Document 8232KXow65YRN91bnMdk4DLmm

FILE NAME: Westinghouse (WH) DATE: 1947 DOC#: WH 115 DOCUMENT DESCRIPTION: Book Excerpt - Industrial Medicine Introduction to INDUSTRIAL MEDICINE T. Lyle Hazlett, M. D., Editor Professor and Head of Department of Industrial Hygiene University of Pittsburgh School of Medicine INDUSTRIAL MEDICINE PUBLISHING COMPANY CHICAGO mm mmmmm mm m mmmum COPYRIGHT 1947, BY THE UNIVERSITY OF PITTSBURGH SECOND EDITION i PRINTED IN THE UNITED STATES OF AMERICA PREFACE Tha ecomuarsteeroianl IonfdtuhsistrbiaoloMk ceodnicsiinsets aotf tthhee lSecchtuoorelsogfiMveendiin of IcnidneusotfritahleMUendiivcienresiitny soofmPeitdtsebgureregho.f cToompprleesteennetstshwe ocuolndtent erexqhuaiursetivae sterreieastmoefnvt owluimtheisn. tIhte iscoimmppaossssibolfe thtoe alettcetumrepst givTehneinletchtuisrecrosurpsaer.ticipating in the course are active work seursbjeinctsthienirthreesbpreicetfievset pfioesldsisb.leTfhoerym hcaovnesispterenstenwtietdh cthlaerir siteyr.veTahse pboaisnitcs coofndceepptasrtwuirteh fworhitchhethsteusdeelnetctwurheossedeianltemreasyt dtheembarnidesf tgimreeataetr oduertadiilspoofsaplr.esentation than is possible in theThsetuvdaelnute's oofwtnhenoletacttiuorness owriilglinbaetinggreaetiltyheernhfraonmcedclabsys dviisdceudsshioenreswoitrh iwndililvaididuailn rgeuaiddiinngg. thTehsetubdiebnlitoignrahpishyexpcruor sioBnesytohnrodugthhetihreimlitmereadtuiartee. value, these lectures may be umseeafunsl iassprfouvtuidreed rfeofrertehnecier pmreasteerrviaalt.ionCaosnsweqeluleanstlyf,ortthhies imGmreadteiaftuel caocnkvneonwielnedcegmofenttheisstmudadenet.of the cooperation of tuhpeoncothnetriirbutitmores, waghroe,eddetsopiptreepthaeremthaeniyr nporetesssinfogr dpeumbalincdas tion. T. Lyle H azlett, M.D. CONTRIBUTORS IndEudstgraibalCH. BygairenneesE, Bng. iSn.eer Westinghouse Electric and Manufacturing Company DepaPrtamlmenetroLf.IBndeuebster,iaMl .HDy.giene University of Pittsburgh School of Medicine 1 J ohnMRed.iCcaolnRoveeferr,eMe . D. Equitable Life Assurance Society of the U. S. ACshsaisrtlaenst MF.eEdincgaellD, iMre.cDto.r Westinghouse Electric and Manufacturing Company DF riraenctkorMo.fGHaetatolt,hPCho.nDse.,rvMat.ioDn. Westinghouse Electric and Manufacturing Company Medical Director, WestTin.gLhoyulseeHEalzelcetrtitc, aMn.dDM. anufacturing Company ProfessUonriavnedrsiHtyeaodf PofitDtsbepuargrthmSecnhtoooflIonfdMusetrdiiaclinHeygiene Chief .SurgMeoanr, lAinlleWgh.eHnyeiLlumdalunm, MS.teDe.l Company AHssaorcoiladteGP.roKfeuseshonr eorf,SMur.gDer.y UCnihvieerfsSituyrgoefoPn,ittPsibttusrbguhrgShchCoooalloCf oMmepdaicniyne C harleMseFd.icKaluAtsdcvhieserr, M. D. Industrial Hygiene Foundation SurgeoFnr,aCnkamSeagyileo-rIllRinoosissitSetre,eMl C. oDm. pany Director, Bureau of JInodseupshtriSahl iHlyegni,enMe,. DD.epartment of Health Commonwealth of Pennsylvania IHnednurstyriFal. SFemllyotwh, JMr.e,lBlo.nS.I,nPsthit.uDte. Professor