Document ZnrNnZZ65qv6vvbmNvdm2ado7

,,a * . y y #7 -" * y y' y . ' I` *,- &y u .-r m \l - ' / I-'y1> *- ft*"' * x- v :> V\ ~>V' 'i/ r ^ Y ^Kettering Laboratory, ^ ^^ V^ ^ '\VW***' A : :v / *' / 3* *<wY College of Medicine, University of Cincinnati, J -.X - .J X :X ' V " v . / 4 : W aTA.\ *Av\.y-v; .\. A.S*->- .-r/t- _v *y . / v . .X " / % ,n \\ " \,Vr Y r> cf yw.v r j r k / / . f ' r ...- v V k \ ' V I^ Y v? 'Vf ^ Eden Avenue, CIHCIIIIATI, OHIO. 21st September, 1950 Dr. Greaud, ... . Socit de Produits Chimiques Ethyl-Kuhlmann, Paimboeuf (Loire Inferieure), F R A N C 1. Dear Dr. Greaud, Pursuant to our meeting in Paimboeuf, I discussed the entire problem with which you are presented with my associated in London. ^ Mr. Bevan decided that he and I should pay a visit to the appropriate representatives of Kuhlmann in Paris, presenting them with our views in person, and also in the form of a general Memorandum. I am sending you for your confidential information a copy of this Memorandum. It is not intended to be complete in all respects, and I have carefully avoided any implications that could be regarded as unduly critical or discourteous. I was also Careful not to involve you in an unfavourable situation. However, I have done the best I could to follow through on my promise to support you in every possible way. I believe that favourable results will follow, and I sincerely trust that this will be the case. It may take a little time, and I hope that you will not have to be patient for an intolerable period. Perhaps you will let me know from time to time what progress is being made. My office address is given above for that purpose. I should like to take this opportunity of thanking you for the fullness of your information. I should also like to express my great appreciation of your hospitality and ray acknowledgment of the splendid luncheon which you provided. I trust we shall be able to resume our conver sation in the not too distant future on some equally pleasant occasion, when there are no troubles to discuss. U ith k in d est personal regarcfs, HE0000380 \ 'C' JAJi.Aj.X OH V I j I V 'X .'iiiY1j " k ' iILJA?i.T. J.J I . . n Up uY ibi. :., IW V & N . . if e a ih - ii 1 W . lUKirOSS. (1) To a s c e r t a i n th e m ed ical f a c t e a s s o c ia te d w ith a n in s ta n c e o f p o s s ib le t e t r a e t h y l lo a d in t o x io a t io n i n M an u factu re a t tie Ktliyl-Kuiilmann l a n t a t j.a ia b o o u f (2) To make s u g g e s tio n s , i f rieo eaaary , to o b v ia te th e t o a a i b i l i t y of intoxioation in fu tu re . A rriv e d a t 'a n te s on tu o a fte rn o o n o f T uesday, 1-3th Jeoember, l'j4 8 accompanied by M onsieur Journoau o f J.thyl S .A ., l a r i s . iio t Hr. bequyer, p a rt-tim e M edical O ffic e r to Kthyl-Kuhltaann, laim boeuf. irooeedod by ro ad t o jra ia b o e u f and Met u o n a io u r io s a o z , th e o r b a ' M enager, I m o n sieu r f .h u f f a r t , C en erai m anager, waa a b se n t^ M onsieur K oubeix, th e rooeas Manager and ed em oiselle Leguen, N urse-H ealth V is ito r. The oaao the in d iv id u al reputed to have died * ith ayuptoina o o m a o i^ o d o n r iu ^ tr e iM n a and te tr a e th y l load p o iso n in g , and iiaerican and n g lisn c u rre n t aathoda of c o n tro l were di.ouaaod in comparison w itn those a t j aiaboouf. A co n d u cted to u r ox' th e le a d reo o v o ry and a l l o y b u ild in g s was made w ith M onalours ro s s o s and k o u b e ix , D r. b^quyer and M onsieur Jo u rn o a u . These b u ild in g s w ere n o t in o p e r a t io n . The o th e r proooss b u ild in g s e re o u t o f n o tio n owing to an e l e c t r i c a l f a i lu r e and were d e fe rre d u n til th e foliow in;- day. S elected process o p e ra to rs ore e.vaainad