, is evidenced by the data on the decline in the general morbidity of workers in recent years (the number of days of temporary disability per 10.0 'full' insured persons according to the data of the Central Social Insurance Administration for the USSR was: in 1928—841.2, in 1929—875.3, in 1930—868.2, in 1931—839.6, in 1932—750.4). In fact, the decline in morbidity was even greater, since the level of these average figures is influenced by the different occupational composition of workers in different years. A more accurate picture is provided by figures for individual branches of industry. For example, for 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, a special registration of occupational diseases has been established. By the decree of the People's Commissariat of Labor of the USSR and the People's Commissariat of Health of the RSFSR dated March 1, 1924 (as amended on February 11, 1928), mandatory registration was introduced for: a) occupational poisonings (caused by lead, mercury, arsenic, phosphorus and their compounds, chlorine and its derivatives, hydrochloric, nitric, nitrous, and hydrofluoric acids, nitrogen oxides, sulfuric and sulfurous anhydride, 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 occupational poisons); b) anthrax; c) glanders; d) cataracts in work involving high temperatures and bright light; e) bladder cancer in work with aniline compounds; f) occupational skin diseases (eczema, ulcerations, burns, etc.) caused by coal tar distillation, turpentine, chlorine, chromium, and other substances. According to this decree, all medical institutions and all doctors without exception, both salaried and private practitioners, must send notifications of these occupational diseases to both the sanitary inspector at the Labor Department and the health authority at the place of work of the sick person. In addition, the administration of enterprises and institutions, in all cases of mass occupational poisonings involving more than three victims or fatalities, is obliged to immediately notify the labor sanitary inspector by telegraph or telephone. Furthermore, the most thorough registration of all poisonings is conducted using the method of signaling statistics from all health centers. In the first years after the introduction of this registration, statistics showed a steady increase in the number of registered occupational diseases, especially occupational poisonings, although this was due not so much to an increase in diseases as to an improvement in the registration that had only just begun to be organized. Subsequently, we observe a picture of their decline despite the growth of industry. The following tables give an idea of the distribution of occupational poisonings and occupational diseases in the RSFSR (according to data from the People's Commissariat of Labor of the RSFSR) in recent years. Table 1. Distribution of occupational diseases by industry. Industries: Leather-fur, Extraction and processing of materials, Chemical, Mining and metallurgical, Textile, Metal processing and machine building, Food and flavoring, Wood processing, Construction, Garment, Paper, Processing of animal products, Others. Total: 1,343, 221, 1,469, 2,227, 3,181, 1,928. Table 2. Distribution of occupational poisonings by industry. Industries: Chemical, Mining and mining-industrial, Metalworking and machine-building, Textile, Printing, Mineral extraction and processing, Food and flavoring, Garment, Woodworking, Paper, Communal business, Leather-fur, Other production. Total: 588, 2,682, 467, 2,093, 1,719, 4,190. From these tables, which by no means claim to be an exhaustive list of poisonings for the reasons indicated above, a definite decline in occupational diseases—occupational poisonings—emerges, even in absolute numbers, 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 indisputably asserted that there has been a clear drop in the corresponding coefficients in recent years, since the growth in the number of workers during these years was incomparably greater than even the increase in the absolute numbers in the table by year 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 occupational poisonings, it was possible to achieve very tangible results, as can be seen from the following table: Table 3. Number of occupational poisonings. Date: 1/X-1926, 2.9; 1927, 1.9; 1928, 1.97; 1929, 1.77; 1930, 1.23; 1/I-1932, 0.7. To provide orientation on which occupational diseases are most common now in the USSR, a breakdown of data on occupational diseases and occupational poisonings by their individual types according to the statistics of the People's Commissariat of Labor of the RSFSR for recent years is provided. Table 4. Distribution of occupational diseases by type of disease. Name of occupational disease: Dermatitis and eczema from acids and alkalis, Dermatitis and eczema from other causes, Body overheating, Tenosynovitis, Chrome ulcers, Anthrax, Folliculitis and furunculosis, Inflammation of the cornea, ophthalmia, Conjunctivitis, Other diseases. Total: 1,469, 2,227, 3,181, 1,928. Table 5. Distribution of occupational poisonings by poison. Name of poison: Carbon monoxide, Lead, Gasoline, Carbon dioxide, Aniline, Zinc oxide, Mercury, Nitro compounds, Carbon disulfide, Sulfur dioxide, Phosphorus, Alcohols (amyl and methyl), Turpentine, Formalin, Acrolein, Hydrogen sulfide, Kerosene vapors, Bisulfite, Other poisons, Unknown poisons. All-Union statistics on occupational poisonings cannot be maintained in relative indicators, for example, per 1,000 insured persons, as is done in relation to general morbidity or occupational traumatism, since it reflects rather random processes—the occurrence of acute poisonings only at individual enterprises, and they are often mass in nature and disappear quickly 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 poisons that are less common in toxic doses appear and disappear in certain years. At the same time, certain conclusions can still be drawn from these tables. Thus, it follows from them that tenosynovitis, which is characteristic of very intense, rapid work, disappeared entirely in 1931, which should be attributed to the mechanization of production; poisonings with lead, gasoline, and aniline are decreasing sharply, to which special attention of labor protection has been paid, but on the other hand, the importance of carbon monoxide (metallurgy!) and cataracts (the effect of radiant energy near various types of furnaces!) is growing. The legislation of the USSR also concerns occupational diseases in connection with the fact that, as the text of the instruction of the All-Union Council of Social Insurance dated January 31, 1929, states, disabled persons who have become such from 'so-called specific occupational diseases, i.e., diseases that are exclusively characteristic of work with certain occupational hazards or at least occur when working with these hazards many times more often than under other conditions,' are issued a pension in an increased amount on a par with disabled persons from accidents. According to the decrees of the Union Council of Social Insurance dated January 4, 1929, and January 20, 1931, a special list of occupational diseases to which this decree applies is in effect in the USSR. In view of its practical importance, it is given in full (Table 6).

