Document xd50Kaed9ROJEm4gzMV3VznLJ

FILE NAME: ZW^W^ DATE: DOC#: W^ DOCUMENT DESCRIPTION:Z .' I. , ~1. ' ,~~' , "-- :. '~'j :~. :) :," . ~' ~~)', ! >,~ t :1. ::r.:}.i i ~/ "\)J t ,l tor ,:_1i,._,.c;t .i1l, fhe J.:l ()1'q:[(; i,roR c .1"..1(:ihlg de- n 1.xmnccUon uemf.,nts of dingnosi.s or ::> i~sedt vviG1 = or ',-HJlf, '.'\ -. . ., ' -,.,,_ntage ,'i'tkhhave le for a par:;p:c;"'..ted JVith " : fl H1e :field of :,.,i.1n will be i1 D;;__,partw t:ros. t ,t Slf:(~:ronic !"'\/tJ\:.:}(.gical ~ i.,1, M.A, ,;nd i ! -., i ,J. 1 i ;;l :sf i,\{ l!I II( 111 Ill 1111 H II: IJ1 Jm Cf J; !1 Ill Ill lll JI JI ll Ill lill ll! II i1 ll !II 2l ;Ill )!!l l\l '.'a )l ill );( ~ r.( ff :'.i rt :,;~ ,:-, l ~:;~t '- ''.-,]::' _j' ~(t_,; .. ' ._/~> 1 :/~ .. , , ',:,_} : ~/ l' .~J ,::, '.1t:;t,,(~::::-i, ,,;ll~ct~;;<I tr:} ,J;,'1,"' ;1.? :- t ':", )},Ot'~ 80 ;!!::y ~1~t rn ,\s ,:.-~,.,<r ~~.,, c//i..-L' l\) 1; t ,b(; <11...tt }?:Jl :\,~y ,'.r(e Hd1..:'1.,t~~:~,~e$ 1; (: a.~-- ~ (~il1:;,; ~Hg)~1~: ,~.~!;Jys i~t,.::re- ---tl- ~-Y ',re .~:1~Sc-: :-:.iag D.1:.\! ,v:;,~~_-:Jt J(1,,:-.;';,f1J.0g to. -1.~111:.1r . sp1. nt .. is 'flt1ung, 'out -----r~rm' there 1t 1s 1.m--..v1sc for us to gner'-3hse. One .111an'& ~11x:iss n1ight he ano1hcr m,,n's mbforti.me. But in making his ,!'-,>--_.'.:; it is ;n, :,csfo,g for rhi: elector to ;, ,, in mind that in ,,nc carefully .,.gf\msed test, the blarn, :as pointed in no micertain rnamwr :,t vitamin-C ckfldcncy. PJbena Bfackcurrant Syrnp prnvides a P 1 .1able snppkmemary supply of the v;uunin totct1:::.er with its .t",aturally aswciated factors. It is ralatable, clii1c,tible and is _pl-lrticularly s11:t2ble :Nhw; v.it:i.min-C <lcficiency is linked ,ait11 tl,e :cc-3fticV ,:1 ,~.ietary of ulceration. i'f.a.:-eu:a ls ;./':rili2ble on i~tcst~r::r,H.on ,-_ "1 ...-"i-:t:-t-0rs .~td! i:rt;!ted to ~1t.He to oor ;:-,;,]l ,:,. ,! ,,;--,1t tf fih, --~ [n...C ,:1,f::-__::\;_;:~cy is rJ:,r..tb,)J~f;(l ,1\~t\'iPg ffi .. ,f;1)1i i~~] :";i/~,-"'.<!fs.,, :,l" ~.i.:~Ht:~~~ --A tree \1fj ~:; f; i t:~i-i, ,::!f\ '",)',I ) '4. :i;; ' )t:,~ .... ~{ ,, ~ ;_~- ( '.\'\ ., i }f1 ::..,_., ~'.l 't'~;--;,;... ,-:=i:-~ '-', ~H~ .1 !I!a: il!I : '/IS , . r7lJ .-,ii lIlit .:,.i,,f ~-- 1-~ llf :>cf lit ll M !ill'. JJl llE ~ ,I lQ l!,( ~ 11 i;fi:-,::,, id: ., . Gt --'ui'f, I( ,, Ji! .ifi 1:',~i-1 '~ M 1 ., ;f ~.?.; J~P'. IfI, ., t: t ~- r ,,;a: ~<, <"-0? l { - ,/ ' :_. ~ , <Y.:-..,, ":?,,.,~, ,:Jf ;_} ',::~:,;;:~ ~:/(jt -:'\ \ / ~. J .l~ ,, ) , \("' ,. ;, ,.,~(:,1;.'N ~';jf~t .:u\/L;\".f,l\(.'