in co n ju n ctio n * ith Dr. ieq u y o r. In th e evening d iscu ssio n s ere held w ith Ur. F . i'raud, C hief o f th e lo c a l A ssociation o f In d u s tria l Medical O ffic e rs, D r. Lequyer and M onsieur Journoau. On ed n esd ay , 15t h December, l a i a b o e u f was r e v i s i t e d . S e t M onsieur G h u ffart, th e G eneral Manager, and had fu r th e r d iscu ssio n s on problem s. A co n d u cted t o u r o f th e toin b u ild in g s o f th e `E th y l* f l u i d r i a n t was made w ith M onsieur j o s j o s , M onsieur J o u b e lx , D r. uequyer and M onsieur Journoau. Fourteen sam ples o f u rin e were c o lle c te d from a oroas se c tio n o f proooss eoployeea and la b o ra to ry s t a f f . In th e ev ening had a f u r th e r d is c u s s io n w ith D r. G iro ire , Company's o d io si O f f i c e r to th e H u n t , who i a th e lo a d in g n e u r o l o g is t i n th e a re a and khyaioian-in-C hargo o f the nouro-aurgical u n it a t .it. Jacques h o sp ita l, N antes, to g e th e r w ith D r. Lequyer, M onsieur i'oaao and M onsieur Jo urnoau. On T h u rsd ay , I b t h Joconber, . i t , Jap q u es h o s p ita l wea v i s i t e d and J r . Gorman, th e rh y s ie ia n ho tr e a te d J r . Lequyer end M onsieur Journoau were a ls o p re s e n t. roturnsd to x n ria in ina afternoon. On F r id a y , 1 7 th December f in d in g s were d is c u s s e d w ith Colonel 0 . Ih e n a u lt. re tu rn ed to bondon in th e aftern o o n . Ui NARRATIVE. One enco u n tered a moat c o o p e ra tiv e s p i r i t , c o u rte sy end h o s p i ta l it y throughout th ia v i s i t . 0000331 CV2 CO CO o o o Uj * r -2- D r. b e q u y e r, god ab o u t t h i r t y y e a r s , . T r ie d , end r e s id in g i n 'a n te s , 47 k ilo m e tre s from airaboeuf, i s a ,.-rf.duta o f m r i s U n iv e rs ity and has tak en a p o a t-p ra d u a to c o u rs e o f s i x months in i n d u s t r i a l mod l o i n . iie a tt e n d s th e tnyl-Kublmann H u n t a t i cinboouf on one h a lf-d a y and one day a lte r n a te ly each week, w here he s u p e r v is e s , i n a g e n e r a l w ay, so n s 550 em ployees e t Use l e n t en d , i n p a r t i c u l a r some yQ em ployees o f tile "? th y l" f l u i d r i a n t , e a ls o looks a f t e r a masher o f f a c to r ie s in N antes. lie ie employed f u l l- t id e on t h i s i n d u s t r i a l w ork, and i s a member o f a n a s s o c i a t i o n o f f i v e d o c to r s who , iv a a f a c t o r y M edical S e r v ic e i n th o haute,-. a r e a , and o f w hich S r . fr a u d ia tho C hief. ;:r. (iiro ire ia s t i l l In te re ste d in the workings o f the a l e n t b u t, owing to p re s s u re o f o th e r p ro fe s s io n a l d u tie s , ho handed th is work over to S r. uequysr in 1945 A fter d isc u ssio n s w ith th ese a s d ic s ! m n , they were in f u l l agrecsiont w ith th o su g g e stio n s and reooaiHondations made f o r m ed ical c o n tr o l. One a in a d th o im p ressio n t h a t th e I n d u s tr ia l Medics 1 S erv ice was in I t s in fa n c y in th e area and th a t s a fe ty p ra c tic e s were not too s t r i c t l y observed in most f a c t o r i e s , a lth o u g h some propaganda had bean is s u e d by " .'A s s o c ia tio n dea in d u s tr ie s do France" and Kthyi-KuhlBSim had issu ed an e x c e lle n t l i t t l e b o o k let e n t i t l e d " jo o u r ito " . Hone o f th e m edical gentlem en had any u p -to -d a te knowledge on tho problems o f th e m anufacture and h an d lin g o f "ith y l" f l u id . I'MMifcUIP. There ia v ery good accommodation f o r th e m edical s e rv ic e w hich, however, i s p o o rly equipped and in ad eq u ately s ta f f e d . There is a m edical la b o r a to r y f o r th e e x a m in a tio n o f p h y s io lo g ic a l specim