OCCUPATIONAL HEALTH
Item
- Title
- OCCUPATIONAL HEALTH
- extracted text
-
RF_OH_4_SUDHA
PRIMARY. health ...care in industry
*******************************
Dr
Lawrence deSouzb
---------------------------
*
CONIW
1’ ‘
Works Sosa
I have chosen to talk on the Health Care of this Sector of the
.papulation working in Industry, primarily because it is vital
to the economic growth of our Country or as a matter of fact to
any other country, and secondly because I am clobely.concerned
with the health of theworking population of one of the largest
Multinational Industrial Organisations, for over 30- years.'
According to Indian Labour Statistics (1976) ..the total number of
Urban &. Rural workers are around 200 million or 33% of the population,
and the total employment in both the public and private sector
industries are over 200 million workers.
We are gathered here today to pjan or shall I say predict the health
of our people by 2000 A.D.
Dr Schilling states that futurologists are particularly concerned
with 3 prime factors which determine the destinji of mankind :
population, energy and food. Meddows and his colleagues predict the
collapse of ecohimic and industrial’systems sometime by 2.100 A.D.,
/
unless, before that,, the birthrate equals the death rate and capital >
investment equal depreciation. However, Lord Ashby concludes in
(
what te calls "A .Second Look at Doom" that a proper Symbiosis between J
Man and Industry would safeguard against such a doom.
It is Man who conceives the idea and is the prime mover in establishing
an industry. In order to achieve his objective he has to engage Men
who will study the feasibility and financial implications-of this
Industry. He will again have to engage men to design, construct
and operate this Industry. Therefore, Man is the main pivot around
-which industry revolves. Yet, you will agree that a great deal of
attention is concentrated and crores of rupees are spent orj Machines >
and materials, but Man who ie, as I pointed out, the Key Fa.ctor in
Industry is hardly cared Tor. Possibly because in our country, with >
a large, unemployed population, Industrialists find it easier to
replace men than Machines! Even so, an Industry can ill afford to
lose a trained or skilled worker. It means slowing,.down or even
stoppage of production, which would result in an appreciable loss
to the Industry.
A trained worker is a more valuable asset than money invested in
Machinery, etc., and that manpower is more important then machinery
for it is upon Man that the advancement or retrogression of our
industrial activity depends. Every trained worker therefore is a
planned investment and his employer must preserve it for the supply
and quality of products. The worker should be looked upon as a Unit
which must" be maintained at peak efficiency. His health must,
therefore be considered vital not only for his personal happiness
but for industrial efficiency and economic value.
Concern, for the Industrial worker is therefore no longer in the
realm of sentimentality. It hag become a vital concrete necessity
even when completely divorced from its humanitarian implications.
Today, large steel plants, chemical plants, Atomic Energy establish
ments, and others are engaged in a frantic race for industralisation,
but hardly any attention is paid to the dangers confronting the
people working in these plants. Increasing members of our working
population, both Urban and Rural, are being exposed to physical,
chemical, biological, and psychological .hazards in their working
environment. In addition, industrial affluents'are polluting the
atmosphere and our waterways. All'this affects the workers health
and reduces his capacity to work efficiently.
2/-
Unfortunately, in most cases,. it.is only after injuries to health
occur, by which time it is too lata, that investigations arri proper
hygienic controls are instituted.
(Current statistics in the U.K. indicates that'every year about
11300 people die as a result of occupational accidents and diseases and
I at least 3,00,00 sustain serous injury whilst at.work. In economic
(terms it has been estimated that the cost of this to the nation is in
I the order of £2000 million per annum. The cost to those involved,
(however, can never be calculated.
Statistics in our country collect-ed from 'Indian Labour Statistics’,
for 1975 reveal the number of fatal accidents was 627 and non-fatal
2,09,357. ESIC report for 1 978 states the accident rate was 187
per 1000 insured workers.
< In 1975, compensation paid for injuries under Workmen’s Compensation
<Act amounted to'98T16 lakhs. There are no proper statistics for
(_the incidence of occupational diseases.
The Central Labour Institute had undertaken some surveys in various
factories and detected quite a few occupational diseases like
Silicosi’s, coal pneumoconiosis, Byssinosis-Chrome effects, Lead
poisioning and Mercury Poisioning, etc.
Several toxic chemicals are being used by our Industries, but hardly
any cases of occupational diseases are reported inspite of the
Factory Act Regulations, Section 89 and 90. I, had carried out
two surveys to find' out the incidence of occupations 1 cancer in
our country and I am sorry to say the information available was
rather disappointing.
At the National Convention.on Cancer, held only last week at Jabalpur,
Dr Deo, a noted cancer expert from Bombay, pointed out that 1,500,000
cases of this fatal di snasn are reported every year. How mahy of
these cases could have had an occupational etiology one does not
fnow, as no detailed history is usually taken of the patients'
occupation or exposure to chemical carciongens, etc.
The Magnitude of the problem may be well understood by the fact
that nearly 80% of tha Industrial Population belong to factories
that have very poor working conditions and only depends on the
ESIS for curative aid.
It is, therefore, essential that a comprehensive health programme
should be planned so that all possible resources 'are utilised to
maintain the physical and mental well-being of working people, and
protect them against accidents and occupational diseases.
In this context it is relevant to recall the scope of Occupational
Health as described by the joint ILO/WHO Committee at its first
| Session in 1950. "Occupational Health should aim at, the promotion
X and maintenance of the highest degree of physical, mental and social
(well-being of workers in all occupations; the prevention among
/workers of departures from health caused by their working conditions;
/ the protection of workers in their employment from risks resulting
and from factors adverse to health; the placing and maintenance of
] the workers in the occupational environment adapted to his physioloI gieal ’and psychological equipments and to summarise the adaptation of
(work to man and of each man'to his job".
The modern concept of a comprehensive Health Service is Multi
disciplinary. It cannot operate in'isolation from other curative
&. public health services, if a man's health is to be looked after
in its totality.
3’
■The two main disciplines concerned are :"1. Occupational Medicine
2. Industrial Hygiene arid Ergonomics.
1. 0ccupatiohel Medicine' again includes various other disciplines
e.
g.
Industrial Physiology, Industrial Psychology, Industrial Toxico
logy, etc., e.g. the physical,chemichi, biological and psychological
factors that may affect the health.
2. Industrial Hygiene and Ergonomics includes temperature, humidity,
ventilation, exhausts, washing and clothing, facilities, and
enthrophology, e.g. dcsignand adaptations of machines, equipment,
etc., to be compatible to health. '•
The functions entrusted to Occupational Health Services vary in nature
and scope depending on the nature of the Industry, its size, location
and relevant legislation. Large undertakings could organise their
own Occupational Health Service within their premises, while small
scale industries could join together to form a group health service.
Whatever way it is set up, it should be in charge of a Physician,
employed either full time or part time with the necessary space,
equipment and staff.- The functions of an Occupational Health Sprwirp.
would comprise in short as laid down by the I,L.P.
:
SurvtnLlance of and advi sing of all conditions in the' undertaking,
affecting'health; Control Health Risks.
b) Pro-cmploymont qnd placement'medical examinations;
c)Periodic and special medicaloxaminations
d) Promotion of health 'and safety education.
a)
Besides these, the Industrial PhysicEh is also expected to provide
for First-Aid Treatment.for medical emergencies and accidents.
He should establish close liaison with external health agencies,
e.g. Government - ESIS and other Public Health Services and Institu
tions of Occupational Health. Unfortunately, in bur Country, the
Industrial Physician devotes more time to curative treatment than to
preventive or occupational medicine.
1.
EMPLOYER'S ROLE :
As the direct beneficiary the employer, has a legal and moral responsibility to provide occupational health services, for his employees.
„
Today, in developed countries, the Employer's philosophy of medical
' service in Industry is fundamentally an attempt to increase the sum
hiatal of human comforts, well-being, working capacity, productiveness
'and longevity^ H eal th and safety must be an integ-ral part of an
organisation and it should be part of every manager's duty and his
personal responsibility to ensure that the health and safety of his
employees are not neglected. The Health and Safety specialists are
comparable to other specialists, finance, personnel or technical
in the organisation and their primary function is to ensure that.
their specialism becomes a feature of work accepted by other members
of the Management team.
In India, most industrialists develop a false sense of complacency
towards Industrial Health. They consider that just because they
contribute to tVie ESI Scheme and comply merely with the letter of the
law rather than the spirit underlying it, they have fulfilled their
^obligation.
....4/-
Even those Industries that provide Medical Services to their
employees consider it as □ part of Welfare Service or an act of
Philanthrophy. Unfortunately, it is well-nigh impossible for the
Medical Services apart from showing reduction in losses due to
accidents and absenteeism, to show any tangible results which may
come from the better health and morale of workers or to calculate them
in terms of money gained. Only few enlightened Industries have
well organised Occupational Health Services in their organisation.
2.EMPLOYEE'S ROLE :
The everage Industrial Worker, is ignorqnt of his health needs and
of the hazards to which he is exposed in his work and therefore,
fails an easy victim to’ disease both occupational and others.
/ Sir Thomas Legge ( 1863-1932) said ' all workers should be told
\ something of the danger of the materials with which they come in
i contact and not left to -find out for themselves sometimes at the
(_ cost of their lives'.
It is therefore imperative that a proper Health Education programme
should be organised for these workers in order to make them health
conscious and teach them the principles of hygiene, nutrition, etc.,'
and how to protect themselves against hazards in their factories.
/ In Britain therehas been an increasing involvement of' the Unions in
\ occupational and safety matters and they have always sought State
\ intervention to ensure maximum standards of healtjh and'safety in
,Industry. They now look forward to state assistance in the positive
•promotion of health. The T.U.C. advocates a teajfApproach of the
; Medical, safety and Hygiene personnel who co-ordinates to prevent
accidents and occupational diseases. They employ an occupational
/ health expert on their staff, to advise onmatters of occupational
X health and investigate and report on any factory where the workers
may be exposed to occupational diseases.
In our country the Trade Unions Organisations have not so far shown
a similar interest in the Health and safety of their members. The
\ employees'-, Unions are more concerned with fighting for higher wages
'"and bonuses,
3.
GOVERNMENT ROLE (INDIA & U.K.)
Our Government has enacted a number of laws and regulations concerning
the health and safety of workers engaged in varbus industries,
mines, docks, etc. Factory Inspectorates operate in all Spates, but
only 10 Medical Inspector have bebn appointed in some States.
Consequently the implementation and enforcement of these laws and
regulations have been extremely difficult due to lack ofresources
and personnel. Though regulation require that a factory should be /
visited atleast twice a year, only 60% of the factories are actually!
visited twice or more and about 25% are not visited at all,
J
The Government should take immediate steps to improve the Inspectorate
services and appoint Medical Inspectors in all States in India, if
it is sincere in its efforts to protect the health and safety of the
working population-.
The Factories Act, Section 45(4) regarding Medical Service in the
factory states that "First Aid Centre or an Ambulance Room should be
provided in charge of the Medical and Nursing Staff as may be
prescribed". Most of the factories have a Doctor on call in case
of emergencies only, because the Factories Act doos not specify the \
functions of the Physician.
/
I
-
5.. -
The Act needs to be amended to give clearly in detail, the duties of
Industrial Physician.
Recent legislative Acts in U.K., U.S.A, and Germany have taken care
to see.that details in occupational health and safety measures are
incorporated in.the.Factories Act. Heavy penalties.have been specified
for breach of the Act.
The T.U.C.'s evidence to enquiry committees, the ILO/WHO reports on
Occupational Health and reports of various■medical and non-medical
organisations etc., have all placed a strong emphasis on the Primary
preventive role of occupational Medicine.
( Research and Toaihing Institutes like the Central Labour Institutes,
I National Institute of Occupational Health, Industrial Toxicology .
\ Research Centre, etc., could assist Occupational Health and Safety
/ Services in Factories by providing technical and other allied services
in Occupational Health, Hygiene and Safety.
The introduction of Employees State Health Insurance Scheme in 1952,
has been mainly to provide curative services to the workers. The
1970 report states that there are 5,542,700 employe^d covered by this
Scheme. The total expenses'for Medical benefits above for 1977/78
emounted to Rs.60,02,68,367 or Rs.108 per capita.
has
/ fhe ESIS/however done precious little in the prevention of occupational
I diseases or accidents. If the ESIS could get involved in an occupational
I health and Safety programmes, it would help in minimizing accidents,
s. occupational and other diseases and. this in turn would reduce .the high
(_ cost of medical benefits that the’ ESIS is faced with.
I would suggest that the ESIS could also, as an incentive, give a
rebate to the Industries who provide an occupational Health and Safety
Services for their employees.
4.
VOLUNTARY 'AGENCIES
C The Indian Association of Occupational Health which was founded in
] 1949, has been holding conferences-, seminars and lectures to-propogate and
< educate all concerned in this new science of Occupational Health. The
I members have undertaken a good deal’of scientific research which is
(being published in the Journals.
At one of its conferences held in Delhi, it was suggested to the1 ■
Ministries of Health and Labour to initiate, plan and implement a resultoriented programme to ensure workers' health in the interest of national
prosperity.
I would here like to propose that a Health and Safety Commissions, as in
U.K. should be set up both at the Central and State levels, tb' study
and advise on all matters relating to Health and Safety of Workers,
and encourage the development of In-Plant Medical Service by making it
a statutory duty for employers to provide such services for their
employees, whenever it should be necessary.
This Commission should comprise representatives of :
a)
b)
c)
d)
6)
Ministry of Health
Ministry of Labour
Employers’ Association
Trade Unions
Occupational Health Physicians.
6
5.PERSONNEL &■ TRAINING :
( A survey carried out some years ago revealed that the number of
, medical personnel in Industry fell far below the requirements.
' Generally in 110,000 Factories employing nearly5,960,000 workers,
there'are only about 1000 full time Doctors and other part-time
(^Doctors, whose main function has been to provide curative aid only
There are only a few progressive industries who have organised
occupational health service.
Even the Government, which is the
largest employer, is lagging behind.
Training in Occupational
Health and Hygiene is indeed very limited in our Country, It is
therefore necessary tcintroduce both under-graduates and post
graduates training in occupational medicines in our Medical Colleges
and increase the various training’ courses that are 'presently being
conducted by the Central Labour Institute, Institute of Management
and others.
CONCLUSION:
The World of Occupational Health as I have described is not small.
It has a difficult but fascinating sphere. It must be placed on
par with other Management functions and regarded as an aid to
production and also a social obligation.
This means employing or having access to a team of inter-related
skills including Occupational Health Doctors, Occupational Hygienists,
Safety Officers, Safety Engineers and other Scientific and Technical
Staff in the Health and Safety field.
Today there'Vias boon a fundamental change in the role of Industries.
"Sir Ewart''Smith, a Depdty Chairman of Imperial Chemical Industries,
has said " The various aspects of our Industrial Work, Technical and’
Commercial efficiency, Safety and Human factors, including the
phychological attitude of all concerned are not separate matters, but'
part of an integrated whole. It is for this reason that we need to
develop and apply a broad philosophy, or dynamic progress, including
a full recognition of human values. Such a philosophy must recognise
that the essdntial function of industry is to serve the social purpose
of providing the goods and services which the community requires,
with a minimum usage of resources".
I 'repast the economic prosperity of a Country depends on increased
production and this can only be effected through healthy and efficient
workers and this prosperity in turn will load to better and healthier
living standards.
I therc.fore appeal to the Government, Employers and Employees and
Occupational Health Physicians, to make a genuine and sincere effort
to promote, maintain and safeguard the health of our working population
so that by the year 2000 A.D. wo can proudly say that our workers are
not only healthy but also very happy.
And finally I would like to quote what a famous author Jhumke once said:
"That the Workmen shall live to his Labour. That his mother shall
have the comfort of his arm in her old age, that his wife shall not
be an umtimely widow.
That his children shall have a father and that cripples and hopeless
wrecks who were once strong men shall no longer be the by products
□f industry. "
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BOMBAY
0 NOV 80
HT.
SJMC (OH)
<->n/)
FORM NO.l /£5'.
PRB-EMPLOYMENT MEDICAL EXAMINATION REPOET
(Medical Section)
Dated:
community health ceu.
47/1,(First Floor)St. Marks,load
NAME:
BANGALORE-5GO 001
for the post of:
a) Apparent Age:
4.
b)
c)
d)
a. Stated Age:
Any Deformity
Conditions of the Thyroid
Lymph-nodes .. Joints:
Evidence of any skin disease
e)
Varicose veins or filariasis
f)
Any other apparent abnormality
Exp:
Height:
5.
•ieight:
Complexion:
Chest:
Insp:
Color of eyes:
ALIMENTARY SYSTEM
6.
a)
b)
c)
d)
Conditions of the Teeth, Gums
« Tongue - any oral sepsis
Liver and spleen
Any evidence of Hemorrhoids,
Fistula or any other
anorectal Pathology
Any other abnormality
GSNITO URINARY SYSTEM:
7.
a)
Urine - Albumin
.....
Microscopy....
Sugar...................................
Specific Gravity....
Deposits
Reaction
.....
cpntd...from pre-page
b)
SJMC (OH) EOBM-.l
Any evidence of diseases
of urinary system
d) Is Hernia present (give
details)
■) Is Hydrocele present (give
details)
f) Any other abnormality
8. NERVOUS SYSTEM:
9.
a)
Any evidence of Nervous
disease, Chronic Headache,
'paralysis, Epilepsy,
Wasting, Tremors etc.
b)
Are the reflexes normal?
c)
Any other abnormality
CARDIO-VASCULAR SYSTEM
9.1 HEART: (■•■.) Mize!
(c) Sounds:
9.2: PULSE;
(a)
Rate:
Vol:
10.
11.
J.
9.
Condition of Blood Vessels:
9-4-
Blood Pressure:
RESPIRATORY SYSTEM:
(b) 2nd Rg.
(Where necessary)
(a) 1st Rg:
■
a)
Any deformity or Abnormality of the Chest
b)
Condition of the Nose, Throat & Tonsils:
c)
Condition of the Lungs:
a)
X-Ray Report:
e)
Any other Abnormality:
*
SPECIAL SENSE:
a) Speech:
b) Ears - Hearing:
Any disease of
.Abnormality:
Rt:
Lt:
Rt:
Lt:
c) Vision: 1. Actuity:
w/o glasses
R
|Distant
| Near
L-
w/Glasses
R
L
:3t
2.
Colour-Vision:
, J. Condition of the -Syes & Lids:
b)
Any other abnormality:
12. FOB FEMALE CANDIDATES OHLI:
a)
Any Menstrual disorder:
b)
Condition of the Breasts:
c)
Any evidence of pregnancy:
d)
Any evidence of disease of
the ovaries, uterus or
external genitals:
o) Any other Gynaecological abnormality:-
13.
Special investigations if any
14.
Consulting Medical Officer's
remarks, if any:
'
’
:>
(Signature of the
Candidate)
MEDICAL EXAMINER
Left Hand:
LITTLE FINGER
RING FINGER
MIDDLE FINGER
INDEX FINGER
THUMB
NEUROLOGY EMERGENCIES'
A
BA^QA‘-GH£.'s^arl<s^O3cl
u ^OOQf
General;
-------------
Whenever a case is admitted as an emergency, a complete case sheet
must be written, the requisite investigations carried out and
the necessary treatment started immediately depending on the case.
This should not take more than 30 minutes to two hours.
For the
above, the responsibility rests squarely on the shoulders of the
Duty Doctor.
This responsibility includes writing up the case sheet and carying
out investigations and treatment.
1.
Non-emergency admissions must have a complete work-up by
next morning.
2.
Progress notes must be written every 24 hours (sc ".ouirries
even more often) in all acute cases and twice a week fri chronic
cases.'
PATIENT IS BROUGHT IN WITH A
HISTORY OF FITS
A
History:
.1.
Ask the patient or the eye witness to imitate or describe
Avoid leading questions
an attack.
2.
Find out indirectly where the fit starts and how it spreads.
Note the presence of any aura or warning symptoms which
occur seconds or minutes before an attack.
3.
Note the occurrence of any injury,,. incontinence or loss of
posture.
Do not-accept, a statement of unconsciousness
uncritically..
4.
Elicit indirectly the presence of any post-ictal phenomena.
Avoid any leading questions. ■
5.
If is always a good practice to allo’-; the relatives or the
patient to come out with the historv in their own words
'
6.
before asking for details .
Rule out the possibility of h yr, ter .a-1 fits (Vide infra).
B
Examination:
1.
IN CASE YOU OBSERVE AN ATTACK, DESCR1 T. IN DETAIL THE TYPE OF
ATTACK WITH SPECIAL REFERENCE "0 11’5 ’GCAL O173EJ (INCLUDING
TEMPORAL LOBE), MODE OF SPREAD AID 'A thl'R IT BECOMES GENERALISED
' '
during an attack-.
OR NOT.
Do not forget to examine t'.
muni Is and the plantars
Look carefully for an; post-ictal confusion
immediately after an attack.
. . .2. .
2.
2.
In epilepsia partialis continue, one must always palpate the
skull for any depressed fracture.
C
Management:
1.
If a patient has had only one or two attacks- and is conscious
•
and not confused, there is no need to admit the patient.
The
party can be asked to take him/her-to.the next out-patient day,
but prescribe phenobarbitone or DFH depending on the-type of
attack and the age of the patient.
2.
If the patient is unconscious or in post-ictal confusion he-
must be admitted.
•
However, if the post-ictal confusion is one
■of excitement the case must be referred to the psychiatry.
department.
3.
If a patient has cluster attacks (attacks in quick succession
with retention of consciousness in-between) or status epilepticus
(attacks- in quiak succession with loss of consciousness in
(
between) the case must be admitted.
D
Specific treatment:
1.
Post-ictal confusional state and cluster attacks;
witnessed-patient conscious:
No attaks
Infants and young children Injection luminal 5 mg per kg of
body weight IM in a single dose.
Children aged 3 years-10
<
years-Injection luminal 100 mg IM in a single dose.
10 years and above-injection luminal 200 mg IM in a single dose.
Oral anticonvulsants must be started concurrently as in D.4.
2.
Cluster attacks witnessed in casualty or wards
Infants and young children below the age of 5 years-Injection
Diazepam I-V (Calmpose 6.5 mg per kg of body,weight) to be
given slowly without using a diluent taking full 2 minutes
(120") for the entire injection; Follow up with parenteral
phenobarbitone as in D.I. and repent if necessary.
In children over the age of 5 years'and adults, the dose of
Diazepam is 10. mg.
(2ml.) I-V and must be followed by parenteral
phenobarbitone as in D;I. to be repeated,-, if necessary.
Oral anticonvulsants must be started concurrently as in 6-4.
..'73.,:.-
w
3
3.
Febrile convulsions:
This must be treated, with anticonvulsants as in cluster attacks
and must be combined with tablet Aspirin 150 mg. every 4 hours.
Cover the child with a wet cloth except for the chest. An
urgent total and differential leucocyte count must be asked for.
4.
Status epilepticus with fits witnessed in casualty or history
of seizures, shortly before admission:
Diazepam IV-initial, dose as in cluster attacks.
after 30 minutes depending on the response.
Repeat
The dose should not
ordinarily Exceed within 24 hours 30 mgs. in children below
5 years and 60 mgs in others.
Follow up with IM luminal as
in cluster attacks to be repeated Sth hourly..
Bass a Ryle's tube and introduce phenobarbitone. 30-60 mg
in a single dose depending upon the weight of the. patient along
with DEH (Eptoin) 100 mg in those below 10 years and 200 mg in
those above 10 years in a single dose.
Marsing care must be the same as; for an unconscious patient.
5.
If the patient has a history of status and is brought in a
state of coma and has riot had a fit in the previous 12 hours, it
is enough if oral phenobarbitone and DPH as mentioned in D.4.
are given through a Ryle's tube. Institute antiederna measures
as follows: D a cut down, pass an I-V catheter and give two
bottles (350 ml. each) of 20% mann'itrol for adults (one bottle
for children below 10 ye&rs), the first to go rapidly within
30 to 60 minutes. Start I-V dexamethasone concurrently as
given in meningitis.
6.
As in other patients, with coma peripheral failure rnust.be
anticipated and I-V .fluids started if the general condition
is poor. The fluid of choice is-5% glucose.
NEVER GIVE I-V SALINE,. PLAIN OR WITH GLUCOSE TO A NEUROLOGICAL/
NEUROSURGICAL PAT’TENT . IN AN EMERGENCY.
PATIENT IN COMA
A
History'
*
Get a qood history so as to arrive at an etiological diagnosis
as fast as possible. The common causes of coma ares
1.
2.
3.
4.
5.
6.
7.
Meningitis
Expanding lesion
Head injury
Ceifebro-vascular accidents
Metabolic disorders
Drugs and post-epileptic.state
Cerebral malaria.
i
B Examination
1.
Record the temperature, pulse, respiration and blood pressure..
Note the condition of the pupils and the presence of bradycardia
relative or absolute with reference to the temperature.
2.
Note the level of consciousness.
, The following is a useful guide:
...4...
- 4 Alert and Wakeful: Immediate and appropriate response to
visual, auditory and tactile stimuli'.
Confusion: This is often associated with irritability,
restlessness and delirium.
Drowsiness: Delayed or incomplete but appropriate response to
visual, auditory and tactile stimuli.
Stupor: Patient lies with eyes closed and is arousable with
only continuous vigorous external stimulation. The response
of the patient to the stimulus is, however, purposive.
Coma: Patient responds only to deep painful stimuli and this
is nonpurposive.
Deep Coma: Only decerebrate or no response whatsoever to
any type of stimulus.
Look carefully for the following:
1. Neck stiffness
2. Parulent ear ^discharge
. 3. Blood from eap Or nose.
4. CSF rhinorrhea.
5. Size in mm of the pupils and their reaction to light.
6. Asymmetry of palpebral fissure and of eye blink.
7. /^symmetry iri corneal reflex.
8. Hypotonia and paralysis
9. Deep tendon reflexes and plantar■response.
10. Careful examination of the optic disks.
11. Pei able spleen.
4.
Do not say papilloedema present or absent. Describe with
special reference to physiological cup; lamina cribrosa, the
veins, arteries, disk• marginscolour of the disk and the
presence of hemorrhages; or expdates. :
5.
Dmcrgency treatment"for the hypertension, -diabetes•’ etc ., is
far more important than that of the neurological deficit.
6.
Uli pat fonts with coma require admission, emergencyinvestigations 'and? management.
a
"
C. ij'lanagcment:
1Tn. patients with' suspected-meningitisor an acute cercbrd ?o
vasculnrtaccident> thc..lf ol-lowing must bo'done as an emergency
procedure:
<•
a) lumbar puncutre is a must unless there is a contraindication
like definite papilloedema or clinical suspicion of an
acute abscess, CSF pressure must always be recorded with
the manometer.- In all cases of suspected meningitis, lumbar
puncture must be repeated even if done "recently out ide.
If the spinal fluid is blood stained get an’RBC count in
the spinal fluid. Centrifuge the specimen to determine
the colour of the supernatant fluid. This will be
xanthrochromic if the intra cranial bledd is over 12 hours’
duration. In bleeds of lesser duration the RBCS will be
crenated. Always compare the spinal fluid with water
before calling it opalescent or turbid. The term xanthoch
romia refers only to the colour and not the clarity at the
spinal fluid. This is not synonymous with turbidity and
the colour may vary from any shade of yellow to orn"gr
and not any other colour. Collect at least 10 ml of CSF
for immediate cell cdunt, biochemistry and VDRL.'
•5
5
b)
3.
If the CSF is opalescent, turbid or purulent an immediate
Gram’s stain must be carried out and a portion kept aside
for culture. Collect 5 ml of oxalated blood simultaneously.
for blood sugar, creatinine, total and differential leuococyte
counts, ESR and 10 ml of clotted blood for serum electrolytes.
Where a metabolic cause is suspected after collecting'the blood
sample give 50 ml of 25% glucose intravenously and note the level
of consciousness. An immediate improvement clinches a diagnosis
.of hypoglycaemic coma . ’
Further management depends’ on the diagnosis . General management
is . common for any comatose patient and includes the following:
a) Nursing care in the prone or semiprone position.
b) Do not use a pillow under the $ead
c5 Change of posture.every 2 or 3 hours.
d)’ Maintenance of a clear air way.
e? No. oral feeds. Feeds to be given through a Ryle's tube
with the distal e.nd below the cardiac sphincter.
PYOGENIC MENINGITIS
A.
Diagnosis:
A clinical diagnosis of pyogenic meningitis must be confirmed
within 30 minutes by appropriate biochemical and bacteriological
findings in the CSF and also a total and differential counts in
the peripheral blood. This is a red-hot emergency and treatment
must be commenced within half to one hour of admission and
on an emergency basis.
In general Gj-am negative organisms are common within'the first
one month of neonatal life, during which period Hemophilus
influenzae infection is rare. However, H. influenzae infection is
common between the ages of 3 months to 3 years after which it shows
a sharp decline. It is an extreme rarity after the age of
10.years. The common pathogens otherwise are meningococcus and
pneumococcus. Staphylococci and anaerobic steptbcocci are to be
suspected if there is a definite focus of extra cranial infection,
as for example in the- lung.
B.
Management
The antibiotic concerned must be given intravenously through
an indwelling polythene tube introduced to a distance of 4” to 8"
into one of the peripheral veins, preferably the leg. The
following are the drugs of choice:
In infants below the age of 3 years or when there is a
suspected staphyloccus infection the drug of choice is ampicillin
given IV. The first dose is 50 mg/kg given over a period of
30 minutes as a drip to be followed by 300 to 400 mg per kg
per day in three or four divided doses. In patients, over the ago
of 3 years Gram positive coccal infections are the cpmmonest
pathogens. The drug of choice is penicillin given intravenously.
The loading dose is 8 million units given over a period of
30 minutes and subsequently 2 million units every 2 hours.
TUBERCULOUS MENINGITIS
A. Diagnosis:
In general the spinal fluid is clear or moderately opalescent
to xanthochromic with moderate rise of cells and or proteins and
a moderate fall in CSF sugar values. A. spinal fluid sugar less
than 40% of a simultaneous blopd sugar level is taken as a
6
reduction in the former. A normal spinal fluid does not exclude
the diagnosis of TBM, especially if the clinical suspicion is high.
B., Management:
1.
IM Streptomycin sulphate 0.5 Gm in children below the age of
4 years and 1 Gm in those 4 years and' above;
2.
Isozone Forte (INH 300 mg plus Thioacetazone 150 mg) Jj tablet
in children aged below'4 years and 1 .tablet in others in a
single dose.
3.
If the patient is in stupor or coma give steriods as 'follows:
Children below the age of 4 years-Dexamethasone IV 4 mg stat and
subsequently 4 mq every 6 hours and in those aged 4 years and
above Dexamethasone IV 8 mg stat and subsequently 4 mg IV
every 6 hours,
Concurrent administration of oral prednisone must be started.
In children below the age of 3 years-30 mg a day in three
divided doses; in the age group of 3 to less than 6 years45 mg a day -in three divided doses and in those aged 6 years ani
above -60 mg a day in 3 divided doses, are,recommended.
. w
IN SUSPECTED INTRA. GRANIAL INFECTION STEROIDS SHOULD NEVER BE
GIVEN WITHOUT AN APPROPRIATE. ANTI MICROBIAL THERAPY.
C
CEREBRAL MALARIA
A Diagnosis:
1. Malaria isagain .rearing .its., head in the .country. 'Cerebral
malaria should be considered in the differential diagnosis of
any coma with high fever.
2.
Clinical suspicion is heightened by past history of fever
with rigors and presence of a palpable spleen.
3.
Examination of.a peripheral blood smear for the malarial
parasite is a must.
4.
If the smear is positive or index of clinical suspicion
high, start treatment immediately.
B. Treatment
1.
Adults: Chloroquine Sulphate ' (Nivaquin) - 40. mg base per ml.600 mg base (15 ml) PLUS 8 mg Decadron (2 ml) given as IV
drip with 5% Dextrose over 30-45 min. Repeat 300 mg of
chloroquine base (7.5 ml) and 4 mg Decadron (1 ml) as IV
drip after 6 hours.
2.
Children: Chloroquine.base 5 mg/kilo of body weight given
in ’two halves of 2,5 mg/kilo by deep I.M. injection at
intervals of 6 hours along with 4 mg per dose of IV Decadron.
3.
Alternative Line of treatment:
Adults : Quinine Hydrochloride 600 mg PLUS 8 mg of Decadron
by I.V. drip with 5% glucose over a period of one hour,
Repeat every. 4 hours for 4 doses.
Children: Quinine Hydrochloride 5 mg/kilo given in two halves
of 2.5 mg/kilo along'with Decadron 4 mg by I.V. drip with
5% glucose over a period of one hour, to be repeated after
12 hours,
In general this includes those cases wherein the neurological
deficit has reached its peak generally within 48 hours.
A.
1.
History:
Check history for previous episodes of transient ischaemic
attacks.
' 2.
Elicit history of head-ache, .with, special reference, to its
location and type and also vomiting.
3.
Check history for known diabetes, hypertension and past
cardiac disease, or’in.women, recent delivery.
B.
Examination:
1.
Check blood pressure and examine the cardiovascular system
for features of left ventricular hypertrophy.
2.
Look carefully for any evidence of nock stiffness, focus
of infectiln (eg. ears, lungs, pelvis) .4
3.