. _l.l,ji,-.~.-.1\;.,.,~ il,,.l...J - , ' -~>' -, ":'-",;~,,-.N\:,r.i y\_,- t"'li L f J,1. . 1-,) THE 'lF,\C}U\G OJ.' !Nrn;s1'1UAL :r,rnnn:INE ., CARE OF 'i'llI~ nrno:<1c SICK ... Hy E. L Stuu1,,, O.IU,:., M.R.C.S., LR.C.P., D.P.FI:., M;irjory .L.R.C.i',, r,td 111~ late A. R. Sdignn, ~1.D., D:f.M.& H. nu: F(J;';DA,n-:N'l'AL I'OSl'fION OF RES'l' ... By Ah1tl.1,- F',nl.M, Jl(D. w. wwren, :11.R.C.S., ARTiflClAL t;\lNLrGHT '.l'REATMENT IN INDUSTRY By WHlinm .n,-,.nmonl., M.R.C.S., L.R.C.P. S02\!E HFD1C1Uj l'lWBLEl\fS OF THE ASBESTOS CE.MENT INDUSTRY By .J. l). lliwll~y-Sndth, ll-f,RC.s.;cR.C.P. ELECTRO\!YOC Rii.l'HY By Crnln11, \V,,dddl, M.D., D.Sr. ROYA}, SOCH:'I'Y OJ? .MEDICINE tUmAml.I'l'ATlON IN CHI:ST SURGERY Uy 'l'. Holme Sl'llor~, l>.M., ~I.Ch. , ar,a THE "A1XtriJLOGY Of' CHRONIC ARTHR.l'!lS. By \V. S. t;, C,,i,emtu;, M.D., F.R.C,P., P}ii1ip .Ellman, l\LD., F'.R,C.P., Ka,foy, M.l)., :F.R.C.P, - \ G.D. FHC(;\f 11rr,; I] ~.s,n, J;'dil));(j Hl i\,f, liL'./U','i.'H c:ot-:t: 0, ,:::.;s, (n{CJ..GO, 19'16 1\011\. HEV ti, \VS .. .,, i' i' \\ 1S U<I) i);OTfS r~)i{ ' t',: rr ;d - \"t, i',~tir.,">E . - ., ~J~ ' , fa.ge 33 31 42' 4850 53 55 55 58 59, 60. ol 6?: . '."1~-: :f:~~ \~--\~~~, t_:, >[e~ "i~, THE BRITISH ~TOu'R.:"\.t E~ .J. !~. ~5lNl1,.,L1-SI\1rti:~ ~'\rtR.{'.~i, L.fL-' .r:\ Part-time l11du,1rial Atedica! O}Jicc:r, Univ,; " . 1.,,:,0 ws M,1 mt),1cturing Company, /-Votjord (Herts,) !\ : pproximatcly live yc\1rs ago f Wah .. :J:c(; W :- 1-_.~ These, in their order or pric,rity, arc as :'ollo1,,, ~ '-:, /-~ \ over the n11;dicaL ~upi.:rv1~iun {11' 1.,ll1 :.t,bc0tu:::. ( i l Dcnnatitis. ~~~.. '. r.} or .L ~-ccrrH.~nc facory~ situall.-J u1 01a; -..1t th.,; l-foruc Counti,:--. Dnd one of its a~sociated br,,n..,h..:s. Having no previous experience of thi, ;,,Jes-!!, : wenl folly into the matter bcfon::hand, aP.: lv, 11:e,! that the rnanufacturt: of asbe:,,v, ccrnc!' t f't'>.i. -y:t-., was scheduled as a "hcav1 industry .. (,n the ,,c 11-,e that almost :-1:1 the manuiacturing pus,:, ,ses required a maximum output of hard manual labour) and also as a "dangerous industry ", because of the special ri~k of '"asbestosis" encount"c<i by those employed in this work. Previous to my appointment the 111cdical arrange- U) lnfections of the upper respiratory tract : vii-:intlucnza, bronchitis, oharyngitis, and so fo~- (3) Rb~l!ti1~ttisn1, p:J rt1cularly fibrositts :'' n,~lq !t::,. (4) Av:iJcntal inJcll), includ,ng stiains, sp,., . culs, abrasion,, '.)ruising antl crush i;c_iurie,. (5) lnfr<.:tious di,1.,ases : ton,:!Jitis, mcn'n;,;1 m11inps and sc, !'orth, ((1) i..::,,:cilic ;11J1.1~trial disease, in ,h1s ,:;,_ a,bestosi~. lt will simplify matters to consider the aoov,::: their reverse order. ments mainly consiskd of a Reel Cr,,., !in,1-:., ,J ourfit ~:-'t ~l bL,ck j:.'