ens some two m ile s from tho le n t, b u t th is has never bean u sed . There a re no chem ists o r teo h n io ian a a v a ila b le to u n d ertak e th is . w ork. The blood counts a r e c a rrie d o u t by e co m p eten t tr a i n e d n u r s e , M ad em o iselle le g u e h , who has been a t th e i l a n t f o r many y e a rs and who a l s o p e rfo rm s d u ti e s a t a i l n r t o th o s e o f a h e a lth V is ito r in th is c o u n try . The scope fo r and .thoda o f re c o rd in g i n i t i a l and ro u tin e m edical exam inations e re adm irable but cannot be c a rrie d out in e n tire ty by tho p a rt-tim e M edical O ffic e r, nor can a l l the n ecessary d e ta ils be completed 8 tho f a o liitie f l a re n o t a v a ila b le . Ab re g a r d s th e s t a f f a t t h e r i a n t , th e a b sen ce o f a S a f e ty O rg an isatio n is th e most o u tstan d in g d e fe c t. gvon though a t p re se n t the P la n t i s a fo u r-au to o iav e u n it, su p e rv isio n o f hygiene and s a fe ty from m edical angles is. considered as e s s e n tia l as in Aaoricah and B ritis h P la n ts . The p a y r o l l em ployees o f t h e r i a n t a re draw n from th e p e a s a n tr y , who f o r g e n e r a tio n s have d e riv e d a l i v e li h o o d from th e io il and to whom f a c t o r y l i f e is so m eth in g ,n ew . One was inform ed t h a t many o f th e workmen had o t h e r o ccu p atio n s in a g r ic u ltu r e and h o r tic u ltu r e in th e a r e a . The m a jo rity s r e s ta te d to be o f C o llie o r ig in and a r e , th e r e f o r e , more s u s c e p tib le to pulmonary tu b e r c u lo s is . in ia b o e u f i s s itu a te d in a wine growing a r e a . Much o f th e v in o p ro d u ced i a o f i n f e r i o r g ra d e w hich i a u n f i t f o r e x p o r t and is consumed in n o t to o m oderate q u a n titie s by m ost. A number o f th e p ro c e s s em ployees, who w ere s t a t e d t o d r in k to e x o s e a , wore p re s e n te d f o r exam ination through th e c o u rte sy o f th e Management. A ll were w e ll nourished b u t in bo b one noted p a llo r , marked trem or o f the tongue, l i p s and hands and o btained a h is to ry o f re s tle s s n e s s , sle e p le ssn e ss, bad ironm s, an o rex ia, e s p e c ia lly in th e m orning, and o th e r d ig e s tiv e d is tu rb a n c e s . 7no d e n ta l s t a t e o f m oat, from o u r p o in t o f v iew , Was sim p ly a p p a ll in g . The blood p r e s s u r e , ta k e n w ith an A neroid i'.phyjmtowsnoaeter, was norm al in a l l o a s e s . The tempore lu res o f come were d e p re sse d , and th e g u is e r a te s w ith in norm al lim its of v ariatio n . F rankly, by c lin ic a l exam ination o nly, i t is im possible to d is tin g u is h between the e f f e c ts o f alco h o l and te tr a e th y l lead in to x ic a tio n in in s ta n c e s o f th is ty p e, alth o u g h from tho h is to ry , the s ig n s and symptoms wore a m o s t c e r t a in l y due to a lo c n o l. I t w ill be a moat u n e n v ia b le ta s k fo r th e MonafOmont, .t-dicsi t t f f i o r and a S a fe ty U rb a n is a tio n to e d u c a te th e s e taen, and to e n fo rc e re g u la tio n s in sa fe working p r a c tic e s . lo st o f th o s e .men have t h e i r a e a la a t home. Some o f t h e i r c l o t h i n g ia p ro v id e d by th e em p lo y e rs. Wooden s a b o ts a r e w orn. -3- '>,o c lo t h in g i s washed once a week i n a sm a ll la u n d ry on th e r i a n t . A fem ale is employed in th e lau n d ry . P ro a th e m e d ic a l p o in t os' v iew th e r i a n t war. s t r u c t u r a l l y so und, sad e x c e lle n t f lo o r s and was w e ll li g h te d . The head ceoovcry h u tid in g , which was c o n stru c te d to d e a l w ith e ig h t a u to