Note the level of alertness/consciousness.
4.
Examine the pupils and the fundi, the latter if necessary
after.mydriasis.
’Look for conjugate deviation of the eyes, dysphasia
hemiplegia and any differential response -to pin prick.
5.
C.
Investigations:
1.
lumbar Puncture :
This must Toe carried out within an hour of admission, if the
patient is unconscious or has neck stiffness, unless there is
a clear cut papilloedema without significant hypertension
(a diastolic BP of 120 and above). If the fluid is blood
stained collect 3 bottles of 5-6. ml each to note- the unifor
mity of staining with blood. Generally in traumatic spinal
tap the subsequent samples would tend to become clear.
This alone is not sufficient. The spinal fluid must be
centrifuged for evidence of xanthochromia which can be
expected.to.be present 12 hours after an initial bleed.
. If the bleed is less than 12 hours old look for crena.ted RBC's
Unless the spinal fluid is grossly blood stained a RBC
count must be carried out in the CSF. This would enable one
to make corrections for cell count and protein. .‘For"every
700 RBCs deduct 1 WBC from the total cell count. . Similarly
for 1000 RBCs deduct 1 mg from the total-value fob proteins.
Please do not forget to collect'a simultaneous blood sample
for estimation.of sugar (3ml in an oxalated bottle).
D.
Management: '
'
If the patient has primary subarachnoid haemorrhage
(i.e. bleeding directly into the subarachnoid space) and proven
by lumbar puncture inform the neurosurgical senior•resident
immediately.
In non-haemorrhagic infarction of less than 48 hours duration
.start IV Dexamethasone 8 mg initially and 4-.mg IV every 6 hours.
- 8 -
GUI LIKIN-BARRE SYNDROME
A.
History:
1.
Ask the patient to take a deep breath and count slowly as
much as he can in one single breath. .A normal adult should
be able.to count up to 15 to 20. A progressive decline
in this number is an ominous sign
*
.
2.
Ask'-.the patient or the relatives for a history of choking,
spluttering or nasal regurgitation while swallowing liquids.
3.
Note any nasal quality in the voice.
B.
Managements ,
1.
Once a clinical diagnosis is made a lumbar puncutre must
be done immediately and treatment started forthwith. For
children below the age of 4,years give Dexamethasone
IV 4 mg stat and repeat '4 mg IV 6th hourly. For others an
initial dose of Dexamethasone IV of 8 mg with subsequent
4 mg IV 6th hourly will suffice.
2.
Concurrent oral steriods in the same dosage as in TBiM must
be given. If there is evidence of bulbar involvement the
steroids must be given only through a Ryle's tube.
3.
Bulbar involvement must be looked for every two hours. If
there is a slightest suspicion, the duty anesthetist must be
informed and further management of the case.' discussed.'
1.
Admit and start on I-V and oral steriods if the duration is
less than 48 hours.
1.
"Information regarding the exact level of consciousness of
the patient soon after the accident and any changes during
transit must be obtained.
2
As soon as the patient is brought, the vital functions
especially respiration, pulse and BP should be ascertained.
If there is any obstructions to airway, this should be
corrected immediately either by suction, introduction of
endotracheal tube or tracheostomy. Surgical shock should
be treated promptly.
3
Patient's level of consciousness, pulse rate, BP, size and
reaction of the pupils to light must be recorded every
half-hour.
4
If there has been a definite history of deterioration of
level of consciousness from the time of accident. Deteriorating
level of consciousness is a more important indication of an
expanding lesion than pupillary dilatation.
5.
If the Senior Resident suspect an extra-dural clot> he must
immediately make necessary arrangements to place burrholes
on the appropriate site.
' BELL'S PAISY
* HEAD INJURY
9
6.
If the examination of the skull suggests a depression in the
region of the scalp laceration, it should be assumed that
there is a depressed fracture and immediate x' rays of the
skull taken to confirm the diagnosis. If the depressed
fracture is confirmed the patient should, be started on
Crystalline penicillin 20 lakhs 4th hourly "TM.
every effort should be made to explore- the wound within
4 to 5 hours of admission.
7.
If the patient has .been conscious from the time of accident
or if there has been no deterioration in the level of
consciousness from the time of accident, an accurate record
of the neurological examination at the time of admission must
be made. If there is indication of injury to the abdomen
or chest as suggested by a rapid and thready pulse and low
blood pressure, intravenous 5% glucose drip should be
started and arrangements made for blood transfusion. Every
unconscious patient must have an airway and his throat
should be cleaned of blood clot and any loos.; pieces of
teeth and dentures removed. ■
8.
If the patient has been fully conscious from the time of
accident and.'has not been complaining of any headache and
he lives locally or has been referred from a local hospital,
he can be sent back with the advice to report if there
are any further developments.
9.
If the patient has become unconscious a few days after the
head injury and has marked neck stiffness, the possibility
of post trauratic pyogenic meningitis must be considered
and appropriate steps taken.
PSYCHIATRIC EMERGENCIES
Acute Excitement:
1.
Talk to the patient and sec if he "responds. Help.him overcome
his fears by tolling him who you are and how you arc interested
only in helpinghim. If he has complaints against his relatives
listeia to him,
(You do'not have to agree with him)
Listening
to the patient reduced his excitement.
2.
Sedate the patient: Before sedating, check the blood .pressure.
If it is normal give'Inj. Chlorpromazine I.M. 100 mg. for an
average weight patient. If the excitement prevents *
the
checking of B.P. and you have some doubt about its being
abnormal, give Paraldehyde 7 ml'deep I.M.
3.
Once the patient is sedated take a careful history from the
relatives. Rule out the possibility of organic pathology as the
cause of excitement. To rule out organic pathology check
the following:
(a) History of fits, fever, recent intake"' of alcohol, intake
of psycholcptic drugs and Head injury.
(b) History of fluctuations of consciousness and confusion.
4.
Do a complete physical examination,, remembering to examine
the fundi.
5.
Carry out a complete, mental examination (Wait if the patient
has slept off!)
6.
Draw blood for Mb, WBC (total and differential), ESR, VDRL
and random’-blood sugar.
. .10,...
10 -
7.
If the history and physical examination point towards an
organic pathology and/or mental examination show that his main
impairment is that of cognitive functions, take .the help of
senior resident/consu'ltant in deciding futther course of action.
8,
If the excitement appears to be due to functional psychosis
further treatment should be given appropriate to the condition
suspected (schizophrenia or mania). Oral medication should
replace parenteral medication as *
soon as possible.
9.
Always look for evidence of dehydration and malnutrition. Many
psychotics in excitement have not had food or. fluids for days
before being brought into the hospital. Rerneber to give the
appropriate nourishment. If there is evidence of severe
dehydration I-V glucose-saline drip may be started.. Other
electrolytes may be added to the regime after a serum
electrolyte check.
HYSTERIA
A. Hysterical fits: These must be distinguished from genuine
epileptic fits.
Though the hysterical symptoms can create quite a panic amongst
the relatives (after all this is the aiml), it is hardly ever
necessary to admit such a patient to the hospital.
The logical treatment is to make the patient realise the meaning
of the symptoms, to help her face the stress and if possible
temove the latter. This may take a long time. The removal
of symptom is however necessary since it allays the relatives'
anxiety and facilities psychotherapy.
fThe removal of symptoms is to be carried out through suggestion.
Verbal suggestion'.usually suffices. However in difficult cases
I-V Penthothal (250 mg in 10 cc, given slowly till the patient
is drowsy) or ether (ppen ether with a mask) may be tried.
The following points may be remembered in connection with
suggestion therapy:
a.
Once the treatment is started do not leave the patient
till the desired objective is attained.
.
b,
Never make a suggestion that symptoms will be removed
completely in that particular session.. Always say that
considerable improvement would result,
ALCOHOLIC ^INTOXICATION
A person under alcoholic excitement does not need admission
except when he is violent. Even then it is usually enough to let
the person 'sleep off thp intoxication. Occasionally it is
however, necessary to control the excitement by giving Inj.
Diazepam 10 mg I,M, . Extreme violence .may require Chlorpromazine
50-100 mg I.M.
Remeniber to maintain the fluid balance, with the help of
I-V glucose (5%) drip if necessary,
■
ALCOHOL WITHDRAVgiL ■
If a person with a long history -of . substantial intake of
alcohol is brought with symptoms of restlessness, confusion,
excitement or hallucinations, think of alcohol withdrawal syndrome.
The typical- delirium and tremors may br many not be present.
A careful history will revel that thie person has missed ‘his
usual quota of alcohol in the last few days...
. . .ll,.-y
11
Management;
1.
Control the restlessness and excitement with Chlorpromazine
50-100 mg 2-3 times a day depending on the severity of the
symptoms. The first dose-may be given intramuscularly.
2.
Maintain the fluid balance. A patient in the withdrawal
state is usually dehydrated. This must be corrected with
I-V glucose-saline drip if necessary.
3.
Maintain the nutrition by giving I-V B
chloride 100 mg) slowly.
1
4.
Occasionally withdrawal state is marked by occurrence of
epileptic fits. Hienobarbitone 30-60 mg once a day willcontrol these fits.
(Aneurin Hydro
STUPOR
T^e functional stupor may bo due' to schizophrenia, depression
or hysteria.
A careful history is the best way of distinguishing the three
varities. History may reveal features of schizophrenic or
depressive illness before the onset of stupor. A hysterical
stupor is usually sudden in onset and in response to a psycho
logical precipitant.
An examination of the patient's appearance and behaviour
will also help in diagnosis.
1.
Schizophrenic (catatonic) stupor is marked by rigidity of
posture and waxy flexibility. Stereotyped movements ~Ay
be present.
2.
In depressive stupor the patient may have a depressed
look or a mask like face but clear expression in the eyes.
3.
In hysterical stupor the patient may resist passive movements.
The patient may reflexly withdraw when presented with a
sudden threatening gesture.
Management,» The immediate necessity is, to provide nutrition
and fluids for all the three kinds of stupor. The patients susually
respond to gentle presuasion and tube feeding is necessary only
in exceptional cases. In catatonic and dressive stupor EiC.T.
should be given as soon as possible.
SUICIDAL TWAT
The suidical threats are made by a depressive patient,
a hysteric trying to attract attention or a person with no
psychiatric abnormality but with a vriable degree of personality
strength unable to face a social stress. A careful history
will reveal the nature of pathology.
Remember to take every suididal threat seriously however
much you suspect the seriousness of intention
*
since you can
never be sure;
Keep the patient under direct vigilanceP^cfietherapeutic
efforts must be started immediately. Initially they consist of
listening...to. the patient, and-if he is unwilling'to communicate,
of gradually.helping-him.to talk. This'requires-patience and
'time, something which every resident must be'willing to offer.
For a patient with depressive psychbsjiS antidepressant
treatment must be started .Immediately. ' Suicidal—intention in a
depressed patient is a strong .indication for’ E.C’.Ti
A situation may arise in the wards when a patient mani
pulates himself into a position when he can commit suicide
within a moment (like getting on t.o the roof top or standing
in a window ready to jump). Any rash attempt at,apprehending him
1'ill only hasten his decision to end his life.
Start talking to the patient: Start asking him the reasons
for his decision. Take him through the history-of his life.
Remind him of his responsibilities. Above all offer the
assurance that you yourself will offer him the emotional support,
the lack of which is making the patient so despondent.. Keep a
continuous flow of conversation and while you talk someone else
should■ try'.to reach him without arousing attention.
r
tMAS
■ r r.
. , , .
tinier Employment Advisers
notes of guidance
Blast dssease, chest
r)<2.C’
iis1?
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rots
OC'”. ";.-
;
•. ■•
COMMUNITY HEALffj/CELl
**7/1, (First Floor) St, Marks Heat?
BANGALORE - 560 001
Department of Employment, November 1972
1 The extent, clarity and contrast of detail that the reader requires
needs a good machine and good standardized radiographic and develop
ing technique. A full plate including both costo-phrenic angles is essen
tial. For survey purposes panel reading is required which may involve
delay. All films should be scrutinized before dispatch to detect those
conditions requiring urgent action.
2 The MRC/EMAS reference panel for classification of X-rays is
endeavouring to define radiological techniques necessary to obtain
satisfactory films of the lungs.
Classification of
3 The ILO U/C International Classification of Radiographs of Pneumoradiographic appearance conioses 1971 provides a means for the systematic recording of radiofor survey purposes
graphic changes produced by mineral dusts. A set of chest radiographs
has been published to act as a standard for limits of normality and for
the classification and quantification of radiological features. The classi
fication may be used clinically but has special application in the study
of the prevalence of radiological abnormalities in populations at risk, or
for following the radiological progression in individuals or groups.
Correction for inter- and intra- observer errors has exercised consider
able thought and multiple reader techniques and statistical treatment
of scores are still evolving.
4 Objects of classification. The aim of classification is to codify the
radiological appearances of the pneumoconioses in a simple, easily
reproducible way. It is intended to describe the radiographic appear
ances of the persistent opacities associated with pneumoconiosis, not
to define pathological entities, nor to take into account the question
of working capacity.
5 Using the standard films for reference the reader examines and
reports on chest radiographs systematically, once having decided that
any of the changes in pleura or parenchyma are characteristic of pneu
moconiosis. The technical quality of the film is first commented on by
the reader.
6
Small opacities
Two types of small opacity are described; small rounded opacities and
small irregular opacities.
Small rounded opacities are classified according to the approximate
diameter of the predominant opacities.
p
= rounded opacities up to about 1.5 mm diameter.
q (m) = rounded opacities exceeding about 1.5 and up to about
3
mm diameter.
r (n)
= rounded opacities exceeding about 3 mm diameter but less
than 1 cm diameter.
Small irregular opacities are classified roughly on the basis of thick
ness of the predominant type of small irregular opacity.
s = fine irregular or linear opacities.
t = medium irregular opacities.
u = coarse (blotchy) irregular opacities.
7
Profusion of small opacities
The profusion of small opacities is defined by the standard films which
indicate the mid categories 1/1, 2/2 and 3/3. The scale runs from 0 - 3.
Category 0 = small opacities absent or less profuse than in category 1.
Category 1 = small opacities definitely present, but few in number.
They are more commonly seen in the lower zones,
but may occur in any zone, or in one lung only.
Category 2 = small opacities’numerous. The normal lung markings
are usually partly obscured.
Category 3 = small opacities very numerous. The normal lung mark
ings are usually totally obscured.
Profusion is considered as a continuum ranging from a parenchyma con
taining no small opacities to one that is grossly abnormal.
. The reader attempts to place the film within the scale. Having made
the definitive classification of profusion the reader considers whether a
category above or below was considered as a serious alternative and
records this. Thus he would record category 2/1 for a film which he
decides is definitely category 2 but where category 1 was seriously con
sidered as an alternative. This elaboration of the categories produces
the following scale:
0/-, 0/0, 0/1, 1/0, 1/1, 1/2, 2/1, 2/2, 2/3, 3/2, 3/3, 3/4.
Subcategory 0/0 is a radiograph in which there are no small opacities, or
if a few are thought to be present, they are not sufficiently definite or
numerous for category 1 to be considered. There may be other abnor
malities present not due to pneumoconiosis. Occasionally films look
exceptionally 'normal', e.g., the normal’architecture is particularly well
seen. These very obviously normal films are usually, though not exclus
ively, from young individuals. Provision for these is made by the category
0/-.
Where both types of small opacities co-exist the profusions are scored
individually; but in the latest revision of the ILO U/C classification it is
suggested that a combined profusion score should be made.
8
Extent of small opacities
The zones in which the opacities are seen are recorded - each lung being
divided into three zones by horizontal lines drawn at 1/3 and 2/3 of the
vertical distance between the apex of the lung and the dome of the
diaphragm giving six zones in all.
9
Large opacities
Large opacities are differentiated into well defined and ill defined.
Reference to standard films will help to make the differentiation.
10
A
One opacity with largest diameter 1—5 cm or several each greater
than 1 cm the sum of whose diameters is 5 cm or less.
B
One or more opacities, larger or more numerous than A whose
• combined area is less than one third of one lung field.
C
One or more large opacities of combined area greater than one
third of one lung field:
Pleural thickening
The extent, width and site of pleural thickening are recorded separately.
The costo-phrenic angle is examined for obliteration using the lower limit
standard film for comparison and the site (right or left) specified. Pleural
thickening affecting the chest wall is classified by site (right or left); width,
in relation to measured thickness of the widest part of any pleural shadow;
and extent, measured by total length related to the projection of the
lateral chest wall.
11
Diaphragm
III
defined diaphragm is recorded if more than 1/3 of a hemidiaphragm
is affected. A standard film indicates the lower limit.
12
Cardiac outline
III defined cardiac outline is recorded and graded according to extent,
using the standard film as reference for the lower limit of Grade 1.
13
Pleural calcification
The site of pleural calcification in terms of site (right or left), chest wall,
diaphragm and mediastinum is recorded, and the extent is graded by
measuring.
Additional symbols
14
Twenty additional symbols have been obligatory, it being assumed
that the phrases 'suspect', 'changes suggestive of' and 'opacities suggestive
of' precede these symbols (e.g.):
ca
es
Suspect cancer of the lung
Eggshell calcification of lymph nodes
od Other significant diseases
tba Opacities suggestive of active tuberculosis
BIBLIOGRAPHY
1/MS/299/275/71
ILO U/C International Classification of Radiographs of Pneumoconioses 1971.
Occupational Safety & Health Series No.22 (rev.). International Labour Office.
Geneva (1972).
Lloyd Davies, T.A. (1971) Respiratory Disease in Foundrymen: Report of a Survey.
Department of Employment. HMSO London.
Dust disease, chest X-rays in (2)
Hoiso from industrial plant is lees ;:.i;.ui:'?.c,..nt than tliat from motor vehicles,
rail traffic and aircraft us a source of discomfort in the community, but it
is of some importance and nowadays rightly receives considerable attention.
To decide what noise limit is apprcuvunte la any paiticv.lai’ case, the engineer
should consider the question under the two hur.dinga of legal requirements and
public acceptance.
COMMUNJTV HEALTH CELL
(First ;-i3 o.-)3t. Marks Road
BAWGIlco >E • 560 001
o community noise.
The
tru mined by public tolerance»
' local authority or courts as
This has to be considered
the'
■.Id. be taken Unde® the Act
fairly widespread discontent
■e part of the works
Any local resident can take action under common law, and
if the court finds that a nuisance exists it will grant
damages or an injunction or both.
To constitute
"nuisance" the noise must interfere materially with
comfort or with enjoyi: ent of property.
The plea that
the noise is unavoidable is not available as a defence.
II
The role of public relations;
Common Lav; requires that a works must avoid material interference with
comfort or enjoyment or property.
In this it is acting to some extent as
an instrument of social conscience and thus legal and public relations
considerations are closely United.
Public relation activity can also make
a more specific contribution towards the setting of design standards by the
thorough investigation of complaints.
111 Respo nse t<>. Community Noise:
The basic problem in setting a standard is that criteria of acceptability
must be based on subjective response.
One assumes that if a significant
number of people in a community are suffering appreciable discomfort, then
some at least of these people will complain.
IV The next step is to use this criterion of acceptability to define limits:
The standard indicates that if the corrected noise
level equals the corrected criterion then complaints
are possible but not likely.
(The British Standard does not set out to recommend either criteria of
acceptability or limits; it is designed to enable the noise to be assessed
and the likelihood of complaints to be forecast. Experience in the oil
companies International Study Group for conservation of clean air and
water -• Western Europe (CONCAVE) and in the oil companies Materials
Association (OCMA) indicates that B.S. is a reliable guide.
Predicted and actual, response level:
According to B.S.Ultl-2 complaints are to be expected if the noise level is
10 dBA above the corrected criterion, but they are definitely not to be
expected if the noise level is 10 dBA below the criterion.
It is therefore
reasonable to take the corrected criterion as the complaint threshold.
Corrected noise criteria:
Basic criterion
Type of installation
Type of district
Time of day (night)
Rural
Urban
50 dBA
+ 5
- 5
- 5
Ac
50 dBA
+ 5
+ 5
- 5
CC
In I.S.O. method the basic criterion is given as 35-1*? dBA against the B.S.
figure of JO dBA.
It does not give a specific complaint threshold.
1£.B.
(a) B.S.M»l2 does not cater for variation in noise
level which is steady.
Third.! >■ ,t he must sec that the necessary noise reduction measures are included
(1)
Some now plants employ banks' of these coolers in both
elevated and ground positions in such a way as to
combine separate relatively small sources of sound
power into, considerable noise generators.
(2)
Use of higher speeds and powers has led to aggravation
of the problem compared with earlier installations.
coiind rower level?
Sound power level from the fans can be calculated as follows:
Lw
=
Lp
+ 10 log 10 2
maximum octave band sound power level.
w^®re Ly
Lp
=
V
-
maximum octave band sound pressure
level at boundary.
distance from source to boundary in
meters.
The total sound power in a given direction from
h, is given by the expression
90+10
log
Till
n
fans, each of horse power
'ieree reinforces our belief tJiat where problems of nuisance ari
If despite all the case exercised by the planning authority a new factory
turns out to be a noisy neighbour, action would fall to be taken by. the
public health authority under the Noise Abatement Act and not by the
planning Authority^
Rules ferjxssessing com^unitj reactions to Industrial Noise
(1)
Annoyance from industrial noise, as from other types of
noise, is a subjective phenomenon affected by many
factors.
(2)
Rules for assessing public reaction to noise which are
being considered by the I.S.O. and those of Stevens,
Rosenblith and Bolt for American conditions are also
appropriate here.
(3)
The procedure devised by Building Research Station
enable a correct forecast to be made in 9 cases out of
10.
W
If planning permission is given for a new factory
which subsequently proves to be a noisy neighbour, any
action taken by a local authority under the Noise
Abatement Act, i960, would be taken by the Public
Health authority and not by the planning authority
and planning authorities should, therefore, consult
the public health authority when considering
Tilanm’rur permission for new factories.
:: the basic. level and allowances
(a)
A basic level of 50 dBA is to be taken for cither
(i)
or
(ii)
or (iii)
(b)
new factories
existing factories in which
structural alterations are being
made such as are likely to increase
the noise transmission to the
outside; for exampke, a cliange
from a.solid wall to one of light
'■".frame construction or the provision
of new ventilation openings.
existing factories in which a new
process likely to cause noise is
being installed.
A basic figure of 55 dBA is to be taken for factories
which have been established for a few years but which
are not typical of the area in which they are situated;
or are in districts where such factories would not .
normally be expected; i.e. they do not obviously fall
Basic level
(c)
A basic- figure of 60 dBj
II
If the noise hc.s a definite distingn siiaule c ont nous not
(whine, hiss, screech, squeal, nctic able humming noise),
(2)
(5)
If the noise occurs on:
Weekdays only 8 a..Ml - 6 p-eIi]e
Ivening up to 10 jieJTlo
fGeKOF'AS
lighttime 10 p.m. - 7 aja
*
(4)
Add OdBA
Add OdBA
Subtract 5
) Lowest
) appropriate
) one. should
be applied.
?yPs of district:
(a) Rural (residential)
(5)
••
'
£Subtract
(b) Suburban or urban,
no road traffic
Add
(c) Residential urban
Add
(d) Urban v;ith light industry
or main roads
Add
(e) General Industrial area
Add
(f) Heavy Industrial area
Add
)
)
0 dBA )
)
5 dBA )
)
)
10 dBA )
15 dBA )
)
20 dBA
)
Select
one
only
In some cases the noise from the process is not constant, but
significantly louder noise occurs at intervals, say foi' less
than half the time.
When these louder noises occur during the
day the following allowances may also be made to determine an
intermittent limiting level:
Noise occurring about 15 minutes per hour
Noise occurring about 5 minutes per hour
Noise occurring about 1 minute per hour
Noise occurring about 1 minute per half day
add 5 dBA
add 10 dBA
add 15 dBA
add 20 dBA
I T I Ltd.,
Form N°- W-829 (Mod. I)
PRE-EMPLOYMENT
MEDICAL
EXAMINATION
REPORT
Name of the Person : -------------------------------------------------------
Father’s Name :'3^, ks Ro
*
Post for which applied:
Category:
BAWGAi.OrlE-560 001
2.
1.
PERMANENT ADDRESS
MARITAL
STATUS
AGE AND DATE OF BIRTH
3.
Stated
4.
FAMILY
HISTORY
•
5.
PERSONAL
HISTORY
Alive or Dead
Tuberculosis
H B P
Cause of Death
Leprosy
Cancer
Age at Death
Diabetes
Mental
Disease
(b) Previous Diseases
(a) Previous Occupation
Asthma
TB
6.
FINGER
IMPRESSION
OF THE
CANDIDATE
Fits
Leprosy
(d) Accidents:
(c) Surgical operation:
Small Pox
(e) Vaccination
Apparent Age
Do you know any of these Diseases in your family
MOTHER
FATHER
Date of Birth
Age
Index Finger
Thumb
Any other
Tetanus
Polio
Ring Finger
Middle Finger
Little Finger
Left Hand
•
Right Hand
Signature of the Candidate
7.
GENERAL
Weight
Identification Marks
Height
CHEST
Expiration
8.
9.
ALIMEN
TARY
SYSTEM
CARDIO VASCULAR
SYSTEM
10.. RESPI RATORY
SYSTEM
Gums.
Heart
Teeth & Tongue
Size
Throat
Rhythm
Pulse &
Any deformity of the chest
Any evidence of
Peptic Ulcer
Liver and spleen
Condition of
Blood vessels
the
Rate
Inspiration
Anorectal Exam.
(in suspected cases)
Rhythm
Blood Pr.
Lungs
P T O
11.
X-RAY REPORT
12.
NERVOUS
SYSTEM
13.
GENITO
URINARY
SYSTEM
Gait &
Muscular
Speech
Co-ordination
Wasting
EXTREMITIES
IS
OTHER
DISEASES
Lymphnodes
16.
SPECIAL
SENSES
(i) Ears.
Sensations
Deformity
Sp, Cr.
Spine
Abnormality
Disease
■ (a) Accuity
RE
(ii) Vision :
Sugar
Alb.
Oedema
Varicosity
Thyroid
Any evidence of
|
para|ySis or Epilepsy. ,
URINE ANALYSIS
Disease in
urinary system
V. D.
Hydrocele
14.
Reflexes
ANY EVIDENCE OF
ANY PRESENCE OF
Hernia
Tremors
Skin
Hearing Right
Hearing Left
(b) Colour Vision
(c) Any other
Abnormality
without
„„ "With
Glass ■Lfc RE Glass
Distant
Near
17.
FOR FEMALE
Any Menstrual Disease
Condition of Breasts.
Any evidence of Pregnancy.
CANDIDATES
ONLY
Any evidence of Disease of Ovaries
18.
SPECIAL
INVESTlGA TIONS IF ANY
19.
REMARKS
20.
CERTIFIED
Any evidence of Disease of
Uterus or Genitals
Any other Gynaecological abnormality
&
FIT / TEMPORARILY UNFIT / UNFIT
Date
Signature of the Medical Officer.
^7; / '■-
A'
°r)St „
Chemical laboratory:
Precision balance
' Pill
/s'
&Se°
Refrigerator
pH meter
Ultraviolet lamp
Deioniser
Controlled-temperature water bath
Spectrophotometer
Laboratory scales
(visible range)
Centrifuge
Electrical hot plate
Polyethylene aspirators
Muffle furnace
Platinum ware
Specimen bottles, etc.
Laboratory glassware (borosilicate)
Laboratory oven
Miscellaneous apparatus such as
Multi-gas detector kit
bunsen burners, etc.
Fume cupboard
Physics laboratory - thermal and ventilation equipment;
Kata thermometers
(all ranges)
Whirling hygrometer
Velometer
Vane anemometer
Pilot static tube
Globe thermometers
Snoke generators
Surface-temperature
Precision barometer
.thermometer (electronic)
Physics laboratory - acoustic equipment]
Precision sound level meter
Precision octave-band
analyser
One third octave band analyser
Tape recorder
Oscilloscope
Calibration device
White noise generator
Impact-noise meter
Vibration meter
Physios laboratory - illumination equipment:
Lightmeter calibrated in lux and
fitted with cosine-corrected photocell
Dust laboratory:
Size-selective personal samplers
Total (non-selective) personal
samplers
Size-selective static samplers
(Hexhlets)
Membrane-filter sampling
head and filters (useful for
aabestos evaluations)
High-resolution miscrope for evaluation of
dustsamples (phase contrast is desirable)
Precision balance
Consideration could be given to the
additional use of a konimeter for rapid
semiquantitative assessments of dusty
situations
,2
:2:
Medical examination room - the final selection will be th© task of the
service medical officer but the following items are suggested:
Scales (weight and height)
Respirometer
Haemoglobinome ter
Lung function test apparatus
Haematocrit centrifuge
(packed-cell volume
determinations)
Visual acuity screening instrument
and colour vision screening equipment
General sampling equipment:
Air sampling pumps
Air flow meters
Fume sampling heads
Gas-washing flasks
Glass fibre, polystyrene and
cellulose filters
Gas sampling bags
HYGIENE STANDARDS FOR COTTON DUST
British Occupational Hygiene Society Committee on Hygiene Standards
Sub-committee on Vegetable Textile Dusts
Continiitec ini hygiene slamkink:
J. R. Glover (Chairman). J. M. Barnes, S. A. Roach, D. Turner, D. E. Hickish (Secretary)
•
Sub-Committee on vegetable textile dusts:
R. S. F. Schilling (Chairman), London School of Hygiene and Tropical Medicine
J. Joy, The British Textile Employers’ Association
J. King, C.B.E., Secretary of the National Union of Textile and Allied Workers
C. B. .McKcrrow (deceased), MRC Pneumoconiosis Unit
O. P. Llewellyn, Courtaulds Ltd,, Northern Textile Division
M. K. Molyneux, Dept, of Social and Occupational Medicine, Dundee University
S. A. Roach (Secretary), Environmental Hygiene Consultant
Assessors [rum the Department of Employment:
J. B. L. Tombleson, H.M. Mcdicai Inspector of Factories
A. G. Wilkie. H.M. Chemical Inspector of Factories
Corresponding Members:
H.- E. Ayer, U.S. Dept, of Health, Education and Welfare
A. Bouhuys, Dept, of Medicine, University of Yale. U.S.A.
H. de Glanviilc, Late bar cs Salaam Group Occupational Health Senices, Tanzania
M. N. Gupta, National Institute of Occupational Health, Indian Council of Medical Research,
Ahmedabad. India
•hi. Khogali. Sudan
F. Vaiic, Andrija Stamper School of Public Health, Zagreb; Yugoslavia
SUMMARY AND RECOMMENDATION
1.
As long as there is any airborne cotton dust in the work environment there may
be some small risk to health. Nevertheless, exposure up to certain limits can be
tolerated for a lifetime without incurring undue risks.
2.
The sub-committee believes that a proper and reasonable objective would be
to reduce the prevalence of grade H byssinosis due to airborne dn«i to less than 4 in
100 (4 per cent) among those who work in the dustiest conditions. It is well-established
that grade II byssinosis is relatable to dust concentration and length of exposure and
that permanent disability resulting from dust exposure usually occurs only among
those who have reached this stage of the disease. However, the evidence of the
relationship between byssinosis grades and permanent disability is not conclusive. In
the meantime it is necessary for the industry to have realistic dust levels at which to
aim in order to reduce the risk of contracting the least demonstrable permanent effects
to as low a level as possible. The values below arc the best that can be derived from
existing data,
3.
It is recommended that exposures which lie in certain ranges of dustiness be
categorized according to the following scheme:
165
166
Hygiene standards for cotton dust
Committee on Hvciene Standards
Category
Dust concentration, less fly
averaged over S hr (ntg/mi)
Moderate
Excessive
0-5 or less
More than 0-5 and less than 10
1-0 or more
The concentration, less fly, is the weight of dust, in milligrams per cubic metre of air,
excluding particles which would be caught by a 2 mm wire mesh gauze, wire diameter
0'2 mm, 1-8 mm square aperture.
4.
The sub-committee believes that there are good reasons for introducing pre
employment and periodic examinations for cotton workers, but that the value of such
examinations should be re-assessed after a period of 5 years. On engagement they
should be questioned on their medical history and be given tests of respiratory
function with the object of identifying those with chronic bronchitis or other res
piratory disability which might be exacerbated by exposure to cotton dust, and placing
those so identified in work away from undue exposure. Periodic examinations are
recommended thereafter, at intervals of not more than three years, and if the dust
exposure is “excessive” the interval should be one year.
These examinations should include an occupational history, a questionnaire on
respiratory symptoms and tests of the ventilatory capacity of the lungs.
It is recommended that alternative employment be sought for any employee whose
symptoms arc worsening and causing disability or whose FEVj.o repeatedly falls by
0-20 litres or more during a shift or whoso FEVj.o is (for males) more than 1 litre
below that expected, or, for females, 0-8 litres below that expected.
It is further recommended that in any workroom where the concentration of dust
in air is less than 0-5 mg/m3, but in which the employees have a prevalence of byssinosis
(grade II) exceeding 4 per cent or an average fall in FEVpo over a shift exceeding
0’06 litres the exposure be re-classified to the “moderate” dust category.
5.
When it is necessary to work for short periods in an environment where air
borne dust concentrations are very high respiratory protection should be provided.
