- Email: [email protected]
Health in factories and workshops in 1934
1935.
PUBLIC HEALTH.
accordance with a promise given in that circular. By way of comment upon the memoranda, it is pointed out that although the Housing Act, 1935, imposes new duties on local authorities, it is essential that in the carrying out of those duties the arrangements made by each local authority should ensure that the task which is now in progress of ridding the country of its slums should in no way be hindered. The Minister sees no reason why, in most areas, the work of slum clearance and the work of abating overcrowdin,, should not proceed simultaneoush~, but if by reason of local circumstances it is necessary to give priority to one of these tasks, the priority should be given to slum clearance. Memorandum A incorporates all the matters dealt with in the memorandum (Hou. 2) which was enclosed with circular 149,3 and accordingly that memorandum is to be regamed as superseded. Memorandum B deals with the provisions of the Act relating to the abatement of overcrowding and details the steps which it is suggested local authorities should take in the execution of the duties imposed on them by section 1 of the Act to inspect their district, to prepare a report on that inspection and to submit housing proposals to the Minister based on that report. The Minister hopes to issue a further communication in the near future specifying the dates which he proposes to fix under section 1 for the completion by local authorities of each of these duties. Hopes are expressed, however, that each authority, without waiting for this further communication, wilt at once take the necessary steps to commence or at least prepare for the survey of overcrowding in their area. Provisional regulations prescribing the various forms referred to in the memorandum have been issued. Memorandum C, which deals with redevelopment areas, will be mainly of interest Io the larger urban authorities. Memorandum D explains the financial provisions of the new Act, including the new forms of subsidy available to local authorities providing new accommodation for the abatement of overcrowding. It is onIy necessary here to add that any application which an authority may desire to make for financial assistance under tim Act will not be prejudicecl by reason of the fact that the building of the hot, ses has been commenced before a
37
decision on such application has been obtained. Memorandum E explains the new provisions for the consolidation of housing accounts and the new rent conditions which are made applicable to all post-War houses belonging to a local authority in place of the special conditions imposed by the various Housing Acts of the past. These provisions are operative at once and the new housing revenue account to be set up under, the Act nmst be set up in relation to the accounts for the year commencing April 1st, 1935. Provisional regulations dealing with the equalisation account have been prepared.
Health in Factories and Workshops in 1934. usual, in tile annual report of the Chief A SInspector of Factories and Workshops for 1934 there appears a chapter on " H e a l t h , " contributed by the Senior Medical Inspector (Dr. John C. Bridge, c.ml.:.). In this, again as usual, the main reference is to tl{e industrial diseases and tile action taken in respect of them and the effects thereby produced, and to first-aid and the work of certifying surgeons. In addition, however, Dr. Bridge finds, as he commonly does find, space for introductory remarks and comment upon some matter affecting industrial hygiene and medicine that have peculiar value since they come from one particularly experienced and skilled in observation. Especially interesting on this occasion is what he has to say on the difficulty of assessing the responsibility of industry and industrial conditions for the production of illhealth in the industrially employed. Not surprisingly, perhaps, without any hesitation at all he announces that it is not within but outside the factory where most of the illhealth detected arises. This is not, however, a reason for belittling the value of medical supervision in combating sickness amongst employees and he is all for the continuance and extension of this service since it possesses advantages both for the employers and the employed. Also he is anxious to see closer co-operation between the medical practitioner and the Factory Department, though he recognises as one of the difficulties in the way that few practitioners appear to know that there, in fact, exists such a department. It
as
PUBLIC HEALTH.