.panni..:<l box~ placed in :J1t.: ~li_"ge 01 a :.imek0:~\JC.1 \'.'hd ~tad a ura1..i !1.;al \\Vrkin~. :. i~, )-...vlcdgc of .Red Cro>,c ,1nd St, John's AmbuL,:t~: iirst aid, Minor accid<:i1ls wcr.:: treakd a:1d dtcs,i.:d by him on the spot, ::nc1 n,ore serious ca\.. s 1.1i~p.ttched ,1s quici-J), as possible :<.> the local hospital. On my arrival I wa~ given by lhe mamtgernent every facility and a free ha:1:' r,., ordi.:1 anything th,,t l consid-:red to be ncces~a1 y. lu due c-0L1r~e u fully equipped surgery-dispensary was 1.:stabl1:.l1"d in thc canteen block, adjacent to v,hich wa~ adde,'. :, solarium with allra-violet and radiant-heat Lw 'fh. An office desk. ttlts and so forth, neccs,,,ll"> ,n c,,pe with forms arid ccrt1ficates, were added, ,,~d a hilltime Seate-registered nurse was engaged ,o tak,: charge of 1,he Factory Clinic, A~besto,is ,\1 1:hough the asbestos ccnwnt imiu~try is schech- 1 ,_ :t \ J:ingcrous ", ow1ng to the pQ::::::.: bk 1ncider\~l', asbc~to,,i,, I have not cncountcrcc a single i:1crn,,, case in r~1.Y 5 years' e.i~1...,: icncc. I have corrv.:: ,--c~ J 7-3 lon~:-,tanding chrv:1:.: <:,tses, but the,-c ~,.t,; oa. H-' k,n.,; bd'ore my time ...rnl cvidendy are stat;c. 'fh.: rca~1-"1 for this state of ,,,ffoirs is o!)vl;:,u 1'he I 1.tn~~c 1 , ,y \tsbcstosis arts(;;; fr..).n t\e iHh~.!,J~,._ of ~hv ~t1rb0r.ne ,~fluff" of tt.~ rnatc:!~ia.l, '-Vhich, ii1 ~: <lty state, rcsen1bles floccul~nl cotton-\vooL "!h-~ iS only one stage of the pr0cess of :he manufac'..:- uf asbestos cement in wh,c':; this danger can ,_,-;~, ,,nd that is in the or0cess \,htch takes pl.ace be""" the opening of th; bde, in whic::i the rav; asb~c ,.tr r,ws at the i1.ctory, aml 1h mixture wit:i cenJ1.'1~: ,, wat<:r to foim the moist inert nu~s from ,./:< factory' products are made. Th,~ c:'l:cicu-: Prevention of absenteeism safeguard,; which are employed duri:_1g. the,' d,;,,'.ig~ I conceived it to be my pr, 11,:1ry objccttV!.! to 1cJ1,c1: ~-,<;t;-SUch as the total cnc!osu,e of ti1c .:n:y J.s">' absenteeism -'"rom health reasons to a minimum, 1n ma special chamber, suction vem1.2.tion ,,.,J:w:, .,, ',, this rc:,.p-.,ct I was the friend of all concemed- :.11 the loose particles in the ai iu:c conveyr,,, Goverrunent, management and working man alike, lt took. several months for the majority of those and the wearing of' respirn~ors '.)J ttoo.c ':"'' -the pro(t.