Document 5Da3YYq59n5kjXm6jNL6Gm6q0

TO* MIMCM 1UUXT1H 9. The purposes and acts involved in exnminutinn of job applicants and employees varies with the employer involved. For information, see Guiding Principles of Medical Examinations in Industry, nn AMA publication; niso Occupational Health Services for' Employees, n pamphlet published by the Department of Health, Education omi Welfare, which is intended to be a guide for state and local govern ment health programs. 10. 101 N.J. Law R. 400,130 A. 9 (1925). 11. 362 Pa. 596, 08 &.2d 595 (1949). 12. 235 Mo.App. 594,144 S.W.2d 850 (1940). 13. 209 S.C. 463, 40 S.E.2d 681 (1946). 14. 108Cal. App.591,291 P.848 (1930). 15. Section 54 of Prosser on Torts points out that a mere gratuitous prom ise to render service, without more, imposes no tort liability; but three cases, Marsalis o. LaSalle, (La. App.) 94 So.2d 120 (1957); Dudley t>. Victor Lynn Lines, 48 N.J. Super. 457,138 A.2d 53 (1958); and lohnson v. Souza, 71 N.J. Super. 240, 176 A.2d 797 (1901), lay down the nile that reliance by a plaintiff on a defendants promiso gives rise to liability. Hypothetically, If a non-treating physician were to mike a promise concerning the discovery of an examinee's disorders, would a cause of action arise from a failure to do so? 10. 273 FJ2d 232 (1956). 17. This Information was obtnined from Dr. Frederic R. Steams, medi cal director of Security Benefit Life Insurance Co., until his recent retirement, and present medical director nf Inland Life Insurance Co. of America, and Mr. Warren C. Van der Voort of the Von der Voort Associates of Chicago. 18. 134 F.Supp. 554 (1955), 19. 183 MJss. 659, 184 So. 426 (1938). ate METHODS OF SURVEYING TOXIC EXPOSURE IN OCCUPATIONAL ENVIRONMENT* JAMES W. HAMMOND Humble Oil & Refining Company In many cases Industrial operations muy be in a questionable health hazard category, depending, of course, nn the level of the occupational exposure. Improved plant control may be costly and naturally manage ment will want proof that it is needed. The tests which can be made to evaluate health hazards in the work place are the subject of this dlscussion. lt U Imped that this discussion will be helpful in those situations where the physician sees the employee-patient before the physicinn has firsthand knowledge of the industrial environment or plant operations. He may need information on materials handled, atmospheric concentra tions, skin contact while patient is on the job, and Information on other job-related conditions nnd exposures. The Council on Occupational Health has In print a revision*1 of "The Survey of the Occupational Environment" which was first published in . 1950. It is one of your guides on good prnctice of medicine in Industry, nnd its contents serve m a bench mark for the subject matter of tills' paper. It explains first the Importance of getting Informed on work areas nnd second, how to do this. All interested In Industrial medicine may profit by reviewing It because It discussed management-physician rela tionship, plant tours nnd the purpose of work area surveys and how to recognize potential health hazards. It stresses the Importance of explain ing thu survey findings and interpretations hy tho physician in terms understood both by the management nnd employees. In other words, tho need for clear communications In this area is fully emphasized. Where the plant has no industrial hygienist, such services arc avail able through normal channels from tho official departments of Industrial health or hygiene in many states und In certain city and county health departments. Some casually insurance companies, various research organi zations and university departments of Industrial medicine and hygiene as well as many private laboratories nnd consultants are also available for these professional services. `Presented at the 24tlj Annual AMA Cnngrau mi (Vciinat/miul Hcallli, Hmishm. Tram. IWW. 1 Nmv nvnllitble. ' E NO 03 03 5 EXX-MOR-003142 mi MIMCM IUUITIN Heiuhs of proper Industrial hygiene field and laboratory tests are always helpful and oftentimes necessary to differentiate occupational diseases from others. In many industrial situations, the best action may be to recommend that the plant avail Itself of expert professional survey services. A good knowledge on the part of the physician aj to why the plant survey is Important makes it easier to convince management to nccept this cost. Survey tests might include quantitatively measuring atmospheric chemical contaminants, the physical conditions and physi cal agents or any port of these, along with other measurements where needed to recommend methods of control. Usually the physician may also need blood, urine, or nlher body fluids analyses, depending on sub stances handled nod workroom conditions. Findings from this type of study or survey serve for