PART II.

+----------+------------+---------+---------------------+---------+ | | | | Particulars of any | | | | | | Directions given by | | | | | |the Surgeon. Any Cer-| | | | | | tificate of Suspen- | | | Reference| | | sion or Certificate | | |to Part 1.| |Number of|permitting Resumption|Signature| +-----+----+ Date of | Persons | of Work must be | of | |Page.|Col.|Examination.|Examined.|entered here in full.| Surgeon.| +-----+----+------------+---------+---------------------+---------+ | (1) | (2)| (3) | (4) | (5) | (6) | | | | | | | | | | | | | | | | | | | | | | | | | | | | | +-----+----+------------+---------+---------------------+---------+

In Part I. of the register the surgeon should, at the times of examination, enter the date at the head of one of the columns numbered 6 to 9; and in the space below, opposite the name of each person examined on that date, a brief note (see next page) of the condition found.

In Part II. he should again enter, in Column 3, the date of examination, with a statement of the total numbers examined on that occasion (Column 4); and in Column 5 any certificate of suspension from work, or certificate permitting resumption of work, and particulars of any other direction given by him, appending his signature in Column 6.

It is the duty of the occupier to enter in Part I. the following particulars with regard to each person examined: (1) Name in full (Column 2); (2) the process in which he or she is employed (Column 3); (3) age when first employed (Column 4); and (4) date of first employment in that process (Column 5); and these particulars, in respect of each person so employed, must be entered immediately on commencement of work in the process named.

Various methods of noting the state of health of the workers have been adopted. Use of the words “Good,” “Very fair,” and “Fair,” is common as indicating the state of general health, with special note in addition, often in the form of a symbol, of the presence and character of definite ill-effects. The object of the register, however, is to keep a record intelligible not only to the Certifying Surgeon, Factory Inspector, and occupier, but also to the workers. Entries, therefore, on a uniform system are desirable, taking account of the two aspects of the health of every lead-worker, which must be considered (a) that indicative of specific effects from the occupation, and (b) that of general health uninfluenced by the employment. With this in mind, the following system of entry in the health register has been adopted:

The entries should be made upon a uniform system, as below, indicating degrees of deviation from normal health, and distinguishing (by use of numerals) those attributable (or possibly attributable, in whole or part) to work in lead, from those not so attributable, for which latter letters should be used. The conclusion is perhaps best expressed as a fraction

1 2 ---, ---, A C

and so on.

The numerals should be taken to mean:

1. Passed without comment (no observed effect of lead).

2. Blue line (or indication thereof).

3. Marked (quasi-pathognomonic) anæmia, or other signs of impairment of health. (Albuminuria, or slight deficiency in tone of the extensor muscles of the forearm, would, and miscarriage, or other suspicious history of illness between examinations, might, come under this head.)

4. Suspension or transfer, by reason of impairment of health from effects of work in lead. (In such cases the surgeon would be prepared to entertain an application for a certificate under the Workmen’s Compensation Act.)

Except in the case of a worker whose exposure to lead is only recent, renal disease should always be indicated by a numeral.

Letters should bear the following meaning:

A. No comment (i.e., fair general health).

B., C. Increasing degrees of impairment of general health. (Pregnancy, if without suspension, should be entered as C.)

D. Suspension or transfer, for reasons other than impairment of health from effects of work in lead.

X. Carelessness, or neglect of precautions, or unsuitability for work in lead. (Suspensions for such reasons should be marked DX.)

Such entries of numerals and letters will in general suffice for the intended purpose; but the surgeon may, of course, find it desirable to make other notes for his own information, and it is within his discretion to supply further details to occupiers or workers concerned.

REFERENCES.

, S. KING ALCOCK, B. M. BOND, A. SCOTT and others, in discussion on the Value of Systematic Examination of Workers in Dangerous Trades. Brit. Med. Journ., vol. ii., pp. 741-749, 1902.

KING ALCOCK: The Early Diagnosis of Industrial Lead Poisoning. Paper contributed to the Second International Congress for the Study of Industrial Diseases held at Brussels, 1910.