is the view of Dr. Bridge that the medical curriculum should include a lecture or lectures on factory legislation and diseases of industry. Another thing that might help, though Dr. Bridge .does not mention it, would be to make industrial hygiene and medicine part of the duty o.f the health authorities--central and local--rather than of the H o m e Office. Tl~e possibility must not be overlooked that the medical practitioner may feel that there is nothing more than a factory side to such conditions as lead poisoning, anthrax, epitheliomatous ulceration, etc., and nothing of a medical or hygienic, because his notification is to the Chief Inspector of Factories and not to the local medical officer of health. As a result of the almost complete exclusion of ~he health departments from all participation in works connected with industrial hygiene and medicine, is the loss to the industrially employed of the vast amount of propaganda and educative work that the Ministry of Health and the medical officer of health and the health department does and can do amongst medical practitioners as well as the general population. :Even such a matter as hours of employment, to which Dr. Bridge also makes reference, could be made much more medical and less purely industrial, and greater benefit secured for those affected, if the health department and health officers, and not the IIome Office and the Factory Department and*:-"fficers whose title identifies them so definitely with the factory and so little with health, were indicated as those concerned. \Vith the opinion of Dr. Bridge that much benefit would result if hours of work were shortened in the heavy industries all health officers will agree. T h e y will agree also that, in the case of y o u n g workers especially, the tendency to employ them to the full limit of the legal hours is a short-sighted polic.v. W i t h the extended influence that specific identification with industrial hygiene and medicine would give, they could render great assistance in securing the improvements in this as in other connections that Dr. Bridge properly considers necessary. .qo far as industrial diseases are concerned the report submitted shows that in general the year did not produce much that was surprising'. Lead poisoning cases were more numerous than in any ),ear since 1%0, a remark which applies also in the case of chrome ulceration and epitheliomatous ulcera-
Now~ml.:~,
tion. Further, the number of cases of dermatitis referred to tile Department during the year was higher than in other years. T h e increase in the case of lead poisoning was foreshadowed in Dr. Bridge's report for last year and is due to increase in the building Irade which has led to el big demand for glazed tiles. T h e number of cases of chrome ulceration increased because of further extended use of tile process of chromium plating. In the case of epitheliomatous ulceration the numbers both of cases and of deaths showed a distinct increase over those of the previous year. According to Dr. Bridge there is " a direct relation between the percentage of deaths and the exislence of a periodic medical examination." H e notes also that, with one or two no.table exceptions, in the cotton industry medical examinations have never been instituted. T h i s is all the more distressing since from a table submitted showing crude deathrates from industrial skin cancer from 1920-19,.34, it appears that the contribution of mule spinning both of cases and deaths is far in excess of any of the other industries in which this condition constitutes a risk. In his note upon dermatitis, Dr. Briftge explains that the increase in the number of cases reported is not to be taken as evidence of increased prevalence in any of the several industries with which the condition is associated. In regard to this association and allegations as to causative agents, the fact that there is a tendencv to blame these in any case of dermatitis in an employed person is one worth mentioning. T h a t it is often difficult to be quite sure as to what to blame, l)r. Bridge admits, as he admits also that it is not easy to suggest preventive measures for adoption other than very general recommendations to avoid contact as far as possible with suspected agents and take great care of |he skin. .\lkalies, sugar, oil, dyes, chrome and dough are amongst the causative agents mentioned, ~he occupations in which these are used being lhose that appear most prominentlv in a ruble dealing with occupations found to have been involved each year since 1.9;~0. In reference to dust as a hazard it is noted that /57 deaths from silicosis and 50 from silicosis with tuberculosis came to the notice of the Department during the },ear, together with six deaths from asbestosis and eight from asbestosis with tuberculosis. As regards
1 !)2,5.
PUBLIC HEALTH.
silicosis it is pointed out that to substitute steel grit or shot in sand-blasting and to obtain a satisfactory result requires in some instances considerable thought and time, both as regards the grade of grit or shot and pressures to he used: which is unfortunate as the provision of some non-siliceous abrasive is the preventive measure necessary. In relation to asbeslosis it is noted that experience of the regulated.trades in the asbestos industry increases belief in the value of safeguards, chiefly efficient exhaust ventilation, directed towards the suppression and removal of dust. The adoplion of such methods as a means of dust suppression makes little headway. Other dusts to which reference is made are French chalk, and those generated in malthouses and from feathers. Of fumes and gases Dr. Bridge treats at some length, making special reference to carbon monoxide--more in evidence in 1934 than previously; nitrous fumes, five cases of gassing having arisen from vats used for dehrassing; ammonia, 18 cases of gassing, 13 in an open-air refrigerator plant; and phosgene, gassing in three cases attributable to fl~e use of a Pyrene extinguisher for putting out a fire. Hydrocyanic acid is particularly referred to in order apparently to impress t151e necessity, having regard to the increased demand for the acid in connection with vermin destruction, of ensuring" that the process of manufacture shall be prevented from falling into the hands of inexperienced persons. In his note on certifying factory surgeons it is interesting to find Dr. Bridge making mention of the fact that certifying factory surgeons have wonderful opportunities of " otSserving conditions which would not only be of interest but also of value in estimating general conditions of fitness for employment exhibited from year to year by those entering industry," and regretting that the practice of supplementing their annual returns by personal observations is only rarely adopted. As sources of information the certifying surgeons would probably be unequalled, and if Dr. Bridge only could secure reports from them his own would probably be longer and possibly even more fascinating than it is at present. This would be a splendid thing, though so far as interest and fascination go there is no ground for complaint with the report as it stands.