-:~:-, is cviCeoced 1:,y ~\:; ~1 :~c~ that~ "'J~., - ,,~_,- employed at the works to find ou: that their trm:bles co;}(...".!t:nn" asbestosis docs not occur i~ t1iis _: i_'t,;: o, cou1d be dealt with eflectively u;1 the spo1, ,'. :i-_, world,:;, hou:s, instead of the long hours ,v ut,.'c'. oi.'tcn neLCssary in their on: t~m" irt the surgeries (, at any nil:.: within the scope of my cxpedcncc. fnfect iuus diseases overworked panel doctos ,,. Mc:.-;u\ :;, . it soon 1:J(;C;,me evic.ent fac.i. the ~pech' , !c>"-'! :de'.,: of the Vi',tious haz,1rds and strcss,~s of ,h-.: \,,,r:z , il<.:h we /\-; reg,, :-r.is infectious diseases, !ittle more ner.:L' ' ~,-' :';:', ,,,,,1 tl1cscarewdlwithinthe!ow:1ver,,'l': b,.; c>.p,,,: Ld ;,t,:,: it ,igorous scc:.i0n of foe co:-'.:-r ai.:quired was of considerable aclva11iag.; m both bctvvc'-:~ :11<.; ,t;l~ of 16 and 6t) year.s1 living v1: ~_:""' treatment and pro0'1ylaxis. !Jcq conditio, , of diet an,! housing obta;u,':,_:; After five years of record-keeping, it 'i:ts becc,11,: h.:Tvy industry at the prcsc!l: ,in,e. nos5i:i\~ to take a constructive view or the mo~t ,Hnmon o' > dis1::as<:s ,vh:ch w~, have to comb.l~ in Accidental injury 'Ii ,e battle ag:1.:nst abse:ik:-~J,m. As regards injuries, the greate: rroportion mT ~, 50 ~y ,:,, ., (L:L ..,,.:.h1,)r:s~ ~1,: -l--- -~s-;, ne cxyxctr:d 1n th12 han~1r.1~~; :11 rn..ttc;1ul. 1;--; 1nr old d,1_y ~ut. b 1nJur:\ \- '-\'_,i-..._: ~') ~)~ :~r\ r:; >,:d'.U1T, \vlth '-.: it ti:t, :h~y ,.:;1f1;-, bc\...,1:~,_: ~cp:ic ,. 10 (;_t; VJCdfflS rec ,;11cc!. ""d ~~<:i! ,2t!cntLJ !'!{);--,("IH'tl ln~atrnent out~,i ,_ :_fie '-f'J~:-~-- ~L-.:.c ;v;J_, r'\O\V rcpoi t\ 0utomatica:::.,, 10 ,,",, y\ v/l',._,,~: ~~1(; abra:)ion is ci1s1nfcch-~ : \ ,.__. p1\.'Y~nt Curr,1cs- anG :::1 ~ \,10~ :~1,2 \Vholc c-1x~:\t(iun ,1cccs.:;1t~(11n:; :.:~:-i:1 11j n:-::nut...::, "l,;r the Job the r,atient 1s ['-..'"'i( ,-();- '-'-!J:,l." priatc , , ,, ,_,_~JL LO 1h,_ local nh;J1cai i, 1,,.aln1c:n~ 1z-; :~i. /en or d::~r;,~ ~c_.,:cl (ga:.::~:v,, cxrl.:cto;~:r n11xrurcs, nascl drop~, li-1:eat r~. ,,,1,1v\, '.t~;-:cs, anu ~,G 0nJ ~lt the s, 1 ;,- >'J. ,-t .