An orinasal dust respirator fitted with an encapsulated high efficiency dust filter and
meeting BS:2091 (1968) is suitable in dust concentrations up to 10 mg/m3. Should
the concentration exceed or be likely to exceed this level a higher standard ofrespiratory
protection should be provided.
6.
The discharged air from an air cleaner in a ventilation system exhausting air
from a workroom might contain fine particles in suspension. It is recommended as a
precautionary measure that this air should not be recirculated unless it is effectively
filtered, or is mixed with fresh air to such an extent that each cubic metre of the com
bined air contains less than 0-1 mg of dust.
7.
The standards are, in our opinion, the best that can be drawn up from existing
knowledge. They should be reviewed over the next 5 years as more information
accumulates.
The data on which they arc based come primarily from experience in cotton
spinning mills, covering the preparatory stages up to and including winding rooms.
The precise agent or agents responsible for byssinosis are not known with certainty
167
and the relative importance of the finest particles has not yet been completely eluci
dated. Due caution should, therefore, be exercised in applying these standards to
other cotton processes and other vegetable fibres.
BACKGROUND
Introduction
The Committee on Hygiene Standards of the British Occupational Society reviewed
the standards suggested by Roach and Schilling (I960) from their studies in the
British cotton industry and the documentation of the ‘Threshold Limit Value (TLV)’
for cotton dust (raw) recommended by the American Conference of Governmental
Industrial Hygienists (ACGIH) (1970) which was primarily based on the British
work.
In the fifteen years which have elapsed since the original work was done in Lanca
shire, the British cotton industry has continued to contract and to concentrate production in fewer mills. This has been accompanied by an increasing use of artificial
fibres, modifications to processes, considerable increases in the speed and throughput
of processing machines including winding machines and the introduction of the
“Crosrol”, a process which gives rise to much dust. Enclosure and exhaust extraction
have become commonplace on dusty carding engines. Further, byssinosis has been
the subject of much research in recent years using a variety of techniques to assess the
prevalence of the disease, the severity of the condition and the dustiness of the atmos
phere. Also, the disease has been found in processing flax and soft hemp (.Cannabis
saliva). Accordingly, the Sub-Committee on Vegetable Textile Dusts was appointed
to review hygiene standards for cotton and other textile dusts and, where necessary,
make recommendations for new standards.
The terms of reference of the sub-committee were:
To recommend hygiene standards for vegetable textile dusts in air.
To recommend sampling instruments, sampling procedures and analytical
techniques for testing compliance with the standards.
3.
To indicate the degree of protection associated with the recommended
standards.
1.
2.
In this report, the sub-committee has restricted its attention to dust arising from
the processing of cotton. Most of the available data on the relationship between air
borne vegetable textile dust and respiratory disease come from studies in the cotton
industry.
The sub-committee interpreted the terms of reference to include discussion of
medical examinations done in association with dust control.
COTTON
Cotton is the downy cellulose fibre which covers the seeds of the cotton plant
(genus Gossypium, family Malvacea). Cotton plants grow in warm, dry climates to a
height of 2—4 ft. The cotton and seed inside it make up the cotton boll which is picked
by hand or machine when fully mature. The bract and pericarp at the base of the boll
and occasionally a short length of twig arc broken off with the boll in hand picking.
In mechanical picking more of the plant, including the leaves and stem, may be picked.
The bolls arc passed through a ginning process to separate the seed and other materials
J6S
COMMITITE ON IIvClENE STANDARDS
I It Rivne standards for collon disst
from the cotton, which is then packed and compressed into bales for shipment to the
spinning mills. At the mills, different grades arc opened and mixed together by
machine. The cotton is mechanically cleaned, drafted and spun, and then wound into
finished yarn in successive stages in spinning mills.
Cotton mills can be classified according to the quality of raw cotton which they
spin and the fineness of the yarn which they produce.
Coarse mills normally process cotton of low grade and short fibre length, whereas
fine milis normally process cotton of high grade and long fibre.
The staple length is a major criterion of cotton quality and is a measure of the
length of the cotton fibres.
The grade of cotton depends upon the colour and “trash” content which can be
assessed visually, e.g. “good middling” (high grade) to “strict good ordinary” (low
grade).
“Trash" is the plant debris and soil from the parent plant. Trash content is ex
pressed as a percentage of the total weight of the raw cotton. The natural colour
ranges from white to brown.
“Fly” is the cotton and very large airborne particles seen by the naked eye in
cotton mills. It consists mostly of broken cotton fibres up to an inch in length, and
pieces of plant debris too large to enter the lungs.
The relative fineness of the spun yarn is expressed in terms of length per unit weight.
Several different units are in use. The English system is based on the “count” or
number of hanks of yarn which make up one pound weight. A hank is 840 yards in
length. Thus, for example, medium cotton of count 20 has 20 x 840 yards of yarn per
pound weight. The higher the count the finer the yarn. The grade and staple length
of the raw cotton commonly used and the range of count produced in each type of mill
are shown below:
The characteristic symptoms of byssinosis occur on the first day back at work after
a break. There may be cough, chest tightness or difficulty in breathing. The affected
worker may first notice symptoms after annual holidays but later on they usually
occur after weekends. Early effects may be noticed during the first year of exposure
to dust and at this stage the first and only complaint may be cough or chest tightness
after the work shift immediately following the weekend break (Mondays in Western
countries). The cough, the feeling of chest tightness, or difficulty in breathing may
disappear shortly after leaving the workplace. On Tuesdays there arc no symptoms.
As the disease progresses, the symptoms worsen and are accompanied by breathless
ness. They extend to Tuesdays and then to other days, although at this stage of the
disease there is still improvement as the week goes on. Eventually, the worker may
become severely affected on every working day with chronic cough and sputum and
permanent breathlessness which docs not materially diminish, even on leaving the
cotton industry. At this stage, the effects of cotton dust cannot be distinguished from
chronic bronchitis, except that the past history of chest symptoms, characteristically
worse at the beginning of the week, may suggest the aetiology.
Classification
Count of
yam spun
Staple length
of cotton
(in.)
Coarse
Medium
Fine
6-12
12-44
40-120
Less than 1
Trash content
of cotton
(%)
4-15
1-1$
2-0 approx
BYSSINOSIS
Byssinosis is a respiratory disease occurring among cotton, flax and soft hemp
workers exposed to dust during the cleaning and processing of fib '.s. It was first
officially recognized as an occupational disease when a compensation scheme was
introduced in 1942 for cotton workers in mixing, blow and card rooms in Lancashire
(Home Office, 1939). Recent investigations have shown that the disease may also
occur during the earlier processes of ginning and bale pressing and in the later pro
cesses of spinning and winding (El Batawi, 1962; Belin, BOuhuys, Hoekstra,
Johansson, Lindel and Pool, 1965; Mekky, Roach and Schilling, 1967; Schil
ling, Vigliani, Lammers, Valic and Gilson, 1963; British Medical Journal, 1962).
There is also evidence indicating that cigarette smoking and atmopsheric pollutants
outside the factory may exacerbate the effects of cotton dust (McKerrow and
Schilling, 1961; Lammers, Schilling and Walford, 1964; Schilling, 1964).
169
Chest radiographs and pathology
No changes have been found either in chest radiographs or in the pathology of the
Jungs which arc specific to byssinosis.
Ventilatory function tests
Exposure to the dusts of cotton, flax and soft hemp causes both temporary and
permanent changes in ventilatory capacity. The most commonly used measurement
is the Forced Expiratory Volume measured over 10 sec (FEV^q). A temporary fall
in ventilatory capacity may be revealed by measuring the FEVI.O at the beginning and
end of the work shift. Such a change is usually more marked in workers with symp
toms of byssinosis than in those without symptoms. Nevertheless, there may be some
workers who have a substantial fall in FEV,.O during the shift but no symptoms of
byssinosis.
An abnormally low FEVpo measured while the subject has been absent from work
for 2 days or more may denote a permanent effect of dust exposure on ventilatory
capacity. Epidemiological surveys have shown that workers with symptoms of bys
sinosis have significantly lower ventilatory capacities than those without symptoms.
In older subjects the reduction in FEV^q may be considerable and associated with
severe disability.
Grading of byssinosis
The symptoms of byssinosis (Schilling et al., 1963) may be graded as follows:
Grade 0
Grade 1
Grade I
Grade II
Grade III
No symptoms of byssinosis.
Occasional chest lightness or difficulty in breathing on the first day of
the working week.
Chest tightness or difficulty in breathing on the first day of every
working week.
Chest tightness or difficulty in breathing on the first and other days
of the working week.
Grade II symptoms accompanied by evidence of permanent incapacity
from diminished effort tolerance or reduced ventilatory capacity.
Committee on Hygiene Standards
H>l-iene standards foi cotton duSii
A grading of acute and permanent changes in ventilatory capacity is as follows
(Bouhuys, Gilson and Schilling, 1970):
machines very nearly so, but it becomes increasingly diflicull to conceive of practicable
enclosure of later processes. The high air volume flow-rates required on partial en
closures or by general dilution ventilation arc costly, not only in themselves but also
because of the necessary conditioning of make-up air. The recirculation of exhausted
air can only be contemplated at'the expense of exceptionally good air cleaning units
with fail-safe features.
Several investigations into the relationship between the prevalence of byssinosis
and dust concentrations have been made during the last 10 years or so. Unfortunately,
there have been differences in the dust sampling techniques employed and in the
170
F 0 No demonstrable acute effect of the dust on ventilatory capacity; no evidence
of chronic ventilatory impairment.
F I Slight acute effect of dust on ventilatory capacity; no evidence of chronic
ventilatory impairment.
F 1 Definite acute effect of dust on ventilatory capacity; no evidence of chronic
ventilatory impairment.
F 2 Evidence of a slight to moderate irreversible impairment of ventilatory
capacity.
F 3 Evidence of a moderate to severe irreversible impairment of ventilatory
capacity.
The acute effect is measured by the fall in FEVi.q from the beginning to the end
of the work shift on the first working day of the week, and is classified thus:
Less than 0-06 litres—no acute effect.
0 06-0-20 litres—slight acute effect.
Over 0-20 litres—-definite acute effect.
Chronic ventilatory impairment may be measured by the FEVpo in the absence
of exposure for 2 days or more in relation to the FEVj.q expected for a normal person
of the same race, age and height (Cotes, 1968).
The results may be classified as follows:
Over 80 per cent of predicted—no chronic ventilatory impairment.
60-80 per cent of predicted—slight to moderate chronic ventilatory impairment.
Less than 60 per cent of predicted—moderate to severe chronic ventilatory impair
ment.
Methods of measuring the ventilatory capacity and allowances to be made for
sex, age, height and ethnic origin are described in Appendix 2.
Derivation of a hygiene standard
The Committee considers that it is not only necessary to prevent permanent ill
effects, but also where possible, to limit temporary effects to the minimum consistent
with practicable control procedures.
There is no exposure which can be guaranteed to be absolutely free of any possi
bility of adverse effects on the most sensitive people. There is no singl * threshold
concentration of dust in air, common to everyone. The achievement of an lir quality
standard does not, by itself, guarantee completely safe conditions of work, but has
to be supported by other protective measures. The application of engineering control
procedures will limit and control the dustiness, but it is unrealistic to suppose that
the dustiness can be reduced to zero. A recommended standard of air cleanliness.
should, to be accepted, be both technically feasible and within the means of the
industry. Completely enclosing a process and exhausting the enclosure is least demand
ing of air volume flow-rate and can be applied where the operation of the machine is
entirely automatic. Mixing and blowing processes may be enclosed and carding
171
Table 1. Prevalence of byssinosis (all grades) and total
DUST CONCENTRATIONS BASED ON DATA FROM 8 INVESTIGATIONS
Total dust
(mg/m’j
0
0510203040—
50+
Prevalence of byssinosis
(all grades)
(%)
1-5
2-8
9-9
8-5
340
55 0
27-5
No. of people
examined
212
108
1259
1226
465
245
92
Total 3607
methods of grading symptoms which make it difficult to combine the results of one
investigation with another.
Nevertheless, data from eight investigations (Tabic 1) show a direct relationship
between total airborne dust measured in mg/m3 and the prevalence of byssinosis all
grades. (McKerrow, McDermott, Gilson and Schilling, 1958; Roach and
Schilling, 1960; Wood and Roach, 1964; Lammers et al., 1964; El Batawi,
Schilling, Valic and Walford, 1964; Belin er al., 1965; Mekky er n/., 1967;Zuskin,
Wolfson, Harpel, Welborn and Bouhuys, 1969).
The relationship is irregular but indicates that the prevalence of byssinosis was less
than 3 per cent in workrooms where concentrations were less than 1-0 mg/m3 and as
high as 55 per cent in concentrations above 4 mg/m3. Only 47 (18-5 per cent) of the
255 workers classified according to grade of byssinosis, had Grade II symptoms
(Table 2).
Schilling and Roach (1961) and Molyneux and Tombleson (1970) showed that
the effects of differences in duration of exposure were small in comparison with the
effects of differences in concentration. Extrapolating from the data in Tables 1 and 2,
it would appear that at dust levels of 1 mg/m3 the risk of developing Grade I! bys
sinosis would be negligible.
However, total dust measurements are unlikely to provide a universal index of
risk because of the variable amounts of fly and finer dust fractions, both in different
processes in the same mill and the same processes in different mills.
Committee os Hygiene Standards
The effect of variation in the fly component can be seen by dividing the data in
Table 1 where this is possible, into two groups in Table 3, as follows:
Group A
Group B
Producing less fly, i.e. coarse processes up to and including cardrooms,
medium and fine processes up to and including blow rooms.
Producing more fly, i.e. coarse processes; spinning and winding
rooms,medium and fine processes card, spinning and winding rooms.
Table 2. Number of byssinotic workers with grade it symptoms at various
LEVELS OF DUST CONCENTRATION
No. of workers with
byssinosis
• .<
1’6
i~
1 7
2u
2-8
40
60
Total
prevalence rates found by Molyneux and Tombleson are higher for equivalent dust
concentrations than those in Roach and Schilling’s investigations:
Roach and Schilling’s study, unlike that of Molyneux and Tombleson, included
spinners who, for similar dust exposures, have a lower prevalence than card
room workers.
2.
In all mills spinning coarse grades of cotton included in Molyneux and Tomble
son’s study, local exhaust ventilation systems had been fitted to carding engines.
These are likely to have reduced the larger and less noxious dust particles
preferentially as demonstrated by Wood and Roach (1964) in a previous
investigation.
1.
References
All grad<:s
Grade II
9
8
13
27
07
22
142
5
0
I
7
7
■>
0
5
29
0
255
47 (18-5 per cent)
Roach and Schilling, 1960
Mekky el al., 1967
Roach and Schilling, 1960
Zuskjn ct al., 1969
Mekky ct at., 1967
• Mekky et al., 1967
MEKKY ci al., 1967
Roach and Schilling, I960
Mekky ct al., 1961
Table 3. Prevalence of byssinosis and total dust concentration in rooms
CHARACTERIZED ACCORDING TO CONTENT OF FLY IN DUST (SEE TEXT)
Total dust
(mg/nP)
1020—
30—
40 —
50+
Group A process
Prevalence No. of people
(%)
examined
' 10
OQ
47
55
36
.
10
145
240
199
39
Group B process
Prevalence
No. of people
(%)
examined
6-3
20
50
21
684
579
225
46
53
This comparison shows that for similar total dust concentrations workrooms with
less fly had higher prevalences of byssinosis than those with more fly.
The sub-committce recommends that the hygiene standards should be based on
dust measurements which exclude fly.
In the recent prospective study of 772 female and 234 male cotton workers by
Molyneux and Tombleson (1970) dust concentrations were measured by a method
which excluded fly. Comparison of their figures with those of Roach and Schilling
(i960) on whose data the previous ACG1H TLV was based, shows, as expected, a
higher prevalence of byssinosis for similar dust levels (Fig. 1). The prevalences of
byssinosis (Grade II) on Molyneux and Tombleson’s investigation, were respectively
6-2 and 6-5 per cent at dust levels (less fly) of 0-34 and 0-58 mg/m’. In Roach and
Schilling’s investigation no cases of byssinosis Grade If were recorded at these dust
levels. Apart from the exclusion of fly, there are a number of other reasons why
Fio. 1. Prevalence of byssinosis (all grades), (a) Plotted against total dust less fly—• Molyneux
etui. 1963. (b) Plotted against total dust—X Roach and SnilLUNO (I960).
3.
While the prevalence of byssinosis depends mainly on the present dust concen
tration it also depends on past levels of exposure. There is also likely to be a
disparity in the dose of dust required to initiate byssinosis and to produce
symptoms once initiated. Thus, although reduction in dust concentration will
be accompanied by a reduced risk of getting byssinosis improvement in those'
already affected may be limited.
A relatively low prevalence is found in all processes of fine mills and this is also
true of spinning rooms which are physically separated from cardrooms in medium
and coarse mills. Relatively higher prevalences may be found in all processes up to
and including winding in medium and coarse mills. Because of these differences it
would be unrealistic to attempt to derive hygiene standards which have overall appli
cation but standards can be derived frtim evidence which relates collectively to
174
Committee on Hygiene Standards
potentially high risk processes (Molyneux and Berry, 1968; Molyneux and
Tombleson, 1970; Tombleson and Wilkie, 1970).
The length of time a person has worked in a cotton mill is an important factor in
determining risk. The prevalence of byssinosis usually increases up to exposures of
20 years and then may remain stationary probably because of the selective withdrawal
from employment of subjects with byssinosis. Examination of the data on 772 women
in the survey by Molyneux and Tombleson shows clearly the increasing prevalence
of byssinosis for both increasing dust concentrations and duration of exnosure
(Fig. 3).
At concentrations of less than 0’75 mg/m3 no byssinosis grades I and II was
found during the first 10 years of exposure. The prevalences for dust concentrations
around the recommended standard of 0'5 mg/m3 (less fly) arc not markedly different
for workers with 10-19 years and more than 20 years exposure (Berry el al., 1971).
The recommended standards are based upon the following conclusions:
The concentration of dust, less fly, is directly related to the prevalence of
byssinosis of all grades and the relationship is similar for processes involving
medium and coarse cotton.
2.
Dust levels (less fly) below 0-5 mg/m3 arc associated with the occurrence of
byssinosis symptoms of less than 20 per cent (see Fig. 1). The data from
Table 2 suggest that this prevalence would be associated with a prevalence of
grade II symptoms less than 4 per cent. The reasons for the higher prevalence
of grade II symptoms found by Molyneux and Tombleson have already been
discussed. Since it is unlikely that all workers with grade II symptoms will be
permanently affected, a maximum average dust concentration of 0-5 mg/m3
less fly, should achieve the objective of reducing the risk of permanent effects
to a very low level. At this dust level byssinosis occurs only in workers with
more than 10 years exposure (see Fig. 2).
1.
Fio. 2. Byssinosis prospective study. Female workers.
Dust levels in excess of 10 mg/m3 may produce much higher prevalence of
by ssinosis and the disease may occur in susceptible individuals within the first
4 years of exposure.
4.
Waste operations should "be considered to carry a potentially high risk as
should spinning operations if they arc not physically separated from the card
room.
It is evident that the risk of disease in any operation may increase or decrease
depending on variation in the toxicity of airborne dust and its particle size distribution,
the daily period of exposure and technical change of process and ventilation. Fine
cotton processes and spinning operations in medium and coarse mills may give rise to
hazardous conditions in isolated instances. This necessitates the use of a system of
periodic medical examinations based on prevalence of symptoms and acute change in
ventilatory capacity which enables the appropriate areas to be classified in terms of
equivalent dust concentration.
3.
MEDICAL SUPERVISION
The composition of the substances in the dust responsible for byssinosis has not
yet been established. An immunologically active agent has been identified by Taylor,
Massoud and Lucas (1971). Bouhuys and his colleagues (Nicholls, Nicholls and
Bouiiuys, 1966; Hitchcock, I’iscitelli and Bouhuys, 1971) have shown that the
bracts of the cotton plant contain an agent causing narrowing of the bronchi from the
non-antigcnic release of histamine. There is ample evidence that the proportion of the
active principle or principles in the dust may be variable since the prevalence of
byssinosis in environments with similar dustiness varies by more than might be
expected by chance alone; indeed there may be local environments in which 1-0 mg/m3
less fly is not exceeded but the risk of byssinosis is excessive.
There is also a large variation in individual susceptibility to byssinosis. Among
those exposed to concentrations of less than 0-5 mg/m3 less fly soific workers especially
sensitive to the dust may be adversely affected.
Thus, medical supervision has two possible functions. Firstly, it may be used as a
monitoring device supplementary to dust sampling, indicating a need for better con
trol of dust exposures. Secondly, it may be used as a means of detecting workers
especially sensitive to dust. The diagnosis of early symptoms which arc progressive
provides an opportunity of recommending a change of employment and thus may
prevent the disease developing to a state where there is a risk of permanent disability.
Although byssinosis has long been recognized as an occupational hazard among
cotton workers in Lancashire, prc-cmploymcnt and periodic examinations of those at
risk have not been statutory requirements. For this reason, there has been no accumu
lation of experience in Britain by which the value of medical supervision of cotton
workers may be assessed. Nor is there any published evidence from other countries
on its use in the control of byssinosis. Nevertheless, the sub-committee believes that
there arc good reasons for introducing pre-employment and periodic examinations
for cotton workers, although their value should be re-assessed after a trial period of
5 years. Where the pre-employment examination is not feasible an early examination
should be done as soon as practicable. The purpose of a pre-employment examination
would be to exclude from processes which-carry a risk of byssinosis, persons suffering
from chronic bronchitis or any other respiratory disability which may be exacerbated
176
Committee on Hygiene Standards
by exposure to cotton dust. The chest X-ray is of no value in diagnosing byssinosis,
but in some countries where tuberculosis is prevalent, chest X-rays will be needed,
particularly in the pre-cmployment examination.
Such pre-cmployment and periodic examinations should include an occupational
history, questionnaire on respiratory symptoms and ventilatory function tests.
These examinations could be carried out by trained persons, who are not medically
qualified, provided they are under the general direction of a physician, who alone
should advise about change of employment on medical grounds.
The questionnaire is a modified version of the British Medical Research Council’s
questionnaire on respiratory symptoms (see Appendix I). Its object is primarily to
assist in diagnosing bronchitis and byssinosis and in detecting changes in sympto
matology during the years of employment. It is suggested that an appropriate level
of bronchitis at which subjects should be excluded from the industry is shown by
positive answers to Questions 4, 5 and 6, or Questions 4, 1’5, 16 and 17 in the
Questionnaire.
Ventilatory function tests (sec Appendix 2) can be used io measure the performance
of an individual compared with that expected .for someone of the same sex, age and
height, to compare the individual with himself in the past, or to measure acute changes
in function during dust exposure over a day or shift. The first use requires normal
values. Those by Cotes (1968) arc adequate for the purpose and given in Tables B
and C in Appendix 2. If in the male the forced expiratory volume in 1 sec (FEVpo) is
under 60 pcr cent of the predicted value, i.c. usually more than 1 litre below that
expected, or in the female 0-8 litre below, the individual has a significant amount of
ventilatory impairment. It is suggested that no-one with this or greater degree of
impairment, together with simple bronchitis shown by a positive answer to question 4
should be selected to work in a cotton dust environment more dusty than that desig
nated “low”. Figures for the forced vital capacity (FVC) should also be obtained as
•these will be of value in assessing any changes in function during a person’s employ-
All persons employed in processes up to and including winding rooms should be
included, especially in coarse and medium mills, unless the concentration of airborne
dust has been shown to be less than 0’5 mg/np. less fiy. The periodic examination
should be carried out at least every 3 years. The interval between examinations should.
depend on the severity of the risk, and in certain circumstances, for example, where the
risjc is high, the interval should be reduced to 1 year.
When possible these examinations should also be done on return from a period
of absence of 3 weeks or more due to a respiratory illness.
The measurements of changes in FEV during the shift should be made after the
weekend break or absence from work, and confined to workers whose dust exposure
is excessive or who arc for any reason thought to be susceptible to dust.
A worker is advised to leave his work for health reasons only after carefully con
sidering the social and clinical consequences of making a change of this kind. Such
advice should usually be given when symptoms are getting progressively worse, and
are accompanied by some disability, or where the FEVj.o repeatedly falls 0-20 litres
or more during a shift, or the FEVj.q for males is more than 1 litre below that expected
and for females 0-8 litres below that expected.
AIRBORNE DUST SAMPLING TECHNIQUES
The amount of dust suspended in the air of a workroom is measured by drawing
a known volume of air through a dust collector, assessing the amount of dust so
collected and expressing the results in terms of the amount of dust in unit volume of
air.
There arc two main classes of dust sampler: those in which a sample of particles
is weighed (mass concentration) and those in which the sample is counted (number
concentration).
By design, or through imperfections in the instruments, particles of different sizes
arc collected with different efficiencies and in particle counting there is usually further
selection of the particles, which arc counted according to their size and shape. Conse
quently, no two methods or types of instrument render identical results and their
relationship may differ in different dust environments.
When the purpose of dust sampling is to provide results comparable with a
hygiene standard, it has to be be me in mind that the standard is based upon work
with specific instruments. The original data were obtained from a gravimetric sampler
of 100 litres per min flow rate and having a rudimentary method of separating fly
consisting of wire mesh gauze with l-8x 1’8 mm square holes over the intake to the
sampler. A similar procedure was used by Molyneux and Tombleson (1970),
sampling at a height of 5 ft. Fly was retained on a 7 cm diameter disc of wire mesh
gauze with I-8 x 1*8 mm square holes and the dust, less fly, was collected on a glass
fibre disc (Whatman GF/B) of a similar diameter. Fly was removed from the gauze
at hourly intervals at dust concentrations of up to 1 mg/m3 but more frequently at
higher levels to prevent prefiltration of the finer particles.
It is recommended that the measured concentration of dust clouds produced in
cotton processing operations should exclude the contribution of the “fly” to the total
dust concentration, where the “fly” is defined as that component of the cloud which
fails to penetrate a 2 mm square mesh gauze made of 0-2 mm diameter wire (1-8 mm
square aperture) mounted at the entrance of the sampler.
The basic elements of a suitable dust sampling apparatus would be:
A suction pump with flow control to draw air through an adequate filter at a
known steady rate of at least 10 lilrcs/niih.
A robust filler holder with facilities for mounting a 2 mm square mesh gauze
made of 0’2 mm diameter wire over the entrance.
3.
A device to remove the fly from the gauze at frequent intervals to prevent any
significant change in the filtration properties of the gauze.
4.
A supporting stand to hold the sampling head approximately 1-5 m above the
floor.
1.
2.
An apparatus used in one of the investigations leading to the presently recom
mended standard is shown schematically (Fig. 3). The elutriator of a 50 litres/min
Hcxhlct sampler (Casella Ltd) was replaced by a 9 cm disc of wire gauze (1-8 mm
square aperture). The gauze was kept-clear during sampling by wiping with a thin
nylon brush, with bristles approximately I cm long (e.g. draught excluder), mounted
on the shaft of a 1/50 hp, 4-5 rev min motor. Dust passing through the gauze was
collected on a 7 cm glass-fibre filter (Whatman GF;A). Preconditioning of these
17S
COMumrs os Hygiene Standards
Fig. 3. An apparatus for sampling airborne cotton dust.
filters before weighing is unnecessary when sampling under conditions of relative
humidity less than 90 per cent.
Different authorities favour different instruments, according to the purpose of the
dust sampling and the importance given to the theoretical, practical, scientific, medical
and economic advantages of the sampling system and to the availability of the instru
ments. Instruments which are suitable for measuring number concentrations have been
little used for cotton dust and have limited application. The relative importance to
health of number, area and shape of the different sizes of cotton dust particles is not
known in detail. Nevertheless, those long fibres which arc readily deposited in the
nose and upper respiratory tract are less likely to be important than others which
deposit in the lower respiratory tract.
The specification of one sampling technique alone would be unnecessarily restric
tive. In recent years automatic particle counters have become available as also have
other “respirable" dust samplers such as the Conicycle and systems which include an
elutriator or a cyclone to remove the coarse particles.
The active agcnt(s) may be only a small proportion of the dust and there is no
simple, specific test for this. At least some of the active agent is water soluble since
aqueous extracts of the dust sprayed in air and inhaled give rise to characteristic
responses ir. individuals. Further, only a proportion of the dust will be sufficiently
fine to penetrate to the alveolated airways of the lung. On the other hand, the prime
purpose of the dust sampling is to indicate as quickly as possible whether the existing
degree of air cleanliness is inadequate so that engineering control procedures may be
properly applied. The simplest of dust sampling techniques has real advantages for
this. Although the sub-committee recommends a hygiene standard based on dust less
fly, the total dust concentration may be used as a guide.
Obviously, if the total dust concentration is less than a certain value, any fraction
l.l>
-I
.l.mtx <<•> c.Ml.-n just
179
of it will also be less than this same value. Thus, lack of specialized equipment,
analytical techniques or great expertise in dust measurement need not necessarily be
a bar to proceeding with dust control in an orderly and effective manner. In many
cases, the simplest of measurements will suffice. In others, dust control may be
difficult and expensive, anti a more sensitive and precise method of measurement is
justified.
It is suggested that a workplace be defined in terms of the area in which people
work on one or a group of identical or similar machines. It is further suggested that
a workplace is assigned its dust category according to the time-weighted average
concentration. This should be determined by sampling continuously or at represen
tative intervals during working hours over one week. The sampling should have been
carried out at a minimum of 5 locations or at a minimum of 5 different locations on
successive shifts in the area, each location being selected to provide a representative
sample of air to w hich one-fifth of the workers arc exposed or exposed for a fifth of
their time.
Il is recognized that in a workplace where the weekly average exposure lies in a
particular category, an occasional shift average may exceed the upper limit of that
category. Accordingly, provided no more than one shift exposure exceeds the upper
limit and the average for the week docs not exceed the upper limit the workplace is
classified in that category.
A workplace where the air concentration is less than 0*5 mg/m3 at a time of
maximum dustiness need not be investigated further.
Respirators
In preventing adverse effects from inhaling cotton dust the first objective is to
prevent the air from becoming contaminated. This is accomplished as far as possible
by process design and engineering control methods. However, to be realistic, there
may always be some processes in which these procedures are not economical, applic
able, practicable or completely clTectivc. Protective respirators are needed in these
situations to supplement the primary control measures or to provide protection while
these arc being installed, maintained or repaired.
When it is necessary to work for short periods in an environment where dust
concentrations are very high, respiratory protection should be provided. An orinasal
dust respirator, fitted with an encapsulated, high efficiency dust filter and meeting
US:2091 (1968), is suitable for up to 10 mg/m3. Should the concentration exceed or
be likely to exceed this level a higher standard of respiratory protection should be
provided.
The choice of a particular respirator should be based, firstly, on a thorough
appraisal of the dust conditions. The limitations of the respirator have also to be
considered including filter efficiency, fit, flow resistance, ease of maintenance and re
pair. A frame holding a piece of gauze or sponge may be effective for large nuisance
particles but is inefficient for fine dust.
Where there is more than one suitable type of respirator available the user should
be allowed to choose the one that he finds most comfortable when fitted. However it
should not be overlooked that an employee selecting a respirator will generally choose
one having a low resistance, regardless of other important factors, such as leakage due
to poor fit, open valves, inefficient filters, and worn or punctured parts.
131
Hygiene standards for cotton dust
Maintenance is an important part of any control programme and this is especially
true for respirators. Inspection, cleaning, replacement or repair of worn or deterio
rated parts and storage should be done at a centralized cleaning station if possible
and supervised by a responsible person with a thorough knowledge of the device.
Recirculation of exhaust air
If large amounts of air are exhausted from a workroom to remove the airborne
dust, an equivalent amount of fresh tempered air should be supplied to tne room. The
supplied air must be heated in cold weather; heating costs may be large if sizeable
amounts of air are handled. Attempts are sometimes made to reduce such heating
costs by cleaning the exhausted air with subsequent recirculation of air into the room.
The discharge air from an air cleaner in a ventilation system exhausting air from a
workroom may contain fine particles in suspension. It is recommended as a pre
cautionary measure that this air should not be recirculated unless it is effectively
filtered or is mixed with fresh air to such an extent that each cubic metre of the com
bined air contains less than 0-1 mg of dust.
APPENDIX 1
QUESTIONNAIRE ON RESPIRATORY SYMPTOMS
General
The questionnaire on respiratory symptoms is a modified version of that approved
by the MRC Committee on Research into Chronic Bronchitis, instructions for which
can be obtained from W. 11. Holman Ltd., Dawlish, Devon.
Its object is to provide information biased as little as possible cither by the ques
tioner or the respondent. The actual wording of each question is laid out and this
should be followed precisely. It is easy to sec that one might get a different answer to
a question phrased “Do you smoke” to one “You don’t smoke, do you”; but from
this extreme example even the intonation of the voice may influence a person in his
answers and one should try to ask the questions in as matter-of-fact way as possible.
They should be put fairly quickly so that the replies are those which immediately
come to the subject’s mind. As far as possible he should be discouraged from trying
to amplify or qualify his answers, although occasionally a question will not be fully
understood and some explanation is needed. When, after a brief explanation, doubt
still remains as to whether the answer should be “Yes" or “No”, it should be recorded
as “No”.
Although the questionnaire may look formidable at first sight, it seldom takes more
than four minutes to complete and usually less than two.