89
Iodine in Biological Substances. known that the element iodine I Tplaysis well a very important part in the metabolism of the body, and particularly in relation Io tile functions of the thyroid gland. The quantities involved are nevertheless exceedingly minute, and study o,f the suhject is lmmpered bv the difficulty of estimating them with accuracy in complex biological substances. The chief need is for a reliable method of chemical analysis for the purpose, and to meet lhis the Medical Research Council, having secured the co-operation of the Government Chemist, Sir Robert Robertson, F.R.S., and a donation towards the expenses, arranged that special investigations should be carried out by Mr. C. O. Harvey, B.SC., A.mC.S., ,~A.C., a member of Sir Robert Robertson's staff. In a report recently issued by the Medical Research Council* Mr. H a r v e y gives the results of his work and describes the methods he has devised for determining small quanlilies of iodine in biological substances. Following practical trial by other workers, the method is shown to be capable of giving consistent results when parts of the same specimen are tested by independent analysts. Promotion of further work on iodine in relation to the nutrition and health of man and animals, in which Mr. H a r v e y ' s method is likely to prove useful, has been e ~rusted to a new committee on iodine deficiency and thyroid disease, appointed jointly by the Medical Research Council and the Agricultural Research Council. Further, since it is now known not only that iodine plays an important r61e both physiologically and therapeutically in hyperthyroidism, but that the blood content of iodine in hyperthyroidism is very high as compared with the normal, a reliable method of estimating the iodine content of the blood such as this, it is believed, may permit a new kind of attack to be made by persons engaged in the investigation of hyperthyroidism.
Papworth Village Settlement. P W ' O R T H Village Settlement has re p Aceived so much, though not undeserved, publicity that the Report of the Committee 'If'rilE DETERMINATION OF IODINE IN ]]IOLOGICAL SUBSTANCES. Special Reports Series, No. 201. H.]V[. Stationery Office, 1935. Price ls. net.
PUBLIC HEALTH.
accordance with a promise given in that circular. By way of comment upon the memoranda, it is pointed out that although the Housing Act, 1935, imposes new duties on local authorities, it is essential that in the carrying out of those duties the arrangements made by each local authority should ensure that the task which is now in progress of ridding the country of its slums should in no way be hindered. The Minister sees no reason why, in most areas, the work of slum clearance and the work of abating overcrowdin,, should not proceed simultaneoush~, but if by reason of local circumstances it is necessary to give priority to one of these tasks, the priority should be given to slum clearance. Memorandum A incorporates all the matters dealt with in the memorandum (Hou. 2) which was enclosed with circular 149,3 and accordingly that memorandum is to be regamed as superseded. Memorandum B deals with the provisions of the Act relating to the abatement of overcrowding and details the steps which it is suggested local authorities should take in the execution of the duties imposed on them by section 1 of the Act to inspect their district, to prepare a report on that inspection and to submit housing proposals to the Minister based on that report. The Minister hopes to issue a further communication in the near future specifying the dates which he proposes to fix under section 1 for the completion by local authorities of each of these duties. Hopes are expressed, however, that each authority, without waiting for this further communication, wilt at once take the necessary steps to commence or at least prepare for the survey of overcrowding in their area. Provisional regulations prescribing the various forms referred to in the memorandum have been issued. Memorandum C, which deals with redevelopment areas, will be mainly of interest Io the larger urban authorities. Memorandum D explains the financial provisions of the new Act, including the new forms of subsidy available to local authorities providing new accommodation for the abatement of overcrowding. It is onIy necessary here to add that any application which an authority may desire to make for financial assistance under tim Act will not be prejudicecl by reason of the fact that the building of the hot, ses has been commenced before a
37
decision on such application has been obtained. Memorandum E explains the new provisions for the consolidation of housing accounts and the new rent conditions which are made applicable to all post-War houses belonging to a local authority in place of the special conditions imposed by the various Housing Acts of the past. These provisions are operative at once and the new housing revenue account to be set up under, the Act nmst be set up in relation to the accounts for the year commencing April 1st, 1935. Provisional regulations dealing with the equalisation account have been prepared.