~- :11 1,i.,,1:ch c..h1-Jn1,__ ca tarn 1, \'. ith or \VL ~e,,i_,:.. :\;curA l:old\ and \Ort ll1roa1'">. i, ,1 i:tclot '-LC(;,, 1.u-,~:c~~lw: \'accinc 1noctilati0n 1~~, ,\CTi (~,:; ,!1c c;-isc ,-ir ... ~1 - ;heLJ111~11i{,r ..1) on <~ , ~)i\:il<, y />ash. : t s ,--,-,:,: p!'.:.c,, L' ,, ,l'.' -.1.;J 1,.1,uc1 dos2.~1.:: ,l;u) :-,tC1<i:: \:,;1' . 1 ,,_:,..: 17f1,.l7,:Jlf! ~ .., '"';,.,(~i(Ji~' Cbro~,jr>:i, rhirci on the J i\1 : !'JJ i-~y a~~ ~L c.~ _.:;: -.Jf a~;scnt1..,'1~'l' ,-,-,, !ta\\ incrca~,c( 1 ;.:.-~c-:-: ~:,CCC~>;:vc YCd.f of fie ,{tf and pO'.->L-\V,.i, -:~:r: 1 . : ( ~- ~c u; far1~.i,. ,1 1d pcrh,.1 : ~~., :' ,- q s tn ~ C<lrbohydrdte,:,. 1:-1 1; r~~l':.>!' jf h ;-;-::rn StJffcrcc! froril rhcun1J t l' rl,. in~ --'.:t;t en \\'Ot ..:u.1g a--. iong ~;s he could ctnJ Tt-,1n, ::; h( con:.::! :1,"> :_:-in ~Jo !ongi__,;~ tccired to beti :,,f' 1, 1 c __ \--:, LJ;:1: ri1c pain ,vas gone. NovV a~ :i-1~~ f11. '/ :J. U.:~1 '.:~,)-,1:'., :::-.. 1nade of 1hc ty~!c ol pain, ',, 1:1 1, ~be,.. ,,!:~, ;:ctiritli:;;, ruH.1 ~n 1~111~h\ and 1 ,~1t- -'1. n :icc-c,1 ( i r:~1). -r11~ trca 1rnc11t of' rhcL11, :~1 tic : 4 ,0t\S ,;i tr\,~ ~=.u:O(Y Clinic is Jc4,1gncd primardy ',rcc:,Y: the c:,' ,,,rn 'Nh1lst cnablrng the m:rn to :it \V,..-::rk, :1-n,: u1 ided 1nto '.:"/1ort-tcnn, n11>_;111n1- <1:J !ong.-~1.rr(.1. jit1asc.;. 'r 1~{.''1/fl JC,"L'f'"![)l7t.- -~-r:1:s ., -.:sts m:unl'. 1)r ll. h..:~,;- :~;nd. G(oSS'.1,-__!C, gii.'Cil ..,y llK' factory ntr~,i..\ c i 1, :1lfec ;_in:e-s ,:...,~c~lY~ ::.,tan nour ,._,(nch i!t\, -~,est ,\, ~'h~ )<.:.ticrn'~ \\-'01-\-:: <..:;v.:dnlc. _,,1n u1c pat1cnt (~:itf (11s reacuon:-,. ~-L-_-ic v,.,~L'.C1 .,en in the cat!y auturrIi1 before ti1c ~rct..::;c,:, _.. ..:>~'- !~/\,._, ~~nd 1nflllcnYa, z~11d in mo1;t ca'>\~\ 1;1~ cou1 .: :, Lt)!'l1plctcd before rnid-l'-:o\Cffib .. ,. H-:.-..~ .._~:-~~L:.G ',. ,~, d1fficu1t tc: SCtY w:1:1t the i~nal tc~uil oF ti\1\ :l'1JCL1:~,~,:= .. 1.ir;tJli\'. (Ol(l') an(~ cnron~c cat(1nh \Vili i~,t_:;~ Dl:t :J-.r_-- ::; 1 11 L' :;1t1ng 1hems1')', ~-- ... 1i1 : 11,_i-~~~1 ll.S ;1L:r:11Jct , , :1,1 u r- hoped 1h,ti } :n:r,..-, 1'1' ,::cgtcc C'i TLh _,, i11 l1t1on, \\'i 1 1Ch, bcc,1us;~ of 1._, itff)Dl'Lu"':C1.. ;cavL , , ll1~ Ia,1, pr(-iv1dcs n1orc ~roubJc t~1an .:.11 u :: t ' :-~!-.;(S put ,, ''.::ct:--icr. ::1 lh,_ , \', th (\>1,11~1, ,1 ttt1011, i.i, ,\'\)J"k'), .'ht.T\"" j()!~;:;-; ,1c,v,._; tt) c ,:ti;Li,!Cj and 1can1-; 1\:1.d I dtt --~-1. ;n ,.;~~ r.:t~~ ;- , ,- 1H:J1_ ii,, no othvr l'1 1.P.::1.Ji)1, ,. :1l SO fflU\.1 :11,~;llu1l: nf llrnc and n1alcr i In ,. 