—In various codes of regulations a surgeon is required to make periodical medical examination of the workers. The term “surgeon” is defined as the “Certifying Factory Surgeon of the district, or a duly qualified medical practitioner, appointed by written certificate of the Chief Inspector of Factories, which appointment shall be subject to such conditions as may be specified in that certificate.” The wording of the regulation varies somewhat in different codes, but the intention in all is the same, and the following example from the Tinning Regulations will indicate the purpose and scope:
“Every person employed in tinning shall be examined by the surgeon once in every three months (or at such shorter or longer intervals as may be prescribed in writing by the Chief Inspector of Factories), on a day of which due notice shall be given to all concerned. The surgeon shall have the power of suspension as regards all persons employed in tinning, and no such person after suspension shall be employed in tinning without written sanction from the surgeon entered in the health register.
“Every person employed in tinning shall present himself at the appointed time for examination by the surgeon. No person employed in tinning shall, after suspension, work at tinning without written sanction from the surgeon entered in the health register.”
Under the Special Rules for white-lead works, examination is required at weekly intervals; under the Special Rules for Earthenware and China, Manufacture of Litho-Transfers and Red Lead, and under the Regulations for Electric Accumulators, and Paints and Colours, monthly; under the Regulations for Tinning, Yarn dyed with Chromate of Lead, and Enamelling, at quarterly intervals, subject to the limitation or extension specified in the regulation quoted.
The limitation as to quarterly examination is useful to meet conditions, on the one hand, where special incidence calls for increased safeguards; and, on the other, relaxation, by reason of adoption of special processes or measures lessening risk. Thus, in a yarn-dyeing factory, in consequence of occurrence of six cases within five months, a weekly instead of a quarterly examination was prescribed. After eight months, as no further cases were reported, a monthly examination was substituted for the weekly, and eventually, with continued absence of illness, the normal quarterly examination was resumed.
An appointed time for the surgeon’s attendance at the factory has been found necessary, because, in conformity with the literal wording of the regulation, the occupier should not continue to employ a worker who, for one reason or another, has not been examined by the surgeon during the prescribed interval. With knowledge of the date and hour posted in a conspicuous place in the factory, excuse for absence becomes difficult. Alteration by the surgeon of his appointed time should, whenever possible, be given beforehand. Surgeons in the past frequently made examination of the persons employed with the view of taking them unawares, and so of precluding special preparation beforehand—a practice which had its advantages; but they are outweighed by the hardship inflicted on workers who were unavoidably absent, as, for example, night-workers. A health register is supplied to all occupiers where periodical medical examination is enjoined, the headings of which and manner of entry are indicated later on in this chapter.
The objects which the surgeon should have in mind in making his examination are:
1. To prevent lead poisoning and minimize lead absorption.
2. To obtain information for the occupier and Inspector of Factories of the relative danger of one process and another with a view to adoption of remedial measures.
In safeguarding the health of the workers, he should make effort to gain their confidence, in order to be able to attach proper value to statement as to subjective symptoms. Suspicion in their minds that the examination is made solely in the interests of the employer militates against success, and increases inclination to conceal symptoms and to give untruthful answers as to the state of health since the last examination. In our opinion, the surgeon will best carry out the first object by attention to the second. The study of thousands of reports on cases of lead poisoning convinces us that 90 per cent. at least are due to inhalation of dust and fumes. The surgeon, therefore, should utilize the earliest sign of lead absorption to warn the occupier and inspector of conditions favourable to the development of plumbism, and due probably either to some unguarded spot in the manufacturing process whereby dust or fumes are not being removed completely, or to ignorance or carelessness (often excusable in the absence of proper instruction) on the part of the worker. He should direct, therefore, especial attention to new workers, not only because of their need for guidance as to precautions to be observed and greater liability to attack during the first year of employment, but also because development of signs in them constitutes the surest guide to defects in the process of manufacture. Occasionally symptoms in a worker may be so menacing as to demand immediate suspension, but generally before the power is exercised attempt to rectify the condition which gives rise to them should be made. The surgeon can do much by influencing the foremen and forewomen, who will necessarily come before him for examination, in insisting on the supervision by them of care and cleanliness by the workpeople under their charge. Should suspension, despite attention in the manner suggested, be necessary, he will recognize that transference to a non-lead process, if feasible, is preferable to entire cessation from work in very many cases. The surgeon, therefore, should know what departments are possible alternatives to lead work.