Comments on individual items
I.
In questions 1 and 3 the word "usually" implies five or more days each week.
In questions 2 and 4 three months refer to consecutive months in the winter. When
night shift workers arc interviewed, the words "on getting up” should be used instead
of “first thing in the morning" in questions I and 3.
2.
In the questions on smoking, allowance should be made in calculating the
average number of cigarettes smoked for differences at the weekend. As a rule, people
smoke more at weekends than when working.
3.
The check list on occupation is useful in jogging the respondent’s memory
about short periods of work in an industry which might be relevant.
QUESTIONNAIRE ON RESPIRATORY SYMPTOMS
WORK PLACE: .,,.fjs....................................
Name............................................................
(Surname)
.............................................................
(First Names)
Date oflnterview|
Date of Birth
|
Age
Sex |
......... ...............................................
|
|
|
p
Civil State|
Address........................................................
666.
Day Month Year
|
| ~~|
Race |
|
|
|
|
ll\r* . . Man.!.’:.1' fi'i v.'ltcn di.133
Committee on Hygiene Standards
NATIONAL (SOCIAL) INS. No.:
Clock No.:.
Standing height
Weight
i
|
I
10.
Interviewer
Use actual wording of each question. Put X in appropriate square after each question.
When in doubt, record "NO"
YES NO
Have you ever worked in a cotton factory?
O
COUGH
yes no
I.
Do you usually cough first thing in the morning (on getting up)?
(Count a cough with first smoke or on “first going out of doors”.
Exclude clearing throat or a single cough. •
2.
If “Yes” to question 1:
yes no n/a
Do you cough like this on most days for as much as three months
each year?
PHLEGM (or alternative word to suit local custom).
If "No" to 9 ask Id:
Has your chest ever been tight or your breathing difficult on any
particular days?
If “Yes"—specify: First day back at work only
Other day(s) also
C
BREATHLESSNESS
If disabled front walking by any condition other than heart or lung disease
put “x" here and leave questions 11-14 unasked
At the weekends:—
YES NO
II.
Arc you troubled by shortness of breath, when hurrying on the level Q Q
or walking up a slight hill 1
(if "No”, grade is I. If “Yes", proceed to next question)
12.
Do you get short of breath walking with other people of your own '
age on level ground ?
(If “No", grade is 2. If “Yes", proceed to next question)
13.
Do you have to stop for breath when walking at your own pace on l~~l l~~l
- level ground?
(If “No”, grade is 3)
14.
Is your breathlessness worse on any particular day?
If yes, specify:
sB
YES NO
3.
Do you usually bring up any phlegm from your chest first thing in the
morning (on getting up)?
(Count phlegm with the first smoke or on “first going out of doors".
Exclude phlegm from the nose. Count swallowed phlegm.)
CHEST ILLNESSES
j
YES NO
During the past 3 years have you had any chest illness which has kept
you oil'work or from your usual activities for as much as a week?
16.
Did you bring up more phlegm than usual in any of these illnesses?
17.
Have you had more than one illness like this with phlegm in the last
3 years ?
IS. Have you ever had: Bronchitis?
.
19.
Bronchial Asthma?
20.
Other chest illness?
If “Yes” to 20 specify:
’
15.
If “Yes" to question 3:
' Do you bring up phlegm like this on most days for as much as three
4.
months each year?
5.
In the pas: three years, have you had a period of (increased) cough
and phlegm lasting for three weeks or more?
(For subjects who usually have phlegm)
6.
Have you had more than one such period ?
TIGHTNESS
YES NO
7.
8.
Does your ehest ever feel tight or your breathing become difficult?
Do you get this apart from colds?
If yes: When?
9. Is your chest tight or your breathing difficult on any particular days?
If “Yes”—specify: First day back at work only .
Other day(s) also
TOBACCO SMOKING
yes NO
21.
Do you smoke?
(Record “Yes" if regular smoker up to 1 month ago)
If “No” to 21:
1S4
22.
Committee os Hygiene Standards
l lygicnc tliindurds lor couon dust
Have you ever smoked?
(Record “No" if subject has never smoked as much as one cigarette
a day, or 1 oz. of tobacco a month, for as long as 1 year)
Age when stopped:
......................
If “Yes" to 21 or 22: Fill in figures below:
Now
IS5
I I LL RECORD OF OCCUPATIONAL AND RESIDENTIAL HISTORY
(optional)
Amount smoked
Before stopping
Cigareltes/day (average including weekends)
Oz. tobacco/wcck (handrollcd)
Oz. tobacco/wcek (pipe)
Cigars/weck (large or small)
.*
Work systematically from birth forwards for residence and from leaving school for
occupation, checking that no periods are omitted. Record actual years of job and
residence started and stopped. Under “residence" record actual towns lived in (put
“outskirts” if this applies). For villages and rural areas record county as well as
village; in the case of residence abroad record only the country. For seamen put “at
sea”.
Give full details of any periods of work in coal or other mines, foundries or pot
teries, with cotton, flax/hemp or asbestos or in other dusty jobs and of any exposure
to irritating gas or chemical fumes.
Dates
or ages
Industry and job
(state actual occupation)
Residence
SPACE FOR ADDITIONAL QUESTIONS:
APPENDIX 2
OCCUPATION
MEASUREMENT OF VENTILATORY CAPACITY
§□□□□□□□□□
gn □□□□□□□□
(Record on dotted lines number of years in which subject has worked in any of these
industries)
23.
Have you ever worked in a dusty job?
24.
At a coalmine....
25.
In any other mine
26.
In a quarry
27.
In a foundry
••.•••.•
28.
In a pottery
29.
In a cotton, flax or hemp mill
30.
With asbestos
31.
In any other dusty job
If “Yes"; specify
32.
Have you ever been exposed regularly to irritating gas or
chemical fumes?
If “Yes” give details of nature and duration:
Spacefor additional questions on special risks or exposures
Instruments
Either the McDermott dry spirometer or the Vitalograph can be used. The forced
expiratory volume (FEV,) is that amount of air which a subject can breathe out with
maximum clfort in I sec having taken a full breath. The forced vital capacity (FVC)
is the total amount of air that he can breath out.
I
Method
The tests should be explained to the subject in simple terms. Usually the statement
“I want to measure how hard you can blow”, though not quite accurate, is readily
understood. 1 !c should remove his overcoat and loosen any tight clothing, such as a
waistcoat, and cither sit upright but comfortably in front of the apparatus, or stand.
On any subsequent measurement the same posture should be used. The height of the
flexible tube between the apparatus and mouthpiece should be adjusted so that it can
be comfortably taken in one or both hands. There is normally no need for a nose
clip. He should be asked to take unhurriedly as full a breath as possible, to insert the
mouthpiece between the teeth, and close the lips around it, and then to blow out as
bard as possible for as long as he can. It is well worthwhile giving him a demonstration
using an unattached mouthpiece. The following sequence of testing is recommended:
I.
The subject makes two practice measurements. During this time he is observed
and any errors corrected, but a completely full expiration need not be insisted
upon at this stage.
2.
Three further similar blows are made but each is continued until no more air
can be exhaled to obtain tins FEV and FVC. Towards the end of the breath
the subject must be encouraged to go on exhaling for as long as he can. Allow
186
Committee on Hygiene Standards
Table A. Corrections of FEV and EVC for temperature
Table A (continued)
(For use v.ith spirometers having no temperature correction in the scale.)
Spirometer reading
(litres)
16PC
18'C
20"C
Corrected reading
(I)
22eC
24°C
*C
26
28°C
Corrected reading
(1)
22‘C
24"C
Spirometer reading
(litres)
16°C
I8"C
20’C
5-5
5'6
5-7
58
59
6-18
6'29
640
6’51
6-63
612
6-23
6-34
6-46
6.57
606
6-17
6-28
6-39
6-50
600
6-11
60
61
6-74
6-85
6-96
7-07
7-19
6-68
6-79
6-90
701
7-12
6-61
6-72
6-83
6-94
7-05
6-3
6-4
26nC
28“C
6-33
6-44
594
605
6 16
6-26
6-37
5-88
5 99
609
6-20
6-31
5-81
5-92
603
6-13
6’24
6-55
6-66
6-76
6-87
6-98
6-48
6-59
6-70
6-80
6-91
6-41
6-52
6-63
6-73
6-84
6-34
6-45
6-55
6-66
6-76
at least 30 see between each of these breaths. If during any of these three
attempts it can be seen that the performance is incorrect, the measurement
should bo rejected and repeated, the reason for the rejection being noted. A
result should not be rejected, however, simply because it is unexpectedly low.
Some common errors in metistiring the
and FVC
During practice breaths, the observer should watch particularly for five faults:
1. The height of the mouthpiece may be incorrect causing an uncomfortable
posture.
2. The subject may not take a full inspiration. It is essentia! that a full breath is
taken before the test starts.
3.
He may hesitate at the beginning of the expiration. Once started the breath
must continue rapidly without any pause.
4.
The mouthpiece may be incorrectly inserted and the lips not closed round it.
5.
The subject may fail to continue his expiration to the end and so produce a
low forced vital capacity (FVC).
(continued over}
Recording results
It is necessary to record the temperature of the spirometer as this will influence
the answer obtained. Instructions for temperature correction arc given in the accom
panying Table A, but it is advisable to keep the room temperature as near constant as
possible for all tests, i.c. keep it cool in summer and warm in winter. Table A gives
the full correction for change in gas volume from spirometer temperature to body
temperature (BTPS) and is to be used only with those spirometers with which there
IK no temperature correction provided in their scale, c.g. the Vitalograph.
Io use Table A, find the spirometer reading in the left-hand column and read of
the corrected value on the same line in the column nearest to the spirometer temper
a7‘??.C,g‘ ‘f lhe sPiromcl.cr reading,is 2-4 litres and the temperature 22°C, then th
*
... ... reading is 2-62 litres. The results may depend both on the time of day ano
• • r.e
of time the individual has had on the shift. Therefore, in follow-uj
Committee on Hygiene Standards
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3 82 3-91 4 01 4 10 4-19 4-28 4-37 4 46 4-56
3-79 3-88 3-97 4 07 4-16 4-25 4-34 4-43 4-53
3-73 3 82 3-91 4 00 4-10 4 19 4-28 4-37 4-46
3-70 3-79 3-88 3-97 4 06 4 16 4 25 4-34 4-43
3-67 3-76 3-85 3-94 4-03 4-13 4-22 4-31 4-40
3-64 3-73 3 82 3-91 4 00 4 09 4 19 4-28 4-37
3-60 3-70 3-79 3-88 3 97 406 4-16 4-25 4-34
3-57 3-67 3-76 3-85 3-94 403 4-12 4-22 4-31
3-54 3-63 3 73 3-83 3-91 4-00 4 09 4-19 4 28
3-51 3’60 3-70 3-80 3-89 3-97 4 06 4-15 4-25
3-48 3-57 3-66 3-76 3-85 3-94 4-03 4 12 4-22
3 45 3 54 3-63 3 73 3-82 3-91 400 4 09 4 18
3 42 3 51 3-60 3-69 3-79 3-88 3-97 4 06 4-15
3-39 3-48 3 57 3-66 3-75 3-85 3-94 4 03 4 12
3-36 3-45 3-54 3-63 3-72 3-82 3 91 4 00 4 09
3-33 3-42 3-51 3-60 3-69 3-78 3-88 3-97 4-06
3-29 3-39 3 48 3 57 3-66 3-75 3-85 3-94 4 03
3-26 3-36 3-45 3-54 3 63 3-72 3-82 3-91 4-00
3-23 3-32 3-42 3-51 3-60 3-69 3-79 3 88 3-97
50
51
52
53
54
55
56
57
58
59
2-56 2-64 2-74 2 33 2-93 3 02 3-11
2-53 2-62 2-71 2-80 2-89 2-99 3 08
2-50 2-59 2-68 2-77 2'86 2-96 3-05
2-46 2-56 2-65 2-74 2-83 2-92 3 02
2-43 2-53 2-62 2-7! 2-80 2-89 2-99
2-40 2-49 2-59 2-68 2-77 2-86 2-95
2-37 2-46 2-56 2-65 2-74 2 83 2 92
2-34 2-43 2-52 3-62 2-72 2 80 2-89
2-31 2-40 2-49 2-59 2-68 2-77 2 86
2-28 2-37 2-46 2-55 2-65 2-75 2-83
60
61
62
63
64
65
2-25 2-34 2-43 2-52 2 62 2-7 ! 2-80
2-22 2-31 2-40 2-49 2-58 2-63 2-77
2-19 2-28 2-37 2-46 2-55 2-65 2-74
2-15 2-25 2-34 2-43 2 52 2-61 2-71
2-12 2-22 2-31 2-40 2-49 2-58 2-68
2-09 2-18 2-28 2-37 2-46 2-55 2-64
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Hygiene standards for cotton dust
tests the measurements should be made, if possible, at the same time in the same shift.
All results and other relevant data arc recorded on the form below.
Prediction of expected normal values
As expected normal values for respiratory function tests depend on the sex, age,
height and ethnic origin of the individual; allowances for these have to be made in
attempting to ascertain whether values for an individual are within the normal range.
Tables B and C give expected values of the FEV[.O for European males and females
respectively and arc derived from Cotes (1968). They enable one to read off formales
or females of any particular age and height the expected values of the FEV,.O.
It should be noted that the expected values of men of African or Asian descent are
0-45 litre lower throughout the Table and the corresponding figure for women is
0-41 litre. Therefore, in estimating the normal value for a person of these ethnic
origins, look up first the appropriate European value and then subtract from the result
the amounts quoted above.
RECORD OF VENTILATORY CAPACITY TESTS
INSTRUMENT:
(If other than regular factory
instrument)
MAKE:
NUMBER:
NAME OF SUBJECT:
M or F:
DATE:
TIME:
NAME OF OBSERVER:
TEMPERATURE °C:
TESTS OF VENTILATORY CAPACITY
I. Forced Expiratory Volume in <)\’E SECO.V/J-fFEV,.1,,) (litres)
2. Forced Vital Capacity - (FVC) (litres)
INSTRUMENT READINGS
No.
(I)
(2)
I
FEVpo
FVC
192
Committee on lbrcjENB Standards
MEAN—Corrected for
temperature
(see tabic A)
=|
| (C)
=I
I (D)
FVC
FEVi-o
EXPECTED “NORMAL”
VALUE
=|
(From Table B or C)
| (X)
=1
I (Y)‘
=|
| (Q
=1
I
+ =D-Y
or
I
— = Y—D
' I
OBSERVED VALUE
DIFFERENCE
+ = C-X
or
- =X-C
I
I
• * If required, expected normal value can be obtained from Cotes (1968).
(D)
2^3
11
Csncer
EMAS
Chief Employment Medical Adviser's
notes of guidance
CO/W.'WUNJTY
(First Hoor
BAWGAtoR E-560 001
^'5^@pE?l5^6Q1
Department of Employment, November 1972
1 Persons engaged in some trades may be exposed to known carcinogens.
Occupational cancer is associated with:
2
Asbestos
Bronchial carcinoma, mesothelioma.
3
Nickel refining by
nickel carbonyl
process
Cancer of the ethmoid and paranasal sinuses
(since the process of refining nickel was
improved in 1924 no case has been attribu
table). Bronchial cancer.
4
Hexavalent chromates
Bronchial carcinoma: in smelting of chrome
ores to produce bichromates. Trivalent salts
of chrome used in chrome plating are not
carcinogenic, as far as is known at present.
5
Iso-propyl oil
Nose, exposure to oily residues left behind
after distilling iso-propyl alcohol (which it
self is not carcinogenic).
6
Wood dust,
especially hard woods
7
Leather dust
Adeno-carcinoma of mucous membrane
covering middle ethmoid: first noticed in
the High Wycombe furniture manufacturers
who are exposed to dust of hard woods,
especially beech, oak and mahogany. May
also (but to less extent) be associated with
exposure to dust of soft wood.
Adeno-carcinoma of boot and shoe manu
facturing virtually limited to operatives in
press and finishing departments.
8
Benzene
Leukaemia, aleukaemia: erythroleukaemia.
9
Arsenic
Skin, bronchial cancer in manufacturers of
sheep dips.
10 Ionising radiations
Blood, bone, lung, skin.
11 /3-Naphthylamine
a-Naphthylamine
benzidine, dichlor
benzidine, ortho
tolidine, dianisidine,
4-amiodiphenyl,
4-nitrodiphenyl.
Cancer of bladder and renal tract.
The latent period varies considerably but
the peak incidence is from 11-18 years.
12 Polycyclic hydrocarbons
Benzpyrene/benzanthracene types
Bronchial carcinoma — air contamination in
vertical retort houses, coke ovens etc.
Tar, pitch, bitumen
Cancer of skin.
Mineral oil
Cancer of skin, especially of scrotum.
13 Cadmium
Cancer of prostate in makers of nickel
cadmium batteries.
14 Heat (repeated
exposures)
Cancer of skin (rare in United Kingdom).
15 The following subjects are dealt with under their appropriate classi
fications; where notification is indicated as appropriate.
Arsenic — 3
Chromium
Mineral Oil - 39
Asbestos — 4
(Electroplating) - 22
Nickel and Nickel
Benzene — 6
Coal Tar distillation — 27 Carbonyl - 40
Cadmium — 10. Ionising Radiations — 29
Renal Tract
Carcinogens — 50
BIBLIOGRAPHY
Amor, A.J. (1939)
Report of the VIILInternational Congress
Vol 2. 248, for Industrial Accidents and
Occupational Diseases, Leipzig (Cancer and
nickel exposure).
Annual Report of HM Chief Inspector of Factories on Industrial Health
for 1958. Occupational Cancer. HMSO, London.
Annual Report of HM Chief Inspector of Factories on Industrial Health
for 1965. Cancer in industry generally. HMSO, London.
Annual Report of HM Chief Inspector of Factories for 1965. Occupa
tional Cancer of the Renal Tract. HMSO, London.
Annual Report of HM Chief Inspector of Factories for 1967. Advisory
Panel on cancer in Industry, mineral oil and cancer of the scrotum.
HMSO, London.
Annual Report of HM Chief I nspector of Factories for 1968. Carcinoma of
the skin and the use of mineral oil, register of mesothelioma cases, survey
of cancer in the rubber and cable industries, cancer of skin due to heat.
HMSO, London.
Annual Report of HM Chief Inspector of Factories for 1947. Pulmonary
carcinoma and asbestosis. HMSO, London.
Buchanan W.D. (1962)
(Arsenic exposure and cancer) Toxicity of
Arsenic Compounds. Elsevier, London.
Carcenogenic Substances Regulations, 1967.
Department of Employment
Technical Data Note 3 (Rev): Occupational
Cancer of the Renal Tract.
Department of Health &
Social Security
Notes on the diagnosis of occupational
diseases. HMSO 1970, London.
De Villiers, A.J. (1964)
(Lung cancer and radioactive dust) British
Journal of Industrial Medicine Vol 21. 94.
Doll, R. (1965)
(Gas works and cancer) British Journal of
Industrial Medicine Vol 22. 1.
Hamilton, A. (1931)
(Benzene exposure and leukaemia) Archives
of Pathological Laboratory Medicine Vol 11.
434, 601.
Hunter, D. (1969)
The Diseases of Occupations 4th Ed. 767-838.
English Universities Press Ltd., London. Cancer and polycyclic hydrocarbons.
Lee, W.R. and McCann,
J.K. (1967)
(Mule spinner’s cancer) British Journal of
Industrial Medicine Vol 24. 148.
Ministry of Social
Security
Pneumoconiosis and allied occupational
chest diseases. 1967 HMSO, London.
National Insurance Industrial Injuries Act, 1965.
Newhouse, M.L. et al
(1965)
(Asbestos and mesothelioma) British Journal
of Industrial Medicine Vol 22. 261.
Scott, T.S. (1962)
Carcinogenic and Chronic Toxic Hazards of
Aromatic Amines (urinary tract cancer).
50
EMAS
Chief Employment Medical Advisers
notes of guidance
Department of Employment, November 1972
------------------ C -»600;------
Properties.
1 Definition: The group of chemicals (See Appendix 2) identified as
renal tract carcinogens and specified in the Carcinogenic Substances
Regulations 1967 are:
Prohibited substances: Beta-naphthylamine, benzidine, 4-aminodiphenyl, 4-nitro-diphenyl, and their salts and substances containing
any of those compounds other than in very small concentrations.
Controlled substances: Alpha-naphthylamine, ortho-tolidine, dianisidine, dichlorbenzidine and their salts. Auramine and magenta are
controlled substances as regards their manufacture.
2
The substances listed belong to the general class of aromatic amines.
Some of this group of chemicals are carcinogenic including those defined
in the regulations but many other aromatic amines do not have this hazard.
For example, aniline, the simplest aromatic amine, is not carcinogenic
despite the early term for occupational bladder cancer, 'aniline cancer'.
Aromatic amines in general, however, are acutely toxic causing 'anilism'
characterised by methaemoglobinaemia resulting in cyanosis of a distinc
tive type: bluish grey colour of the skin and mucous membranes. Massive
or prolonged exposure may produce anaemia secondary to haemolysis.
Chronic hepatic toxic effects are rare in workers although liver damage
and hepatic tumours (benign and malignant) can be induced by many
aromatic amines in many different species of animal. Toluidines and
chlorotoluidines may induce chemical cystitis with pain, frequency and
haematuria, but do not cause vesical cancer; this effect is uncommon in
modern plant conditions.
Threshold limit values
3
Sources of exposure
4
Not established.
The industries in which exposures have occurred more frequently are:
Dyestuffs. In the dyestuffs section of the chemical industry as well as
in textile dyeing and printing, where dye may be produced on the
cloth by reaction of chemicals applied to it by dip or print methods.
Rubber and cable-making. In these industries the substances have
been used as antioxidants.
5
Lesser exposures have occurred in:
The manufacture and printing of security paper: the compounds
serve here as anti-forgery agents.
The manufacture of organic chemicals including organic pigments
for paints.
Rodent extermination. ANTU, i.e. alpha-naphthylthiourea contain
ing traces of naphthylamines.
Gas industry. Traces of beta-naphthylamine may be present in the air
in retort houses.
Laboratories. Although their use is relatively trivial, these compounds
may be used in hospital and analytical laboratories as test reagents,
e.g. use of ortho-tolidine in water testing.
Metabolism
6
Absorption of aromatic amines is by inhalation of either the dust or
vapour. Absorption through the skin and ingestion also occur.
7
They produce their carcinogenic effect after conversion in the liver to
metabolites (ortho-amino-phenols and/or aryl hydroxylamines) which are
conjugated with glucuronate. Enzymatic hydrolysis, however, in the urine
releases the proximate carcinogen to exert effect on the urinary tract
epithelium, notably in the bladder. Differences in metabolic systems be
tween man and experimental animals complicate the investigation of the
carcinogenic activities of these compounds.
Biological and
clinical effects
8
Induction periods. The disease manifests itself at differing times after
the first exposure. Extremes are under 5 years and over 50 years but the
most common time is between 15 and 20 years. Consequence of this long
induction time is the necessity for medical supervision throughout the
remainder of their lives of workers who have been exposed to risk.
9
Pathology. Occupational tumours of the bladder may be benign or
malignant papillomata, single or multiple or recrudescent.
Diagnosis
10
Medical examination. Symptoms due to tumours of the urinary tract
may arise early or late in the progress of the tumour: frequently symptoms
do not occur until the tumour has progressed to the invasive stage. The
purpose of medical examination is to ensure detection of the condition, if
it arises in a worker, at the earliest possible stage, before invasion has oc
curred so that treatment holds a reasonable chance of cure. The only
practicable way to offer the chance of earliest pre-symptomatic diagnosis
is by exfoliative cytological examination of the urine (see below). As in
any medical examination, a careful history should be taken as part of a
continuous sequence of supervision of that worker. The degree of exposure
to the specified chemicals should be precisely recorded. Any renal or uri
nary symptoms should be noted and an account should be taken of illness
whether causing absence from work or not. These records may be of value
at a later date, should a tumour arise.
11
Exfoliative cytology. Cells exfoliated from a tumour, whether papilloma
or cancer, can be detected in the urine at an early stage. Clearly, if tumours
are left until a late stage, cytology is likely to be positive. Serial cytology
will, in the majority of cases, show malignant or suspicious cells at an early
and pre-symptomatic stage of the disease, and occasionally before a tumour
can be seen easily by cystoscopy. Much more needs to be known about
the success rate of treatment at the earliest stage, but on general priniciples,
early treatment of malignant conditions is highly desirable.
12
Every medical examination made under the Regulations must include
such a cytological examination of the urine. Facilities have been set up
at designated hospitals by the Department of Health and Social Security
and the Scottish Home and Health Department; a list of these laboratories
is appended. Details of these facilities were notified to general medical
practitioners by the DHSS on 6th April, 1965 (Circular ML 3/65) and by
the SHHD on 20th April, 1965 (Circular HOS/17/18/2), both documents
entitled 'Presymptomatic diagnosis of cancer of the bladder by exfoliative
cytology'. Specimen bottles containing preservatives are available on de
mand from the pathology department. About 4—6 oz. of urine should be
collected and sent forthwith to the chosen laboratory for examination.
Advice should be obtained from the laboratory as to the type of speci
men required; some laboratories prefer a specimen of urine taken when
the patient is active, i.e. not an early-morning sample.
13
In the laboratory, smears are prepared by a special technique (the
Papanicolaou method) and examined microscopically. The interpretation
of the smears is difficult and requires skilled assessment, not only in
differentiating the criteria of malignancy but also in identifying the
numerous variations from the normal due to non-neoplastic conditions.
The results of assessment of cytological characteristics of exfoliated
cells may be expressed according to a classification laid down in the
particular laboratory; the method of expressing these results should be
ascertained from the laboratory where the tests are to be carried out. A
typical convention for expression of results is as follows:
Class I
normal
Class II
atypical
\
>
J
negative
Class III --------------------------------------------------------- suspicious
Class IV
probably malignant
,,
,
,
..
>
positive
Class V
definitely malignant
J
Action
14
On results of exfoliative cytology. A positive result is considered an
indication for cystoscopy. Suspicious smears (Class III) are regarded as
positive if exposure has been heavy or if blood is also present. The urine
is, of course, also examined for the presence of red cells, which may not
be visible on ordinary observation (microscopic haematuria). In other
cases repeated samples are examined until a decision can be reached. A
carefully taken occupational history is of value.
15
In all cases designated as positive or allocated to a positive class on
further enquiry, immediate steps must be taken to secure treatment for
the patient. The worker should be referred to his general practitioner, to
whom full clinical information should be made available. While explana
tions of the test results and descriptions of treatment should be left to
the general practitioner, it may on occasion be necessary to provide
sufficient information to the worker to ensure that he appreciates the
need to attend for consultation with his own general practitioner.
Records
Under regulation 8 (5) the following records must be kept:
Register of Medical Examinations (F2282). To be kept in the factory,
in which there shall be entered in the case of each person medically
examined for the purposes of these regulations his name, address, date
of birth, national insurance number, the dates of the periods of his
employment in the factory in manufacturing process or work con
nected with the controlled substances and the dates when he was so
medically examined.
Cautionary Card (F2257). A copy of the approved cautionary card
relating to controlled substances must be given free of charge on the
termination of his employment in that factory to every person who
has been employed on work connected with controlled substances;
the duty to ensure that such workers do receive the warning card falls
on the occupier of the factory.
16
Positive results of cytological investigation or other evidence of devel
opment of tumour in a worker who is examined under the provisions of
the Carcinogenic Substances Regulations are not required statutorily to be
notified. Nevertheless, information about positive reports of cytology and
Rena! tract carcinogens (2)
of cases of cancer of the renal tract in workers manufacturing or using
carcinogens should be carefully preserved.
Legal requirements
17
The relevant regulations are the Carcinogenic Substances Regulations
1967 (SI 1967 No. 879) and the Carcinogenic Substances (Prohibition of
Importation) Order 1967 (SI 1967 No. 1675).
The Carcinogenic Substances Regulations 1967
18
These Regulations prohibit, subject to the power of the Chief Inspec
tor of Factories to grant exemptions in certain cases, the presence and use,
and the employment of persons in connection with the making, in factories
and in other premises and places to which the Factories Act 1961 applies,
of certain carcinogenic compounds, namely beta-naphthylamine, benzidine,
4-aminodiphenyl, 4-nitrodiphenyl and their salts, and substances contain
ing any of those compounds other than in very small concentrations.
The Regulations also control the employment of persons in connection
with the making, in factories and other premises and places to which the
said Act of 1961 applies, of alpha-naphthylamine, ortho-tolidine, dianisidine, dichlorbenzidine and their salts and auramine and magenta, and
(except in the case of the last two substances mentioned) control the use
of the said substances in such factories and places, so as to make provision
for the safety and health of the persons employed. Provision is also made
for the medical examination of persons employed in such factories and
places in connection with the making or use of any of the said substances
or who have been so employed.
The Carcinogenic Substances (Prohibition of Importation) Order 1967
19
This Order prohibits the importation into the United Kingdom of the
following chemical compounds, namely, beta-naphthylamine, benzidine,
4-aminodiphenyl, 4-nitrodiphenyl and their salts and any substance or
article containing any of the said compounds. The prohibition does not
apply in the case of substances or articles in which the said compounds
are present in less than specified concentrations. The Order provides for
the granting by the Chief Inspector of Factories in specified circumstances
of exemptions from the prohibition on importation where material is to
be used for the purpose of or in the course of medical or scientific research,
where benzidine monohydrochloride or benzidine dihydrochloride is to
be used in any process of manufacture carried out in a totally enclosed
system, and where material is to be brought into a dock, wharf or quay in
the United Kingdom for the sole purpose of re-export.
20
Medical examinations. It is the duty of persons so employed to sub
mit themselves for medical examination and to provide samples of their
urine as required. These examinations will take place within six months
of first employment and will be repeated at intervals of not more than
six months so long as employment in the factory continues. On leaving
this employment the worker must be issued with a warning card, advising
him of the need to continue to have the urine test and instructing him in
the way to arrange this and the facilities available. During employment
the medical examinations will take place at the factory unless other ar
rangements have been approved by the District Inspector of Factories;
the Regulations impose a duty on the occupier of the factory to provide
suitable accommodation and facilities.
Voluntary medical
examinations
21
Voluntary medical examinations. Cytodiagnostic facilities were pro
vided by the major chemical manufacturers and by the British Rubber
Manufacturers' Association Health Unit for present and past employees.
Many firms were not covered by these arrangements although the hazardous
chemicals had been used. Arrangements were made for the distribution
by such employers to exposed persons of warning cards supplied by the
Department. Cytodiagnostic facilities are available nationally through
laboratories designated by the DHSS and SHHD (See Appendix I). Work
ers at risk now are covered by the provisions of the Regulations. Past
workers who have received the warning card from their former employer
should be referred through their own general practitioner for regular
cytological screening of the urine. Any worker referred on account of
haematuria or cancer of the renal tract should have a full occupational
history recorded and be advised to consult his general practitioner
immediately.
22
Prescribed disease No.39. There are relevant provisions under the
National Insurance (Industrial Injuries) Act 1965, first prescribed on De
cember 1st, 1953 under old National Insurance (Industrial Injuries) Act
1946. Primary neoplasm of the epithelial lining of the urinary bladder (pa
pilloma of the bladder) or of the epithelial lining of the renal pelvis or of
the. epithelial lining of the ureter. Extended on July 7th 1958 to ensure that
exposures to all compounds recognised as carcinogenic were covered but
many other nitro and amino compounds not suspected were still excluded.
Benefits for proven cases arising from exposures prior to 1948 are assured
by the Industrial Injuries and Diseases (Old Cases) Act 1967.
Prevention
23
See references covering technical methods either for substitution of
the carcinogenic substance of sophisticated design of plant.
BIBLIOGRAPHY
Annual Report of HM Chief Inspector of Factories on Industrial Health for 1961
and 1965.
Boyland, E. (1963)
The Biochemistry of Bladder Cancer. Charles C.
Thomas, Illinois, USA.
Carcinogenic Substances Regulations, 1967.
Carcinogenic Substances (Prohibition of Importation) Order, 1967.
Case, R.A.M. (1966)
Annals of the Royal College of Surgeons Vol 39. 213.
Chester Beatty Research
Precautions for Research Laboratory Workers who
Institute
handle Carcinogenic Aromatic Amines Institute of
Cancer, Royal Cancer Hospital, London.
Davies, Joan M. (1968)
Transactions of the Society of Occupational Medi
cine Vol 18.42.
Department of Employment
Technical Data Note No. 3: Occupational Cancer of
the Renal Tract (Revised).
Form F 2173
Notes to Former Workers in the Rubber and Cable
Making Industries (Advice on Cytological Examin
ation of the Urine for Workers Currently and No
Longer Exposed to Urinary Carcinogens).
Form F 2205
Notice to Workers and Former Workers in the Chem
ical Dyestuffs, Textile Dyeing, Printing and Paint
Manufacture Industries (Advice on Cytological Exam
ination of the Urine for Workers Currently and No
Longer Exposed to Urinary Carcinogens).
Form F 2257
(Cautionary Card to be given to Worker with Con
trolled Substances at Termination of this Employ
ment).
Form F 2282
(Register of Persons Working with Controlled Sub
stances and Medical Examinations Required under
the Regulations).