c la v e s , works f o r two weeks and is c lo s e d f o r two w eeks. I t wna n o t i n o p e r a tio n a t th e tim e o f in s p e c ti o n . I t as s ta te d th a t v ery t i t t l e tro u b le was encountered w ith th o w et slu d g e conveyor, th e d r i e r , th e vacuum and the condensate ta n k . The A llo y b u ild in g was prob ab ly a l i t t l e d u s tie r th a n a t S o rthw ich, and a p p a re n tly th e oaaa tro u b le s in p acking hoppers e x is t a t i s imbueu f as e lse w h e re . One n o ted two men d e a li n g w ith a h o p p er w ith o u t u s in g d u s t m asks. In t h e T e tra e th y l bead b u ild in g , which a ls o deal w ith th e washing o f te tr a e th y l le a d , th e re w ere sm all le a k s from th e re a r glanda o f the a u to clav es and soue sig n s o f co ntam ination o f th e su rfa e e s o f tile s t i l l s . -ro p -le g clea n in g c a r r i e d o u t a f t e r e a c h c h a r g e . The men c a r r y in g o u t t h i s o p e r a tio n wore observed to be w earing os nia to r re s p ira to rs . There were some d e f e a t s in th e oxnnust v e n ti la t io n o f th e 1 . i l . t . w ashing room and th e e x h a u st.o n - th e drum p a u sin g o o o th , w hich w as b e in g u s e d , was n o t w o rk in g . lions of th e s e , w ith th e p re s e n t r a t e o f p ro d u ctio n , would be s u f f i c i e n t to g iv e ris e to f a ta l te tra e th y l lead poisoning, although excessive lead absorption ro d p e rh a p s s i g n s o f m ild in t o x i c a t i o n may p o s s ib ly be e n c o u n te re d . One was inform ed t h a t tn o men d id n o t l i k e (.`firin g th o s i r l i n e C ask s, an? as n ro u tin e th e o a n iu te r type masks a re used, th e c a n is te r s being changed s ix m onthly. heather gloves are a general iaauej th e la te r types have n o t y et been obtained. L oad-in-air fig u res in the .K .L . m illin g e re h ig h e r th a n in h'o rtk w io h , b u t g e n e r a lly u n d e r % 0 mgs. p e r te n c u b ic m e tre s o f a i r by th e lead su lp h id e motnod. The th r e e ita in d e f e a t s , when compared w ith American and B r i t i s h l i a n t s , e r e inn U s-u p to m ed ical c o n t r o l , i n d i f f e r e n t m a in ten an ce and a b se n c e o f e s s e n t i a l s u p e r v is io n , e s p e c i a l l y on atelo b e nance jo b s . In the instance o f the n who d ie d on th e l 3 t December, i->ts In S t , Jacques u o ap !x !^ ^ ^ at!W s d ia g n o s is o f d e liriu m t r e a s n s , th e p o s s i b i l i t y o f t e t r a e t h y l lo a d in t o x i c a t i o n s a y fca c o n sid e re d under the usual four headingst- 11) S i g n i f i c a n t e x p o su re . 12) C l i n i c a l is a n ife s t t i o n s . 13) E vidence o f abnorm al amounts o f le a d in f a e c a l ex cretio n s and body tis s u e s . (4) Any o th e r c a u se . (1) S ig n ific a n t exposure. Aa s t a t e d a b o v e, a g e n e r a l su rv e y o f th e 1`l a n t does n o t w a rra n t a c o n c lu s io n t h a t exposure o f tho workmen i s e x c e s s iv e . Owing t o la c k o f s u p e rv is io n , however, and in th o absence o f any re c o rd o f th e s o tu a l work c a r r i e d o u t by t h i s man d u r in g th e t h r e e weeks p r i o r t o th e o n s e t o f d is e a s e , i t i s n o t p o s s ib le t o s t a t e t h a t he d id n o t u n d e rta k e somo h a z a rd o u s jo b o f maintenance w ithout o d e p a to p ro te c tio n and su p erv isio n . In th e absence, VJ t h e r e f o r e , o f an y c o n c re te ev id en o o i t m ust be p r o v i s io n a l ly a c c e p te d t h a t , ' from th e n a tu re o f h ia o ccu p atio n , s ig n if ic a n t exposure was p o s s ib le . seoooo 3>i (2) Cllniof-l .f-i-inlroffteJAflna. T h ere a r e some u n u su a l f e a t u r e s i n t h i s oaoe w hich have n o t h i t h e r t o been ro co rd ed b u t , on tiwi w h o le, th e sy ap to a a w ere s i m i l a r to th o se w hich may be e x p e c te d i n o ase s o f t e t r a e t h y l lo a d p o is o n in g . T)r. Corman, who t r e a te d A lb e rt h io k o la s , o o n sid o red him to t e a e sse o f d e liriu m trem en s, a common d is e a s e i n th e a r e a , b u t he d id n o t resp o nd to tr e a tm e n t in th e u :u a l manner. 