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the trouble April, 1919 impulses thus aroused reflexly stimu- late the vaso-constrictor center, or a part of it, and cause blanching of the © skin. That cold may produce evident changes in the appearance of certain parts of the body, notably of the extremities—the feet, hands, ears and nose—is a matter of common obser- vation. It has been pointed out that ex- posure of the hands to cold usually produces at first a pallor of the skin which is evidently due to a constric- tion of the cutaneous arterioles. When the exposure is prolonged, however, the color is heightened and the skin usually becomes more or less cyanotic. Almost universally, therefore, cold produces a constriction of the cutane- ous arterioles and a slow flow of blood through the skin. The varia- tions in color are thus caused by the varying amounts of blood that collect in the skin capillaries. The flow through the blood vessels is also in part influenced by the muscles which surround them. Anything, therefore, which interferes with or impedes the normal action of the muscles will have its effect in turn upon the cir- culation, as it is the changing state of contraction and relaxation of the. muscles which aids in the flow of blood under normal conditions. Where a group of muscles is held in a con- tracted state for a considerable length of time the circulation is thereby im- peded. With the workman, whether using a chisel and mallet or a pneumatic hammer, the factors of cold, continued muscle contraction and cutaneous irritation are all present to a consid- erable degree and demand due evalua- tion in the consideration of such dis- orders in the hands as are sometimes observed. The fact, borne out with uniformity in this investigation, that occurs only in cold weather indicates most conclusively that the low temperature itself is one of the most important factors in the causation. The continued muscular contraction and the mechanical irrita- tion (vibration) may play a role in its causation, but evidently these are of secondary importance. Hammer Hand Not Affected The fact that the trouble, when present, pre-eminently affects the left hand, which holds the chisel and not the hammer, indicates clearly that other factors than the hammer itself are of more signal importance in its causation. The cramped position of the chisel hand with the more or less continuously maintained contraction of the muscles is one of these 1m- portant factors. However, the ham- mer or the grip of the chisel, either alone or combined, are not sufficient - to produce the condition, as is proved by the“fact that it ‘does-not occur in’ the warmer seasons of the year when industry is at its height. The role of the vibration is uncertain, but as the trouble occurs in the hand not hold- ing the hammer, it is doubtful if this factor is of much importance. We have left, therefore, the factor of low tem- perature which seems to be the final and most important element in the production of those vascular changes seen in the hands of some workers which, although physiological in na- ture, form the pathological basis for the occurrence of “white fingers” and_ “dead fingers.” So far as can be ascertained the condition leads to no permanent disability and results in no organic disease. a portion of stone cutters are affected cannot be answered. Whether cer- tain undetermined conditions’ of poor general health or. specific diseased condition existing, but not recognized, predisposes certain men to this. dis- turbance is not evident from this: in- vestigation, although apparently such is not the case. With one or two exceptions they were all well devel- oped, robust -men without demon- strable general physical or mental disease. Draws Interesting Conclusions Conclusions drawn from a _ com- paratively small series of observations must be subject to some limitations. However, the uniformity of the re- sults of the examinations made in this investigation, taken together with the testimony of the workmen and of others, reasonably justifies the follow- ing deductions: 1. Structural steel workers, ship- builders and stone cutters as a class, enjoy good general health and are not, because of their trade, especially susceptible to any particular disease. 2. Stone cutters are liable to a dis- order affecting the hands, especially the left hand. 3. This disorder of the hands is of a vascular character, not due to or- ganic changes in the circulatory sys- tem, but dependent upon vaso-motor reactions. 4. These reactions are physiological in character and are occasioned by three factors incident to the work of stone cuttng: Mechanical irritation of the skin, continued muscular contrac- tion of a cramping nature and low temperature. : 5. Of these three factors, cold is considered the most important be- cause the condition only occurs dur- ing the severely cold weather and never in the summer, and warmth and Why it is that only THE MARINE REVIEW 189 measures to» restore the circulation (rubbing, swinging the arms and the like) cause its disappearance. ~ 6. It cannot be caused by the ef- fect of the air hammer alone because it occurs in those who have not used the air hammer. It does not occur in warm weather when industry is at its height and, therefore, when the air hammer is most in: use. mostly in the left hand and. not in the right hand in which the hammer is held. is 7, The vasomotor: disorder: is of temporary: duration and is not: known: to have resulted in. permanent. dis- ability of the hand, nor itself to have been the cause of development of any™ other local or constitutional: disease. 8. It is possible that once having. occurred the person is rendered: more’ susceptible to its reappéarance, just ' as is the one who had had his ears” or fingers frostbitten by the cold is more susceptible’ in* these parts to the subsequent exposure to cold. This’ explains the occurrence of “white fin-' gers” when not actually engaged: at - cutting but otherwise exposed to low temperatures. 9. There is no sufficient reason in the signs and symptoms presented in this disorder to conclude that one has to do with Raynaud’s disease, acroparesthesia, neuritis or an occu- pational neurosis. 10. The institution of measures to warm the chisel before and while using, enlarging the chisel and covering it to make it pos- sible to hold without so cramping a grip, the wearing of gloves, and the discontinuance of the prevalent custom of blocking the exhaust out- let, and thus forcing a draft of chilled air out along the chisel and onto the fingers of the left hand would do much toward the prevention of this trouble. Late Marine Patents Copies of the following patents can be obtained by sending 15 cents in stamps to Siggers & Siggers, National Union Institute building, Washington, by mentioning THE MARINE ReEvIEw: 1272834.—Water-tight bearing for propeller- shafts and the like. A. R. Middleton, Way- side, Md. 1272680.—Torpedo snare, Alfred M. Lane, St. Louis. 1272683.—Explosion-engine. Isidor Lesem, Wichita, Kans. 1273149.—Pleasure cruiser. Irwin Chase, Bayonne, J. : 1273176.—Rowing boat. Charles J. Olsen, New York. 1273298.—Lifeboat. D. A. Whitaker and H. A. Thayer, Sacramento, Cal. 1273315.—Davit tackle block. J. T. Bell, deceased by Josephine T. Bell, adm., San » Francisco. 1273330.—Torpedo-repelling device. M. Ci- ganenko, Pittsburgh. .- It oceurs - shank of the 7 a x 4 a Pit ae pe MMe IS oe eT Tee TR a ONCE 2S ge Pe SE ee TAT s tS 3 A 3 s “2 FON COTE IRE