1 : ,r, _i \Vith ~ndu~trial dc:m3r;i ,, ol"f'1c, 1 F;i.;:\~, 13_:t c:1ru<1l~ _!J:Y1al1c lJztLt',,, ,1t,t1-;o:;trep~_.Jco,.)..:: J v~iccinc in \.he i_',1\agc is t1u:J-;-~,._.crive (ap-oroximatcly --~5,C 1, ;ii,i~\~ Ofganism.< and t..ioc~., not in any \Vdy ;i-;\i..'.T!tcn~c the ,--:.1.~;cnt. lt 1:-;, nf course, gi\c,1 'rl~' ::ach ye:~-,; a11 incrcas1> ,,i-'lll \'l 1','1\ ;trc r'or H1i, in~~~trnenL ~t 1~ ,J c~1dy to att1vc i!'Ee dt.:::cJsion a~ to the t1or,11yl1ct1c value of ,,i~:t. - 11cn..:uh1L,Jn~ but thc!-c 1~ CV('r:i :,., 11c1'!"1on ",., provmg ,,,, ;,_, i1:;ncrcnL :~ ~~tt&io:y tnfecti1.Jn , J.: ~1 c..-s;1ir:1toty 1rac1.. infection is the principal t. :'t,:._' ;;'Jr1 du:ing the first ~Lktt ~er of the ';'r-,c,c t f1.;:,~on to ~urpo~c that there 1~ , r.;:, :~.:,art fron1 t:1c ,:;('.ncra! (: inciplv of '-~d,1(1~, the ffi.~:-:1nlu1n degree of fitnc~:-., th...:1c is ,;) 11G (:one. t:tJC:..:t l\. 'i\ ;"'-lii10!:)r4:~~0.: c~bnorrna]:ty is c\ 1Jcnt Ji. ;,.he nx., s1HU")t:;t ti nd so foru1, requiring '5-t.lf- "".l\C which we do not fuiiy underswnd a, ,1r1:tblc to controL atutude of--c patient L0\\~1:--...:~-; tr. \ 11'-' attitude o: ',l~ n1t1.nagemcnt L>v,,._i.rd~ it. e')en', 1~,c~:: .,,:t of the \Vorkn1cn's Corn .,1 .):~ ,\1.l ,1 n.L11:on to it. / /1, fl,'t!ltre u( dcnnutiriv , 1 1.<1rd;., the LiJ:-,,ea'.;c 11...cif, it is cvidcr:~ :hat \Vi~.:~: ''.\.' 1c:ncc of th,: clmicai aspeCl :, ,c:J:i"cd, ny er'.', ,1)'.~ 1ing of knowlc(\~,e ob(~tined frorn ,"r:,.:1~... ciiJerf~fL, l-,r:::_:he~ of 1nJu~tr), before ,vc CQO fo~n1uh..~ si en::",,,,,, medical pol,cy, .__ c.:11~,1 ,, 1 c deeper !~~./c:.::: 0/ lne :::f;_i:1 (tcdill')l 1c~1.l_,,.:,11,1 . ,.,- 1r1;1at!on, lJLlt . ~:oi-r:..1riat1-:=l:.1; although tb,s 1s ., r-:;,,onably sound g<:nernl:L.t.,0,, iherc 1s nmhing co;1stant about ,t Some :ndiv1duab arc 1n co,F.ict vv,~c1 su.:)-, 1rr. 11 ,,,! their !ivc~, ~p1c! ,!-,(-)'\ no c( ::n lC. contacl \Vtth :i1 a sign o[ ti'OL1 '.- , vary fron1 :.l i~: \, ihc same won, 1:1': ;.n inlcr\,Ji C<1..~i(~,;, 'Nilicr_ ;-::.,_l, .1:1~ ~o a fc\V ye:,~,_) U~i'.. '<Nr1er1 ;ltTI1cd, dcnnal,1:[,; bcc,.H(:=: Q,_e, 51 t c,;;!j :dc;,cc ~lSl -it-'..- e fir~ .. p-ectfic il the how)ugr:: m tnc v/ork e skin tlients~ bymi Kero' and, ov1in;__; Id bG 1ly fo, , : -~~r L,-: r:d., , ~:.: ni sztbJ ltty , , . :: ,-~ to ::-.on1c LH.::;Cc }i\ 1 (\}:1SH.ut OiM! ir~Jr exan1p:.: rhcL~ i~,;, ,,a1 , ::_._,,~iJ r1e ccrr:1c-~; ":ndcr the opcr<11i1'. 