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and even to improve the child dental health in
this country.
Staff Health Service
In the first (1967) report of the service the basic
components of a staff health service were set
out as the supervision of the health of staff the
supervision of the working environment and health
counselling. The work of the service during 1968
will be described under these headings -
Supervision of the health of staff.
The number of medical examinations of new staff
increased slightly and formed a little more than
one fifth of the total number of assessments
obtained from the completion of a medical questionnaire
While it is desirable to have a medical
base line for most employees routine examinations
is uneconomic of medical time and selec
tion is carried out on the basis of medical
history occupation hazard and age of the worker.
A system of medically examining registered
disabled persons and workers with an occupational
hazard at regular intervals was established
An increasing number of follow up medical examinations
were carried out. The value of these
examinations became very evident in members of
staff suffering from chronic illness where working
conditions and methods may need to be modified
in accordance with the workers physical and
mental state
People returning to work after prolonged
illness require careful rehabilitation A system
whereby such cases were notified to the service
before the persons returned to work was set up
in order that rehabilitation measures could be
carried out under medical supervision, The most
difficult cases in this respect are those due to
ischaemic heart disease where a nice balance
between progressive activity and avoidance of
cardiac symptoms has to be maintained. Some of
these patients need supportive therapy for a
prolonged period if cardiac neurosis is to be
avoided.
The supervision of the working environment
The annual survey of chemical substances used
by employees brought to light several toxic com
pounds in regular use The first of these was
ortho-tolidine a colour indicator used in the
estimation of the chlorine concentration in
swimming pool water This compound is now
recognised as a bladder carcinogen. The operators
carrying out these chlorine estimations now use an
alternative method where no known toxic substances
have to be employed in carrying out the test.
A workman employed spraying a herbicide on to
weeds growing between pavement stones, became
ill after several weeks of this work The herbicide
contained paraquat (dimethyl bipyridylium) and
diquat (dihydro diazoniaphenanthrene) He complained
of nausea and abdominal pain but has no respiratory
or neurological symptoms or signs In view of this
toxicity from the herbicide was not suspected and
his condition resolved while away from work but
returned as soon as he began using the herbicide
again. He was taken off this work and has not had
any further symptoms.
It is not generally realised that gastric irritation
can be caused from chemical substances used in
spray form going into solution in the saliva and being
swallowed. Persons carrying out spraying using
insecticides and herbicides in the open should spray
down-wind not into the wind thereby avoiding
inhalation and ingestion of the toxic chemicals
Industrial dusts can cause other conditions
besides the pneumoconioses. A rodent operator com
plained of epistaxes when using warfarin a blood
anticoagulant, as a rodenticide He was in the habit
of mixing the rat bait each evening always taking
care to wash his hands following this operation
The warfarin powder was mixed with oatmeal in a
bowl and it was evident that he was inhaling warfarin
dust through the nose. Inhalation of all dusts in harm
ful to the respiratory tract to a lesser or greater degree
Employees cannot be expected to use dust masks
satisfactorily they are uncomfortable and always
liable to be misplaced Adequate cowling and exhaust
extraction should be installed in all processes giving
off dust into the working environment
Because of the continual introduction of new
chemicals into industrial processes a constant look
out has to be kept for substances that are physio
logical irritants and may in the long term prove
carcinogenic.
Health counselling
An occupational health service should be orientated
towards preventing disease To achieve this end it
is necessary to communicate certain occupational
health principles to workers A system of issuing
staff health circulars at regular intervals was started
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