000038 *rji Ui r jzjc -A- (3) evidence of. ftbngr^i^aiaQ untfl. at .ifee..a ..An n p o sn A - e.a g m U P m . and body tis s u e s . here are no reco rd s o f previous oxoretiona in u rin e end fa e c e s. Samples o f tis s u e s end one aample o f u rin e have been bunded to ir o fe s a o r Podda f o r A n aly sis, on r e c e ip t o f th e r e s u lts o f which n f u l l case re p o r t on th i s sen w i l l be co m p iled (4) Any o th e r c a u s e . The deceased workman was a known c h ro n ic a lc o h o lic , w hich i s a d is e a s e o f m e n ta l ty p e , and a s su ch th e man sh o u ld n ev er have been employed on th e m anufacture o f te tr a e th y l le a d . D elirium trem ens r e s u lts from p e r s is te n t d rin k in g , g e n e ra lly under the stim ulus o f tem porary unusual am ounts, sudden c e s s a tio n o r shook. According to B ritis h m edical teac h in g , a death ra te o f about one in seven i s to be expected in d eliriu m trem ens, even w ith adequate treatm en t, and o f these most are under fo rty years of a g s . The e n t i r e d is e a s e p ro c e s s may b e due t o one c a u se , nam ely, a lc o h o l . On th e o th e r hand, i t i s g e n e r a l ly a c c e p te d t h a t p e rso n s B ddioted to alco h o l a re u n re lia b le , c a re le ss and d e fe c tiv e in judgem ent, and i t i s q u it e p o s s ib le t h a t t h i s man may have u n d e rta k e n noma m ain tenance work w ith o u t s u f f i c i e n t c a re and re g a rd to th e hnssard in v o lv ed , and being an a lc o h o lic would n a tu r a lly be more prone to th e to x ic e f f e c ts o f te t r a e t h y l le a d . .hatevor is th e f in a l co n clu sio n In th i s c a se , JLt can be s ta te d , a t. t h i s s ta g e , t h a t th e f a t a l te rm in a tio n was in p a r t duo to e x c e ssiv e d rin k in g o f a l c o h o l , and t h a t ex p o su re t o t e t r a e t h y l lo a d may p o s s ib ly have p la y e d a p art. T his u n s a tis fa c to ry s t a t e o f a f f a ir s i s due to inadequate m easures o f c o n tro l, and i t is ad v isab le th a t tuo i'.F .b . P la n t a t Bnimtoeuf should consider extending and im proving sa d ia a l c o n tro l and hygiene to th e standards recommended by i) r. K ehoe, so t h a t i t w i l l bo p o s s ib le a t a i l tim e s t o know the degree of exposure and ab sorption o f te tra e th y l lead of a l l groups o f workmen and in d iv id u a ls engaged oh th e l e n t . t h i s should be co n tem p lated a t th e e a r l i e s t p o s s ib le d a t e . Xf f u l l f a o i l i t i e s a r e u n li k e ly to b e in i ti a te d th en an in te rim scheme o f c o n tro l could be co nsidered im m ediately. T his would b rin g t h i s i a n t in to lin o w ith c u rr e n t p r a c tic e in American and B ritis h H a n ts . For sa fe working and o o n tro l th e e s s e n tia ls a re considered under th e follow ing four headinga:- i 1) M edical and H y g ien e. 12} E n g in e e rin g , d e s ig n pnd m a in te n a n c e . 