and HeaFdroafnDk eHparStmtteenntinoof.MMe.cEha. nical Enginsering University of Pittsburgh DirecWtoirlloifamRePse. aYrcahnta,nBd.SD.,eDve.loSpc.ment Mine Safety Appliances Company TABLE OF CONTENTS PAGE I ndustrial M edicine -- H istorical N o t e s ................................................1 An I ndustrial M edical D e p a r t m e n t .....................................................7 M inor I n j u r i e s ...................................... < ........................................27 E ye I n j u r i e s .................................................................. - . . . 3 1 Gases, Vapors, D usts, F umes and M ists . '. . . . 43 I ndustrial D u s t s .........................................................................................81 Sil ic o s is ................................................................................................................90 I ndustrial E xposure to Some T oxic M etals . . . . 99 Carbon M o n o x id e...........................................................................................113 Solvents and Volatile Organic M a t e r ia l s ....................................... 130 P ersonal R espiratory P r o t e c t io n .....................................................145 Laboratory M ethods.......................................................................................176 I ndustrial H ygiene Su r v e y s .............................................................. 185 E lectricity......................................................................................................... 195 Air Co n d it io n in g ...........................................................................................203 H eat D i s e a s e ................................................................................................210 N utrition in I ndustry................................................................................. 223 E ducation in I ndustrial H e a l t h .......................................................... 232 M edico Le g a l ....................................................................................................239 Bib l io g r a p h y ................................................................................................246 I n d e x .................................................................. 254 THIS BOOK IS ENDORSED BY THE AMERICAN ASSOCIATION OF INDUSTRIAL PHYSICIANS AND SURGEONS CRSBMR M M iiR n ia INDUSTRIAL MEDICINE Historical Notes T . Lyle H azlett, M X). I nwdeustcranianlotMpkredsicuimnee ftiondfsixitsanryoogtsivienn adnactieenatshimstaorrkyi.nWg hthilee tbieognianlnihnagzaorfdisntwereerset irneciongdnuizsetrdiacl ehnetaulrtihe,s wbeefkonreowthtehaatdovcecnutpaof Cthheridsitsiaenasiteys. oWf eruanrneetrosl;dththaat tPAlirniyst,oatlme ocnogncoetrhneerd ohbimsesrevlaftiwonitsh, ndoutsetds; tthheatuHseipopfomcraastekss