tlie basis of. a sound preventive occupational disease program. It is obvious that the physician's experience in the Interpretation of the plant survey results and knowledge of control measures being employed permit him to give specific pre-placement and periodic examinations. Where the raw materials or substances handled by the industrial em ployee or your patient are received in packages, these containers very often are labeled as to their hazardous nature. Texts of cautionary labels will likely explain the chief health danger and may give pertinent In formation in acute exposure cases to guide one on first nid measures. From the text on ti well-written label, the type of test to have made to evaluate occupational factors In the case will be brought' to mind. To keep this discussion of (lie method of surveying exposure in occu pational environment within a reasonable length, all Interpretations and conclusions of analytical data will be limited to reactions of "normal" workers. The yardstick to be applied In evaluating exposures and plant conditions Is the Threshold Limits Values reviewed and republished annually by the American Conference of Governmental Industrial Ilygleslsts. Without further discussion, It is generally recognized that there are differences of opinion on the value of these bench marks or standards and the fact that they are under constant study and are occasionally m MtTWODI Of SUIVSTHO IOXIC KXfOSUU IN OCCUPAnONAl IHVUOHMINI changed would Justify reservation on their full acceptance. However, hi their defense are many years of industrial application with few cases of occupational diseases developing under exposure conditions where these standards have governed. Also, they are practical levels which can be attained by ventilation and operation measures. The methods to be used In an industrial hygiene survey of a plant will depend on the materials under study. For example, in exposures to min eral dust such ns slllcn, asbestos nnd talc, the sample Is collected In the breathing zone of workmen with a standard Impinger, The dust particles are counted by light field technique. This method has been standardized and is recognized by mflny state workmen's compensation boards. The resulting count is compared to the number set by A.C.G.I.H. The TLV Is based on clinical findings In personnel who had prolonged occupational exposure to dust concentrations of known levels and definite chemical composition. We are dependent here on the air sampling equipment and the counting technique for our plant appraisal. There are no usual bio chemical laboratory testj to evaluate dust exposure sooner than the ap pearance of X-ray markings of dust deposit In the chest or the discharge `of asbestos bodies In case of asbestos exposure, Pneumonosls-causlng mineral dusts are characterized generally by their physical and chemical inertness. In many cases of industrial exposure to substances, it is both accurate and feasible to use the employee or patient's excretion or body fluids as well as the plant survey results to measure occupational exposure levels. In these situations, the workman may serve as an integrated sampler. Data thus obtained have some advantages over air testj in that they Indicate averaged past exposures for days or even weeks; and they reflect body intake by any or all routes of entry; Inhalation, skin absorption and swallowing. These substances Include Iienzol or benzene (using sulfate rntlo or phenol content), methanol or methyl nlailtol and many intirgunlc elements. Some specific heavy metals are good examples of substances that may be checked by this approach. The methods of measuring toxic exposure in air for LEAD compounds are well established. EMO 03 03 6 EXX-MOR-003143 THf MlMCAi UJUXTIM Urinalysis /or lead Is specific and blood analysis Is specific being di rectly related to the level of exposure. --mu wuo uu nwim *ui n uu ti ut MfTHODI OP IUIVITNO TOXIC EXfOJUU IN OCCUPATION*! INVIIOHMINT PAINTERS SHOWING SIGNIFICANT URINARY LEAD VALUES Baytown Refinery Paint Department NiMan or nuNTcni lwd-bvi (Employee In Group I a 2) Porphyrin Is helpful but not specific for lead exposure and also stippled cell count ii helpful but not specific. Their advantage Is that these tests ore quickly and easily made. Interpretation of urinary values in light of specific gravity Is helpful. One milligram per liter of lead Is upward limit for excretion from chronic Industrial type of exposure. Cadmium excretion limits ore lower; whereas mercury, arsenic, fluoride and selenium are excreted in higher concen trations than lead, following severe occupational exposures. To illustrate the relationship between field conditions and urinary lead values in a major plant paint department over an S-year period, we have it shown graphically in Chart II. The exposure Which was