13) B d u a a tio n . {4} K nfornam ent. . .A M e d ic a l O f f ic e r employed f u i l - t i m e on a P l a n t r e q u i r e s a b o u t two y ears to a c q u ire a proper p e rs p e c tiv e o f the g e n e ra l hexurda and o o n tro l. To accom plish th e n e c e s s a ry work under ox is t i n * c o n d itio n s , th e s e rv ic e s o f a M edical O ffic e r f o r a t l e a s t th re e days p e r week would be re q u ir e d . As th e P la n t w ill e v e n tu a lly have e ig h t e u to o la v e a , i t i s recommended th a t a f u l l tim e ils d io a l O f f i c e r be ployed who h as had some i n i t i a l t r a i n i n g I n a n o th e r t e t r a e t h y l le a d B le a t , and who sh o u ld r e s i d e w ith in te n m ile s o f ia itn b o n u f. One f u ll- tim e te c h n ic ia n ia n e c e ssa ry , even a t p re s e n t, to c a rr y o u t th e blood exam inations re q u ire d . The o n ly .afe end r e l i a b l e *;uide to a b so rp tio n and e x c r e tio n o f te tra e th y l lead is tho a n a ly s is o f p h y sio lo g ical sam ples of blood, u rin e end faeces o f in d iv id u als oxposed. i f i t is not p o ssib le im m ediately to put Into use the lab o rato ry provided fo r th is purpose, i t is suggested th a t a n a ly s is o f fre s h ly voided specim ens o f u rir.o , by a s h o r t saethod, be in i ti a te d -5- on th e le n t a t th e e a r l i e s t pos.iibio d a te . At le a s t one, end p re fe ra b ly two te c h n ic ia n s would be r e q u ir e d i n i t i a l l y f o r t h i s p u rp o s e . den fo r employment should be v ery thoroughly examined hen f i r s t p re s e n te d , end o n ly sen who e r e o r g a n i c a ll y sound, m e n ta lly s t a b l e and o f a t le a s t average in te llig e n c e should bn a n le o te d . I f any d e fe a t is found wnioh '-is o f d o u b tfu l s i g n if l o a n o e , th e Company ah o u ld bo g iv e n th e b e n e f i t o f th e do u b t, and th e p ro sp e c tiv e employee re je c te d as u n su ita b le and u n f it. 1 a rs o n s a d d ic te d to a lc o h o l sh o u ld d e f i n i t e l y n o t be em ployed. The superman is n o t so u g h t. A physique which is cap ab le o f undergoing moderate b u t n o t aevoro s t r a i n i s ndo ju n te . P rev io u s work in th e le a d tr a d e is a ls o a cause fo r re je c tio n . 'ho s t a n d a r d s u sed in th e n o rth w ic h ria n t a r e n ttn o h e d . A ll men s e l e c te d sh o u ld have f u l l blood c o u n ts c a r r i e d o u t b q J, where o o m ld ered n ecessary , li v e r fu n c tio n t e s t s , Xray o f c h e s t, blood te s t fo r s y p h ilis , sedim entation r a te and minor biochem ical a n a ly sis,su c h as blood urea and blood sugar d eterm in atio n . The load c o n cen tratio n in u rin e and fneoes should be determ ined and, p referab ly a ls o , the blood lead co n cen tratio n before engagement on th e p ro cess. In no e a s e sh o u ld a man be p erm itted to s t a r t work on th e process u nloas p assed as f i t and s u ita b le by the aed io al O ffic e r. S ta r tin g w ith an o rg a n ic a lly sound in d u s tr ia l oocsaunity, th e o b je c t then i s to promote and preserve th e h e a lth o f a l l employees a t th e h ig h e s t p o s s ib le l e v e l . Any d e v ia tio n from norm al may be r e a d i l y d e t e s t e d , re rso n s developing o r s u ffe rin g from any o rg an ic d ise a se o f a tem porary o r permanent, n a tu re should be precluded from work on th e m anufacture o f t e t r a e t h y l l e a d . As s t a t e d a b o v e , tlie Company sh o u ld be j l v e n th e b e n e f i t o f any doubt a t th e i n i t i a l exam ination, b u t o f te r employment and engagement on the process th e in d iv id u al should be given the b e n e fit of any doubt and, i f n e c e s s a r y , fo u n d a l t e r n a t i v e work n o t in v o lv in g e x p o s u re . A man re tu rn in g to work a f t e r sic k n e s s absence should bo re-exam ined and c o n sid ered as to fitn e s s fo r re-employment on