abnyd claetretarinGawleonrkwerrsoteexopnosleedadtopomiseotnailnlgic. Oonthinerduchstarriaacltmeresdoicfihneis.tAormyohnagvtehceomntmriabyutbeed mtoetnhteioenaerdlyAtvhiicnekninnag, rwehpoortmedadeth, epehretirnneianst oobbsseerrvveadtioinns rounnnpelrusm; bJuisvme;naPl,lawuhtuos,nowthedo tohtuast, fworhgoe iws osrakiderstoexhhavibeitebdeecneprtoasisnibelyyethpeathfiorslot gtoy;sapnedakHoefrothde dieAtmoof nwgortkheers.later writers we find one Ulrich Ellenbog who, acberotuatintwfoermntsyoyfetaorxsicbeexfpooresutrhese. discovery of America, wrote on ci,nTehbeegexantenlasitveer wcoitmhpsiulacthiown oorkfskansowthleed"gDe eofmionrdbuisstmriaeltalmliceidsi"-' o1f55P6araancdelsaus;nuthmebe"rDeofrewmorektsallbicya,"othpeurbliasuhtehdorbsy. AAmgroicnoglathine tpoopisicosnidnigscubsysedleawde,remtherecudriys,easceosbaolft, mciandemrsiuamnd, samndeltearrssenanicd. hRaezpaorrdtss aolsno baegvaanriteotyappoefarsuinbjtehcetsladtteearlihnaglf wofitthheoscecvuepnatteieonntahl cenIntur1y70in0 tahebo"oTkranapsapcetaiorends owfhtihche RbooryealthSeoctiietltey," "inDeEnmgloarnbdis. abreteinficaicucmlaimdieadtritbhae."fathItesr oafutihnodru,stBriearlnmareddiincoineR. aImt aizszdinoiu,bthfausl tzhinait iannytheotrheearlmmaonf ihnadsusetvreiarlrmeaecdhiecdineth. eInemhiinsenepceocohfalRcaomnatrzi bwuitthionth,eRhamazaazrzdisniofemocpchuapsiazteiodn.theHeexdisitsecnucseseodf adilsaeragsee vcaornineetycteodf oincgcsupinatihoinssb. oTohke, cfohlolosewninagt arraendmoemreflyroamfethweoofrtihgeinaclhaepdtietironheaandd 2 J. INTRODUCTION TO INDUSTRIAL MEDICINE the second w hich appeared thirteen years later: m iners of METALS, CHEMISTS, GLASS WORKERS, TOBACCO WORKERS, CORPSE BEARERS, STARCH MAKERS, STONE CUTTERS, PRINTERS, WEAVERS, a n d SO ARPamMAazKzEiRnSi.'s book has been of such great importance and its qcounotteaxtitonissoffrosmuchit imntaeyrebste tcoonthsoidseerewdhaop'hroapvoesreinadthiits, tdhisactuassifoenw. In his chapter on the miners of metals we find the following: ' em"Iitntedorfdroermttohepmuriinfyeratlhsaatndimtphreisboondeidesaoifr tihnefemctiendersb,yalsthoebyexthhealfautimoness oaifrliagnhdtefdorlcaemipns,frseuspherainndtenpduernertsaoirf bmyinmesearengsuolafrclyeretaxipnelvtehnetiltahtiicnkgsmtaale cthheinyesprwohteiccht tthheeylecgosnannecdt hbayndsshaofftsthweitmh itnheersbfortotomminojfurtyhebymimnee.anAslsoof lteogtghinegssaafnetdygolofvmesin. eIrtsi,sfeovr,idaecnctortdhiantgthtoe JaunlciiuesntPsoalllsuox,ptahideygruesaetdattotencotivoenr tthheeyir choeualddssweeiththrsoacukgsh. Othveemr twhietihrofuatceinshtahleinygtithede lpoeorsneicbiolaudsddeursst;s.oPtlhinayt says that this is done by polishers of minium." In the discussion on tobacco workers these lines appear: tho"sNeowwhwo hmaatkseortot boafccsoa?fegTuhaerdexschiatlilngthceaumseedciacnanloptrboefersesimonovperdo,vaindde tfhoer sowffeeentsisvme etlol