brought into control has since been kept there. Air samples for lead are still necessury and today these may be col lected in the workroom and analyzed in the field by modem kits which are readily available. The dlthlxone colorimetric method is commonly used in these and the laboratory lead tests ns well. ' MERCURY In most forms or compounds Is easily measured by n Mercury Vapor Detector. It measures the air concentration of mercury vapors by ultra violet light absorption. Direct reading colorimetric tubes nre nvulluble In tho last few years. Stable or nonvolatile mercury dust must be measured by the collection on paper filter In an Impinger tube or other collector of particulate matters. Urinalysis for mercury Is specific and blood analysis is specific, show ing a quantitative relationship to occupational exposure. EM003037 EXX-MOR-003144 THK MfMCAl RUUITIN Mercury Is more readily excreted by the kidneys than lead; therefore, the ratio of excreted mercury to absorbed mercury is higher than in the caso of lead. DUhizone colorimetric and electropreclpitatlnn are both commonly used laboratory methods for mercury determination. For CADMIUM evaluation the urinalysis Is specific and the dithlzone method is generally used. Because the industrial usage of cadmium has been limited, there are not much data to permit correlation of cadmium In the environment to urinary values. NICKEL --only nickel carbonyl Is considered where urinalysis is spe cific. Also the analysis of hair for nickel deposit or accumulation is specific. The test is generally made colnrimetricaily with potassium dithloxainlo reagent. U is a sensitive method which is needed for nickel because low amounts are significant. To evaluate solid ARSENIC compounds the urinalysis for arsenic Is specifio and the analyses of hair and fingernails are specific. Arsenic may be found In the hair for several months after exposure has ceased. ARSENIC CONCENTRATION EH00303S MfTHOD! Of tUtVTTNO TOXIC IXFOSUU IH OCCUfATlONAl IHV1IOHM1NT Chart III shows the laboratory results on hair mid nails from n patient who was receiving arsenic from some unidentified source over a Q-yeor period. The Cutzeit method Is both accurate and sensitive for all types of arsenic samples when prepared properly. ARSINE is a highly toxic gas released from acid reaction on metals containing arsenic in trace to large quantities. Urinalysis for arsenic (s specific for evaluating arsine exposure ami also analyses of hair and fingemuiis are specific for arsenic which readily accumulates where anine exposure is experienced. Normal, significant and dangerous ranges: Any detectable arsenic in urine, hnlr, nnd fingernails following exposure to ursine signifies danger. Suggested limit Is 0.5 mgm. arsenic per liter In urine, > 0.4 mgm. arsenic per liter suggested for Lewisite exposure. Data on intake and excretion of MANGANESE are not so well estab lished as the metats previously discussed. Urinalysis for manganese is specific but only positive while exposure is continuing. Blood analysis is specific and shows manganese longer Ilian urine does after exposure ceases. The colorimetric method with strong oxidizing reagent is generally used. SELENIUM is u highly toxic inutai hut seldom found in the industrial environment. Urinalysis for selenium Is specific and the method of choice is the colorimetric one with hydroxylamine reagent. Occupational exjiosurfl to many other substances besides metals can be evaluated by the biochemical technique. Among the nnnmctalilc chemicals of Importance to industrial medicine are FLUORINE compounds. Urinalysis for fiuorlde Is specific and the thorium nitrate titration method is accurate in tire hands of a good nnulyst, CARBON MONOXIDE Is released in some level whenever fuel is burned under Industrial conditions. It may bo measured in the air by available detector kits which give tho results on the spot. 1HI ftUMCAl lUUniN flit**) mmlyjb for curium monoxide with hemoglobin I* positive nnd reflects recent occupational exposure. Pyrotannlc acid nnd reagent of sodium hyposulfite, saponlne with sodium oxalate may be employed as reagent. . BENZENE or benzol may be checked In the air by detector kit reagenU that are readily available. Also urinalysis for Inorganic sulfates rutlu to total sulfate Is specific within four hours after exposure ceases. Sjredmen should lw collected near the end of work period but before the expiration period has passed. This test must be made soon after the specimen is obtained. Tire phenol urinary test is also commonly used today and Is an accurule method, having the advantage over the sulfate test In that It Is possible to keep the sample for a longer period before analyzing It. Among other chmmon Industrial substance* which may be measured either by air sampling or by urinalysis ore the following list: Trichloroethylene Carlton disulfide Dlnitm-a-cresol Phenol Bromine Methyl Alcohol Vanadium Xylldlne Aniline Toluene Organic Anime Naphthalene Organic Insecticides Beryllium Physical agents such as noise, radiation, etc., are read or recorded directly by portable Instrumentation. , , Conclusion The measurement or evaluation of exposure to chemical and physical agents which nre potential health hazards has been discussed briefly, ft is necessary to explain that by confining this discussion to the quantita tive measurement of exposure levels, there has been no room to describe n full Industrial hygiene investigative procedure or plant survey. That would have encompassed n much longer discussion of the detection, im'iiiiirement, evaluation and engineering control of the environmental agent. wthooi or suxvirwq toxic ixfcuuii in occumoonai invuohauht With all due respect to the methods herein described, without which there could not have been established the ma/nr number of exposure criteria, It Is the correlation of quantitative human exposure dnta with observed clinical effect! in humans which In turn determines the need for engineering control. That is the proving ground of exposure criteria or indeed the proving ground of our environmental hygiene program. The physician in hit clinic determines If it is effective nnd adequate, and the design engineer may work within closer economic limit with assurance. Instruments or air sampling devices ore: 1. Implnger for mineral dust, soluble organic vapors or gases, in* organic oxides, salts, and aerosols or mists. 2. Combustible gas Indicator for combustible gases. It Is relatively insensitive and nonselectlve. 3. Gas Indicators for HiS, CO, Hg., etc. 4. Gns detector with reagent tubes for 50 nr more common industrial hazardous substances. 5. Test paper methods for direct rending Indicators nf several gnsrs and vApors. 6. Filtering device fnr collecting samples that arc checked in the laboratory. 7. Electric precipitation for collecting of particles of samples In hr tested in the laboratory. EM003039 sir EXX-MOR fHI MIMCAI lUlifTlH 8. Absorbing devices (bubblers, silica gel, and charcoal) for gnaes and aerosols samples, 9. Crab sample devices (evacuated flajk or vessel) for gases and vapor for laboratory analysis. REFERENCES American Conference of Covemmental Industrial Hygienists: Air Sampling Instruments for Evaluation of Atmospheric Contaminants, 2nd ed,, Cincinnati, 1962. Elkins, H. B.: The Chemistry of Industrial Toxicology, 2nd ed.. New York, Wiley, 1959. ' lieprinted from t The Bulletin of the Tulane University Medical Faculty Vol. 4, No. 4, August, 1965 SCIENTIFIC EXHIBIT AMERICAN MEDICAL ASSOCIATION, ANNUAL MEETING* SAN FRANCISCO, JUNE 21-25, 1954 Acute Upper Respiratory Illnesses in Industrial end ; Military Populations--Epidemiology, Etiology | and Prevention Nail! K, Waavar, M.D.f and William J. Mogabgab, M.D.f Industrial workers of a Urge petrochemical plant ind military recruits at a Urge southern sir force base were studied with respect to acute upper respi ratory illnesses over the five-year period, 1958-1963. The importance of these illnesses as a cause'of industrial absenteeism is demonstrated by monthly frequency rates and days .absent from work experienced bT the employee group, a stable population of 3,000, avenge age 43. Similarly, the impact of acute up per respiratory diseases at the military base is shown by monthly attack rates (based on out-patient dispensary visit* and hospital admissions) in the recruits, a labile population, average age 20. Etiologic agents of respiratory disease which were active in the populations were identified by virus isolations and serologic responses, and by bacterial cultures for beta hemolytic streptococci. Although a urge number of potential etiologic agents were implicated, the find ings indicate brut a high percentage of illnesses were due to relatively few viruses. There was significant variance in distribution of specific viruses in the two populations, From the etiologic studies, there is reason to believe that multivalent vaccines can be developed to provide protection against a number of ! respiratory illnesses. Influenza vaedne reduced illness and absenteeism rates I during two episodes of Asian influenza in the Industrial population, and ap parently prevented outbreaks of the disease In the military subject*. Advanced ( vaccines, which incorporated a common cold virus and additional respiratory j disease agents, were demonstrated to significantly reduce illness rates In both ' populations over a trial period of four yean. HonanhU Hasttos--B*tln s taraitU* HsSklso. r . P?ula Oil A tUtintov Cea>Mr n4 Amo. M of arid Plraaler. SmUm of IsfreU**, DImu*. 0Mttmst f Madfclnt, Talaha Untaartltf Bahoel ot MsSielnt, Naw Orltaat, Loulilans. EMO 03 04 0 ZOQ EXX-MOR-003147