Occupational Health Practice

475 Pages·1973·8.706 MB·English

by  R. S. F. Schilling (Eds.)

Occupational
Health
Practice
Edited by
R. S. F. Schilling
M.D., D.Sc, F.R.C.P., D.P.H., D.I.H.
Professor of Occupational Health,
University of London, and
Director of TUC Centenary Institute of
Occupational Health,
London School of Hygiene and Tropical
Medicine
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First published 1973
Reprinted 1975, 1977, 1978
Italian translation in preparation
© Butterworth & Co (Publishers) Ltd 1973
ISBN 0 407 33700 8
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Contributors
P. Branton, B.A., M.Phil., Dip.Soc.Sci.
Ergonomist to the British Railways Board
Alexis Brook, M.A., M.B., B.Chir., M.R.CPsych., D.P.M.
Consultant Psychiatrist, Tavistock Clinic;
Senior Lecturer in Psychotherapy, St. Bartholomew's Hospital;
Consultant in Mental Health, London Borough of Islington
G. W. Crockford, B.Sc, M.I.Biol.
Senior Lecturer in Environmental Hygiene,
TUC Centenary Institute of Occupational Health,
London School of Hygiene and Tropical Medicine
A. Ward Gardner, M.D., D.I.H.
Medical Officer, Esso Petroleum Co. Ltd.,
Fawley, Hants
Suzette Gauvain, M.A., M.R.C.S., L.R.CP., D.P.H., D.I.H.
Senior Lecturer in Occupational Health,
TUC Centenary Institute of Occupational Health,
London School of Hygiene and Tropical Medicine
S. A. Hall, M.B., B.S., D.P.H., D.I.H., Dip.Occ.Hyg.
Senior Lecturer in Occupational Hygiene,
TUC Centenary Institute of Occupational Health,
London School of Hygiene and Tropical Medicine
J. M. Harrington, M.Sc, M.B., B.S., M.R.C.P.
Lecturer in Occupational Medicine,
TUC Centenary Institute of Occupational Health,
London School of Hygiene and Tropical Medicine
vii
CONTRIBUTORS
W. T. Jones, M.D., D.P.H., D.I.H.
Senior Lecturer and Physician in Charge,
Information and Advisory Service,
TUC Centenary Institute of Occupational Health,
London School of Hygiene and Tropical Medicine
Robert Murray, B.Sc, M.B., Ch.B., F.R.C.P.(Glas.), D.P.H., D.I.H.
Medical Adviser to the Trades Union Congress; Part-time Lecturer,
TUC Centenary Institute of Occupational Health,
London School of Hygiene and Tropical Medicine
Muriel L. Newhouse, M.D., F.R.C.P.
Reader in Occupational Medicine,
TUC Centenary Institute of Occupational Health,
London School of Hygiene and Tropical Medicine
S. J. Pocock, M.A., M.Sc, Ph.D.
Visiting Fellow, State University of New York, Buffalo; Formerly
Statistician, TUC Centenary Institute of Occupational Health,
London School of Hygiene and Tropical Medicine
P. A. B. Raffle, M.D., M.R.C.P., D.P.H., D.I.H.
Chief Medical Officer,
London Transport Executive
S. A. Roach, Ph.D., Dip.Occ.Hyg.
Commonwealth Smelting Ltd., Bristol;
Formerly Reader in Occupational Hygiene,
TUC Centenary Institute of Occupational Health,
London School of Hygiene and Tropical Medicine
R. S. F. Schilling, M.D., D.Sc, F.R.C.P., D.P.H., D.I.H.
Professor of Occupational Health, University of London, and
Director of TUC Centenary Institute of Occupational Health,
London School of Hygiene and Tropical Medicine
R. Sergean,M.A.
Postgraduate School of Librarianship and Information Science,
University of Sheffield; Formerly Occupational Psychologist,
TUC Centenary Institute of Occupational Health,
London School of Hygiene and Tropical Medicine
Vlll
CONTRIBUTORS
P. J. Taylor, B.Sc, M.D., F.R.C.P., D.I.H.
Chief Medical Officer, The Post Office; Formerly Deputy Director,
TUC Centenary Institute of Occupational Health,
London School of Hygiene and Tropical Medicine
M. L. Thomson, B.Sc, Ph.D., M.B., B.Ch.
Reader in Applied Physiology,
TUC Centenary Institute of Occupational Health,
London School of Hygiene and Tropical Medicine
Joan Walford, A.I.S.