In addition, according to the relevant notes: a) medical workers of psychiatric institutions who directly serve the mentally ill and have lost their ability to work due to severe neurosis with degradation of intellect and change of character, or due to early arteriosclerotic dementia, or due to clinically expressed mental illnesses arising at an age not corresponding to the given disease, are subject to provision on the same grounds as persons who have lost their ability to work from the Occupational Diseases listed in this list; b) syphilis infection may be recognized as occupational if the localization of the primary lesion is characteristic of the performance of professional duties, for example, syphilitic lesions of the hands in obstetricians, of the breasts in wet nurses, and in the area of the mouth in glassblowers. In order to detect occupational poisonings and Occupational Diseases in chronic conditions or in their early stages, etc., the legislation of the USSR establishes mandatory medical examinations for workers in hazardous industries. By decrees of the People's Commissariat of Labor and the People's Commissariat of Health of the RSFSR dated September 24 and December 5, 1928 (on the basis of Article 143 of the Labor Code), a mandatory medical examination was introduced for those working with lead, mercury, arsenic and their compounds, for workers in the production of acids, chlorine, ben-

Table 6. Item No. Name of disease Occupational hazard causing the disease Professions in which this disease occurs predominantly or exclusively Ankylostomiasis Progressive myopia Work underground Prolonged eye strain during close-up work Varicose veins of the legs with edema or ulcers Prolonged standing or prolonged walking

Loss of voice due to paresis of the vocal cords, chronic laryngitis, or 'singer's nodules' Cataract Caisson disease Chronic skin inflammation, ulcers Systematic strain of vocal cords Systematic exposure to radiant energy of significant intensity Increased atmospheric pressure Work with irritating and caustic substances Dupuytren's contracture Systematic traumatization of the palmar fascia

Neuralgia and neuritis of the extremities Occupational coordinatory neuroses (such as writer's cramp) Nystagmus Poisonings Pneumoconiosis Skin cancer Retinitis Chronic inflammation of the mucous bursae of the knee, elbow, and wrist joint Hearing loss due to damage to the inner ear Chronic changes of the joints of the extremities (flat foot, baker's legs, etc.) Chronic tenosynovitis Severe tissue lesions (dermatitis, ulcers, cancer, atrophy) Overexertion of the corresponding extremities or pressure on nerve trunks Overexertion of the corresponding muscle groups Work underground Occupational poisons Prolonged inhalation of large quantities of dust Work with resin, tar, 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 sharp sounds Increased load on joints Intensified work of the corresponding muscles X-rays, rays, and radium rays Ulcers of the mucous membranes of the nose and mouth, [and] cornea; Work with irritating and caustic substances

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., 1931; 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. Maye, Industrial Ear Injuries and Their Combat, B., 1928; Teleky u. 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.