othfegsaeinwomrakkeerss, tshoewsememlluostf gtoivbeactchoemlessthpeerfcoellpotwibinleg aanddvilcees:s Wthehmenwthoeuyldgbriendli,kseifdtooinr ghawnidtlheouint waninyewaanydtbhreesaedw, faorerso--urtospdiroitswwithoouuldt cdarouotiponanadgasioncsitalthliafet swwoaurlmd loafngfluoiasthin--g tahtoeymsmbuystctoavkeerienvgertyhepomssoiubtlhe parned nrionssein, gfrethqeuetnhtrlyoabtrveaetrhyinogftefrneswhiathir,vwinaesghairnganthdewfaacteer;inthceoyldswhoauteldr, aalnsdo dblruinnktinitg, ftohrenirotshhinargpnisesms owrehseunitathbeley fohravweasahdinhgeraewdaytothtohsee ptharrotiactlesanodr sthtoempaacrhticthleasninsfolmictetwhiinllgbien lweshsiecnhedvibnyegtahreisfoalnloiwnignrgedrieemnte.dTiehse: heamrumlstihonast soofrmt ieslocnarsreieeddso,nbainrleilyl-vgreunetli,lawtehdeya,nrdicdeabmopilepdlaicnesm, eilskp.eSciianlcley twhoerkgroinfdtihnigs onfautosebaa,cIcohalevaevreesgiunlatrhlye pmreilslc,raibneddtheme ewtiocrskaesrsthcoemqpuliaciknesotfwhaeyadoafcgheettainndg vriodmoitf."the dust inhaled, which of its own nature provokes the desire to theInfoltlhoewicnhgaipntteerredsetianlginpgarwaigtrhapthheapdpiseeaarss:es of stone cutters scu"Wlpteorsm, uqsutarnroytmeunn,dearnedstiomthaeter sthucehmwaolarkdeierss. tWhahtenattthaecyk hsetowneacnudttecrust, mofaterbnlebruenadtheergirnoutnhde roorucghhi,seslhaitrpt,ojamgagkeed sstpaltiunetesrsanthdaot tghlearncoebjoefcft;s,hethnecye HISTORICAL NOTES 3 tmhaetyicaraeffuescutiaolnlys tarnodubbleedcowmiethcaoncsouumgpht,ivaen.d- Msoomreeoovfetrhefrmomcotnhteracmtaarsbtlhe, tthufean, oasnedasntodnberaeimn.aTnahteeys saaymtehtaaltlisctovnaep-ocur twtehrischwhevoidweonrtklywsitehvetoreulcyha-sfftoecntes aerxehasloesaftfheacttetdheiny tahree hsoemadetainmdesstofomrcaecdh tboyvtohme ifto. uWl ohdeonrtthheabtoidt iceosnosftasnutclyh swtoonrkeesr.sDaireemdeirsbsreocetecdk, gthiveesluanngsinhtearveestbinegenacfocuonudnttoofbseevseturafflesdtowniet-hcusmttearlsl wpihleos doifedsaonfdasinthtmhae; lwunhgesn, hsoe dmisuscehcteodf itht etihractaidnavceurtstihneg fwouitnhd,hhise ksnayifse, tohfrosaungdh. tHhee spauylsmtoonoarthyavtehsieclwesashetofldeltbyasathmoausgtherhsetowneer-ecuctutettrinthgaat wbohdeyn hbeladwdaesrschhiasneglliinngg isntotnhee awodrukssthaorpo;sein, sfoacftinien tthhaet ciotuprseeneotfraotnede ytheearohxefmoaunnddethclaatreadhtahnadtfuthlaotfdtuhsist wduosutldhagdraadcucaulmlyuplartoevde ifnastiadletao bstloandde-ecru. tTtehres who took no precautions." In the chapter devoted to weavers we read the following: ho"wNolowoakdaayssthwooumgehntshietytowwereeavseta,nbduitngin. Tsuhcihs akipnodstoufrewtohrakt itshecyerstaoimnley bvaecryk,fsaotigthuiantge,vfeorrythpeartwohfoltehebobdoydyisattaosknceed,shbaortehs hinantdhse, waromrks., Ifneewt,inatnedr tlhineenpecalsoathnt inwothmeens,tawbhleos,theesnpeacriealnlyo tthbeusgyirlisn bthefeofrieeltdhse, ywmeaavreryh,efmorpetnheoirr