Statistician, TUC Centenary Institute of Occupational Health,
London School of Hygiene and Tropical Medicine
H. Beric Wright, M.B., F.R.C.S.
Director of Medical Services, British United Provident Association;
Honorary Medical Adviser, Institute of Directors
ix
Preface
The need for a book describing what the physician, hygienist and nurse
actually do to protect and improve the health of people at work has
become increasingly obvious to the staff of this Institute. Although
many books have been written on occupational health, there are none
in English which deal comprehensively with its practice. We teach the
principles of occupational health practice to postgraduate students in
occupational medicine, nursing and hygiene, and the lack of a standard
work of reference has made the task of both teaching and learning more
difficult.
Our academic staff and visiting lecturers have attempted to fill
this gap which is repeatedly brought to our notice by students.
While our primary aim is to meet a need in formal course programmes
it is hoped that the book may also be useful to the many whose
interests encompass occupational health but who cannot attend a
course, and that it will be of some value to medical and non-medical
specialists in related fields.
Our students come from all over the world, many from countries
undergoing rapid industrialization. We have therefore tried as far as
possible to offer a comprehensive, up-to-date, account of occupational
health practice, with some emphasis on the special needs of work people
in developing countries. Eastern European countries attach great
importance to occupational health and provide comprehensive occ-
upational health services and training programmes. We refer to their
methods of practice and training as well as to those of the western world
because we believe both East and West have much to learn from each
other,and the developing countries from both.Terms such as occupational
health, medicine and hygiene often have different meanings, particularly
in the eastern and western hemispheres. Occupational health in the
context of this book comprises two main disciplines: occupational
medicine, which is concerned primarily with man and the influence of
work on his health; and occupational hygiene, which is concerned
XI
PREFACE
primarily with the measurement, assessment and control of man's
working environment. These two disciplines are complementary and
physicians, hygienists, nurses and safety officers all have a part to play
in recognizing, assessing and controlling hazards to health. The terms
industrial health, medicine and hygiene have a restricted meaning, are
obsolescent, and are not used by us.
The three opening chapters are introductory; the first gives an
account of national developments, contrasts the different forms of
service provided by private enterprise and the State; and discusses
factors which influence a nation or an industrial organization to pay
attention to the health of people at work. The second is about man's
work and his health. Everyone responsible for patients needs to realize
how work may give rise to disease, and how a patient's ill health may
affect his ability to work efficiently and safely. It is as important for
the general practitioner or hospital consultant as it is for the occupational
physician to be aware of the relationship between work and health.
The third chapter outlines the functions of an occupational health
service. The chapters which follow describe in more detail the main
functions, such as the provision of treatment services, routine and
special medical examinations, including 'well person' screening, psycho-
social factors in the working environment and the mental health of
people at work. There are chapters on occupational safety and the
prevention of accidents and occupational disease which are often the
most important tasks facing an occupational health service. Methods
used in the study of groups of workers are outlined in sections on
epidemiology, field surveys and the collection and handling of sickness
absence data; these chapters are of special importance, as it is
essential that those practising occupational health think in terms
of 'groups' and not just of the individual worker. Epidemiological
expertise enables this extra dimension to be added to the investigation
and control of accidents and illness at work.
One chapter is devoted to ergonomics while five on occupational
hygiene deal with the physical and thermal environments, airborne
contaminants, industrial ventilation and protective equipment and
clothing. There are concluding chapters on ethics and education in
occupational health. Undergraduates in medicine and other sciences
frequently lack adequate teaching on this subject and we hope that this
book may be useful to them and their teachers.