te tra e th y l load m m ufnoturo. I t is recoaaonded th a t th e stan d ard o f m edical equipm ent be improved im m ediately, th a t the apparatus fo r thorough exam ination o f eyes, e a rs , nose and t h r o a t bo p ro v id e d end t h a t a chock eh o u ld be f r e q u e n tl y made on sphygmomanometers:. The m ercury type o f sphygmomanometer i s r e f e r r e d . Ac re g a r d s p h y s io lo g ic a l sam p le , when th e s e r v ic e i s f i r s t s t a r t e d a l l p ro c e s s w o rk ers sh o u ld h av e an a n a l y s i s made o f a l l f a e c a l m a tte r and u rin e c o lle c te d o v e r a tw en ty -fo u r hour p e rio d . T his should bo c a rr ie d o u t a t s i x w eekly i n t e r v a l s , and'S nap aa.oplo o f u rin e should be examined a t th e th re e weeks in te rv e n in g between th e s ix w eekly sam ples. In th is way th e b a sic d a te req u ired to e s ta b lis h tho degree o f exposure and lead ab so rp tio n in groups o f workmen osn be r e a d ily o o lie o te d and com pared. A fterw ard s, ' the system can be m odified to s u it th e needs of the -riant, fo r example, i t w ill probably be found th a t th e persons working in th e te tr a e th y l lead b u ild in g w ill n o t re q u ire analysis o f fa s c e s , and th e people w orking in th e load sm eltin g and a llo y b u ild in g s w ill re q u ire to have such sam ples analy sed u n t i l such time a s the e x c re tio n o f lead in fa e c e s approaches th e mean fo r the le n t. Blood sam pling can be Introduced a s th e s e rv ic e p e rm its. KE 0000385 The " C r i t e r i a f o r th e I n t e r p r e t a ti o n o f A n a ly tic a l Bata." by l) r . 3 . A. i-.ohoe i s a t t a c h e d . - The blood ex am in atio n s should be made under te r n s o f a b s o lu te v a lu e s i f p o s s ib le , and c e r ta in ly a r e l i a b l e method o f d eterm in atio n o f haemoglobin, such as th e a lk a li or sc id heeasatin methods, i s d e s ira b le . In th e B r i t i s h i 'l s n t a minimum o f 9k- iiaom oglobin (IOO/) = 1 4 .7 5 g ram s), i s a c c e p te d n s th e lo w e s t a t w hich a man ithouid be p e rm itte d to c o n tin u e employment on the s la n t. S tip p le d c e il counts should be e r;ro u se d as numbers per m i ll io n and i t is ; reooiaaondod t h a t m ethods oonraon to th e A m erican end B r itis h H a n ts bo u se d . Prom th a o l i n i o a l , p h y a io lo ,fic a l and blood examine tio n s th e ie d io a l O f f i c e r w i l l be in e p o s i t i o n to know e x e o tiy wtsoro ex p o su re l i e s . Ke ah o u ld spend a c o n s id e r a b le tim e on t h e p l a n t t o a s e e r t a i n th e s o u rc e s from w hich ex p o su re hns a r i s e n , and make recom m endtions to th e Management - 6- a o o o rd in g ly , i n o rd e r t h a t th e so u rc e s o f h azard may bo c o n tr o ll e d . The Medloa! O ff ic o r should a p p re c ia te th a t he a u a t upend a c o n sid e ra b le tim e on th e r i a n t . His a ttitu d e , owing to a d if f e r e n t type of tr a in in g , w ill be q u ite u n lik e th a t o f th e Chemist and engineer, b u t th e th re e to g e th e r ought to oompromioe in Such a manner a w ill le a d to g r e a te r e ffic ie n c y , production and sa fe ty in M anufacture. The M edical O f f ic e r should be ro s p o n s ib ls f o r th e tr a in in g o f f i r s t a id p e rso n n el, and e x e rc ise su p erv isio n over a i r sam pling fig u re s and p r o t e c ti v e c l o t h i n g . He sh o u ld n o t have any e x e c u tiv e a u t h o r i t y on th e r i a n t , b u t th e anagoment should g iv e due c a re and c o n s id e ra tio n to h i s recom m endations. Heoommendationa mad i n re g a r d to em ployees sh o u ld always be follow ed and accepted. K