Appropriation.... SUMMARY STATEMENT Amounts available for obligation Transfer to "Operating expenses, Public Buildings Service," General Services Administration. Total..... Obligations by activities Summary of changes 1962 enacted appropriation---- General Services Administration_. Administrative reserve_‒‒‒‒ Total estimated obligations 1962_ $3,981, 000 -14, 000 -114, 000 1963 estimated obligations---. Total change.... A. Program increases: 1. Research grants- INCREASES 2. For expansion of laboratory research programs: 3,853, 000 4, 022, 000 +169,000 3,000 $28, 300 2, 900 Research grants.-A net increase of $3,000 is requested for research grants. Expansion of laboratory research program.-An increase of $79,000 is requested to provide four professional positions and one auxiliary position to expand the study and evaluation of the biochemical effects of toxic substances on the blood and effects of toxic substances on the blood and tissues and to evaluate animal behavioral reactions as guides to human reactions to and tolerances for toxic substances to determine maximum allowable concentrations of these substances in humans. Expansion of epidemiologic studies.—An increase of $87,000 is requested to provide four professional positions and one auxiliary position to start a critical review of current dust sampling and counting techniques, the preparation of a definitive manual of recommended practices, and revision and/or establishment of criteria on industrial ventilation design; to increase educational activities in connection with the study of health hazards in uranium mines to accelerate the necessary medical examinations of the miners and to spur compliance with control measures; and to study selected occupational groups subject to pulmonary diseases. 115 positions offset by 5 positions transferred to "Bureau of State Services management fund." PREPARED STATEMENT 8, 112 14.040 5, 280 1 91.766 31,866 59,900 Senator HILL. Dr. Magnuson, we are glad to have you with us this morning and you may proceed in your own way, sir. Dr. MAGNUSON. Thank you, sir. If I may, I shall file the statement and comment on just a few highlights which may be of interest to the committee members. Senator HILL. Your statement will be inserted at this point. (The statement referred to follows:) STATEMENT BY CHIEF, DIVISION OF OCCUPATIONAL HEALTH, ON "OCCUPATION AL HEALTH, PUBLIC HEALTH SERVICE" Mr. Chairman and members of the committee, it is a privilege to present this report on occupational health, which represents a part of the environmental health activities of the Public Health Service. As American technology develops, the occupational health problems confronting industry increase in complexity as well as number. Occupational health today must not only continue the application of conventional methods for the detection of old and new toxic agents, but must also extend its traditional concept in new dimensions. The problems we face today contain many elements that are new, but our methods of attack have been slow to adapt to the new challenges. The health of the worker is still far from optimal. Not only does frank occupational disease persist, but other less obvious effects of work on health must also be considered. Residual or slowly developing disease or dysfunction may not be detected by conventional clinical examinations or by conventional reports of disease. Some occupationally induced disease can easily be confounded with so-called normal deterioration, such as in aging. If our workers are to enjoy maximum health during their productive years, followed by an active and rewarding retirement, it is important that we identify and control harmful occupational factors which may contribute to physical deterioration. There is increasing awareness that impairments now being encountered are not produced by single, isolatable, and easily incriminated factors. Many are the result of multiple factors working together, each adding its own insult and helping others to add theirs. Only tentative beginnings have been made to answering such questions as the effects of high atmospheric pressures or thermal stress on the tolerable limits of toxic chemicals. Recognition of the interrelationship of various environmental factors has perhaps been most evident in our greater consciousness of the effects of the growing chemical world surrounding us. The constant introduction of new chemicals and the intricate interactions of new processes pose problems of synergistic and additive as well as individual effects. A BEGINNING IN NEW DEPTH AND DIRECTION Strengthened by a doubling of its intramural funds in 1961, the Division of Occupational Health has made a substantial beginning in achieving new depth and direction. A new section on physiology was established during the past year to investigate the effects of industrial conditions and exposures. Studies will include effects on pulmonary function, fatigue, cellular defense, physical and mental work capacity, and resistance. A more thorough and persistent consideration of the psychological component of occupational health problems has also been made possible by the recent addition of this competence to the staff. LABORATORY RESEARCH In our toxicologic studies, we have probed deeper into subcellular body processes in our search for early indicators of injury. Following several promising leads, we now need to examine further how altered enzyme patterns and metabolic aberrations can signal early progressive biochemical effects of toxic substances. Such information will also be useful in studies of individual susceptibility to specific toxic exposures, and will aid greatly in the diagnosis and control of occupational diseases. There is also need to assess behavioral reactions in animals as indicators of probable responses to and tolerance for toxic substances. Modern applications of conditioned reflex techniques have been reported on favorably by European investigators and need critical evaluation. The requested increase will permit more intensified work in the study of biochemical profiles and a start in the evaluation of behavioral reactions. Findings of several toxicologic studies of the past year found practical application in guidelines for worker health protection. Laboratory study showed that toluene diisocyanate, used extensively in the plastics industry, produced an immunologic response detectable in the blood and in the skin, as well as severe effects on the respiratory tract. Due in part to this research, the American Conference of Governmental Industrial Hygienists has recommended a downward revision of the threshold limit of toluene diisocyanate to 0.02 part per million parts of air. Other toxicologic studies are being directed toward development of acceptable