Although it is not possible to cover fully the practice of occupational
health in 450 pages, we hope to convey the broad outlines of the
subject to a wide variety of people.
I owe many thanks to many people for help in producing this book,
especially to the contributors and to those who assisted them in preparing
xu
PREFACE
their manuscripts, and to the publishers for their patience and under-
standing. For the illustrations I am particularly grateful to Mr. C. J.
Webb, Miss Anne Caisley and Miss Juliet Stanwell Smith of the Visual
Aids Department at the London School of Hygiene and Tropical
Medicine, and also to the Wellcome Institute of the History of Medicine,
to the Editors of many journals, and to Professors Kundiev and
SanoyskioftheUSSR.
Manuscripts were read by members of the Institute staff and others
who made valuable suggestions; the latter include Professor Gordon
Atherley, Professor R. C. Browne, Dr. J. Gallagher, Dr. J. C. Graham,
Dr. Wister Meigs, Mr. Wright Miller, Mr. Andrew Papworth, Miss Brenda
Slaney, Professor F. Valic, my wife and my daughter Mrs. Erica
Hunningher — I am indebted to them all; I am also grateful to Dr. Gerald
Keatinge and Dr. Dilys Thomas for reading proofs, and to my secretary,
Miss Catherine Burling, for her help and enthusiasm throughout the long
period of preparation.
R.S.F.S.
Xlll
Foreword
Occupational health is a field which is growing rapidly all over the
world. Its objectives have gradually broadened from dealing mainly
with occupational hazards causing accidents and occupational disease to
include all kinds of factors at work or related to working conditions
that may cause or contribute to disease or deviation from health.
The activities of occupational health services have changed and their
scope is now much wider than before, not only preventing occupational
hazards but also promoting the general health of the worker and the
adjustment of work to man and of man to work. Occupational health
services are now expanding from industrial undertakings to all places of
employment, such as offices, agriculture, forestry and transport.
The basic problems of occupational health and of occupational
health services are the same or very similar in different countries.
The practical solutions, however, may be different as many local factors
have to be considered, such as the administration, the development of
medical care and public health in the country concerned.
In many countries there is a great need for practical information
on occupational health practice. Professor Richard Schilling and his staff
at the TUC Centenary Institute of Occupational Health in the London
School of Hygiene and Tropical Medicine, have international experience
in this field from working in different countries as WHO consultants and
as members of international research groups; they also have experience
derived from the training and education of postgraduates from many
countries. This book will meet the great need for information in this
rapidly expanding field all over the world, and will be of the greatest
value in promoting the development of occupational health.
Sven Forssman
XV
/ - Developments in Occupational
Health
Λ. S. F. Schilling
History offers a stimulus of imagination and understanding
which can enrich a man's life by deeper insights into
human behaviour. It is perhaps the greatest humanist
medium of our time, educational and cultural.
David Thomson (1969)
Both ancient and modern societies have been slow to recognize and
control the health hazards associated with work. Sigerist (1943), the
medical historian, tells us that a history of developments in occupational
health will help to reveal the factors involved - those that retard and
those that accelerate developments, and so enable a modern society to
act more intelligently and pave the way into the future.
AGE OF ANTIQUITY
Mining is one of the oldest industries and has always been a hazardous
occupation. Conditions in the gold, silver and lead mines of ancient
Greece and Egypt have been described and they reveal an almost complete
disregard for miners' health and safety (Rosen, 1943). Since the miner
of antiquity was a slave, prisoner or criminal there was no reason to
improve his working conditions. Indeed, the reverse was true, because
one of the objectives was punishment and there were ample reserves of
manpower to replace the injured men. One of the earliest references to
the control of hazards is in the second century AD during the Roman
period. Miners at that time enveloped themselves in bags and sacks, and
used bladders to cover their mouths as a protection against dust inhala-
tion (Legge, 1936).
1