Doll, R. etal (1965)
British Journal of Industrial Medicine Vol 22. 1.
(Cancer in Gas Workers).
Guide by British Association
of Urological Surgeons on
Occupation Tumours of the
Urinary Tract (1961)
British Journal of Urology Vol 33. 1.
Rena! tract carcinogens (3)
National Insurance (Industrial Injuries) Act, 1965.
Carcinogenic and Chronic Toxic Hazards of Aromatic
Scott, T.S. (1962)
Amines. Elsevier Publishing Co., London.
Scott, T.S. et al (1956)
British Journal of Industrial Medicine Vol 14. 150.
Symposium on Occupational
Proceedings of the Royal Society of Medicine
Bladder Cancers (1966)
Vol 59. 1247.
APPENDIX I
List of hospitals and centres with pathology laboratories undertaking
exfoliative cytology.
ENGLAND AND WALES
Newcastle Region
Newcastle General Hospital, Westgate Road, Newcastle-upon-Tyne.
Royal Infirmary, Durham Road, Sunderland, Co. Durham.
Cumberland Infirmary, Carlisle Cumberland.
General Hospital, Hartlepool, Co. Durham.
Leeds Region
Royal Infirmary, Lindley, Huddersfield, Yorkshire.
Castle Hill Hospital, Castle Road, Cottingham, East Yorkshire.
Hospital for Women at Leeds, Coventry Place, Leeds, 2.
Sheffield Region
Nottingham City Hospital, Hucknall Road, Nottingham.
Derbyshire Royal Infirmary, London Road, Derby.
East Anglia Region
University Department of Pathology, Tennis Court Road, Cambridge.
North West Metropolitan Region
Lister Hospital, Hitchin, Herts.
Barnet General Hospital, Wellhouse Lane, Barnet, Herts.
Watford Peace Memorial Hospital, Rickmansworth Road, Watford, Herts.
Ashford Hospital, London Road, Ashford, Middx.
Mount Vernon Hospital, Northwood, Middx.
Hillingdon Hospital, Hillingdon, Nr. Uxbridge, Middx.
King Edward Memorial Hospital, Mattock Lane, Ealing, London, W.13.
Central Middlesex Hospital, Acton Lane, London N.W.10.
Royal Northern Hospital, Holloway Road, London, N.7.
Whittington Hospital, Archway Road, London, N.19.
North East Metropolitan Region
Mile End Hospital, Bancroft Road, London, E.1.
Forest Gate Hospital, Forest Lane, Forest Gate, London, E.7.
Chase Farm Hospital, The Ridgeway, Enfield, Middx.
Herts and Essex General Hospital, Bishop's Stortford, Herts.
Chelmsford and Essex Hospital, London Road, Chelmsford, Essex.
Essex County Hospital, Lexden Road, Colchester, Essex.
General Hospital, Prittlewell Chase, Southend-on-Sea, Essex.
Oldchurch Hospital, Oldchurch Road, Romford, Essex.
South East Metropolitan Region
Lewisham Hospital, High Street, Lewisham, London, S.E.13.
Kent and Canterbury Hospital, Ethelbert Road, Canterbury, Kent.
Royal Sussex County Hospital, Eastern Road, Brighton, 7, Sussex.
Brook General Hospital, Shooters Hill, London, S.E.18.
South West Metropolitan Region
St. Stephen’s Hospital, Fulham Road, S.W.10.
St. Helier Hospital, Wrythe Lane, Carshalton, Surrey.
Kingston Hospital, 37, Coombe Road, Kingston-upon-Thames, Surrey.
Farnham Hospital, Hale Road, Farnham, Surrey.
Wessex Region
Southampton General Hospital, Tremona Road, Shirley Warren, Southampton.
Portsmouth and Isle of Wight Area Pathological Service, Central Laboratory, Milton Road,
Portsmouth.
Oxford Region
Churchill Hospital, Headington, Oxford.
Northampton General Hospital, Billing Road, Northampton.
Kettering and District General Hospital, Rothwell Road, Kettering, Northants.
Royal Berkshire Hospital, London Road, Reading, Berks.
Stoke Mandeville Hospital, Mandeville Road, Aylesbury, Bucks.
Princess Margaret Hospital, Swindon, Wilts.
Wycombe General Hospital, High Wycombe, Bucks.
Horton General Hospital, Oxford Road, Banbury, Oxon.
South Western Region .
Gloucester Royal Hospital, Great Western Road, Gloucester.
Southmead Hospital, Westbury-on-Trym, Bristol.
Manor Hospital, Combe Park, Bath, Somerset.
Welsh Region
Institute of Pathology, Welsh National School of Medicine,
Cardiff Royal Infirmary, Cardiff, Glamorganshire.
Royal Gwent Hospital, Cardiff Road, Newport, Monmouthshire.
Beck Laboratory, Swansea Hospital, St. Helen's Road, Swansea, Glam.
Royal Alexandra Hospital, Marine Drive, Rhyl, Flintshire.
Birmingham Region
Selly Oak Hospital, Birmingham, 29.
North Staffordshire Royal Infirmary, Hartshill, Stoke-on-Trent, Staffs.
Warwick Hospital, Lakin Road, Warwick.
Manchester Region
Preston Royal Infirmary, Deepdale Road, Preston, Lancs.
Bolton Royal Infirmary, Bolton, Lancs.
Crumpsail Hospital, Delaunays Road, Manchester, 8.
Withington Hospital, West Didsbury, Manchester, 20.
Royal Infirmary, Oxford Road, Manchester, 13.
General Hospital, Ashton-under-Lyne, Lancs.
Liverpool Region
Whiston Hospital, Whiston, Prescot, Lancs.
Ormskirk and District General Hospital, Wigan Road, Ormskirk, Lancs.
General Hospital, Lovely Lane, Warrington, Lancs.
Royal Southern Hospital, Caryl Street, Liverpool, 8.
Sefton General Hospital, Smithdown Road, Liverpool, 13.
Broadgreen Hospital, Edge Lane Drive, Liverpool, 14.
St. Catherine's Hospital, Church Road, Birkenhead, Cheshire.
Clatterbridge Hospital, Bebington, Cheshire.
Chester Royal Infirmary, St. Martins Fields, Chester.
SCOTLAND
Northern Region
The Royal Northern Infirmary, Inverness.
North Eastern Region
University Department of Pathology, Foresterhill, Aberdeen.
Eastern Region
Maryfield Hospital, Dundee.
Royal Infirmary, Perth.
South Eastern Region
University Department of Pathology, Edinburgh.
Royal Infirmary, Edinburgh.
Victoria Hospital, Kirkcaldy.
Bangour Hospital, West Lothian.
Peel Hospital, Galashiels.
Western Region
Western Infirmary, Glasgow.
Royal Infirmary, Glasgow.
Victoria Infirmary, Glasgow.
Stobhill Hospital, Glasgow.
Southern General Hospital, Glasgow.
Royal Infirmary Dumfries.
Royal Infirmary, Falkirk.
Royal Alexandria Infirmary, Paisley.
Vale of Leven Hospital, Alexandria.
Ballochmyle Hospital, Ayrshire.
(Continued)
Rena! tract carcinogens (4)
APPENDIX 2
Auramine
Benzidine
Magenta
4-Amino-diphenyl
(Xenylamine)
4-Nitro-diphenyl
Ortho-tolidine
Dichlo-r benzidine
1/MS/350/198/71
4
153/09/05/-
DEPARTMENT OP EMPLOYMENT
MEDICAL SERVICES DIVISION
CMA's NOTES OF GUIDANCE
COMMUNITY HEALTH CEU
^7/1. (First Floor.)St. Marks
NOISE
BA Rig.:: lore - 550 001*1
2
NOISE
1.
Definition Noise has been described, as "sound without musical quality",
"sound I dun1 L want Lo hear", and so on.
It is.best defined in the ordinary
sense as unwanted sound.
2.
The P'iTTsic.-. of Sound When a surface vibrates in an clastic medium such as
air, the immediately surrounding air is alternately compressed then rarefied,
so that small fluctuations above and below atmospheric pressure are propagated
outwards as a sound wave which has three primary properties:
'Frequency. This determines the pitch or note of the sound; high
frequencies give rise to the sensation of high-pitch notes on the musical
scale.
An octave is the rise in pitch brought about by doubling the
frequency, and the frequencies 'within- that range are known as an octave
bund, which are generally specified by their geometric centre frequency.
The average normal young ear receives as sound frequencies between 20 and
20000 cycles per second (cps or Hertz), that is a range of ten octaves;
in marked contrast, the receptive mechanism of the eye is sensitive to
visible light of wavelength'5500-8000 AU - just over one octave.
Intensity. This determines volume or loudness.
Sound intensity is a
measure of the flow of sound energy per unit area of cross-section in one
direction along the wave, and is therefore easier to deal with than the
alternating quantity of sound pressure - intensity being a function of the
„square of pressure.
The range in magnitude of audible sound intensity is so enormous that it
becomes convenient to express relative pressures and intensities on a
logarithmic scale.
A barely audible sound (at 1000 Hz) is taken as a
standard (0 dB) and thereafter every step of 10 dB represents a- tenfold
increase of intensity.
It happens that every such step of 10 dB doubles
tho subjective impression of loudness.
The human car normally receives
as sound intensities from around 0 dB to the threshold of feeling or pain
•at about 150 dB.
Wave^ Form. The shape of the sound wave determines the quality or timbre
of the sound.
Sine-waves from a- vibrating source in harmonic motion
give ra.se to pure tones, and harmonically related composite-waves produce
•musical notes; but most industrial noises have waves of irregular comnlexity
and when most frequencies are present more or less equally it is known as
•white noise
*
.
-.(42706-1)
SOURCES Ob' EXPOSURE IN JlWUSTRf
3.
Much of industrial noise is continuous, steady, and. consists of a broad.
band, of frequencies.
4.
The noise level probably exceeds 90 dB if it is necessary to shout to be
heard at a distance of less than 1 ft.
The factory Inspectors have simple
noise level meters which incorporate three electrical circuits known as
weighting networks, A, B, and C.
The C-weighting produces a fairly uniform
response over the whole frequency range, whereas the A.-and B-weightings reduce
the -i r>st-rnmAnt:1 s sensitivity to the lower frequencies to simulate the human
car (at higher and lower intensities respectively).
Recent work has shov/n that
for continuous exoosure to steady broad band noise the A-weighted measurement,
expressed in dBA, provides a satisfactory measure of the hazard for routine
purposes.
Some examples are:
Noise-level in dB
Jet motor at 75 ft.
130
Rivetting, crimping, tack-making
110-125
Planers, routers, circular-saws
110-115
Weaving sheds, air drills
Automatics, milling machines etc.
90-110
•
80-95
These should be compared with:
Average radio or street
60-80
Noisy home, average conversation
40-60
Very quiet homo, whisper at 5 ft.
20-40
5.
For continuous noises which contain much of their energy concentrated, in
gwiWBi bunds of frequency, the Engineering Branch use a more complex frequency
W.alysing instrument, and the hazard has to be assessed accordingly.
Damage
risk criteria are usually expressed in terms of octave intensity levels, with
lower levels allowed for the speech frequencies, for example 80 dB for the four
octaves 250 - 500 - 1000 - 2000 - 4000 Hz, and rising by 5 dB for each octave
outside this range; such criteria aim to preserve normal speech perception for
the majority oyer a (near) lifetime of exposure for 40 hours each week.
In
n.’iy octave an additional 3 dB is allowed for each halving of the exposure time.
the exposure is intermittent or the noise is impulsive, or much oi’ the
energy is concentrated in narrow bands of frequency, the hazard is less easy to
predict and measurements require more complex apparatus, but there are several
organisations which will undertake full investigation of noise problems and
make recommendations, including the Department of Trade and Industry and the
Advisoi-y Services based on the Universities of Durham, Manchester, Southampton
and Dundee.
(42706-1)
BIOLOGICAL AJW CLINICAL EIT'ECTS
6.
The offocta of noise arc generally considered under the following headings:
Psychological Effects. These depend very much on the pre-existing mental
' attitude - the significance attached to that noise by the individual;
psychological response is further influenced by the time and circumstances
under which it is heard.
The characteristics of the sound itself are of
secondary importance, but in general more psychological disturbance or.
nuisance is created by noises which are high-pitched rather than low-pitched
musical. i-al.hcr than discordant, interrupted rather than continuous, and
loud rather than soft.
Industrial workers rarely complain of the noise of
their own trade, but do so occasionally when changes in processes or layout
subject them to unaccustomed noise.
There is some evidence of improved
output and accuracy of work when a high noise level is reduced.
Physiolo.gical Effects. There have been reports that very loud noises
cause i'usLur metabolism, perspiring palms and. soles, etc., but her; far
these are the accentuation or result of the psychological effects it is
difficult to say.
Interference with communication. The noisy industrial environment in which
warning signals or verbal instructions become masked plainly deprives
workers of a vital human defence mechanism.
Temporary Deafness. Loud noise may cause temporary deafness lasting up to
16 hours or more, extending from the end of one shift to the beginning of
the next, so that only at weekends or holidays can normal hearing return,
and only on Monday mornings can hearing losses expected to be permanent bo
measured.
Permanent Deafness. Permanent partial deafness of occupational origin was
recognised by R.'ininssi.ni (17'13)> from 18J0 it has been described .in many
groups of workers, including blacksmiths, sheet metal workers, boilermakers,
riveters, fettlers and grinders, textile weavers, and more recently engine
testers, particularly of jets.
Noise-induced deafness is insidious in its onset; the worker is frequently
.unaware Lh;d. anything is wrong until iivcvcrsibl'e damage has Lean sun Lair,cd.
The first subjective indication is the inability to carry on a conversation
in which several take part or against a noisy background - the so-called
"society deafness".
7.
Broadly speaking, the form of the deafness corresponds with that of the
r-ease tnat Inns caused it, and the degree of deafness is determined by the
■ucudness oi‘ the causative noise and the duration of exposure; but for reasons
not. z'ully understood the middle frequencies are particularly susceptible to
damage , no that noise—induced hearing losses nearly always r.l.art end Lend to be
maxauuL at 1.000 Herts.
Speech sounds usually lie mainly within the frequency
range pC’O-JOOO Herts; but the raised voice is higher pitched and the sound
frequency.shaft to the right then impinges upon the kOCO cycle deficiency.
with continued exposure, the ’10)00 cycle dip' in the andi nwn deenens and
spreads to involve neighbouring frequencies, notably in the speech range.
(42706-1)
-3 -
Tiro variations in individual, susceptibility to noiso-i.nd.ucod hearing loss
have bcm high-lighted by the recent investigations of Burns and Robinson.
The early detection of the extra-susceptiblcs (and those others who have not
worn their ear defenders) is the primai-y justification for pre-cmploymcnt and
periodic audiometric examination.
The now entrant should be tested to pure
1.0111’3 over
wide frequency range BhU-UUUU Ils and at regulux- intervals decided
by the medical officer some form of screening audiometry performed.
Audiometry
is simple in principle but difficult to perform reliably in practice; portable
equipment is no?/ reasonably cheap, but if audiometry cannot be performed by the
company's medical officer it may be possible to make arrangements through a
specialist agency.
9.
The hearing losses to be expected in an average population with otherwise
normal hearing can bo soon from the following table drawn from the Burns and
Ifob.i.nson Report.- These authors showed that for whole time continuous exposure
to r.l.c.-idy broad band noise there is one index of noise exposure for the various
«:cniib.i.iiations of noise level and time (in years).
The total energy (e) is the
product of noise intensity and years, that is E = I x T.
Since intensity is
usually expressed in the logarithmic decibels, 10 log-|0 E = dB + 10 logic T;
when the sound intensity is measured on the A-weighted scale the logarithmic
“xpression of E is called E^
E^ for one years exposure
= dBA
E^ for three years exposure = dBA + 5
E^ for ten years exposure
= dBA +10
E^ for 30 years exposure
= dBA +15
10. The quantitative relationship between noise exposure, hearing losses, and
individual susceptibility is as follows:
11.
The hearing losses shown are the average of the hearing losses in decibels
.it 500, 1000 and 12000 Ils.
The avex-age hearing loss ut these pure tone frequencies
is an index of difficulty in speech perception.
It is usually assumed that such
disability cer-xonccs at 15 dB loss and becomes total at 82 dB loss.
Thus for
any decibel loss shown in the table it is necessary to deduct 15 and then
multiply-the remainder by 1-i to arrive at a percentage disability for speech
perception.
12.
from the table, 50 years exposure to 90 dB (E^ 105) will cause no speech
disability in 50 per cent of workers but 2 per cent will likely suffer a
12 per cent disability.
At
120 the median subject will only be at the fringe
of suffering disability whereas 2 per cent of workers are likely to suffer
50 per cent disability.
(42706-1)
■
-4-
PREVENTION
13. The noise problem should be considered at the factory planning stage, in
the choice of site, disposition of departments, specification of building
structure and materials, and the selection of processes.
In the existing
factory the Factory Inspector may offer- advice along the same general principles
as are applied to the suppression of dust or fume, for example:
Substitution - e.g. welding for rivetting, grinding for chipping,
belt drives for gears.
Reduction at Source Good maintenance of machinery, including lubrication;
rubber linings of chutes; fitting of exhaust silencers and baffles.
Segregation and enclosure
of machines from people and vice versa.
Reduction of transmission Through the floor by resilient mountings,
through the air by partitions or baffles, and by reflection from walls
and ceilings by lining with absorptive materials.
Personal Rotation
and time.,
Noise damage is proportional to the product of intensity
14« i'edical Supervision: Wherever noise remains above safe levels workers
should be protected by ear defenders.
There are now many ear protectors
available commercially.
Cotton Wool Plugs
Ineffective and usually unhygienic,
Glass-down Y/ool Easily formed into well-fitting plugs to provide an
attenuation of 15 to 25 dB.
It is a method generally acceptable to
workers and management; glass-down does not irritate as might be expected;
but it i;j probably conl.ra—.i nd i.c.’i!.<■<! by perf’orat i on or <li:-.<:b.'rgc.
Moul-lf-il Ear ring.-.. Those arc often unhygienic. and must bn well fitted
individually to get a may-;rnum attenuation of 15 to 25 dB.
Ear Muffs These arc expensive and obvious, but the bettor models vzith
fluid-filled muffs can attain attenuations of 35 to 45 dB over a wide
frequency range.
15. The provision of ear defenders should be related to the ear-damage •
susceptibility of the individual, otherwise adequate protection for all will
mean the over-protection of the majority vzith attendant discomfort and the
dangers of diminished hearing acuity.
(42706-1)
- 5 -
BIBLIOGRAPHY
Burns W. ana. Robinson D.W.
(1968)
'An Investigation of Hearing and Noise
in Industry’ Report to the Secretary of
State for Social Services
Murray - London. 1%8
Burns V/. (l%8)
'Noise and Mun'
Bull A. (1966)
•'Noise. An Occupational Hazard and
Public Nuisance’ World Health
Organisation.
Public Health Papers No. 30
Euinton L.E.
'An Introduction to Noise and its
Problems’ Transactions of the Society of
Occupational Medicine (1968) 18 142-155-
’Report of the Committee on the Problem
of Noise
*
1%3. H.M.S.O. London.
Aldersley-Williams A.G.
'Noise in Factories’, Factory Building
Studies No. 6 1900. H.M.S.O. London.
Department of Employment and
Productivity (1968)
Safety, Health and Welfare Booklet New
Series No. 25 Noise and the Worker
H.M.S.O. London.
The Chief Inspector of Factories
Annual Report for 1969
Advisory Leaflet SHW 2124
(adverse effects and prevention)
TtM 427C6/1/266 500 6/71 TL
- 6 -
OCCUPATIONAL DEAFNESS.
The Industrial Injuries Advisory Council in their report on
Occupational Deafness (HMSO Cmnd. 5461 - October, 1973) concluded
that occupational deafness can satisfy the conditions laid down by
Section 56 (2) of the Industrial Injuries Act, provided that (a) the
deafness from occupational noise is substantial; (b) diagnostic tests
are carried out in existing hospital ENT departments under the
supervision of a consultant otologist and (c) the occupational cover
is defined by reference to particular processes and a minimum period
of employment in them.
They recommended prescription and a scheme on the following
lines;-
(1) the disease to be defined in terms of deafness which is
substantially permanent and of the sensorineural type, and
which is due to, or results from, exposure to noise in the
course of employment;
(2)
the occupational cover to be limited initially to drop forging
and to the use of pneumatic tools in the metal manufacturing'•
and the shipbuilding and repairing industries;
(3)
a minimum period of 20 years employment to be required
in the prescribed occupation;
(4)
claims to be allowable only if made within one year of the
date of last employment in the prescribed occupations;
(5)
the degree of disablement to be assessed by reference to the
results of pure-tone audiometry;
(6)
benefit to be awarded only where the hearing loss in the better
ear is 50 dB or more, averaged over the 1,000, 2,000 and
3,000 Hz frequencies.
(7)
the date of development of the disease to be taken as the date
of a successful claim;
(8)
a presumption of occupational origin to be given;
continued. . .
- 2 -
(9)
a presbyacusis correction to be made by means o£ a 0.5 per
cent deduction from the assessment at age 65 with a further
deduction of 0.5 per cent for each year over 65.
(10)
no regard to be had to the use of hearing aids or the ability
to lipread;
(11)
the assessment should not be reviewed for a period of 5 years
from the date of an award; a similar limitation to apply to
repeat claims by unsuccessful claimants, unless in the
circumstances of the case the medical board consider that a
^shorter period would be justified.
'Sir Keith Joseph, the Secretary of State for Social Services has
accepted the council's recommendations for this compensation scheme
(limited because of the need to maintain existing ENT Services), but
has not revealed the precise form or timing for its introduction. It
is anticipated that it will be introduced in 1974.
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supplemented by questions related 10 the specific hazard. In addi
tion the natural history of the 'disease' may require to be gone
(b) Physical examination
Inspection and auscultation will rcvt ' >bvi< us dyspi ■■■■, wl. (
ing as the result of airway obstruction, crepitations as the result
of parenchymal and alveolar pathology or nothing.
(c)
Lung function
Ventilatory capacity measurements will be routine, supplemented
as occasion demands by more subtle tests of respiratory mechanics
and gas exchange.
(d)
Radiological
A PA film carefully taken may be instrumental in detecting tran
sient inflammatory infiltration or permanent interstitial fibrosis.
The reading and scoring of films may be on a simple 'clinical' basis
or utilise an epidemiological technique such as the ILO U/C scheme
(CEMA's Notes of Guidance 'Dust Disease, Chest X-rays in' — 20}
(e)
Immunological
Careful history taking. Skin testing with common allergens to
determine atopic status. Skin testing with suspected allergens to
detect Type I reagin mediated phenomena primarily and perhaps
to detect delayed type response (see CEMA's Notes of Guidance
'Skin Tests in Dermatitis and Occupational Chest Disease' — 54).
Testing of sera for circulating precipitating antibody is routine
where Type III (IgG mediated) mechanism is implied or sus
pected. Experimental methods exist for measuring other immuno
globulins. Where the history is equivocal and a specific diagnosis
for therapeutic purposes is essential, then the patient may need a
'challenge' test with the suspect material under careful control in
hospital.
(3)
Environmental studies
These may require the conjoint services of chemists, mycopathologists,
bacteriologists, industrial hygienists and immunologists to decide on
potential hazards, identify the most serious hazards, prepare reagents
for skin and laboratory testing and to measure the amount of allergen
present in the atmosphere under various circumstances.
(4)
Statistical studies
The frequency of symptoms in a group of exposed individuals can
be compared with that of a control population matched for age, sex,
geography and smoking habit. Radiographic and physiological signs
can also be studied in relation to controls. Skin testing and serologi
cal testing also require careful statistical control. The survey can be
a 'one off' exercise or form a series where the 'progress' of symptom
atology, immunological response, lung function and radiographic
signs can be studied both for individuals and groups and related to
the exposure history in terms of time and concentrations of dust.
Apart from the mathematical significance of departures of indices
from the 'predicted', it may be necessary to carry out long term
surveillance to study morbidity and mortality.
.IOGRAPHY
120/149/72
Medical Research Council
Committee on the Aetiology of Chronic
Bronchitis (1960)
Standardised Questionnaire on Respiratory
Symptoms. British Medical Journal 2, 1665.
Cl?
COMMON.
AI.TH CULL
47/1,(First FJOorjCc. Marks Hoad
BANGALO<;£ - 560 001
SOCIETY FOR PARTICIPATORY RESEARCH IN ASIA
45, SAINIK FARM, KHANPUR, NEW DELHI-110062
ASBESTOS ;
THE DUST THAT KILLS
The killer fibre had penetrated the very essence of his
being. His cough was more painful than ever. Each succe
ssive breath was a harsher rasp than the previous one.
"Death's clutch'-’> asbestosis had gripped yet another vic
tim. This time it was S, Rajagopal, who joined Hindustan
Ferado Limited (HFL), as an operator in the dust-prone
breaklining and clutch facing department in 1961. Ten
years later the disease struck.
The diagonisis pronounced by the Employees State Insurance
(E.S.I.) medical team and private practioners was asthama
or bronchitis. But a few months later another verdict was
delivered by the Sion Hospital authorities - asbestosis.
His pleas to the management for a thorough medical exami
nation went unheeded for a long time. Finally the manage
ment decided- to refer him to Dr. G.G.Dave, medical inspec
tor of factories, (Maharashtra). Dave's diagnosis was
"acute bronchitis."
Unsure of Dave's conclusion, he filed a petition to the
Chairman of Turner and Newall (the transnational corporation
link in Britain), for a proper medical screening. In the
meanwhile, his health deteriorated and the Sion Hospital
authorities adviced immediate treatment. But he resigned
from HFL, to collect his gratuity. Why? His wife was ill.
Rajagopal left the company but continued to fight. He
filed a writ petition with the Bombay High Court, to set
up an ESI medical board to examine him. The ESI board was
constituted and the High Court suspended the writ petition.
In a preliminary medical interview with Rajagopal, the
newly formed ESI medical board (Coimbatore) consisting of
the Dean of the Coimbatore Medical College, the superin
tendent of the ESI hospital and a cardiac thereby specia
list flatly ruled out even the remotest possibility of
asthama or bronchitis. There was no mention on their-part
of the nature of his ailment. Rajagopal goes on to say
that he even signed the papers they presented to him ruling
out asthama or bronchitis.
The examination consisting of a chest Xray and a blood
and urine test was completed in September 1982, and Raja
gopal watched and waited anxiously for the results. To
his utter amazement, the medical board's diagnosis was
"chronic bronchitis" and not "asbestosis."
Finding the.results suspect and believing his ailment to
be asbestosis, Rajagopal has filed a case before the ESI
Court Bombay under section 75 of the ESI Act. He has que
stioned the credentials of the ESI Medical Board and de-
community health cell
326, V Main, I Block
Koiamangala
Bangalore-560034
India
2
manded an examination by experts in occupational diseases,
unless it is proved that the constituents of .the ESI Medi
cal Board were experts in occupational disease. He also
demanded a submission of all his papers (case history/
medical reports and certificates) by the Coimbatore ESI
hospital to the ESIC court. If after a careful consider
ation of the case, the Court can prove that the medical
board did not consist of experts in occupational diseases,
Rajagopal is adamant that it should direct the ESI autho
rities to get him examined by experts in occupational'di
seases and grant him the consequential relief.
The hearing of the case came up on the 28th of April 1983,
after which the Corporation appealed for time upto the 28th
July 1983, to file in its written statement.
A long arduous protracted struggle already begun, will con
tinue: the respondent -the ESI medical board (Coimbatore)
the petitioner - a dying Rajagopal, trying to keep alive
the last flicker of hope, that his success will not only
vindicate him but also pave the way for thousands of simi
larly afflicted workers.
*
*
*
*
*
What is this monster called asbestos ? Where is it found?
How does it endanger a worker's health ? What is.asbesto
sis ? How does it affect a worker? What are the laws and
controls for the regulation of the use of asbestos? How
are they implemented? The following piece entitled,
"Asbestos: The dust that kills", attempts to explore the
answers to the above questions.
Asbestos derives- its name from a Greek word meaning "un
quenchable" an adjective that could well describe both
the properties of the substance, as much as the thirst
for profit that drives those who organize both men and
asbestos for their commercial use. The Roman slaves who
mined it in the Italian Alps 2000 years ago probably suff
ered from the same diseases as do workers in modern facto
ries today. The technology may have changed but the con
flict between health and profits remain.
Asbestos is a hydrous mineral silicate containing magnesi
um, aluminium, iron, sodium and calcium.
/here are about six varieties of asbestos which can be
broadly classified into 2 main groups:
*
K
3
-
the serpentines: These are hydrous silicates contain
ing magnesium. The white variety of asbestos called
Chrysotile belongs to this group.
-
the amphiboles: These are hydrous silicates chiefly
containing iron and aluminium. They also contain cal
cium, sodium and magnesium. Crocidolite or blue as
bestos which is perhaps the most dangerous variety,
falls into this category.
Kinds of Asbestos
a)
Chrysotile; The most commercially used variety of
asbestos is a white, fine, silky, flexible, serpen
tine variety called chrysotile (whi^e asbestos).
It has the longest and strongest fibres and can be
spun. It is primarily responsible for asbestosis.
b)
Anthophyllite: Anthophyllite like chrysotile is whitee
and contains magnesium.
It is brittle.
c)
Crocidolite: It is also called blue asbestos, because
of its colour. It mainly consists of iron. Even a
short exposure of a few months, can give rise, upto
20 years later, to mesothelioma of pleura (cancer of
the membranous lining of the lungs).
d)
Amosite: Amosite is a straight brittle fibre ranging
from light grey to pale brown in colour.
d)
Actinolite and (f) Tremolite : They consist mainly
of calcium, and are used in filters, papers, etc.
The minerals exist in several forms and differ in their
physical properties and chemical composition, but they
are similar in their fibrous nature and flexibility. Asbes
tos is a very versatile material. It is fire resistant,
insoluble in water, resists corrosion by a large number
of chemicals, has high tensile strength, is abundantly
available, and is very cheap.
USES
OF
ASBESTOS
Asbestos has over 3000 commercial applications and is used
for both domestic and industrial purposes - as pipes, in
sulation boards, protective clothing, rope production, heat
and sound insulation for plant and building structures,
mattresses, roof sheeting, brakelinings, clutch facings
and several other articles of daily use. It is effectively
integrated as a filler, binder and as a reinforcing subs
tance with other materials like cement and rubber.
We therefore encounter asbestos on an increasing scale
in several places (see box 1) and it is not surprising
that industrial interests insist that there is no ade
quate substitute.
4
Box 1 .
The industries using asbestos.
1.
2.
3.
4.
5.
6.
7.
8,
9.
10.
11.
12.
13.
14.
15.
16.
17.
Docks and transport - handling sacks & balls.
Asbestos factories - milling, weaving, turning, manufacturing asbestos cement sheets and pipes.
Power stations - lagging and delagging.
Iron and Steel works and other heavy engineering
industries - boiler furnace insulation.
Locomotives and rail carriage building - heat and
sound insulation.
Ship building and repairing - asbestos insulation,
lagging and delagging.
Paper making - filter papers.
Manufacture of floor tiles, mats & roofs linoleum and asbestos sheets.
Adhesive and plastic manufacture - used as
fillers for strengthening.
Automobile industry - brake shoes lining?, and
clutch facings, insulated under the body of cars.
Light engineering - gesket washers etc.
Packaging manufacture.
Construction - laying of pipes and fitting of sheets
on insulation boards, asbestos spraying on walls.
Electrical engineeting industry - insulation.
Insulation mattress manufacture.
Asbestos textile manufacture - safety clothes.
Chemical plants and heat treatments shops-linings
of furna, ces, boilers & chimneys.
(Source: Asbestosis: A
Killer disease: Audyogiki ■
Jeevan Manch)
HOW
ASBESTOS
IS
PROCESSED
Before asbestos appears as an everyday commodity it is
processed by human labour - an operation which consumes
both the raw materials, labour and the labourer. There
are basically two processes involved in the manufacture
of asbestos — the wet and the dry. In-the former, water
is added to a dry mixture of asbestos and cement. A slu
rry is formed. This is moulded and extruded with heat
and pressure. In the dry process, the asbestos fibres
are fluffed and combed. For instance, in the textile ind
ustry the fluff is mixed with cotton before 'carding; and
the later is spun and woven, in a dry state. Both pro
cesses expose workers and the environment to asbestos dust,
fumes, and heat.
It is chiefly the dust which enters the
worker's lungs that leads to the depreciation of the lab
ourer's health and life, but a "depreciation", that never
enters into the calculation of cost.
5
The handling and use of asbestos therefore raises two
problems:
1.
The problem of protecting asbestos workers from a
number of asbestos-related diseases like asbestosis
and cancer.
2.
Protecting the environment from pollution and the
risk of cancer for the population.
HOW
ASBESTOS
AFFECTS
THE
WORKER
Asbestos fibres enter a worker's body insiduously. The
most dangerous fibres are those which cannot be seen by
the naked eye (less than 2 microns thick). They are able
to pass through the natural filter system of the nostrils
and the mucous lining of the airtubes, and accumulate in
the airsacs of the lungs, turning the elastic tissue of
the airsacs into rigid'fibrous tissues. This is called
asbestosis. This condition obstructs the free exchange
of gases in the lungs and thus impairs the lung function.