1):~ t> 't r:; :-kalth n~nra !n.T ,_.i\ct, v,1hatcvcr ~, re tf11- ,. :-:-,ri,nc,2; Gf ni:-; ,::mploymc,.: ,,,:h th:; vast maJomy of Ul\, .' , encounter. ,:'1,t1.tJy, 1t is no1 difficult to decide under \-.. ti, .. , ,tt,.L.o:y ~1.he dl','~';1,,.: ~:1ould Oe iistcd. hidustri~ll .,:im,titi-s, howcvc.-, presents somc,11ing of a problem, ~..1v1r':i ;"':1(tny spec13l difficulties o:~ 1:s O\\'n. It 1s, ,u1 ;r,~,Li1.ncc, aln1os1 1111possiblc to pi." ,~n~ c,trclessncss n..:'.dcct on the part of the crn,'"J"L'\: :, 0 take full ~::V::r~lage of the ptccautions provi\;1_J. lt 1s alJn,,--.t lT:;r:ii,,ibk to make any rirogno,,, regarding the , ;-..hJ;11e duration of i:fl act,tck, which may vary :ror:1 a ficw days to many years. In many case,. it i, ,,,lrcneiy difficult to decide just when to r,y:1rd a :nrt:('nirii attack n~; being cured and :h,_i t1:1piny~;c tit to r.:. ~~,r:-1 to ,-vork. ii! ,-;c1 of ,lli these uncertainties, it is eviu,.i1i 1i1a1 ir1Vc ,s a wide field 1n: cxploitafr,,,, varying from :f ..:<;n,.:eahnc-nt on the one han,t 1 t.., 1n:t:111:1;ering on the bCCOflh \ 7 In,: '-,C-;7i Lui~ lnc.:Ltstrial dcrn1atitis J'~ he~d :o , ,1:: rcs 1)t1,-'"'d<'i1 v of th<: c1nploycr and c'-1n;_cs uncier the \Vorkmen's 1 ,1;:icmation Act. If the d,,tw,e ;. ,: u:y constitutional (a, f bciieve it 10 ;.,,;,: ,, crnp:oy..:c 111ight be "dcrmaLitis-pronc ~,:t or ni1,; , . ,1:dly be s,11foring from dermatitis, whc:1 he wa~ id,<::n into employment. Undc: existing cgulation, th" is nothing to prevent hu:1 fro:n iKcoming a !1;fri;!1ty upon ,.h,: firm for the rest of his !if. if he cc1n establish the cl,iJm that the dcrmatifo ~tarted after his employment began. in view of these facts, one 1s compelled t0 conclude thal industrial dermatitis as a disease is in urgent need of i,_,,,,'. investigation by the Medical Rcscard, ,, 't111nc1I, 1",l Lo .:~tablish a system of :wocedure for ,:,,; ;;L:idancc nf industrial medical officers, and ,ccondly to recw:.,1dcr the position with regard to the question of c,1111pen,a1ion, p,Hticularly m respect of the " dermatitis-prone., ern 1)!oy,e, ELEC-fROMYOGRA P1d V ustrial )f LWO ~ptible by ihe- It ;,, riabl~. ~ non..cptib!e ~ , , ~ rimary .d the :l as ~aatitis- ,; 1imsc;f :led a~ 1duso-: andlcd being, ~'s ~O''H;JD:t':rl 1ployee .if mploy . , ~orters1 - ~;_ some come:; 1sati:on ;e, lf,, '., ;- , GRAHAM \YEDDELL, ,:, ..:., D.Sc. R,,,11fer in Human A1wto1u1, { l11, ,'!.;fty /vl11se11111, Oxford .