onnoltytodobwerymiisstkrnesoswoinfgthhioswatrot. wNeoawvea;nitoisccaudpiastgiorancesofofraatigpueiansganntawtuormalalyn hcaarsryitsanddrawexbpaeclkst,heespfeectuiasllyprfeomrawtuormeleyn,afnodr iifn pcroengsneaqnutetnhceeyinecausirlymmanisy aeinlgmaegnetds wlahtoerllyoni.nItthifsolloocwcusptahtaiotnw, oomugehntwtoeabveersp,aIrtimcuelaanrlythohseealwthhyoaanrde yroebaurssta,reotchoemrwpieselletdhetoy abbraenadkodnotwhins ftrroamde.o"verwork and as they get on in thoTuhgehstes eoxfcaerpgtrseaatrephyrespicrieasnenwtahtoiveoveorf ttwhoe coebnsteurrvieastioangso laanidd theOftohuenr daimtiopnosrtoafnitndwursittriniaglsmefodlilcoiwnee.d the -work of the great oItcacluiapnatiopnhsy,siwcieanf.indAdadeddevteolopthineg psuorceilayl cmoendsiccioalusninetsesrewsthicihn lroooukneddingcritthicealelympulpooynmethnet oufnfwavoomreanbleancdoncdhiitlidornesn.ofThweorerkissunro idmoupbotrtathnat tfathcteorgrionwsitnigmusolactiianlgetnhlieghgtreonwmthenot fwiansd.uisntriiatslemlf,edain cInine1.83P1ubalibcoaotikonasppoefarbeadsiucnvdaelruteheapapuetharoerdshfipromof Csehvaerrlaels sTouurrnceesr,. "aTndheHEaffbeictsts ooff ALritvs,inTgradones Lanifde ParonfdessLioonnsgeavnidtya."ll CInivicFrSatnactees, 4 INTRODUCTION TO INDUSTRIAL MEDICINE iJn. L18.0A6.liFbiefrtteepnubyleisahresdlattheer ofinrsat wFroernkchonpeinridoudsictrailalwdheicrmh aetxoelrotgeyd awapsofwiresrtfuplubinlifslhueendcuenodnerththee dneavmeleopomf "eLntesoAf ninndaluesstrdia'Hl yhgyigeineen.e" Ototlhoegry Farnednchtoxaiuctohloogrsy.mIandeGiemrmpoarntyantsuccohntariubtuhtoiorintastiivnedewromrkas " aanppdeaorthederassutbhjeecststu;daiensd otfheHwalrfiotirntgosnotfoxHicirgt aasnesd, Lduehstms,anfant.iguIne ttrheeatUisneitpedubSlitsahteeds iwne1f8i3n7d eanmtiotnlegdth"Oe neatrhley Iwnfolrukesncine tohfeTfriaedldesa, Ppurobfleisshsieodnhs,isawnodrkO, c"cOucpcautipoantiso."nsOofvtehretPheirotpyley."ears later Walker veTryhegaredavta.ncAes lmaragdee nsiunmcebethr eoofnismetpoofrttahnist cpeunbtluicryatihoanvse hbaevene "aDppaenagreerdouasmTonragdwesh,"ichpumblaiyshebde minen1t9io0n2edanSdirGTrheeorm'sas"TOrleiavteisr'es onCOocncsuidpeartaibolnealreDsiesaeracsheswaansd dAocnceidienntsth"epufbirlsitshtewdoinde1c9a0d9e. s of tpheetutswteonltaietethr rceesneaturcryh. buTthedsied mstuucdhiestondoetveolnolpy ingdavuestrgiarelamt eimdi cgiansee.s,Apmluomnbgistmhe, tvhaeripendesuumbojeccotnsiodseeasl,tfwatiitghuehaavned baececniddeunststs. Tanhde irnagngsecoiefntthiefisce rgersoewarthchehsasis buencdoomubintgedelvyenbbeeronadinefrluaenndtitahle riensuthlte evsetrasbitliiesshmboetnhthoefrecaonudrseasbrionadi.n-dustrial medicine at various uni beAenn thineteIrnetsetirnngatieonntaelrpLriasbeouorf OinfftiecernaattioGnaelnepvaro,pSowrtiiotznesrlahnads. SDeisveearsaelsIhnatverenbaetieonnhaelldC. ongresses of Industrial Accidents and indAumsterriaiclanmewdoicrkineer.s Ahamvoengbetehnepirmolpifoicrtainnttheeairrlycownotrrikbsutwioensfintod