SIGNS
AND
SYMPTOMS
OF
ASBESTOSIS'
Difficulty in breathing.
Crackling sound during breathing.
Breathlessness oh exertion.
A Dry cough.
Weight loss.
'Finger clubbing'- (thickening around-the base of
the nails.)
1.
The sputum test: A person inhaling asbestos fibres w.
will show asbes’tos bodies in the sputum. These
bodies Consist of asbestos fibres surrounded by vari
ous proteins and iron particles and can be identified
under a microscope. This test employed in isolation
does not conclusively lead to a diagnosis of asbesto
sis, because people in industrial communities may
have asbestos fibres in their lungs which are other
wise normal. The presence of asbestos bodies in the
sputum, however, confirms exposure to asbestos.
2.
Asbestos bodies in the lungs at biopsy: (severing a
lung section for examination).
In asbestosis, a lung-biopsy reveals a large number
of asbestos bodies in the lung. They appear in smea
rs of fluid scraped from
lung surface.
But this is a random method of diagnosis as the sev
ered lung section may not contain any fibres,
3.
Radiographic appearance:
(Xray findings)
Fibrosis (rigid fibrous lung tissue) in asbestosis
occurs as a fine network in the lungs. The network
resembles ground glass or fine cobweb.
1
4.
Respiratory Functions tests.
These are tests to check the respiratory function of
the lungs but are of li'ttle value in diagnosing as
bestosis in its infancy. A series of readings over
the previous years must be obtained.
Loss of elas
ticity and rigidity of lung tissue, and a decreased
capacity for gas exchange signify an impaired lung
function.
A combined usage of these tests, together with symptom
detection will lead to a more accurate diagnosis of as
bestosis. In fact, the Pneumoconosis Medical Board of
the U.K. has clearly laid down that any worker suffering
from even two of the symptoms, of asbestosis, and has
been exposed to asbestos at work, is immediately certi
fied as suffering from asbestosis.
(This is in sharp
contrast to the situation in India, as indicated in the
Rajagopal case).
Asbestosis, which is time and dose related, appears two
to thirty-five years after the first exposure. Once the
disease sets in, it progresses even after the worker is
prevented•from further exposure.
It even paves the way
for lung cancer. The risk of contracting asbestosis is
minimal below certain exposure levels. Smoking increases
the risk of contracting the disease extensively.
INCIDENCE
OF
ASBESTOSIS
Recent studies from different parts of the country indi
cate a high incidence of asbestosis
1.
In a.survey of an asbestos cement unit in Faridabad,
a Central Labour Institute (CLl) researcher found,
'that out of 850 workers, 58 suffered from asbestosis
and 58% experienced changes in the functioning of
the lungs.
2.
A similar study of 800 workers of Asbestos Cement Ltd.
Bombay, conducted by the National Institute of Occu
pational Health, (Ahmedabad) revealed that out of 800
workers, 224 suffered from more advanced stages of
asbestosis. While the management flatly denied these
figures, the study also noted that another 128 workers
had- contracted the disease as well, although it had
• not reached the. later stages.
The widespread and as yet under-reported incidence of
asbestosis is perhaps best summed up by Dr. S.R.Kamat,
head of the faculty of thoracic medicine, G.S. Medical
coliege, Bombay, who notes, "There is.no doubt that one
third of the workers in asbestos factories are suffering
from asbestosis."
Besides asbestosis, the other diseases related to asbestos
dust exposure are: pleural plaques, pulmonary tuberculo
sis, mesothelioma of the pleura and peritoneum, lung can
cer and cancer of the stomach, oesophagus, colon and rec
tum.
PLEURAL
PLAQUES
Pleural plaques are present in asbestosis,
They appear
as fibrous scars on the external lining of the lung. This
is due to the irritation caused by the asbestos fibres
which are lodged in the external lung lining. Pleural
plaques are nodular or smooth. They are composed of firm
white material, which may be seen on an X-ray if there is
calcium deposition.
PULMONARY
TUBERCULOSIS (T.B.
OF
THE
LUNGS)
Research indicates a definite association between tubercu
losis (T.B.) and exposure to asbestos dust.
In one study
in the U.K., out of 82 patients who died of asbestosis,
36% were also suffering from T.B.
MESOTHELIOMA
OF THE PLEURA AND PERITONEUM
(Cancer of the membranous lining of the lung and abdomen)
Mesothelioma is a tumour occuring on the membranous lining
of different organs. As an asbestos-related disease, it
occurs on the membranous lining of the lungs (pleura) and
abdomen (peritoneum). Pleuraland peritoneal tumours occur
either alone or together.
The following are the signs and symptoms of mesothelioma:
1 .
2.
3.
4.
5.
6.
Breathlessness' accompanied by chest pain.
Cough and blood in the sputum.
Accumulation of straw-coloured or blood-stained fluid
in the lung's lining (pleura).
Thickening of the pleura and enlarged growths (tumours).
Lung Collapse.
Malignant cells in the lining of the lungs and abdomen.
Blue asbestos is about ten times more likely to cause mes
othelioma than the white variety, and some experts claim
that' just five minutes, inhalation of blue asbestos dust
can produce mesothelioma even twenty years later. Smoking
apparently does not increase the risk of mesothelioma. How
ever, families of workers exposed to asbestos dust from
work clothes do face the risk of this kind of cancer.
People living near asbestos factories and mines are also in
danger of contracting the disease.
This is a fatal disease. There is no drug, surgical or
radiation treatment that can cure it.
- 9 -
LUNG
CANCER
Lung cancer is yet another asbestos related hazard and of
ten follows asbestosis. It occurs in the lower lobes of
the lungs. The risk of its contraction is greatest in the
workers exposed to high levels of asbestos dust, especially
in those who smoke. The risk of contracting lung cancer is
90 times greater in smokers than in non-smokers.
This form of- cancer was first reported by Merewether (Medi
cal Inspector of Factories in the U.K.) in 1947, based on
a study of 235 death certificates recording asbestosis.
Other studies confirm this.
CANCER OF THE STOMACH, FOOD,PIPE, LARGE INTESTINE AND
RECTUM
These forms of cancer are also caused by exposure to asbes
tos fibres.
The method of diagnosis for mesothelioma and the other
forms of cancer is a biopsy.
According to an article by J. Kumar in Science Today, no
case of cancer due to asbestos has yet been notified in
India. This can be due to the fact that asbestos workers
are not followed up after they retire and occupational his
tories of cancer patients are not recorded. In cross-sec
tional studies of workers, it is difficult to find a person
who is still working while suffering from lung cancer or
mesothelioma of the pleura.
There are, however, several studies confirming the wides
pread occurence of mesothelioma, lung cancer and cancer
of the stomach, oesophagus, colon and rectum in the West.
INCIDENCE
OF
THE
CANCERS
1 .
In a study conducted by Dr. Irving J- Selikoff (Mount
Sinai School of Medicine, New York), of 632 asbestos
insulation workers in New York and New Jersey between
Jan 1943 and Dec. 1974, it was revealed that there
were 35 deaths of mesothelioma - 10 pleural and 25 peri
toneal. There were' 42 reported deaths of lung cancer,
20 deaths of cancer of the stomach and food pipe and
23 deaths of cancer of the large intestine.
2.
In another study, conducted by Irving J. Selikoff, of
17,800 asbestos insulation workers in the United States
and Canada (International Association of Heat and Frost
Insulators and Asbestos Workers, AFL-CIO, CLC), between
Jan. 1, 1961 and Dec. 31, 1973, the'wide prevalence of
cancer was established. There were 36 deaths of pleu
ral mesothelimoma and 67 deaths of peritoneal mesothel
ioma. It was further revealed that there were 321 dea
ths of lung cancer, 16 deaths of stomach cancer, 14
deaths of cancer of the food, pipe and 39 deaths of can
cer of the large intestine and rectum.
- 10 -
3.
In 1967, 17 fatal cases of pleural mesothelioma were
reported in the"small town of Manville in New Jersey.
By 1973 there were 72 victims of this cancer
cancer in this town of 15,000 people, where the giant
U.S. Corporation Johns-Manville still has its largest
Manufacturing Plant.
REACTIONS
IN
THE WEST
An avalanche of medical literature and new found public
knowledge about the toxic nature of the silicate, has un
leashed 'massive public opinion and protest in the West.
This has led to a plethora of legislation to control and
regulate the use of asbestos in the manufacturing process
and otherwise. Technology in the west has geared itself
to devising engineering controls, a variety of personal
Q
respiratory protective equipment and cate in layout plann
ing. These measures would help to effectively reduce dust
levels inside the work premises to 2 fibres per c.c. - 0.2 9
fibres per c.c., for different varieties of asbestos fibres.
(The Asbestos Working Group in the U.S. reported in 1980
that there is no safe exposure limit for asbestos and that
all commercial and several non-commercial forms of asbestos
cause disease.
It recommended a new standard of 0.1 fibre
per c.c. as the maximum exposure limit.. This is the small
est quantity that can be measured by techniques currently
available.) (See box 2 and 3. U.K. asbestos code and U.S.
Occupational Health & Safety Act.)
BOX
2
Asbestos Safety Code in the U.K.
1.
Asbestos dust can cause lung diseases and there are strict
regulations governing the manufacture and commercial use
of asbestos products.
Fur the home handyman and domestic user of asbestos prodcts it is very unlikely that harmful quantities of dust
will escape in normal use. As a precaution they are ad
vised to avoid creating and breathing asbestos dust.
1)
Dampen the work: damp dust does not become airborne
and is not inhaled. Do not sand wall plugging comp
ounds, unless damped. When relining car brakes, remove
the dust from brake drums with a damp cloth.
.
2)
Damp any dust that falls to the floor. -Pick it up as
soon as possible and place it in a plastic bag and
seal the bag.
3‘j
A
Work in well-ventilated space e.g. outdoors while
sawing, filing,, drilling, sanding.
4)
Use hand saws and drills which produce less dust than
power tools.,
5)
Renew worn or frayed asbestos insulators.
(Source: Occupational Hazards:Hunter)
- 11
BOX
3
Basic features of the U.S. Occupational Safety and Health Act
related to asbestos :-
1.
Permanent structural changes to make the workplace safe.
2.
Tools generating dust must have exhaust systems at the
point of contact of tools.
3.
Respirators to limit the amount of dust inhaled are perm■issable only "if engineering controls are under construct
ion. They cannot be a substitute for engineering controls.
4.
Asbestos must not be used loose, waste must be sealed in
polythene.
5.
Warning signs at workplace and,on all products of asbestos.
6.
Protective clothing and separate lockers for work and st
reet clothes.
;
7.
Prescribed standard of an average of 2 fibres/c.c. for an
8 hour" shift. Monitoring of air at a 6 month interval.
'
8.
If a worker is’ exposed to excess dust (above the standard)
then he must be informed within 5 days.
j
i
;
I
i
9.
Comprehensive medical examination once a year.
'
10.
An individual worker or Union can complain directly to
the state authority. The reply must be displayed near
the workplace.
11.
A Union Representative in every factory (called 'walkaround’ representative) will accompany the factory
Inspector on his visits and sit in on all discussions
between Inspector and Management.
(Source: Asbestos: The killer disease,
Audhyogik Jeevan Manch)
The industry, has however, tried to skirt the stringent
controls with an uncanny slyness. Litigation has uncover
ed proof that the industry was not only aware of the deve
loping medical literature on asbestos, but was .actively
tampering with the scientific reports of the studies and
suppressing reports of other studies. As a sequel to
these revelations and others, there has been a .move in the
U.S. Congress to declare these as federal crimes.
The International asbestos industry’s own view of its res
ponsibility to label its products as potentially lethal
was recently revealed by the disclosure of an internal mem
orandum of the Asbestos International Association dated
7th July 1978.
12
According to the memorandum, the industry was unanimous in
the view that the best warning label'was none at all. Many ■
participants felt that if the use of a label was absolutely
unavoidable it would be advisable to adopt the U.K. label
which merely states "Take care with asbestos."
Workers and their unions, (particularly in the U.S.A.) still
vehemently insist on managements adherence to workplace re
gulations, incentive payment for hazardous work, the stopp
age of asbestos usage and the search fgr substitutes. Insu
rance carriers have raised workers compensation insurance
rates for employers, who continue to' use asbestos. In courts,
several thousand victims of asbestos cancer have so far
used the industry for knowingly marketing deadly products
while making no efforts to inform product users of the time
bomb danger of breathing in asbestos dust.
The law suits which are on the increase each day cost gian^
corporations like the Johns-Manville, Owens Corning, Armstrong and a dozen others and their insurance carriers se^
eral billion dollars in damages.
As a result of mounting public pressure, tight legislation,
skyrocketing law suit charges and swelling compensations to
workers, the consumption of asbestos has decreased in the
West. By 1980, the Johns Manville Corporation had closed'
down four asbestos cement pipes and manufacturing plants in
the U.S. alone.
But the company still persisted in sustaining itself with
a dogged determination. According to a Business India
article, on the 26th August 1982 the company filed for pro
tection under Chapter II of the U.S. Bankruptcy Code, which
shields a concern from 'creditors law suits.
It is also
suing for $5 billion in damages from insurers alleging ta:^
dy settlement of its claims on them.
Multinational companies ruthlessly continue to manufacture^
and aggressively market asbestos to third world countriesW
where some or all of the following factors ease their
entry:-
1.
The local elite are willing to import raw asbestos or
use the fibre in the manufacture of various products.
2.
There is a high demand for the raw fibres and finished
asbestos products.
3.
Labour is cheaper.
4.
The political climate is stable.
5.
Government legislation and controls are lax.
6.
The levels of working class and public consciousness
is in its initial stages of development.
7.
The extent of unionization is low.
13 -
The western corporate magnate's profit is intact: The
Third World capitalist makes his cut. The worker in both
countries is doomed to a slow and agonising death. India
is one such example.
THE
ASBESTOS
INDUSTRY
IN
INDIA
The asbestos industry in India employs over 7,000 people in
twenty units, spread over Andhra Pradesh, Gujarat, Mahara
shtra, Tamil Nadu, and Haryana. All the large units are
either subsidaries of multinationals or collaborations.
(See Box 4).
BOX
4
The following table is a list of the major asbestos companies
in India, their products and their linkages.
Name of the Company
Product
Transnational Corporation Link.
Hindustan Ferado.
Brakelinings, sheets,
yarns, jointings, te
xtile, mattresses,
millboards, packing
cloth.
Turner & Newall
(U.K.) (T&F)
Hyderabad Asbestos
Sheets, millboards,
pressure pipes,
jointings, thermal
insulation.
Johns Manville
USA (T) and
Societe Italians
Shree Digvijay
Cement Co.
Sheets and pressure
pipes.
Johns Manville
U.S.A. (T & F)
Sundaram Abex.
Friction materials
like brake linings.
Abex Inc. USA
(T&F)
Suri Asbestos Industry
Textiles, ropes,
packings, yarn,
laggings, j ointings.
Johns Manville
(T & F) U.S.A.
Rane Brake Linings
Brake linings and
clutch facings.
Small and Parkeass
*
U.S.A
(T & F)
Reinz Taibros
Asbestos Jointings
Reinz Dichtung A.G. Vilest Germany
(T & F)
I
I * T: Technical
I * F: Financial
(Source: DGTD Handbook: of Foreign
Collaborations 1980).
|
I
14 -
In 1977, 11 units produced 4.1 lakh tons of asbestos cement
sheets. This is .4% of the total value of industrial pro
duction in India, while in the same year by comparision the
total bicycle production was 15.37%.
Most of the asbestos used in India is imported and only
about 20,000 tons is mined in Andhra Pradesh, Bihar and
Rajasthan.
(See box 5).
BOX
5
Imports of Raw Asbestos
/
Year
/
Metric tonnes actual Imports „■
1978-79
/
...1979-80
1980-81 /
198V82
.- z- 'Z62,707
/
/
/
/
z ‘
/
75,470
84,264
80,854
Portwise im'ports are in the approximate range
z
a)
Bombay
- 60%
b)
Madras
- 20%
c)
Calcutta - 20%
(Source:
M.M.T.C.)
BOX 6
Couto any
Net Profit
•Sales of larger Conroanies
Metric Tonnes
Hindustan Ferado
Lakhs
1981
198C-81
1981-82
V,000
V,000
98.3V
■1981
3MV.52
1982
33.79Year
Hyderabad Asbestos Cement
30,000
23,000
Asbestos Cement
18,000
18,000
1982
336.66
n.p. after depreciation,
taxation, and investment
allowance.
Year
1980
Shri Digvijay Cement
Company
9,000
15,000
■Sundaram Abex.
500/1000
1500/200
Rane Brake Lininga
1 ,000
1,5oo
1981
67.27
7V.V2
n.p. after tax.
Year
1982
1983
0.2h0.^1
n.p. before depreciation
and tax „
1979
1980
68.6V
89.80
(Source: for sales M.M.T.C.)
(Source for profit CMIE News
clippings)
n.p. = Net Profit.
16 -
LEGISLATION
IN
INOIA
With intensifying debate and gtowing consciousness about
the health hazards of asbestos, asbestosis has been incor
porated as a notifiable disease in India, in an amendment
in 1976 to the Factories Act of 1948.
The following are the salient features of schedule 14 of
the Factories Act, applying to asbestos workers
*
It applies to factories in which asbestos is handled
and manipulated in various processes (The provision of
the schedule can be relaxed or suspended by the Chief
Inspector of factories, if he is convinced (i) that
the use of asbestos is restricted or temporary.
(ii) and therefore will not endanger the worker's
health. This certificate can be revoked at any time).
*
All manufacturing and conveying machinery must be fitt
ed with a mechanically operated exhaust draft, to supp
ress dust release.
*
Mixing and blending of asbestos fibres should not be
done by hand but with a mechanically operated exhaust
draft, to prevent dust generation.
*
The making or repairing of asbestos insulating mattre
sses must be carried out in an isolated room with ade
quate exhaust and ventilation equipment.
*
Only workers engaged in filling, beating or levelling
should be present.
*
Floors, benches, covers and fibre filled mattresses
should be dampened whilst filling, beating or levell
ing is carried on.
*
Storage chambers, bins containing loose asbestos, dust
filtering and setting appratus should not be kept in
a workroom. Suitable methods of storage should be
found.
*
Arrangements should be made to prevent dust discharge
from exhaust apparatus.
*
The floors, benches and plant should be kept clean and
free of asbestos debris.
*
The room should be well-lit.
*
Sacks used as asbestos containers should be cleaned
by machines and made of impermeable material.
*
All ventilating and exhaust equipment should be tested
at least once in six months and the defects rectified.
*
A register containing these records must be maintained
and should be made available to the factory inspector
on demand.
17 Breathing apparatus; overalls and head coverings must
be provided for those engaged in handling loose asbes
tos. cleaning of dust settling or filling chambers and
other equipment, and those engaged in filling, beating
or levelling in the manufacture of insulating mattress
es .
No Young person should be employed in or in connection
with the manufacture of insulating mattresses, blending
or mixing of asbestos by hand, in sackcleaning, in cham
bers or apparatus for dust settling or filtering, in
chambers containing loose asbestos or in stripping or
grinding ...the cylinders, including the doffer cylinders
or any other part of the carding machine.
MEDICAL . PROVISIONS
IN
THE
LAW
A person is employed only after a fitness certificate
is awarded by the medical inspector of factories or
certifying surgeon after a medical examination,.
Every worker should be X-rayed by a qualified radiolo
gist at the cost of the employer, before he is employed
The Xvray should be submitted to the medical inspector
or certifying surgeon within three months of the exa
mination date.
Medical examinations should be conducted by the medi
cal inspector of factories or certifying surgeon at
intervals of twelve months after the first medical
examination,
The Medical Inspector of factories or certifying sur
geon can direct the employer to arrange for an X-ray
of a worker at the employers own cost, whenever it is
necessary, the X-ray must be then handed over to the
medical inspector/certifying surgeon.
A worker who is declared unfit to work on processes
specified in the Schedule is banned from working on
the same unless an X-ray is taken at the employers
cost and the worker is once again certified fit. Dur
ing such time he may be permitted by the Medical Ins
pector or Certifying Surgeon to work on any other
process which may be safer. This is allowed if the
medical inspector is convinced that the worker is
not totally incapacitated.
The Me'dical Inspector or Certifying Surgeon can direct
a worker for radiological, clinical or pathological
examinations or any special treatment at the expense
of the employer, if he thinks it is necessary.
The Certifying Surgeon should after each examination
grant a certificate which the manager must maintain
in a proper register or file, and produce before the
inspector on demand.
- 18 * The manager should maintain the details of every medical
examination and the register shall be produced before an
inspector whenever demanded.
LOOPHOLES
IN
THE
LAW
The law framed by a government which represents the inte
rests of private enterprise, is bound to mirror the inters
ests of private industry and management. Both in its for
mulation and implementation, the schedule is ridden with
loopholes, which are taken maximum advantage of by indus
trialists in their drive for profit.
The following are the major loose ends in the Schedule:More dangerous diseases like lung cancer and mesothe
lioma continue to be left out of the scope of the
Schedule.
The power of the Chief Inspector to relax or suspend
provisions can be misused at the behest of the mana
gement or in his "own interests."
While the Schedule states that "no young person" should
be employed in or in connection with certain manufac
turing processes, the term "no young person" smacks of
gross ambiguity.
Provisions have been laid down for the suppression and
control of dust within the factory premises but not oct
side the plant. This is likely" to affect the people in
the vicinity of the factory.
A provision for separate lockers for work uniforms and
ordinary clothes has not been made, leading to conta
mination of the latter.
There are no clear cut technical specifications outlined
for the nature and quality of the respiratory apparatus,
protective clothing and engineering controls. Manage
ments therefore have no qualms about providing inferior
quality and inadequate equipment.
There is no mention of a ban on blue asbestos which is
banned in other parts of the world.
There is no indication for fixing warning labels on
the asbestos products.
There are no provisions for workers’ access to their
own medical reports and the factory inspection assess
ments .
Furthermore, workers do not have the right to informa
tion regarding the materials they use and the produc
tion process itself.
19 *
The activities of asbestos companies are veiled in
secrecy and the only people who can examine them are
the factory inspectorates. The government and its re
lated agencies and institutions are also fighting shy
of exposing 'revealing' and 'controversial' research
reports on occupational health hazards.
A case in point is Central Labour Institute, that has
been with-holding from the public its detailed studies
on the Shree Digvijay Asbestos Plant in Ahmedabad and
others, A provision should be made in the law to grant
permission to journalists, researchers (government and
private), social workers and the like to conduct surveys
and publish their reports for the public. Permission
to take photographs of the plant must be granted.
Constitutional litigation is frustrated- by redtape,
nepotism, bribery, and unending delays making a myth
of justice. The petitioner often looses faith in the
judiciary and his will is ground to a halt.
*
As per the provisions of the Factories Act it may be
pointed out that the inspector has a series of functions
ranging from checking of licenses to health and safety
measures. He has to conduct inquiries in the case of
accidents and attend courts too.
It is ironic that,
the last National Labour Conference, 10 years ago re
commended 1 inspector for 150 factories.
In Maharash
tra there are instances of the ratio of inspectors to
factories approximating 1:190. It is no wonder then,
that, among other things, a facile circumvention of an
already impotent law is possible.
CASE
STUDIES
Not only are there blatant: shortcomings in the law, it also
remains a paper tiger which is flagrantly abused and flou
ted at every stage. It may be interesting to note that 2
years ago there was a fiery debate in the U.K. on the con
ditions in Indian asbestos factories and the double standa
rds adopted by multinationals to which these Indian Com
panies were.linked. This was sparked off by a report in a
popular scientific journal in the U.K. The heated debate
left the Indian public and worker untouched. Public and
worker consciousness about the health hazards of asbestos
continues to be in its infancy here. Besides being unaware
about the health problems caused by asbestos, workers are
blissfully ignorant about the materials they handle and the
production process they are engaged in. They are un-informed about their legal rights and have no access to their
medical reports. Due to the legal implications involved,
factory medical officers rarely identify asbestosis. A
Times of India report dated February 11, 1983, states that
asbestosis is even deliberately confused with T.B. and
bronchitis to avoid legal implications and compensation
costs. More often than not, when asbestosis is diagnosed,
the management retrenches the worker.
20 -
Case studies of the Asbestos Jointing Unit at Andheri,
the Shree Digvijay Asbestos Cement Plant in Ahmedabad and
Hindustan Ferado Limited in Bombay, are examples of the
appalling conditions and brazen evasion of the law found
in asbestos factories in India.
1•
The Asbestos Jointing Company
The Asbestos Jointing Company at Andheri employs 70 work
ers. It manufactures joints for insulated pipes. The
hazards in this unit are primarily of materials handling.
There are 5 basic processes involved in the manufacture
of joints:*
Fibre strage and handling which exposes the worker to
dust.
*
Mixing of fibres with rubber, petrol and benzene in
high heat conditions. The emission of benzene and
petrol fumes and the generation of asbestos fibres in
cleaning and maintenance operations is hazardous.
*
Sheet making and cutting under high heat conditions,
resulting in fatigue and exhaustion.
*
Shearing which.generates dust and
*
Shredding operations. Two cyclone machines are involv
ed in the shredding process. The loading into the
machines is done with bare hands.
Spillage occurs at
two points :-
a)
when the cyclone works at the loading bay and
b)
where bags are filled by a vaccum system. The bag<-s
are coated with a film of fibre which gets lodged
beneath the worker's skin to form a corn.
The Asbestos Jointing Company outrageously violates the
conditions and regulations laid down by the Factories Act.
1.
Though the plant has stopped using blue asbestos, piles
of white and blue asbestos are heaped outside the unit,
polluting the environment. This is in contravention to
the storage norms prescribed by law.
2.
The workers are not provided with gloves and there are
no washing and changing facilities.
3.
Though the law provides for the provision of proper
breathing apparatus, and head covering, the management
has provided them with cloth masks which is a piece
meal measure. The cloth masks have no filter system.
They get clogged with asbestos fibres which the workers
inhale. Often the workers find the mask so uncomfor
table that they remove them.
4.
There is no local exhaust system (vaccum suction deviee)
general exhaust fan or shower to dampen the floor.
21
5.
The workers claim that there has not been any inspectbn
by the factories inspectorate and no genuine records
have been maintained.
6.
The medical tests seem very perfunctory. The workers
report that their nails are just superficially checked
and they are sent back.
7.
According to the workers, the management has refused to
discuss the problem of health hazards with them. This
is an outright denial of the right to collective bar
gaining even after the issue has been raised before the
management and the factory inspector.
Further developments have occurred after a letter was
sent in recently by the union to the Management and
Factory Inspector demanding a medical check up of the
workers. The management has insisted on a medical
check up. But no official written reply has been re
ceived from the factory inspector. What develops further
remains to be seen.
II. Shree Diqvijay Asbestos Cement Plant (Ahmedabad)
According to a study conducted by J. Kumar of the Central
Labour Institute Bombay and the annual report of the Nati
onal Institute of Occupational Health 1980, the Ahmedabad
based Shree Oigvijay Asbestos Cement Plant's safety record
is no better. The studies revealed that:-
1.
The fibre concentrations in the yarn unpacking, mixing,
spinning, weaving and rope divisions were 367 fibres
per c.c., 418 fibres per c.c., 225 fibres per c.c., and
216 fibres per c.c., respectively. This is far above
the statutory permissable level of 2 to 0.2 fibres per
c.
for different kinds of asbestos.
2.
Out of 320 workers selected at random, 6.5% suffered
from asbestosis due to exposure.
3.
The plant continued to use crocidolite which causes
mesothelioma. Perhaps it should be pointed out here
that manufacturers in the U.K. imposed a voluntary ban
on the import of crocidolite fibres in the early seve
nties .
Another study of the same plant conducted by Barry
Castleman, and published in the "New Scientist" said
that :-
The road leading to the unit was lined on both sides
by asbestos cement waste.
5.
A high wall surrounded the factory and beyond it un
treated waste water was emptied into a trench and
piled with solid asbestos waste on either side. Children
played on the waste around their homes.
22
6.
III.
Some of the houses were made from hunks of asbestos
cement pipes and scraps of corrugated asbestos waste
sheets.
Hindustan Ferado Limited (HFL)
Hindustan Ferado Limited (HFL) in Bombay is a subsidary
concern of the British Asbestos Company Turner arid Newall,
The Indian Plant which opened in 1956 manufactures clutch
linings and asbestos textiles. A collation of reports from
the Times of India, India Today,- Business India, New Scien
tist and Science Today point a dismal picture of the health
and safety conditions in the unit.
The Company brazenly abuses the law in several ways:-
1.
2.
Dust levels stand above the statutory permissable stan~
dards and the heat is so opressive that the workers are
unable to wear respirators because they feel suffocated
Simple housekeeping measures are not employed.
a)
b)
Floors are swept dry creating dust.
The same lockers hold overalls and the workers
clothes, which are thus contaminated.
3.
Labourers who work in the dry process and carry the
waste from the ventilation traps have no protection.
They are covered with asbestos dust.
4.
As a result, many employees have been found to be suff
ering from asbestosis. At least 35% of those still on
their jobs are afflicted and not compensated.
5.
The ESIC is another eyewash. When a worker is not in
service, ESIC contributions stop and he can avail of
medical treatment only for a period of 6 months. When
a worker dies in service, the ESIC provides for compen
sation of upto Rs.80,000/- maximum, payable in instalmentsof Rs.500/- p.m. But as soon as it is proved that
he has asbestosis he gets retrenched. Further if he
dies of the same disease, say two years after he re
tires from service, neither the management nor the
ESIC takes on the liability.
Union representatives have been demanding an improvement
in HFL, viz the provision of proper ventilation facilities,
separate'lockers and bathing facilities for workers. Under
such pressure the management has taken the following mea
sures
1.
In 1980 HFL introduced personal respiratory protection
equipment on the shop floor. These form the second
line of defence, the main precautionary measure being
engineering controls.
2.
Raw asbestos is now packed in polyethelene bags which
are placed in another polyethelene bag. This is an
23
improvement over the original packing in jute bags,
many of which were damaged, leading to fibre spillage.
This decision probably followed Britian’s refusal of
shipments of asbestos products as they were not triple
packed in polyethelene bags as a safety measure.
3.
According to government regulations, cleaning and grin
ding of asbestos fibres in the carding sections as in
several other departments should be a mechanical pro
cess. Under a recent Union agreement, the management
has decided to import some new equipment from Germany.
4.
Though the management has introduced plastic strip
curtains to separate the dust prone carding section
from other sections, much is left to be desired. Plas
tic strip curtains together with a plywood door, or
better still, an air curtain (engineering device, by
which air can be blown in a particular direction) would
be a safer measure.
5.
HFL's contract department used to handle another dan
gerous area. Workers had to go out and spray asbestos
fibres for insulation. This activity finally stopped
when many workers began suffering from chest ailments.
6.
Workers in the carding and fluffing sections get an
"inconvenience" allowance for working in these sections.
The point in question is whether workers should accept
such an allowance.
After much feet dragging the management has been forced
to concede to several of these demands under union pre
ssure. It still tries might and main to diffuse issues
and evade its responsibility. Its line of defence is
is that improvements cost money. The HFL management
complains that its wage costs are 28% of the manufac
turing costs, while that of Sundaram Abex, another as
bestos unit is only 17% of the manufacturing costs.
Such costs however should be counted under capital ex
penditure and not under wages as they are not perks
given to workers but are an essential pre-requisite
for the manufacture of asbestos.
WHAT
CAN
BE
DONE
History bears evidence of industry's reluctance to give
up the use of such a versatile material, without .a massive
amount of public opinion and worker pressure.
*
A move to use appropriate substitutes in lieu of asbes
tos must be initiated.
*
As long as it continues to be used, its use must be
regulated by the most rigorous control.
*
While it is necessary to use the existing law for some
protection, it is necessary to ask for new provisions
to be incorporated (as pointed out in the loooholes of
the Act).
24
*
Pressure must be brought to bear on the management,
for the proper implementation of the Factories Act.
*
Workers must demand the right to appoint "safety re
presentatives" from among workers at the factory/
plant level and union representatives who have access
to facilities and records, both administrative and
medical.
*
They must also insist on the right to information re
garding details of materials/chemicals used, processes
and hazards involved^ and such other information as is
relevant to the health of workers in the industry.
*
Workers must press for the revision of compensation
rates according to current price levels.
*
If. a worker who contracts an asbestos related disease
is retrenched after the disease is identified, then
the management should be pressurized to pay a compen
sation till his death. Workers must in addition de
mand compensation from the Company, in instances of
deaths resulting from asbestos related diseases, even
after retirement.
(Reproduced from CED
/hrs.
bulletin"counter fact" No. 5.)
SOCIETY FOR PARTICIPATORY RESEARCH IN ASIA
45, SAINIK FARM, KHANPUR, NEW DELHI-110062
MAP OF VINAYALAYA LOCATION OF THE WORKSHOP
1.
2.
3.
4.
3.
6.
8.
9.
10.
11.
12.
Retreat House
Slum hutments and
stalls
Pond
Appartment Building
Garage compound
Cemetery
Holy Family Church
and School
Chakala-f/iahakali
Road Chowk
Airport entrance
Andheri Railway
Station
Flyover (vehicular
overbridge)
Vile Parle Railway
Station
Bus Services
From Andheri Railway Stn. East:
From Andheri Railway Stn. West:
Route Nos,
312, 331, 332, 333, 336, 337
396 Ltd.
328, 388 Ltd.