Health in Factories and Workshops in 1934. usual, in tile annual report of the Chief A SInspector of Factories and Workshops for 1934 there appears a chapter on " H e a l t h , " contributed by the Senior Medical Inspector (Dr. John C. Bridge, c.ml.:.). In this, again as usual, the main reference is to tl{e industrial diseases and tile action taken in respect of them and the effects thereby produced, and to first-aid and the work of certifying surgeons. In addition, however, Dr. Bridge finds, as he commonly does find, space for introductory remarks and comment upon some matter affecting industrial hygiene and medicine that have peculiar value since they come from one particularly experienced and skilled in observation. Especially interesting on this occasion is what he has to say on the difficulty of assessing the responsibility of industry and industrial conditions for the production of illhealth in the industrially employed. Not surprisingly, perhaps, without any hesitation at all he announces that it is not within but outside the factory where most of the illhealth detected arises. This is not, however, a reason for belittling the value of medical supervision in combating sickness amongst employees and he is all for the continuance and extension of this service since it possesses advantages both for the employers and the employed. Also he is anxious to see closer co-operation between the medical practitioner and the Factory Department, though he recognises as one of the difficulties in the way that few practitioners appear to know that there, in fact, exists such a department. It
as
PUBLIC HEALTH.
is the view of Dr. Bridge that the medical curriculum should include a lecture or lectures on factory legislation and diseases of industry. Another thing that might help, though Dr. Bridge .does not mention it, would be to make industrial hygiene and medicine part of the duty o.f the health authorities--central and local--rather than of the H o m e Office. Tl~e possibility must not be overlooked that the medical practitioner may feel that there is nothing more than a factory side to such conditions as lead poisoning, anthrax, epitheliomatous ulceration, etc., and nothing of a medical or hygienic, because his notification is to the Chief Inspector of Factories and not to the local medical officer of health. As a result of the almost complete exclusion of ~he health departments from all participation in works connected with industrial hygiene and medicine, is the loss to the industrially employed of the vast amount of propaganda and educative work that the Ministry of Health and the medical officer of health and the health department does and can do amongst medical practitioners as well as the general population. :Even such a matter as hours of employment, to which Dr. Bridge also makes reference, could be made much more medical and less purely industrial, and greater benefit secured for those affected, if the health department and health officers, and not the IIome Office and the Factory Department and*:-"fficers whose title identifies them so definitely with the factory and so little with health, were indicated as those concerned. \Vith the opinion of Dr. Bridge that much benefit would result if hours of work were shortened in the heavy industries all health officers will agree. T h e y will agree also that, in the case of y o u n g workers especially, the tendency to employ them to the full limit of the legal hours is a short-sighted polic.v. W i t h the extended influence that specific identification with industrial hygiene and medicine would give, they could render great assistance in securing the improvements in this as in other connections that Dr. Bridge properly considers necessary. .qo far as industrial diseases are concerned the report submitted shows that in general the year did not produce much that was surprising'. Lead poisoning cases were more numerous than in any ),ear since 1%0, a remark which applies also in the case of chrome ulceration and epitheliomatous ulcera-
Now~ml.:~,
tion. Further, the number of cases of dermatitis referred to tile Department during the year was higher than in other years. T h e increase in the case of lead poisoning was foreshadowed in Dr. Bridge's report for last year and is due to increase in the building Irade which has led to el big demand for glazed tiles. T h e number of cases of chrome ulceration increased because of further extended use of tile process of chromium plating. In the case of epitheliomatous ulceration the numbers both of cases and of deaths showed a distinct increase over those of the previous year. According to Dr. Bridge there is " a direct relation between the percentage of deaths and the exislence of a periodic medical examination." H e notes also that, with one or two no.table exceptions, in the cotton industry medical examinations have never been instituted. T h i s is all the more distressing since from a table submitted showing crude deathrates from industrial skin cancer from 1920-19,.34, it appears that the contribution of mule spinning both of cases and deaths is far in excess of any of the other industries in which this condition constitutes a risk. In his note upon dermatitis, Dr. Briftge explains that the increase in the number of cases reported is not to be taken as evidence of increased prevalence in any of the several industries with which the condition is associated. In regard to this association and allegations as to causative agents, the fact that there is a tendencv to blame these in any case of dermatitis in an employed person is one worth mentioning. T h a t it is often difficult to be quite sure as to what to blame, l)r. Bridge admits, as he admits also that it is not easy to suggest preventive measures for adoption other than very general recommendations to avoid contact as far as possible with suspected agents and take great care of |he skin. .\lkalies, sugar, oil, dyes, chrome and dough are amongst the causative agents mentioned, ~he occupations in which these are used being lhose that appear most prominentlv in a ruble dealing with occupations found to have been involved each year since 1.9;~0. In reference to dust as a hazard it is noted that /57 deaths from silicosis and 50 from silicosis with tuberculosis came to the notice of the Department during the },ear, together with six deaths from asbestosis and eight from asbestosis with tuberculosis. As regards
1 !)2,5.