D18r6.9.F.InA.18W84alDker.r'sGe"oOrcgceupHa.tioHnosheofputhbelisPheeodptlhe"e p"uHbylgisiheende oinf O"TchcuepOatciocnusp.a"tioInnal19D1i4seaaspepse"araendd DDrr.. WGe.orGgielmMa.n PTrihcoem'sp"sTonh'es MlisohdedernitsF"aScttuodryie'.s" oIfnth1e91M9 ethdeicaUl.a8n.dPSuubrlgicicaHleCalatrhe oSferIvnidceusptruibal Wwaosrkfeorusn."deIdn athteHsaamrvearydeaUr tnhivee"rJsoituyr.naIlt oifs InnodwustkrinaolwHnygaisenthee" "imJopuorrntaalntofpuInbdliucasttiroianl iHnyigtsiefnieeldanind tThoisxiccooulongtryy". and is the most HISTORICAL NOTES 5 indMuesntrtiiaoln msheoduiclidnebeinmAadmeeroifcatnheuinnivtreordsiutcietiso. n HofarvcoaurdrsesUnoin vtoerisniatyugiusrraetepocroteudrsetos ohfavsetudbeyenfotrhdeefgirresetsininstiintudtuiosntrioalf hleyagrineinneg. surSvineyces o19n3m2 etdhiecaAl mseerrviiccaens iCnolilnedguestorfy Saunrdgehoanss ehvaoslvceodndstuacntedd ardPsubwlihciacthiomnsusot nbetomxeictofloorgyaphparovvealinbcylutdheed ciomllepgoer.tant contri bPuotiisoonnss biny tAhme eUrincaitnedauSthtaotress." Abmy oAnlgicteheHmamariletotnhein"I1n9d2u9starinadl aunnodtehretrhewotirtkleboyf t"hIinsdeumstirniaenl tTsotxuidceonlotgwy.h"icOhneapopfeathreedstiannd1a9r3d4 texTths,e"AToirxiHcoylgoigeyn,e" Fwoausnidssautieodn boyf MAmcNeraicllay cianm1e93i7n.to being in Pstiuttdsibeus.rgThheinor1g9a3n5izaatniodnhiassnocwonktrniobwutnedasathvearIinedtyusotrfiasligHnyifgiiceannet FoTuhnedamtioonntohflyAmpuebrilcicaa.tion, Industrial Medicine, was founded inI1n93129. 37 the Council on Industrial Health of the American McoendsiicdaelrabAlessoincfialutieonncecianmetheinteovobluetiinogn. oTfhihsigbhoedr ystahnads aerdxsertfeodr mfoerdmicaitnioeninofincdomusmtriytt.eTesheoncoinudnucisltrhiaals mbeeedniciinnestrinumloecnatlalmienditchael socOienteieos.f the significant recent developments has been the growth osiftainteddusatrhiailghnutryspineg.oTf hneurnsaintugreseorvfiicnedwushtirciahl hparsacattictreachtaesdnesocmese onfurtsheerebpersetsnenutrssinagn tiamlepnotr.taTnhteppharesseenint sthtaetuhsisotofritchael ienvdoulsuttriioanl ofIinndu19s3tr6iatlhmeedSicchinoeo.l of Medicine of the University of Pitts bapuprgeharssetot huapveabe"eDnetphaertfmirsetnotneofofInitdsuksitnridalatHleyagsitenaem"onwghtihche meCdliicnailcaslchwooolrskofinAmtheericoac. cupational diseases naturally began Msomilaend, eIctaadlyes, aingo.19I1t0iswsaasidthtehaftirtshtefcoluinnidcedbeganuynwbhyerDeevfoortothine sincieitnstiofitchesrtuadspyecotfs.inVdaursitoruiaslcmlineidciscionfeiminpoitrstanclcienihcaalveasapwpeelalreads iant tthhies CcoorunnetlrlyMaemdoicnagl wSchhicohol,mtahye bUenmiveenrstiiotyneodf tPheonsnesyfolvuanndiead, 6 INTRODUCTION TO INDUSTRIAL MEDICINE ONhewio YSotartke UUnniviveersristiyty, ,thteheUnHiavrevrsairtdy oSfchIloloinlooisf MPuedbilcical HScehaoltohl,, awnodrkthoef thNeoserthcwlineisctseranndUonfivoetrhseitryorMgaendiizcaatlioSncshaonodl. oBfensuidmeesrothues itniodnivsidtouailns,dumsetrniatilonmesdhiocuinlde