standards of exposure to oil mists. Studies on oxides of nitrogen in the laboratory have supported present standards. A year ago we reported that disturbances in the metabolism of zinc and copper were implicated in the early stages of carbon disulfide toxicity. Following this lead, a comparative study was made of diets fortified with a metal salt mixture, and diets not so fortified. The metal-fortified diets were found to delay the onset of neural signs of carbon disulfide poisoning in rabbits. Associated with these changes was redistribution of copper and zinc in critical tissues, particularly in the spinal cord of the rabbit. This study points to at least one specific relationship between diet and the response to a toxic agent encountered in industry. Supportive work continues in analytic research, directed at developing and evaluating new, more sensitive, and reliable methods for detecting and measuring the chemical and physical components of the work environment. The ion exchange procedure developed by the Division for the isolation and concentration of trace quantities of toxic substances has found various applications. Other recent developments in environmental evaluation techniques include comprehensive experimentation with direct reading devices for toxic gases and vapors, the design and construction of a miniature multipurpose recording air analyzer, and the testing of a particle analyzer. One of our most urgent needs is a critical review of current dust sampling and counting techniques, with preparation of a definitive manual of recommended practices. Work will also get underway on the industrial ventilation design criteria. EPIDEMIOLOGIC STUDIES Our resources for field studies last year were largely committed to the silicosis and the uranium mining studies. The field work in the reevaluation of the silicosis problem in the metal mining industry has now been completed, and the extensive data are being analyzed by the Division of Occupational Health and the Bureau of Mines. Fifteen thousand metal miners were examined, represent ing 57 percent of the underground miner population employed in 1959. Environmental conditions were studied in 60 mines. The findings of this study will form the basis for recommendations as to further research that may be needed in the cause and control of silicosis in American industry. The Division's investigation of health hazards in uranium mines was strengthened through contracts negotiated with the States of New Mexico and Colorado and with private medical facilities to complement the clinical studies and control efforts. A special research project in which the Division is involved seeks to determine the value of cytologic examinations of sputum in the early detection of lung cancer. Following the conference of Governors called by the U.S. Department of Health, Education, and Welfare in December 1960, considerable progress also has been made by some of the uranium-producing States to reduce excessive radiation levels in the mines. A sharp increase in the number of lung cancer deaths among uranium miners in this past year confirms the severity of the hazard, and points to the need for continued and intensified activity. A new industrywide study of occupational health hazards was begun in the asbestos products industry, which employs about 20,000 workers. Initially, the study encompasses an examination of mortality records of workers in this industry throughout the country, with a detailed and searching analysis of the mortality experience of asbestos products workers in a selected State. This epidemiologic technique, using records of the Federal Bureau of OldAge and Survivors Insurance, will be extended also to other industries, both as a means of obtaining quantitative data on the incidence of suspected occupational disease, and for detecting unidentified hazards in the working environment. Records of the four State disability insurance programs will be similarly analyzed in a proposed cooperative study. On a broader scale, we plan to undertake a detailed study of mortality data for 1960 to pinpoint areas of the country where there are unusual variations in male-female mortality ratios which might be associated with occupational hazards. TECHNICAL CONSULTATION AND TRAINING Since the nurse carries the main burden of occupational health services in industry, the effectiveness of such programs depends to a large extent on the scope and quality of her activities. To help improve the performance of the Nation's 17,000 industrial nurses, the Division has undertaken an intensified program of training, research, and consultation in occupational health nursing. Immediate steps planned for training include a 3-day workshop on "Trends in Occupational Health Nursing Consultation" for occupational health nurse consultants in governmental agencies; and a 5-day course for occupational health nurse supervisors, the first of its kind, to be given jointly with the Loyola University School of Nursing. Research plans call for a survey of present practices in part-time nursing service to small industries. The findings of such a study will assist in promoting the extension of this service to more industries by a larger number of public health nurse agencies. At present, not even 1 in 10 workers has access to health services at his place of employment. Another proposed study of nursing in an occupational unit will provide a practical basis for assessing the industrial nurse's role and maximum potential contribution. To strengthen consultation services to State occupational health agencies, a nursing consultant from the Division will be assigned to serve two Public Health Service regions as a pilot project. The consultant will assist in the recruitment of personnel and demonstrate the effectiveness of occupational health nursing programs in the States. Increased emphasis has been placed also on strengthening occupational health programs in State and local government agencies, where direct responsibility lies for helping industry solve its occupational health problems. As part of this expanded effort, we have undertaken a cooperative occupational health study in Tampa, Fla. This project seeks to assess all official and nonofficial agencies that can assist in improving the health of the industrial worker, and to determine how a local health unit can mobilize these community resources. The techniques developed will be applicable to efforts in other areas. A new impetus has been given to orientation courses for local health officers. These courses are designed to provide local health officers with a background and understanding of the opportunities for better community health offered by occupational health. To date, four such courses have been held. |