(Get off the bus at the Chakala bus-stop, near the Holy Family
High School)
&
2^
SOCIETY FOR PARTICIPATORY RESEARCH IN ASIA
45, SAINIK FARM, KHANPUR, NEW DELHI-110062
SLATE PENCIL WORKERS OF MANDSAUR
MADHYA
PRADESH
Though environmental pollution, which leads to acute health
problems, is common phenomenon in most of the mining and
factory areas of India, perhaps no where it is in as acute
a form as in the slate pencil production belt in the Dis
trict of Mandsaur in the State of Madhya Pradesh. Most
of the factory workers of the area men, women and children,
suffer from respiratory problems because of prolonged and
uncontrolled exposure to stone dust. Most of them look
double their age and almost all of them die prematurely.
In the recent past, the pitiable condition of these workers
has attracted the attention of politicians, social workers,
journalists and even labour and health officers. Inspite
of sincerity of purpose of these groups, little has actu
ally been done to improve the situation.
The district of Mandsaur is located in the western part
of Madhya Pradesh.
It is close to Chittorgarh, on the
border to Rajasthan.
It is in the northern part of the
plateau of Malwa. The main mineral resource of the dis
trict is Binota Shale sedimentary rock of which slate
pencil are made. The mines for this rock are situated in
the villages of Multanpura, Gujarda, Birpeeth Khaeri,
Dharia Kheri, Balaguha, Gogapur, Bugalia and Daudhari of
Mandsaur Tehsil, There are some mines in Malhargarh Tehsil as well.
It may be pointed out that it is the only area that supp
lies slate pencils to the whole of India.
It is an irony
of fate that the material which exposes children all over
India to literary makes the children of Mandsaur orphans,
compels them to work as child labour and remain illiterate
and sick for whatever short lease of life they have.
Most of the slate pencil factories are located at Multan
pura, Mandsaur and Pipaliamandi. There are about eighty
factories of various sizes in these areas, they employ
nearly five thousand workers. Most of the workers are
local. Nearly 65 per cent of them are Muslims and 35 per
cent from among other residents of the area. A wagon
load of slate pencil boxes is sent out daily to be sold
throughout the country.
The Binota Shalo sedimentary rock is first dug and cut
into blocks. The blocks are cut into thin parts or plates
by an electric saw. The plates are further cut into the
rough shape of a pencil according to required specifica
tions. The pencils are given a finishing touch (e.g.
made round and pointed) manually. Then they are packed
into boxes. These activities, especially the cutting of
rocks into small parts by an electric saw, produce a large
COMMUNITY HEALTH CELL
326, V Main; I Block
Ko^am-nga/b
HEALTH CELL
Bangalore/560034
'b(First Fioor)St. Marks Hoad
India
BANGAiOnE . 53.J
2 -
quantity of silica dust which contains 69.63 percent sili
con dioxide. It is an established fact that exposure to
silicon dioxide is fatal to workers. Yet the mines and
factories of the area have not taken adequate precautions
to safeguard the workers from exposure to silica dust^ As
a result, most of the workers eventually suffer from sili
cosis, which costs them their lives.
The silica dust is inhaled into one's system. During the
first six months of his work, the worker gets cold and
cough. He sneexes and coughts very frequently. He com
plains of minor respiratory ailments. Gradually, as the
dust is accumulated in the lungs, the worker feels pain
in the chest. He coughts like an asthmatic patient.
If
his chest is X-rayed, a black line in the shape of an eye
brow can easily be found. As the pain increases, the wor
ker turns into a patient. He feels that he suffers from
T.B., little knowing that, unlike tuberculosis, his dise
ase is incurable. According to a local doctor, about 150
workers die of this disease in the area annually. During
the last twenty five years, approximately 3,500 workers
have died of silicosis.
It is not only the regular workers in the mines and slate
pencil factories who are exposed to the silicon dust, the
factories also bcfer indirect and casual employment to
others, mostly women and children, who are allowed to take
work home. The women give finishing touches' to pencils a
and children pack them into boxes. The job no doubt aug
ments their meagre income, but it also fills their dingy,
ill-ventilated homes with silica dust, exposing even new
ly born babies to the hazard. Needless to add that the
polluted home environment aggravates the sufferings of
the patients of silicosis who, laid off by the factories,
death at home. Besides, it causes environmental pollution’
throughout the area, exposing the entire population to the
dust and disease. In sum, the situation is harmful and
dangerous not only for those who work in Binota shale sedi
mentary rock mines and slate pencil factories, but also
for the common men living in the area.
What makes the situation even worse is the fact that the
people of the area are so poor that they have got to work
in these mines and factories even th-ough they know well
what lies in stone for them. The industry offers perma
nent jobs to only healthy workers; but the exposure to
silica turns them into chronic patients. As soon as they
become sick, they are deprived of their jobs. They stay
back at home, awaiting death. But the family must have
money to look after the patient and to feed its members.
This compels even children and women to go out and do
the same work as has already proved the cause of the dis
ability to the major earning member of the family,
The factory Act, 1948 and the Mines Act, 1952, passed by
the Government of India, have declared silicosis a fatal
industrial disease. The implications of this declaration
are obvious. The duty of the mine and factory owners is
not only to pay compensation to the families of workers
die of silicosis, but also to take effective safety mea
sures to control the amount of silica dust produced by
- 3 the Industry. As most of the dust is caused by the elec
tric?saw, some effort has been made to control the dust
when the machine is in operation. However, such efforts
are inadequate.
Efforts should be made to control the direct exposure of
workers to the silica dust while they are at work. No
effort has been made so far to control the amount of sili
ca dust in the atmosphere, nor has there been any measure
to protect women and children sharpening slate pencils at
home. As already pointed out earlier it exposes not only
them but also newly born babies and old sick persons at
home. As a matter of fact, everybody in that area is ex
posed to some amount of silica dust and little has been
done to control this grievous health hazard.
In so far as mine and factory workers are concerned, much
can be done under the existing laws to safeguard their
interests. For instance, all mines and factories must
fulfil the minimum sanitary and health conditions laid
down under the laws. The Labour and Health Departments
can see to it that the laws are strictly adhered to. Un
fortunately, this seldom happens.
So long as factories are not modernised and the state of
pollution is not minimised workers are hound to be sick.
As the field reports suggest, most of the workers are able
to work only for the short span of eight to twelve years,
As soon as they get sick and betray symptoms of silicosis,
they are fired on one pretext or other. According to the
laws, a factory worker is entitled to adequate compensation
if he is a victim of silicosis. However, the bullying
tactics of the employer create problems for the workers.
The worker is usually threatened; if he plans to claim
compensation, his family members are denied jobs. If he
works for a small entrepreneur of his own community, the
pressure on him is even worse. Very often he is given
meagre compensation as soon as he is disabled on condi
tion that he keeps quite. As no medical certificate is
issued, it is difficult for his family to prove before
the Labour Court that he died of silicosis. Consequently,
no compensation is paid to the family in case of death.
There are various government sponsored schemes, such as
the group health scheme, personal and group insurance,
etc. which can help workers in hours of need. But, as
the workers are not organised and unionised, they are mostlyunaware of these schemes. There is no conscious effort
on the part of the government agencies to bring them effactively under these schemes. As a result, they are deprived of the benefit of these avenues open to them.
Any solution to the problems of mine and factory workers
in this area needs a two-pronged approach, preventive
and remedial. While priority should be given to preven
tive measures, remedial measures ought to be taken in
all seriousness to improve the condition of those who are
victimsof the prevailing situation. The minimum that need
4
to be done is as follows:a)
To improve the general environment by controlling
the release of silicon dust.
b)
To enforce the existing laws in such a way that the
health of the worker is protected, if the worker
falls ill, he gets all medical treatment at the cost
of his employer and if he dies, his family is given
adequate compensation;
c)
To provide alternative means of livelihood so that
nobody takes up this job merely because he has no
alternative.
Efforts should be made to organise the workers of these
mines and factories. Only then the Mines and factory
laws can be faithfully implemented. The organised labour
will not only demand
enforcement of various provisions
of the law, but also educate its members about the preven
tive measures that can be taken to minimise health hazards
compensation that can be claimed in case of a worker is
affected by silicosis and protection to be given to him
and his family. The organised labour can also fight for
the centralisation and modernization of these factories.
They can further educate the workers about how to save
money, insure themselves against calamities and accidents
and educate and prepare their children for other jobs. A
break-through is badly needed to make the workers realise
that they can have alternatives for their children if they
so desire collectively.
/hrs.
- 5 List of Workers suffering from Silicosis of Slate
______ Pencil Industry of Mandsaur.
Mr. Abdul Rehman
1
Mr. Pappan
2
Mr. Bhola Shankar
3
Mr. Parvet Singh
4
Mr. Nand Lal
5,
Mr. Jagdish
6,
Mr. Jawahar Lal
7,
Mr. Salim
8
Mr. Nanukhan
9,
Mf. Babu
1 0,
11
Mr. Sapteer
12,
Mr. Hussain
13,
Mr. Asiz
14
Mr, Salim
15,
Mr. Wasir
16
Mr. Pappu
17,
Mr. Ismile
18,
Mr. Babu
Mr. Naru
19,
20.
Mr. Girdhari
21 ,
Mr. Rajvir
22. Mr. Mohd. Siddiqui
23. Mr. Abbas
24. Mr. Safi Mohd.
25. Mr. Mr. Kanwar
26. Mr. Salim
27. Mr, Chota Khan
28. Mr. Devi Lal
29. Mr, Surinder Prakash
30. Mr. Kesoram
31. Mr. Shankar Lal
32. Mr. Roop Lal
33. Mr. Hira Ram
34. Mr. Kasturchand
35. Mr. Kunwari-Bai
36. Mr. Sangabai
37; Mr. Ganpath
38. Mr. Hussain
39. Mr. Mangi Lal
40. " Mr. Nashir Shah
41. Mr. Farooq
42. Mr. Babu Lal
43. Mr. Ayub
44. Mr. Heigh Raj
45. Mr. Radha Bai
46. Mr. Hamid Khan
47. Mr. Mohammad
48; Mr. Mohan Singh
49. Mr. Bhawal Lal
50. Mr. Mohammad Hussai
51. Mr. Chota Khan
52, Mr. Raghunandan
53, Mr. Nazir
54. Mr. Ismail
55.
56.
57.
58.
59.
60.
61 .
62.
63.
64.
65.
66.
67.
68.
69.
70.
71 .
72.
73.
74.
75.
Mr.
Mr.
Mr,
Mr.
Mr.
Mr.
Mr.
Mr.
Mr.
Mr,
Mr.
Mr.
Mr.
Mr.
Mr.
Mr.
Mr.
Mr.
Mr.
Mr.
Mr.
Hiralal
Bhagirath Kaneer
Dev Ram
Ram Das
Abdul Latif
Mubarik
Shakur
Ayub Shah
Nathu
Mubarak
Kanchanpuri
Sarif Saha Nasir Shah
Suraji
Kasim
Ghasi
Shanti Lal
Jahur Mohammad
Nanha
Abbu
Nanha Badari •
- 6 Workers of Slate Pencil Industry of Mandsaur District,
Madhya Pradesh who have died.
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Shri Narain s/o Ganga Ram
Nanuram s/o Chunni
Man Singh s/o Kishan Singh
Bani Ram s/o Ganga Ram
Nasruddin s/o Iman Baksh
Radha Shyam s/o Buahji
Shakti Narain s/o Moti Lal
Devi Lal s/o Kalu Ram
Gaffur s/o Vali Mohamad
Nisar s/o Nazir Shah
Kasim s/o Jumma Khan
Sukha s/o Kashi
Chunni Lal s/o Nathuji
Rajinder Singh s/o Gajinder Singh
Bhawar Singh s/o Gamair Singh
Gowardhan s/o Devi Lal
Aziz Khan s/o Mustafa
Mustaq s/o Sardar
Sobha Ram s/o Nathuji
Kanya Lal s/o Ganga Ram
Ram Das s/o Narain Das
Gopal Das s/o Narain Das
Champa Lal s/o Baunji
Babu Singh s/o Sukhdev Singh
Akthar s/o Ayyub
Dull Chand s/o Lalji
Jairam
Naval s/o Nathuji
Prabhu Das s/o Chunni Das
Shyam Singh s/o Khuman Singh
Gulam Mohammad s/o Hari Mohamad
Badri Nath s/o Nanu
Dal Chand s/o Luxman
Nanda s/o Sita Ram
Bahadur Singh s/o Shiva Singh
Kanhaya
Narain s/o Nath
Bhuwan s/o Kalu ji
Nabi Noor s/o Alimuddin
Shukur s/o Khjulu Walia
Nabi Noor s/o Ramjani Mogia
Alla Noor s/o Ramjani Mogia
Maqbool Shaw
Abdul Latif s/o Magizool
Fakir Das s/o Tikam Chand
Sukh Lal s/o Shasi Ji
Ghisi Bai
Samiulla
Nanu s/o Deva Ji
Nathu Lal
Hanif
Ratan Lal
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Ram Chand
Balu
Shankar Lal
Bogidi Ram
Mangi Lal
Bansi
Hira Lal
Chand Mohamad
Gopal
Sallamuddhin
IRA
Society for Participatory Research in Asia
45, Sainik Farm, Khanpur, New Delhi-110 062
NEWSLETTER
July-September 1983
Editorial: Networking
Several persons have been asking questions about the increasing growth of a variety of networks.
The networks of Participatory Research, started seven years ago, are one of the early illustrations of this
phenomenon. The need for a network emanates in those situations and issues where a wide and diverse
variety of perspectives, experiences and resources are needed, and where these are geographically spread
over long distances. A network is different from an organization in that it comprises of individuals in a
variety of organizations and different organizations, sharing a common worldview inter-linked through
and with each other in ways that satisfy the needs of all those who are part of the network. Since no
single organization can possess a diverse range of perspectives, experiences and competencies on a given
issue, network becomes a viable alternative for pursuing and promoting that issue. A network has no
fixed hierarchy and flow of information, ideas and materials can take place directly between any two or
more members of the network.
However, some people have to make an initial effort to start and nurture a network. In the
networks of Participatory Research, we started with Regional Coordinators. The regional coordinators
acted as a node for flow of information and ideas. Based on our experience, we have found that a lot of
correspondence, a periodical information sheet or newsletter, a method of informing people about new
experiences, materials and events, and an occasional meeting or workshop etc. help considerably in starting
and sustaining a network.
But this single node or coordination is only an initial phase. Gradually, people in the network
begin to take their own initiatives, in accordance with their own needs. So the coordination function in
the network becomes more widely shared. In fact, people and organizations remain a part of the network
only if it continues to meet some of their ongoing and changing needs. As time passed, the Participatory
Research networks also became more decentralised. In several regions, coordination of Participatory
Research networks has begun vigorously on a sub-regional and/or national levels. This is indeed a healthy
sign and the long term viability and usefulness of Participatory Research networks depends on further
decentralization and more active communication across nations, sub-regions and regions. We hope the
Participatory Research network in Asia will be able to move clearly in that direction with your active
collaboration.
4
HEALTH CELL
" BAW"A°nr,St' IWarks Roa<*
problems of international coordination were infor
mally discussed recently in Toronto. It was felt that
PR networks can grow stronger if more decentralisa
1. Meeting on Participatory Research in tion in coordination took place. In North America,
3-4 centres of research, education and action are
India
active in local and subregional networking. In Latin
As a follow-up of earlier consultations with part America, a colleague has taken over coordination
ners and other like-minded people, this meeting of from Francisco Vio Grossi. In Africa, several natio
Participatory Research was convened by Society for nal coordinators are being identified in nine different
Participatory Research in Asia on April 22-24, 1983 countries. In Europe, Southern European PR Net
work is emerging and in 2-3 other countries, initiati1
at Dehradun, India.
The objectives of the workshop were two fold: ves at national networks are being taken. In Asia,
RICE
(Rural Institute for Community Education:
firstly, to generate new questions and clarification on
PR; secondly, to review past activities and role of Eileen Belamide coordinator, Address: Room 304
Caeg
Building,
7611 dela Rosa St., Makati, Metro
PRIA and to evolve future directions. The meeting
was attended by 23 representatives of 17 organiza Manila, Philippines) has emerged as a major sub
regional
networking
effort for Philippines, Indonesia,
tions.
The workshop discussed issues like Ideology and Thailand and Malaysia. More Such subregional and/
PR, linkages between Participatory Research, Parti or national networking efforts are needed to further
cipatory Evaluation and Participatory Training, the strengthen PR networks. Do you have ideas and
nature and complexity of roles of participatory rese suggestions in this regard?
archer, etc. Working in small groups, participants
focused upon some special interest topics like pri 4.
RICE News
mary education and PR, forest studies and PR,
The Rural Institute for Community Education
designing a baseline survey in PR, women and PR,
etc. The discussion on future role of PRIA parti (Eileen Belamide, coordinator, Address: Room 304
cularly focused on developing a wide variety of Caeg Building, 7611 dela Rosa St., Makati, Metro,
Manila, Philippines.) held a regional meeting recently
resources on PR.
to evolve a three year program. Comprising of Phi
lippines, Thailand, Indonesia and Malaysia, RICE is
2. Primary Health Care Meeting
encouraging both national workshops and activities
The meeting of case study writers from nine
and bilateral exchange and learning—e.g. Thailand
countries—Canada, Chile, India, Indonesia, Nicara
Philippines exchange on organic agriculture; Malay
gua, Philippines, Senegal, Tanzania and Venezuelasia—Indonesia exchange for cultural workshops.
in the ICAE study on “The Role of Adult Education
The major areas of work of RICE members are
in Community Involvement in Primary Health Care”
peasants, workers and urban poor. RICE is planning
took place in Peterborough, Canada during July 4-8
to bring out a regular publication on South East Asia
1983. There were 18 participants including members
situation.
of the study Advisory Group, representatives of
ICAE and WHO and the study coordinator. Key
findings from each case study were shared, collective
analysis of factors and strategies relevant to effective
utilization of adult education principles and methods
in promoting and sustaining community involvement
in primary health care was made, the participatory
research methodology of preparation of case studies
1. Highlander Nominated for Major Peace
was discussed and plans for next phases evolved. A
Prize
report containing analysis and abridged case studies
is being prepared. For further information, write to
The Highlander Research Education Centre
ICAE or Rajesh Tandon, study coordinator.
(address: Box—370 RFD 3, New Market, Tennessee
Reportage
You may be Interested to
Know
3.
37820, U.S.A.) has been nominated for the Nobel
Peace Prize.
From its inception in 1932, Highlander has embo
Participatory Research Networks
The status of the different regional networks and
2
to study land ownership and alienation patterns in
Appalachia region of USA. Ms. Juliet Merrifield has
evolved participatory research and training methodo
logies in order to study and solve problems -of
occupational safety and health. We are considering
to utilize their resources through a couple of train
ing workshops. We would welcome ideas and
suggestions from you regarding your interests and
possibilities in this regard.
died an ideal of education for social change. It cele
brated its 50th Anniversy in October, 1982.
Any associations or persons wishing to support
the application of Highlander to receive the prize
are urged to write to The Norwegian Nobel Com
mittee, Det Norske Nobelinstitutt, Drammersveien
19 Oslo 2, NORWAY.
2.
PR Training Needs
One of the outcomes of the Dehradun PR mee
ting was the recognition of need for PR training
materials. Simple, illustrative PR materials, particu
larly in local languages, are, at present, almost non
existent.
Both PRIA and Streevani are very much intere
sted in this venture and seek the help of others
engaged in the field of PR to identify the type of
training materials needed. Interested persons please
write to: Dr. Frances M. Yasas, Streevani, Women’s
Research Project, C/o Society of St. John, Dole
Patil Raod, Off Sasoon Road, Pune-411 001.
3.
Materials of Interest
1.
2.
Gram Vikas Primary Education
Programme
Postponment of Asian Regional Forum
on Participatory Research
Due to unavoidable circumstances, the proposed
Asian Regional Forum on Participatory Research to
be held in Manila, Philippines, in collaboration with
RICE, has been postponed to Spring 1984. Those
interested in contributing a case study or theoretical
paper can contact RICE or us immediately.
Development by People
Written by Guy
Gran
and published by
Praeger Publishers, CBS Educational and Profes
sional Publishing, A division of CBS Inc. 521
Fifth Avenue, New York 10175, U.S.A, 1983. It is
an analysis of why poor people in third world
countries remain poor or become poorer and how
this process can be reversed. This book emphasizes
the need for human development—where people and
their active participation matters.
Gram Vikas is planning for a new and innovative
primary education programme for the tribals they
have been working with in the Kerandimal region of
Ganjam district of Orissa.
Suggestions regarding
materials, resources,
ideas are welcome: Please write to Gram Vikas,
Narasinghpur,
P.O.
Mohuda, Via Berhampur
Orissa-760002.
4.
Education and Revolution in Nicaragua
Written by Rebort F. Amove and published by
Indian Social Institute, Lodhi Institutional Area,
Lodhi Road, New
Delhi-110003 1983.
Price
Rs. 7.50. It describes the scope, organisation and
content of the Nicaraguan National Literacy Crusade
of 1980 and its aftermath.
3.
DAE Newsletter
A periodical published by Directorate of Adult
Education, Ministry of Education & Culture, 34,
Community Centre, Basant Lok, Vasant Vihar, New
Delhi—110057. It reports on various activities in
■ the field of Adult Education in the country.
4.
Women Hold up more than Half the Sky
A Third World Perspective on Women and Non
5. Participatory Research, Land Alienation Formal Education for Development, by Anne
Bernard and Margeret Gayfer. Published by ICAE,
and Occupational Health
29, Prince Arthur Avenue, Toronto, M5R 1B2
Two colleagues from Highlander Education and CANADA. It is a report, of a ICAE project to
Research Centre, Tennessee, USA are likely to be investigate, in seven Third World regions, nonwith us during January—March, 1984. Dr. John formal education programmes for women. As a
Gaventa has considerable experience in utilizing PR final stage of the project, a workshop was held in
3
8.
India to share the findings. Report of the workshop
is also included.
5.
Worldlit
A quaterly newsletter published by World Literacy
of Canada. The Newsletter focuses on a theme for
critical discussion, reports on various projects of
WLC and brief news items on literacy/adult
education. Available with a minimum annual dona
tion of 8 15 from World literacy of Canada, 692,
Coxwell Avenue, Toronto, Ontario, M4C 3B6,
CANADA.
6.
9.
From the Outside Looking In
Subtitled ‘Experiences in Barefoot Economics’, by
Manfred A Max-Neef, 1982 Dag, Hammerskjold
Foundation, Ovre Slottsgatan 2, 75220, Uppsala
Sweden.
The book illustrates two cases of barefoot econo
mics. The first relates the miseries of Indian and
black peasants in the Sierra and coastal jungle of
Ecuador and the second the problems of craftsmen
and artisans in a small region of Brazil.
Towards A New Forest Policy
Subtitled ‘Peoples’ Rights and Environmental
Needs; it is edited by Walter Fernandes and Sharad
Kulkarni (Price Rs. 25/-). This book is a result of a
workshop on a New Forest Policy, held at the Indian
Social Institute, April 12-14, 1982. Contains papers
and case studies presented during the workshop.
Order from: Indian Social Institute, Lodi Road, New
Delhi-110003.
7.
CENDHRA Network Newsletter
A quarterly brought out by the Centre for the
Development of Human Resources in Rural Asia.
It acts as an information link between development
partners. Request for copies can be made to::
CENDHRA, 12230, Narra Street, United Paranaque
I,
Paranaque, Metro Manila, Philippines.
10.
Capacitacion Y Organization
Compesina en America Latina
Prepared by Francisco Vio-Grossi and GIA
(1982) on training and organisation of peasants in
Latin America. Available with: GIA, Casille 6122,.
Santiago 22, Chile.
A Handbook to the Management of
Voluntary Organisation
Written by R. Sankaran and Ivo Roderigues
(1983), this is a very useful and handy guide to volun
tary organisations in matters relating to the frame
work of laws and accepted norms and procedures of
organisational management for voluntary organiza
tions.
Orders from Alpha Publishers, 161, Mount Road,
Madras-600 002, Price Rs. 65/-.
11.
TRACE (Training Animators in
Conscientization and Education)
This book is useful in training field level anima
tors and advocates Paulo Freire’s conscientization
method. Price Paper back: Rs. 17/- Hard bound Rs.
24/-. Order from: Trace Team, Janseva Mandal,
Korit Road, Nandurbar-425 412, Maharashtra.
4
Society for
Participatory Research in Asia
OBJECTIVES
(i)
To develop, refine and promote the concept and practice of Participatory Research in
Asia;
(ii)
(iii)
To strengthen and advance the Participatory Research Network in Asia;
To promote research, action and education into people's participation in development
processes;
(iv)
To catalyse, advocate and support the utilisation of Participatory Research in various
developmental projects and programmes in different countries of Asia;
(v)
To coordinate with various regional and international PR networks of International
Council for Adult Education;
(vi)
To collaborate and maintain links with other similar networks and institutions in Asia and
elsewhere;
(vii)
(viii)
To establish and maintain libraries and documentation centres;
To provide information/reports/publications
to members of PR Networks and other
interested individuals and organizations;
(ix)
To organize seminars, workshops, conferences, exchange visits, study tours etc. on PR
and its application to different sectors of development;
(x)
To promote continuing and liberating education of adults, particularly the under-privile
ged sections of different societies;
(xi)
To publish books, papers, monographs and other materials for furtherance of the Society;
(xii)
To conduct projects on PR in Asia on its own and others' behalf;
(xiii)
To organize, sponsor and support training programmes on PR and its related aspects;
(xiv)
To support, fund and collaborate with similar projects being conducted by other similar
institutions;
COMMUNITY HEALTH CELL
47/1, (First FloorjSt. Marks Road
R'>
Society for Participatory Research in Asia
45 Sainik Farm, Khanpur, New Delhi 110062
Participatory Research Network Series
(in collaboration with International Council for Adult Education)
A special series on Participatory Research is being published on behalf of the network. Intended to
promote access to experiences in Participatory Research to people in different regions, the following
publications are currently under way:
1.
Creating Knowledge : A Monopoly?
Edited by Budd L. Hall, Arthur Gillette and Rajesh Tandon, US $ 7.00 (foreign), Rs 30 (India)
(August 1982). Contains a selection of 13 papers (theoretical and case studies) from different regions
of the world. 209p.
2.
Participatory Research : An Emerging Alternative Methodology in Social Science
Research
Edited by Yusuf Kassam and Kemal Mustafa, US $ 7.00 (foreign), Rs. 30 (India) (Qctober 1982).
Based on the 1979 African Regional Workshop on Participatory Research held in Mzumbe, Tanzania,
it contains the four theoretical discussion papers along with responses to them, and seven case studies
from different countries of Africa. Approx. 250p.
3.
Participatory Research : An Introduction
This is a collective product of the international network of Participatory Research, US $ 4.00
(foreign), Rs. 15 (India) (October 1982). Based on the case studies presented and discussions held in
and since the International Forum on Participatory Research in 1980, it is intended to be a simple
introduction to PR for community organizers and field level staff. Approx. 60 p.
4.
Case studies in Participatory Research
Contains 18 case studies presented in the International Forum on Participatory Research, Yugoslavia
1980 (1983). Also contains the discussions and debates that were held in the International Forum.
Price to be announced later.
ORDER FORM
Please send me the following'.
I.
Creating Knowledge: A Monopoly?
copies, Rs. 30.00 each (India)
US $ 7.00 each (Foreign)
2.
Participatory Research : An Emerging
Alternative Methodology in Social Science Research
copies, Rs. 30.00 each (India)
US 8 7.00 each (Foreign)
3.
Participatory Research: An Introduction
'
copies, Rs. 15.00 each (India)
US $ 4.00 each (Foreign)
Add US 8 2.50 per copy for foreign air mail postage or Rs. 5.00 per copy for postage in India.
Local Cheque or Money order enclosed for US 8
Rs.
NAME :
MAILING
ADDRESS:
Recent Publications on Participatory Research.
Research for the People—Research by the People
Edited by Thord Erasmie, Jan de Vries, Folke Dubell, 168 pp, US S 8.00 (for airmail add US $ 2.00).
Selection of 11 papers (case studies and theoretical papers) from the International Forum on
Participatory Research, Yugoslavia, 1980.
Order from: Linkoping University^ Department of Education, S-581 83 Linkoping, Sweden; and,
Netherlands ^{udy and Development Centre for Adult Education, Box 351, 3800 A J Amersfoort,
The Netherlands.
Participatory
of Liberation
Research
and Evaluation Experiments in Research as a Process
Edited by Walter Fernandes and Rajesh Tandon, 216 pp. US $ 5.00 (for airmail add $ 3.00), Rs. 25
(India). Based on papers for the 1981 Workshop on Participatory Research and Evaluation held in
Ranchi, India.
Order from: Indian Social Institute, 10 Lodi Road, New Delhi. India 110 003.
Participatory
Convergence
Research:
Development
and
Issues, special report
in journal
(3,1981) Six feature articles, selective bibliography, book reviews, US 8 4.50 (cheque or money order),
Orderfrom: International Council for Adult Education, 29 Prince Arthur Ave., Toronto, Ontario
Canada M5R 1B2.
Investigation Participativa y
Desarrollo Communal
Praxis
Rural: Nuevas Conceptos en Education y
Edited by Francisco Vio Grossi, Vera Gianotten & Ton de Wit. 223 pp, US $ 6.00. Collection of nine
papers from different countries; Spanish only.
Order from: Universidad Nacional de San Cristobal, Casilla 36, Ayacucho, Peru.
Investigation
Adults
Partipativa: Una Opcion
Metodologica
By Anton de Schutter, 376 pp; no price given.
Order from: CREFAL (Centro Regional de Education de
America Latina), Patzcuaro. Mich., Mexico.
para
La
Education
de
Adultos y Alfabetizacion Functional Para
Perquisa Participante
Edietd by Carlos Rodrigues Brandao, 212 pp. Published by Editora Brasilieuse, s.a. 01223—r. general
jardim, 160 Sao Paolo—Brasil.
Participatory Training for Rural Development
Edited by Om Shrivastava and Rajesh Tandon, 200 pp,US $ 6.00 (foreign), Rs 25 (India). Published
by Society for Participatory Research in Asia, 45 Sainik Farm, Khanpur, New Delhi-110062, India.
Order should include postage (foreign airmail US S 2.50 each, India Rs 5.00 each).
Society for Participatory Research in Asia
45. Sainik Farm. Khanour. New Del hi-1.1110^2 .
Thv Knoxville
: Sunduy, Aoril 24, 1983,
HIGHLANDER TURMOIL friAY LEAD TO PRIZE
-----
NEW MARKET (UPl) - On a farm in the shadow of the Smoky Moun
tains, the people of Highlander lead a restful life, but the
memories of Martin Luther King Jr., night riders and "We shall
Overcome" c.re never far away.
The roots of the Highlander Research and Education Center are
deep in the history of labor movements, and civil rights for
blacks and the poor mountain folk of Southern Appalachia.
For teaching blacks how to register to vote and spearheading
social change in the 1940s, ’50s and ’60s the old Highlander
Folk School was petted with stones, firebombed and accused of
being a Communist training ground.
Today, the Highlander School has been nominated for a Nobel
Peace Prize by Atlanta Mayor Andrew Young and Rep. Ronald
Dellums (D-Calif.).
"The mayor has been very familiar with the work of the center
over the years and is supportive of it," said Young spokesman
Tom Offenburger.
"He feels they have made very important con
tributions to social progress in the country."
The Highlander Center, after being ousted from Monteagle and
leaving a headquarters in the center of the black community
in Knoxville in 1971, now inhabits a 104 acre farm in New
Market on Bays Mountain 20 miles east of Knoxville.
It is a serene and pastoral setting. Twelve staff members
work from a woodframe house With a porch swing. There is a
dormitory and a library atop a grassy hill.
Gone are the days when a Highlander student like Rosa Parks,
a black seemstress, can touch off a spcial storm by refusing
to sit in the rear of a bus Montgomery, Ala.
Staffers at the Highlander center spend theii’ days helping
Appalachian working people cope with poverty, unsafe coal
mines and textile mills and toxic wastes.
The people gathers at the fam on weekend workshops to discuss
problems and decide among themselves what changes need to be
made to solve them. The chax-ges that the center was a hotbed
of civil disobedience and subversiveness have quietened. But
they are never forgotten.
Myles Horton founded the Highlander Folk School in 1932 atop
a mountain in Monteagle to organize labor unions and improve
civil rights. Folk singers Woody Guthrie and Pete Seeger were
friends of the group.
"We Shall Overcome," the anthum of the civil rights movement,
was introduced to black students by a staffer.
Perhaps the most pivotal time for the school came during its
25th anniversary celebration on Labor Day, 1957, when civil
rights leader Dr. Martin Luther King Jr. was a keynote speaker.
2.
King was a rising.star in civil rights at the time and Georgia
Gov. Marvin Friffim sent along a photographer, Ed Friend, to
infiltrate the meeting. What followed led to the closing of
Highlander in Monteagle.
Friend took pictures of King at the conference and soon billborads and postcards popped up accross the South proclaiming
"King Attended a Communist Training Center."
King, a 1964 Nobel Peace Prize recipient, later said he was
the victim of a "smear campaign."