eooaaendetions in reg ard to r i a n t ohangss in p ro cess, re p a irs , m aintenance, e tc . should be considered by th e management. A ll th e a e d io a l men c o n ta c te d w ere v e r y in t e r e s t e d in th e m a tte r s d iscu ssed , and e x tr a c ts from world li t e r a tu r e , to g e th e r w ith vario u s recommendations and re g u la tio n s , which th e y req u ested , w ill be forw arded to t om. A S a fe ty O ffio e r should be ap p o in ted whose d u tie s w ill be th e ed u catio n of th e employees in th e ty p es and d eg rees o f hazards on th e i 'l a n t , and th o methods by w hich th e y c a n be c o n t r o l l e d . He w i l l be re sp o n sib le fo r th e m aintenance and deploym ent of e l l s a f e ty equipm ent and sh o u ld s u p e r v is e b o th c lo t h in g and th e w e lf a r e o f th e men. He sh o u ld be p re se n t, a t le a s t fo r a tim e, on m aintenance jobs to see th a t th e r e g u l a t i o n s and r u l e s r e g a r d in g s a f e t y a r e b e in g o b serv ed b y th e workmen employed, and should ensure th a t a s a fe ty sh e e t is prepared fo r a l l workmen c a r r y in g o u t a h a z a rd o u s j o b . He sh o u ld be r e s p o n s ib le f o r th e deployment o f f i r s t aid personnel tra in e d by th e M edical O ffic e r. I f he should fin d th a t th e b ath ih g accommodation is in ad eq u a te, and f e e ls th a t a l l w orks' c lo th in g should be provided and washed, say tw ice w eekly, he should make recom m endations a c c o rd in g ly . A ll persons engaged in the m anufacture o f te tra e th y l lead should be den tally f i t . The above i s o n ly a rough o u tlin e o f w hat i s n e c e ssa ry and d e t a i l s w i l l Le fo rw ard ed l a t e r . (2) E ngineering, d esig n and m aintenance. From th e m e d ic a l v ie w p o in t we can make no c o n s t r u c ti v e c r i t i c i s m on th e H a n t d e sig n , b u t would li k e to s t r e s s th e n e c e s s ity f o r u n re m ittin g s e a l in th e iearoh fo r sources o f contam ination from the- i'la n t equipm ent, and e f f o r ts to a b a te them. A -summary ox' th o p o in t s a t w hich le a d , or,,anio and in o rg an ic, has been found to be most p re v a le n t in o th er -H ants w i l l be forw arded l a t e r . The id e a l i s t h a t th e r e sh ould be no exposure to le n d , o rganio o r in o rg a n ic , on th e X 'lant. HE 0000386 (3) E ducation. E d u catio n o f th e men a t th e in im b e e u f l i a n t w i l l c e r t a i n l y be a v e ry d i f f i c u l t t a s k . As i n a l l t e t r a e t h y l le n d p la n t s i t i s th e M edical O f f ic e r 's d u ty to ed u c a te th e Management and t i men, and a ls o to ao cept the education o f th e Chemist and E ngineer, ag ain , in o rd er th a t maximum p ro d u c tio n may be o b ta in e d w ith maximum e f f i c i e n c y , economy and c o n tro l. (4) Enforcem ent. Enforcement o f th e re g u la tio n s ia a m atter of su p erv isio n and f a l i j w ith in th e province o f th e f o r k s ' Manager, th e urooess Manager, th e S afety O ffio e r, th e M edical O ffio e r and the I'oreoen. -7- * A ttached fo r re fe re n c e *nd inform ation a re copies o f:- \ ' (1) S tan d ard s o f F itn e s s f o r P erso n n el S e le c te d f o r Employment in 1e tra e th y i Lead M anufacture* (2) Works K u le s. (3) S afety K ules, (4) S a fe ty C e r tif ic a te ( th is i s norm ally prepared in .d u p lic a te ) (5) Notes on th e c o lle c tio n o f Faeces and U rin e. \ (6) A S h o rt Method o f A nalysis o f U rin e. (7) S ta in in g o f S tip p le d C e lls in B lood. (8) C r ite r ia fo r th e In te rp re ta tio n o f A n a ly tic a l D ata. E . Davison. (Senior M edical O fficer) . 22nd Deoember, 1948. 0000387