bmeadmeadbey othf ethUe. vSa.luDabelpearctmonetnritbuof SLearbvoicre, .thTeheUs.e So.ffBicuiarleaaugeonfciMesinheas,veanddontheemUu.cSh. tPoubfulircthHereatlhthe ogfroiwtsthhigohf sintadnudsatrridasl. medicine and to encourage the development chrTohneolopgreyceodfingindauccsotruianlt miseadicbinriee.f Faanrd minoerveitaimblpyoirntacnotmpthleatne thhaes sgpueicdiefdicpervaecntitcsemthernotuiognhedthies ptehreiocdhaonfgtiinmgepchoivloesroedphbyywthheicshe pevheynsitcs.ianF'srocmhietfheinteearerlsyt tchoencaedpmtsinwishtriachtiomn aodfefitrhset-aiinddutostrtihael hinajzuarredds woef hinavdeusrteryachaerde anesutatrgaelizoefdprboegfroerses twhheeyrehtahvee paoctteunatlilayl cininfleictheads haatrtmai.nFedromto ittls frdagevmeelonptamryenbteogfinhniignhglsyinodrugastnriizaeldmperdoi lgarragmespoafrtheoafltohurcopnospeur dlioonn wenhgiacgheadffienctththeelawbeollrsbeoifngindofustthrayt. Hmoewdicitnheisfudnecvtieolonpsmtoednatyhwasill bbeeecnomaettaapinpeadrenatnfdrohmowtheinadccuosutrniatsl which follow this sketch of its early growth. . AN INDUSTRIAL MEDICAL DEPARTMENT T. Ltle H azlett, MJD. Organization Thmeabneagiesmneontuonfifomremdiitcyal odfepparartcmticeentsininthiendoursgtaryn.izTathioenchaanrd amcetenrt oafs atogiwvehnatincdounsstrtiyt,utietss saizpep,raonpdriathtee mcoendciecpatliosnerovficme atnoagthee owfoarkmeresdaicraeltdheepfaarctmtoersntw. hich determine the nature and the scope sivIenlythwisitbhrieafdmdiisnciusstsriaotinveit pisrocblleeamrlsy. iLmipttolsesibmleorteo cdaenal beexteant tseemlecpttiendg baeymoenddicathl,enumresrineg,meenngtiionneeroinfgt,heandimcpleerraictiavlepenreseodnnoefl paserafodremquedatealnydtraasinaeddapatsabploessaisblpeosfosirbltehetopathrteicpuelcaurldiaurtineesetdos boef theBpeyaortnicdulpaerrsionndnueslt,ryththeeycasreerfvuel. disposition of physical equip mcaerenftulilny adpepveroloppreiadteslyystepmlanonfedrecaonrddswaerlel okfepthtequutamrtoesrts imanpdora teamnpceh.asOizfedt,hies garepartoegsrtamsigcnaifliccualnactee,d tnhootugohnlyofttoenseinrvsuefftihceienimtly lmisehdeidatebunteetdos oafnttihceipwatoerkfeurstufroer owphpoomrtuthneitideespafortrmseanftegisuaersdtainbg ganradtifiyminprgovtiongthteheehnetearlpthrisoinfgempphlyosyiceeiasn. Iint sihnoduuldst,ryin tfhaactt, hbies wanodrkgrioswntho.t Tshoerreigaidrelywsidtaenodpaprdoirztuednitaiesstfoordtihsecofuurratgheerindeitviaeltoivpe imnge,ntthoef iimndaugsintraitailonm,eadnicdintehewhenicehrgayreoflitmheiteidndounsltyribaly pthhyestircaiainn. calOndetphaertfmolelonwt inogf paaglearigseouintldinuesdtrtihale ocorgnacnerinz.atiIotniosfnthoet mgievdein caosnacnerninrfeleqxuiibrlees mfoorditesl. obwunt nseimedpsl.y as one which this particular Physical Examinations adTeshemdaeyvebloepmsaeindt otof Ihnadvuestreixahl iMbieteddicitnheeinfotlhloewpiansgt tshurceceesdseivce phases: (a) surgical, (b) medical, and (c) the preventive with