(ix 185 l Schiff notice,, thRt den,:(\ at.;:d voluntary ~ ,nusdc wa~ in a constant state of surfac,.' agitation ;~,h:e w mi.1wLe isolated contractions. rhis con:i;ion he described as fibrillation. Jn l 93f. Det1t1'-'faown and Pennyback,)r reconkd elcctncnl acti,,i1v :,om dencrvalCd human muscies and found th:: l , liiler~a in char:,ctcr from that occurring in normal :,,1man 1r:%ci,,,. 1n 1941 Eccl.;,: showed that the ,!,~trical activ;ty recorded from dencrvatcd muscle is ;,, ,,,ult of the contraction of single ,rn,cic t,hr," '11-~ i Wc,idell, Feinstein and Pattle studied th..: " , . ,_ d-,1ity of muscles from the time of denerv.:' ,, .. ",.;mlete re-innervation in n:.,:, and in experi- ,.,;--;," .l ~.,imab. They showed ,...,c a conccntnc dc:.:lrode, ,;,)upled to a high-gain amplifier ,i:11 a \hort-tinw ,.;011,t,111! driving a :C,dd-spcaker and .~11101.k-ray osc1lloscope, can i,c .1. ,-,,:d for c:in1cll f'"<;ioses without any difficui,-.. ,,c, .-.,c dec:.rod., ,;, abo be used, although, in the majc,rily of oil,. , ., ,>,;h r!.!ported by \Veddell, co-axial electrodes \\ 1.1 ~ ,,.>cl. For p,;:;rmancnt record5, photographs ,_.; ,;;:1"10,:fo-ray tube Lr;;,:.;~ or sound r~cording5 have to r: r,1,1ae; 1he latter are the more u-;,., ::. Ink wnters :.,,: 11n,utisfactory for recording the t;\i;ctrical activity from dcnervatcd muscle'>, for the potenti,ds are of too ~hort dura11r)n, :\c,hm po,...,11.ial~ in contracting muscle : >,c cicc1: 1cal activity c1-..:ucring in a norrnal con- :r,1,"1ng ;,i:,!'ln nrnscle take~ the form c,f so-called mt,:or-unit action potentials, They appeM as monophas1c and diphas1c ,pikes, bu1 occas10naily they are more complicated in form, [n amplitude they vary from 100 microvolts to l millivolt and in duration they last from 5 to 10 milliseconds. Bo:h the frequency of repetition of each action potential and the 1,,,1,her of di!Terent action polcn\ials recorded vary ,.,-.. 'ording t,, the strength of the contraction. They MC heard,,_,. low-pitched sounds. It has been obscn ,:u that, in 1;,,in, no action potentials can be r0eord0d from a normal relaxed voluntary muscle. although they arc arou~ed momentarily during the insertion of the needle . Fihrmation potential~ in dcnervated muscles 'r i1c electrical acliv,ty occurring in cwnervateci human muscle, on the other hand, takes the ,orm of a ~- i,, of so-called fibrillation action potenuzds, r,,c,,e arc 01 two types: (J) those aroused by 'd,c wsertion of die needle eicctrode, and (2) spontaneous 53