PUBLIC HEALTH.
silicosis it is pointed out that to substitute steel grit or shot in sand-blasting and to obtain a satisfactory result requires in some instances considerable thought and time, both as regards the grade of grit or shot and pressures to he used: which is unfortunate as the provision of some non-siliceous abrasive is the preventive measure necessary. In relation to asbeslosis it is noted that experience of the regulated.trades in the asbestos industry increases belief in the value of safeguards, chiefly efficient exhaust ventilation, directed towards the suppression and removal of dust. The adoplion of such methods as a means of dust suppression makes little headway. Other dusts to which reference is made are French chalk, and those generated in malthouses and from feathers. Of fumes and gases Dr. Bridge treats at some length, making special reference to carbon monoxide--more in evidence in 1934 than previously; nitrous fumes, five cases of gassing having arisen from vats used for dehrassing; ammonia, 18 cases of gassing, 13 in an open-air refrigerator plant; and phosgene, gassing in three cases attributable to fl~e use of a Pyrene extinguisher for putting out a fire. Hydrocyanic acid is particularly referred to in order apparently to impress t151e necessity, having regard to the increased demand for the acid in connection with vermin destruction, of ensuring" that the process of manufacture shall be prevented from falling into the hands of inexperienced persons. In his note on certifying factory surgeons it is interesting to find Dr. Bridge making mention of the fact that certifying factory surgeons have wonderful opportunities of " otSserving conditions which would not only be of interest but also of value in estimating general conditions of fitness for employment exhibited from year to year by those entering industry," and regretting that the practice of supplementing their annual returns by personal observations is only rarely adopted. As sources of information the certifying surgeons would probably be unequalled, and if Dr. Bridge only could secure reports from them his own would probably be longer and possibly even more fascinating than it is at present. This would be a splendid thing, though so far as interest and fascination go there is no ground for complaint with the report as it stands.
89
Iodine in Biological Substances. known that the element iodine I Tplaysis well a very important part in the metabolism of the body, and particularly in relation Io tile functions of the thyroid gland. The quantities involved are nevertheless exceedingly minute, and study o,f the suhject is lmmpered bv the difficulty of estimating them with accuracy in complex biological substances. The chief need is for a reliable method of chemical analysis for the purpose, and to meet lhis the Medical Research Council, having secured the co-operation of the Government Chemist, Sir Robert Robertson, F.R.S., and a donation towards the expenses, arranged that special investigations should be carried out by Mr. C. O. Harvey, B.SC., A.mC.S., ,~A.C., a member of Sir Robert Robertson's staff. In a report recently issued by the Medical Research Council* Mr. H a r v e y gives the results of his work and describes the methods he has devised for determining small quanlilies of iodine in biological substances. Following practical trial by other workers, the method is shown to be capable of giving consistent results when parts of the same specimen are tested by independent analysts. Promotion of further work on iodine in relation to the nutrition and health of man and animals, in which Mr. H a r v e y ' s method is likely to prove useful, has been e ~rusted to a new committee on iodine deficiency and thyroid disease, appointed jointly by the Medical Research Council and the Agricultural Research Council. Further, since it is now known not only that iodine plays an important r61e both physiologically and therapeutically in hyperthyroidism, but that the blood content of iodine in hyperthyroidism is very high as compared with the normal, a reliable method of estimating the iodine content of the blood such as this, it is believed, may permit a new kind of attack to be made by persons engaged in the investigation of hyperthyroidism.
Papworth Village Settlement. P W ' O R T H Village Settlement has re p Aceived so much, though not undeserved, publicity that the Report of the Committee 'If'rilE DETERMINATION OF IODINE IN ]]IOLOGICAL SUBSTANCES. Special Reports Series, No. 201. H.]V[. Stationery Office, 1935. Price ls. net.