"We know pretty clearly that there was a movement among.South
ern politicians to see if they could do something about High
lander," said Hubert Sapp of Eutaw, Ala, Highlander’s current
director.
"They got together and figured out that they ought
to close down this "hotbed of trouble."
Highlander was raided in 1959, workshop participants were
arrested and the center was charged with operating an integraed school and selling liquor without a license because parti
cipants could take beer from a cooler and leave 25 cents.
It reappeared in 1961 in the middle of a black community in
Knoxville and was quickly enbroiled in another controversy.
Baptists wanted the school's charter revoked and its deors
padlocked.
Rocks and firebombs were thrown through its windows
and the Ku Klux Klan staged protest rallies.
The Knoxville News-Sentinel carried this two-paragraph story
in September 1983;
"Twenty-three Knoxville H<egro leaders have written Mayor John
Duncan a letter defending Highlander Research and Education
Center and atacking those who oppose the institution as a
"know nothing minority..”
"The letter, made public by the Negroes today, said that High
lander seeks to teach Negro and White leaders how to better
the condition of the poorer and less literate Negroes."
The letter did nothing to abate the critics.
Opponents in the Tennessee Legislature called for an investi
gation into Highlander, but the federal courts prevented it.
Lewis Sinclair, the director of Highlander in those days,
said the group had to rise above the controversy.
"We didn't let those things slow us down; We knew we were not
Communists and were not influenced by Communists and that
these were the sort of charges that are thrown at individuals
and groups that tried to bring about change," said Sinclair,
68, a former TVA economist now in semi-retirement in Atlanta.
"The criticisms have abated," said Sinclair, who's been in
volved with Highlander for 37 years.
"It's perhaps because
most people have become more sophisticated, and now believe
in the same things that Highlander' has always believed in."
A
For more information Contact
The New York Times
Highlander Center
Box 370, RFD 3
New Market, TN 37820
Section 12.
SURVEY OF CONTINUING EDUCATION
Sunday , September 7, 1980.
This
School
Helps
Grass
Roots
Grow : by RONALD GROSS
New Market, Tenn..
The scene suggests somnolence: cows grazing near fields plan
ted with corn and beans, rows on rows of the Smoky Mountains
fading into the distance, bloated clouds in the sky. But
awakening people to social-consciousness is the purpose of
the Highlander Research and Education Center here, a rare
effort in adult education.
"The setting may seem sleepy," said a typical participant who
is regularly a union organizer in the region's coal-fields.
"But these sessions really woke me up to where the power lies
around here."
Currently, the conversations at Highlander focus on an un
precedented study of land ownership in Appalachia that the
center is about to release. Planned and conducted as a comm
unity -- education project, the enquiry has reportedly yielded
the largest data base on land ownership ever compiled for one
region of the country. Sixty people from six states partici
pated in its preparation, and the findings will now be taken
back to the grass roots.
"It's not a process of us telling them," insisted Mike Clark,
director of the center.
"Fokks here already know damn well
who's got the land. What we've done is to put the data in a
form where the people themselves can use it to press fox1 re
lief from land and tax inequities.
"Highlander," he added, "is a place where the working people
of Appalachia
coal miners, millworkers, farmers - can gather
to study their problams and decide what needs to be changed to
solve them."
That indicates why Carman St. John Hunter, co-author of the
Ford Foundation-sponsored report "Adult Illiteracy in the
United States," at a conference of experts on adult education
last year, singled out Highlander as "the most notable Ameri
can experiment in adult education for social change."
Founded by Myles Horton in 1932, at another location, near
Chattanooga, Highlander has been repeatedly raided by the
police, burned out by night riders, evicted and red-baited.
Shortly after the school opened, Mr. Horton was arrested dur
ing a bitterly fought coal strike in Wilder for "coming here,
getting information, and going back and teaching it."
.................... 2O
- 2 In 1959, the center was raided and closed by the police. All
its assets were seized for its violation of two state ordi
nances: Holding intergrated meetings, .and selling liquor
without a license by letting conference participants take
beer from a cooler and leave 25 cents.
It took Highlander’s staff more than a decade to acquire and
develop the present 104-acre site on Bays Mountain 20 miles
east of Knoxville.
During the 1930's, the center was a training base for the
Congress of Industrial Organizations in its efforts'to unio
nize Southern industry. Later, in the 50's, it was used
heavily by leader's of the civil rights movement.
Recollecting those early days, Mr. Horton, now 74 years old,
said: "I got into adult education because I got tired of hear
ing each generation say that our only hope is with the child
ren - the next generation will clean up our mess, make our
society better.
I realised the world would only change if
the people who are now running things, who are already adults,
changed. So I decided that if we want a more decent society
we would have to work with today's adults on today's problems."
Today Highlander is run by a young staff with deep roots in
the region. Mr. Horton has consciously passed along his
authority, though he is still a vital and active presence at
the place.
Mr. Clark came to the center with a record of activism against
rural poverty, strip mining and other regional afflictions.
Under his leadership, the program has rapidly expanded over
the last three years. The main work is in occupational and
environmental health, labor education, social history, re
search and cultural activities.
Helen Lewis and Robin Grega head the health program, which
aids community clinics organized by millworkers and mine work
ers, to cope with problems ranging from poor housing and
inadequate nutrition to occupational health hazards and
depression brought on by political powerlessness. Miss Lewis
said, "We help the clinics recruit health professionals, to
define what they need to know to run their clinics effectively
like how to stay solvent - and to educate their neighbors to
promote a healthier community."
A program developed by June Rostan to enable workers to earn
their high-school-equivalency diplomas has been hailed by the
Amalgamated Clothing and Textile Workers Union as a model for
replication in other regions. Juliet Merrifield works on
problems of health and safety for the Unite 1 Furniture Workers
of America. Her husband, John Gaventa, a former Rhodes Scho
lar with a doctorate in political science from Oxford Univer
sity, provides research assistance to community groups in the
region and makes video-tapes to alert people to public issues.
3.
3
"There is no similar place in the mountains," he siad, "Where
community groups can find information on the issues they face,
or where they can receive help from staff members to research
the roots of their problems."
David Gann, a young farmer who had always wanted to farm his
native soil but couldn't obtain enough land of his own, came
to Highlander to raise food, in order to cut costs by making
the center more self-sufficient.
The heart of the program is a series of residential conference
in which local people come together to articulate their grie
vances and work out plans for social • change. About 35 parti
cipants can be accommodated in four large dormitory rooms.
Recently, black-lung sufferers from the coal-fields met with
cotton millhands to discuss brown-lung disease, how to orga
nize and how to gain compensation.
The comment was typical for the kinds of people who come to
Highlander - more likely workers from a furniture factory,
union organizers and literacy volunteers rather than lawyers,
teachers and executives customarily participating in most con-.
tinuing-education programs.
In addition to the workshops, a Library-Resource Center pro
vides information to aid people in solving community problems.
The shelves are organized not by academic categories, but to
yield facts and figures essential to social change. Such re
search stemming from Highlander has helped local farmers learn
about and stop a coal company's plans to develop the largest
strip mine in Appalachia in their community.
The staff has
also aided community groups discover who owns the land and
coal in their area and to challenge the low taxation of vast
coal-company reserves.
Highlander isn't all work for social change: it is also fun
and fellowship - for social change. Candie and Guv Carawan
foster the traditional music (particularly singing), poetry
and theater of the region.
Nimrod Workman, a retired West Virginia coal miner, now in
his 80's sings ancient ballads and Baptist long-meter hymns,
side by side with satires and laments out of the day's papers.
Looking to the future, Highlander hopes to help build a uni
fied movement for change in the mountains and even link up
with other social-action groups around the country. The
center's future is best suggested by Frank Adams, who chroni
cled Highlander's past in "Unearthing the Seeds of Fire."
"Highlander's life springs from the struggles of hard-pressed
people seeking a just society," he said.
Indeed, there are signs that the Highlander idea may be spread
ing. One noted school reformer, Herbert Kohl, has recently
started the Coastal Ridge Research and Education Center, near
San Francisco, in which he plans to "apply some of Highlandert
educational ideas." Mountain migrants from Cincinnati recentl
started the Harriet Tubman-Mother Jones Folk School, and visi
tors from Northern Ireland visited with Highlander staff mem
bers to explore establishing a similar institution in their
country.
Society for Participatory Research in Asia
45, Sainik Farm, Khanpur, New Delhi-110062.
With growing industrialization in India, problems of occupa
tional health have also surfaced.
It is now well known that
several categories of workers suffer from various types of
diseases and health disorders which are directly caused by the
production process itself. These arise from dust, humidity,,
temperature, chemicals, and noise.
It is estimated, for exam
ple, that eight lakh textile workers in India suffer from res
piratory disorders related to cotton dust.
Though detailed
records of affliction to workers health from work-related causes
are not available, the severity of the problem of occupational
health in India can not be minimised.
*
Yet, there is very little that is being done in the country on
this issue.
The managements and owners are hardly interested
in these problems and are exploiting labour surplus situation
in the country to avoid making any effort or investment towards
preventing the incidence of occupational ill-health.
The gover
nment has an indifferent machinery and attitude towards these
problems, even though the Factor5.es Act provides some safeguards
to workers.
The continued preoccupation with daily struggles mostly around
wage issues have led to a situation where most trade unions and
their leaders are also unable to take up these questions. Even
when occupational health issues enter a charter of demands, it
is only in the form of compensation (a glass of milk, two boil
ed eggs, etc.) to workers for the damage done, rather than any
preventive efforts.
When organized sector is showing indiff
erence, it is easy to see how much more the unorganized and
informal sector will be suffering
*
Under these circumstances, it is clear that a new awareness
among worker's and shopfloor level union activists in essential
for such issues to be dealt with.
Ordinary workers who are most
directly affected by the production process caused health dis
orders, need to become collectively aware and mobilised to put
pressure on the managements, government and the unions to work
towards prevention of these problems.
Though several technical
studies on sources and methods of preventing occupational health
2
problems exist they are so clinical and technical in nature and
methodology that they are not able to make the workers aware of
these, thereby not being of much use.
In discussions with a variety of trade union activists and
workers over the past six months, it is being proposed that a
systematic effort is launched in this direction.
We are, there
fore, planning to utilize Participatory Research methodology in
enhancing worker awareness towards occupational health problems.
Participatory Research is an ideologically biased, non-neutral
methodology of inquiry into the phenomena of oppression, poverty
and marginalization, with the active collaboration of the have-
nots (or their representatives), with a view to their obtaining
knowledge, as well as its tools, about their situation and there
by acting on the basis of that newly acquired knowledge to change
the situation structurally by collective actions in their common
interests.
ihe following steps are being tentatively envisaged:
a)
A workshop (say in Bombay in late February or early March
1984) where 2-3 person teams of workers, activists and
researchers from a variety of industries and factories
attend.
A maximum of 15 such teams could be accommodated.
During the 3-4 day workshop, the general problems of occu
pational health are discussed, PR methodology and its
application to occupation health issues is explored, and
each team plans a concrete study in their work situation.
The teams will thus be able to develop skills in this res
pect for continued future use.
b)
These teams spend next 6-9 months concretely investigatin'",
in a particular factory or shop floor, workers’ knowledge,
experiences and responses to specific occupational health
problems arising from that particular production process.
During this period, our staff could periodically assist
these teams in carrying out such investigations.
c)
The teams then analyse their findings (we could assist in
that as well) and then come together for another workshop
of 2-3 days where planning to produce educational materials,
3.
based on these studies and their findings, is done. These edu
cational materials should be locally relevant in content and
appropriate in form for raising worker awareness.
d)
Over the next 3-4 months, these educational materials are
prepared (we could also assist in that).
e)
Then these materials.are used with local workers to raise
their awareness through an educational process that is lo
cally designed and conducted. Short seminars, discussion
meetings or workshops could be used for this purpose.
It is likely that we may have two resources persons from High
lander Research and Education Centre, Tennessee, USA (see en
closed information) during the first workshop: Drs. John Gaventa
and Juliet Merrifield have both been very actively involved with
local unions and action groups on a variety of similar issues.
We are approaching Indian Council of Social Science Research
and International Development Research Centre to provide fund
ing to us for carrying out this effort.
We would like to know
a)
your suggestions to the above proposal;
b)
your interest in participation in this venture; and
c)
if you are interested in participating, can you begin to
identify industry/factory and focus to a particular set of
occupational health problems for your study and action, and
likely members of your team ?
i;e feel that a 2-3 person team comprising of atleast a worker
activist/union leader and someone else (preferably employed in
the same factory or working closely with workers there) who are
interested in these issues and likely to carryout brief local
investigations, would bo most appropriate.
An early response from you would help in planning this venture
more concretely and making preparations prior to the workshop.
1 1 OCT 1983
hrs.
Society for
Participatory Research in Asia
45, Sainik Farm
Khanpur
New Delhi -110 G62.
JUST
SOCI ALT ST
VOL.
I
<7>
OUT.'
HEALT H
NO.3
REVIEML
DECEMBER, 1984
FOCUS:' WORK AND HEALTH.
Under capitalism health becomes equated to the ability to
produce goods, a concept which alienates the worker and
reduces him to being just a form of energy for the production
process. In this situation,when the working class is looked
upon merely as a tool in the production process it is easy
to understand why neglect of safety precautions occurs,
particularly in countries where surplus workforce exists.
Many groups and individuals are experiencing a growing
awareness that the political and social dimensions of health
and safety at work need to be understood in greater depth.
The Socialist Health Review, in this issue, throws light on
health issues at the work place. Some features :
*
Politics of Health and Safety
As unequal contract
exists between labour and capital. The capitalist class has
successfully established an ideological framework that
individualises the problem of health and safety at the workplace,
thus preventing it from becoming a social issue.Anurag Mehra
and Sandeep Agarwal critically look into this ideology and show
how the scientists, technocrats and doctors protect the
interests of the capitalist class by commanding a monopoly of
’the knowledge pertaining to work process and its consequences
for the working class.
* Illness , and. Accident reporting. ..in Industry .; Manipulation
and control of the reporting system for occupational diseases
►and accidents at the workplace by the managerial class and the.
capitalists,the corruption and’lack of concern for workers'
health and the loopholes is labour legislations pertaining
to workers' health and safety are examined and analysed in
this article by Jean D'cunha, Loy Rego, Mihir Desai and
Vijay Kanhere, On the basis of this,the authors show why
workers have failed in their struggle for a better working
environment and point out the directions for future action.
* Indy.str i£1
. and.
jS.n.aJL. JjejJt
cpuntjriesj._ In this article reproduced from a recently
published book, Roy Eiling examines the political economy
of industrialisation in underdeveloped countries dominated
by the export of highly hazardous workprocesses,with a view
to determining Jgpw this has contributed to the degradation of
the work environment in these countries. The article
hypothesises that only a 'self- determining democratic socialism
can prevent abouse of workers' health.
* Hazards of Agricultural Work ; The intervention of modern
technology in agriculture has not only heightened the
probability of accidents at work, but has led to other
health hazards as well.
The People's Health Group from
Punjab presents a case study from the ' green revolution'
Punjab showing that technology in itself does not lead
to accidents, but the fault lies with the mode of production
and the class relations.
COMW-;
47/b (First
U7ALTH CELL
Road
vUO.lt -550 00-j
*
Death on the Job ;
A review of this now famous book by
Daniel Bergman on the US workers' struggles f.br health and
safety. The book provides historical analysis of how
the American bourgeoisie and the State tried to block
efforts of workers for almost 75 years-bef ore the Occupational
Health and Safety Act (OSHA) was- passed.
Plus
Book News,
Newsclippings, reports etc,.
We invite you to participate in developing an understanding
of how the politics and ideology of health care and medicine
affects workers.
BOOK YOUR COPIES
NOW.'
Copies may be obtained from:
1.
2.
3.
4.
5.
6.
7.
8.
Dr.K. Ekbal,Dept.of Neurosurgery, Medical College,
Trivandrum.
Dr. Vijayan House Surgeon's Quarters,Medical College,
Calicut.
Vimal Balasubramanyam, 605/1 Lancer's Barracks,
Secunderabad 500 026.
Centre for Education andDocumentation, '3, Suleman Chambers,
4,
Battery Street Behind Regal Cinema, Bombay-400 039.
Samarajit Jana/ Ajoy Mitra, Presenjit Memorial Community
Health Centre,1.1E, Hemchandra Naskar Ro ad, Calcutta-700 010.
Mira Sadgopal,Kishore Bharati,PO Bankheri, Fbshangabad
Dist. MP481990.
G.Satyamala,C-152, MIG Colony,Saket, New Delhi-110 017
Amar Singh Azad,People's Health Group, Galli No.3,
Gurunanak-Nagar, Patiala - 147 001.
Individual copies are priced at Rs.5/_ each.
If you wish to obtain copies by. mail, please send Indian
postal Order in favour of Amar Jesani or Padma Prakash to
Socialist Health Review c/o. 19, June Blossom Society,
60-A, Pali Road,Bandra,Bombay-400 050.
The Socialist Health Review is a quarterly ( 4 issues a year)'.
Our.first issue,June 1984 was on 'politics and health'
(now.sold out). The second issue Sept. 1984 ,om women & Health',
also sold out, has now been reprinted. Forthcoming issues :
Politics of Population control- March '85; Health and Imperialism.
June 1985; People in Healthcare September '85.
Annual Contribution(subscription. )r at es are ; Rs.20/- For
individuals,
Rs. 30/- For Institutions.
Subscriptions to be sent by Indian postal order, cheque
or demand draft drawn in favour of Amar Jesani or Padma Prakash^
(On outstation cheques please add Rs.5/_ towards bank charges’^
to Socialist Health Review C/o.19, June Blossom Society,
60-A, Pali Road, Bandra,Bombay-4OO 050 Bulk orders for the Decemb.PT,19R4 issue—be. ...acpeptedJ=Tea se_. ^j±^a_nd_en^yjire’“
immediately.
***************
Health Impact of Bhopal Disaster
An Epidemiological Perspective
Thelma Narayan
The chemical accident at Bhopal has been an experience of a public health emergency caused by a technological
disaster, a disaster which overwhelmed the capacity of individuals, physically and psychologically. Because of
the numbers involved and its complexities it also overwhelmed the capacity of the macrosystem, that is, the social
and administrative structures to respond. An epidemiological perspective and method of study is vital to under
standing the pattern and distribution of the adverse outcomes in the community and can provide a variety of data.
The article, the first part of which appeared last week, uses an epidemiological perspective to appraise and
review available literature concerning the health impact of the disaster and discusses methodological issues rele
vant to an epidemiological approach to the study of such a disaster.
VI
Review of Epidemiological Studies
THERE have been very few epidemiological
studies about the health impact of the
disaster. Reports that are available have been
of studies conducted by non-governmental
groups. They provide important information
about the type and distribution of morbidity
in the community. The methodology and
findings of these studies will now be describ
ed in some detail. Findings from the popu
lation-based, cross-sectional study by Banerji
et al have been discussed earlier in the sec
tion on mortality.
General Morbidity
(1) Andersson et al [1984] conducted a
survey in the first fortnight (December 11-17,
1984) “to assess possible long-term visual
disability among survivors”. The sample
comprised of 8 clusters of households,
selected in different localities which had
received varying degrees of exposure. Tvo
localities of similar socioeconomic status, 15
and 17 km away from the factory, were
selected as the control groups. Details of
location of the exposed groups are not
known. The sample size consisted of 261 ex
posed and 91 unexposed individuals. The
sample size and distribution of the popula
tion in each cluster is not known. It was
stated that the sample size was restricted
because of shortage of time before the
' exodus from Bhopal during Operation Faith,
which disrupted daily life for some weeks.
Assumptions to determine sample size have
not been mentioned. It was observed that
. the worst afflicted families had left by the
time of the survey leading to an under
estimation of effect. Method of sampling
has not been mentioned—it was probably
not randomly done. Three ophthalmologists
(one with an interpreter) were the inter
viewers. An attehipt to maintain uniformity
was made—standard questions, method of
examination and simplified nomenclature
was used.
The findings are: The post exposure death
rate (which was specified as the number of
deceased/the number exposed) in the worst
Economic and Political Weekly
affected cluster was 3 per cent. There were
differences in symptoms between the various
clusters or exposure groups: burning of eyes
and throat and coughing were the most fre
quently mentioned symptoms; vomiting was
the third most frequently mentioned symptom
in clusters close to the factory; further away
choking and shortness of breath was higher;
collapse and unconsciousness was reported
only in the cluster second in distance from
the factory—among those unconscious,
there were few or no eye symptoms, upon
recovery; signs of respiratory distress were
most marked in this cluster affecting about
20 per cent of the community; over one half
of this cluster demonstrated eye signs; fundal
changes were more common in the exposed
group especially venous dilatation; there was
no case of blindness, irreversible eye damage
or difference in age standardised visual acui
ty; there was a significantly higher propor
tion of people with active eye infection in
the unexposed communities (5 per cent as
compared to 1 per cent)—it was stated that
this was possibly due to widespread use of
antibiotics in the week preceding the survey
(absence of secondary infection was observed
by Bang in the respiratory system); there was
a similar incidence (this should be pre
valence) of Bitot’s spots in the exposed and
control groups reflecting a similar nutri
tional status in the two groups; and there was
evidence of fairly widespread trachoma in
all the groups, though very few active cases
were seen.
Andersson et al [1985] reported on a twomonth follow up in the clusters mentioned
above. Among the exposed excluding one
cluster to which they had ‘no access’ the
follow up rate was 50 per cent. In both the
exposed and non-exposed groups only 36 per
cent (131/360) were located and reexamin
ed. This is a very high drop-out rate. No in
formation has been given about the baseline
or known characteristics or attempts to
follow up the dropouts. The clusters were
enlarged and 490 people were examined. No
information is given about the new ex
aminees, viz, regarding their distribution ac
cording to localities, their demographic
structure, method used for their selection.
August 25, 1990
etc Hence data will have to be interpreted
with caution. The findings were:
There were no cases of blindness, decrease
in visual acuity or defect in colour vision.
There were no corneal scars in the original
group but six scars which could impair
vision were detected in the new examinees.
It was not slated whether these were attri
butable to the disaster. There was regression
of the early healing seen in the first examina
tion. There was one case of persistent
unilateral corneal oedema and three with
complaints of persistent excess watering in
an otherwise quiet eye.
A Patel et al [1985] conducted an
epidemiological study of the general health
status of the exposed people (see Tables 2-4).
It was a population-based.'cross-sectional
study, using an exposed and a control group.
The study was conducted three months after
the disaster. Post exposure mortality rates for
the different localities, as given in publica
tions by the state government, were taken as
indicators of the degree of exposure. Jaya
Prakash Nagar, 100 yards from the factory
in the direction of the wind that fatal night,
had an exposure mortality of 2.34 per cent
and was chosen as the study population.
Anna Nagar, 10 km from the factory with
an exposure mortality of 0.32 per cent, was
used as the control group. Both areas were
comparable with respect to housing, sanita
tion and economic status of the population.
Study results showed that mortality rates
were useful indicators of exposure: However
the crude mortality rates found in the study
population were much higher than those
reported in the government publication. The
study findings were: JP Nagar - 86.6/1,000
population, Anna Nagar - 7.9/1,000 popula
tion. Post disaster hospitalisation rates were
also found to indicate differences in ex
posure: JP Nagar - 30 per cent, Anna Nagar
- 0.72 per cent. Sample size determination
was made on the assumption that morbidity
would be 15 per cent in JP Nagar and 5 per
cent in Anna Nagar. With a 5 per cent level
of significance and 90 per cent power, a sam
ple of 180 persons in each group (exposed
and control) was chosen. Persons of both
1905
sexes, more than 10 years of age were
studied.
Numbering of all the households to pro
vide a sampling frame was already done by
the ICMR and the same was utilised in this
study. As random selection of individuals
was not possible, a random selection of 50
household units was made to yield the
required sample size.
A house-to-house survey was conducted.
This consisted of the following: (a) a detailed
history on a predesigned questionnaire. Non
standardisation or pretesting of the ques
tionnaire has been accepted as a limitation,
and was reported not to have been done
because of shortage of time, (b) general
clinical examination of all the systems, the
parameters for which had been defined, (c)'
pulmonary function tests using Morgans
electronic spirometer set at ETPS. A trained
investigator, with experience in field-based
studies carried out the tests, (d) estimation
of haemoglobin percentage, (e) open-ended
questions on the people’s perception of the
health services available after the disaster.
Information about training of the inter
viewers has not been given. They were not
blind to the hypothesis as this was not possi
ble in any of the studies conducted in that
situation. Group meetings were conducted
in the community to obtain consent. The
people were informed about the research
group—that they were not related to the
government nor were they providers of ser
vices, nor involved with the claims for com
pensation. This would reduce the possibi
lities for ‘compensation malingering’ as
claimed by some. It was found that members
of the particular sample chosen had not
been included in any of the other studies
being conducted, thus ruling out the possi
bility of the learning effect or Hawthorne
effect.
The two populations were comparable
with respect to age and sex structure, body
surface area, history of chronic disease and
smoking. The exposed were slightly better
off socioeconomically than the controls.
There was a rather high non-response rate
of 29 per cent in the exposed group and 15
per cent in the control group. However
available information about the non-res
ponders was collected. Their age and sex
structure was similar to the responders and
50 per cent or more of them were exposed.
Sixty and 50 per cent of non-responders in
the exposed and control groups respectively
were out of town, while 25 per cent were
away for work. There were no refusals.
Repeated visits were made in the time
available to maximise the response rate (the
investigators were a group of people who
had come from different parts of India and
were not resident in Bhopal). It has been
argued that since, the actual difference in
morbidity was much greater than the 10 per
cent assumed in sample size calculations, a
smaller sample size would have demonst
rated a difference and non-response may not
make such an impact. Nevertheless the high
non-response would have altered the process
of random selection and it must be kept in
1906
mind that the non-responders may differ
from the responders with respect to the out
come following the exposure in unknown
and variable ways, e g, as stated by
Andersson et al if the more seriously ill were
among the non-responders there would be
an underestimation of effect.
Briefly the study findings are as follows:
Prevalence rates of 26 symptoms were
measured ip the exposed and control group
at the time of the study. Tests to see if the
differences were statistically significant were
done.
The following 15 symptoms were found
to be highly significantly different, being
higher in the exposed group: cough with ex
pectoration, breathlessness on usual exer
tion, chest pain/tightness, blurred vision/
photophobia, fatigueability, weakness in the
extremities, muscle ache, headache, tingling/
numbness, loss of memory, nausea, abdomi
nal pain, flatulence and anxiety/depression.
The following six symptoms were signi
ficantly different: dry cough, breathlessness
at rest, watering of eyes, skin problems,
bleeding tendency and impotence.
The following five symptoms were not
significantly different: fever, blood in
sputum, jaundice, vomiting, blood in vomit
and malaena.
As many as 63 per cent reported all the
important symptoms. Only 2.7 per cent
reported exclusively pulmonary symptoms,
while 35.14 per cent did not report any
pulmonary symptoms. Every person in the
exposed group reported at least one serious
symptom,- but quite a few in the control
group did not report any.
There was a significant difference in the
number of attacks of respiratory infections
in the month preceding the study. In the ex
posed group it was often described as a con
tinuous respiratory problem. It was said that
this could be a supportive finding to indicate
a state of lowered resistance or immunity.
Exposed women had a significantly higher
rate of abnormalities of menstrual flow,
alteration in the length of the cycle,
dysmenorrhoea and leucorrhoea. The sample
was too small to report on abortions and still
births. Fifty per cent of exposed mothers in
the exposed group reported failure of lacta
tion or a decrease in milk output post ex
posure, compared to 11 per cent in the con
trols. Impotence in meifwas reported by 8.1
per cent in the exposed group and 0.72 per
cent in the controls.
On examination: There was no difference
in the resting pulse and respiratory rates. The
mean haemoglobin per cent in both males
and females was significantly higher in the
exposed group. There was no case of
cyanosis. This was stated to be a significant
negative finding in view of the findings of
87 per cent with breathlessness on exertion,
the raised haemoglobin concentration and
that extensive lung damage was expected Jo
have occurred. 9.4 per cent of the exposed
had crepitations and rhonchi in the chest,
as against 2.1 per cent in the controls
(P<0.025). This rate was also stated to be too
small to account for the much higher rate
of breathlessness on exertion.
There was a statistically significant dif
ference in pulmonary function tests in both
sexes in the age groups of 15-45 and 45-60
years. The difference in other age/sex
categories were not significant. However
there were only a small number of observa
tions in these categories. The mean values
of FEV1 and FVC and the FEV1/FVC ratio
in all age/sex categories were diminished in
JP Nagar compared to Anna Nagar. The
15-45 and 46-60 age groups showed a restric- •
tive pattern while the over 61s had an
obstructive pattern. It was stated that the
control population was also minimally ex
posed, thereby diluting or masking the effect
of the exposure.
Women’s Reproductive Health
R Bang [1985] conducted a study of the
status of women’s reproductive health three
months post exposure. This followed the
earlier survey of a small number of women
Table 2: Comparison of Symptoms Reported by Individuals in JP Nagar and Anna Nagar
(Expressed in percentage. Numbers-of cases are shown in brackets)
SI
No
2
3
6
8
9
10
11
12
13
14
15
Symptoms
Dry Cough
Cough with expectoration
Breathlessness at rest
Breathlessness on usual exertion
Chest pain/tightness
Weakness in extremities
Fatigue
Anorexia
Nausea
Abdominal pain
Flatulence
Lacrimation
Blurred vision/photophobia
Loss of memory for recent events
Tingling/numbness
JP Nagar
(Per Cent)
Anna Nagar
(Per Cent)
P Value
*
(a).
27.70 (41)
47.29 (70)
10.13 (15)
87.16 (129)
50.00 (74)
65.54 (97)
81.08 (120)
66.21 (98)
58.10 (86)
53.37 (79)
68.91 (102)
58.78 (87)
77.02 (141)
45.27 (67)
54.72 (81)
14.49 (20)
23.91 (33)
2.89 (04)
35.50 (49)
26.08 (36)
36.95 (51)
39.85 (55)
28.26 (39)
16.66 (23)
25.39 (35)
25.36 (35)
42.62 (58)
33.40 (53)
11.59 (16)
20.28 (28)
P<0.01
<0.001
<0.025
«0.001
«0.001
0.001
0.001
0.001
<0.001
< <0.001
< <0.001
< < 0.01
«0.001
« 0.001
<<0.001
•(a) P Values were calculated by x method.
Source: Patel A and Patel A [1985]. The Bhopal disaster aftermath: an epidemiological and
sociomedical survey.
Economic and Political Weekly
August 25, 1990
in the two affected slums (refer to section
On morbidity). The sample consisted of 114
womenjn two severely affected areas and 104
women in a_-control area (see Thble 5).
Reasons for selection of sample size have not
been given. Selection of the sample was from
community based ob/gynae clinics. This in
troduces the problem of self selection as
women with ob/gynae problems would be
expected to attend these climes. These cases
cannot be related to any population or
denominator. Hence epidemiological extra
polations from these case studies cannot be
made. It is not known if standardised ques
tionnaires or examination schedules were
used. The findings of the study were
reported in Thble 5. The differences are all
highly significant (P <'0.001).
The results shown are from a smaller
subset of the original sample, as pelvic
examination could not be performed in some
women due to various reasons like pregnancy,
not being married, and refusals, i e, a selec
tion at this stage has also occurred. However
in spite of the limitations mentioned and
also because similar factors of self selection
occurred for both the exposed and control
groups the difference between them is large
enough to suggest real differences in the two
groups and point to the need to study this
area. Other studies, subsequently, too have
reported similar findings [Patel et al, 1985
and Sathyamala 1986].
In the exposed group there was a history
of spontaneous abortion in seven, still birth
in four, threatened abortion in one and in
complete abortion in one after the gas leak.
No women in the control group reported any
of these adverse outcomes of pregnancy.
Severe pallor was found in 37 (36 per cent)
of the control group but only in 3 (3 per
cent) of the exposed group. This corresponds
to the finding of an increase in haemoglobin
percentage in the exposed population found
in other clinical and epidemiological studies.
Outcome of Pregnancy
Sathyamala C [1986], conducted a community based study of pregnancy outcome,
10 months post exposure (see Tables 6-8). A
large sample was needed to detect significant
differences in rates of abortion and still
birth. The sample size took into account a
non-response rate of 25 per cent which had
been found in earlier studies. A total popula
tion of 8,165 people in 1,632 households were
surveyed. Details regarding assumptions to
determine sample size, power of study, etc,
were not reported. Three exposed localities
(bastis) were selected on the basis of post
exposure morbidity and/or mortality rate.
These were as follows:
JP Nagar - mortality rate 65.3/1000, mor
bidity rate 66 per cent
Kazi camp - 46.7/1000, 54-60 per cent
respectively and
Kenchi chola - 35.7/1000, 91.9 per cent
respectively.
These figures were taken from later, un
published analysis of the study by Banerji
et al. The sampling frame provided by the
Economic and Political Weekly
ICMR was utilised and random sampling of
households done. A ‘historic control’ was
utilised, i e, history of pregnancy outcome
in the year preceding the disaster, in the same
population was used as a comparison. This.
was chosen on the basis 6f studies carried
out elsewhere which demonstrated an abor
tion recall of 82 per cent accuracy even after
a lapse of 10 years. This may have lead to
an under-reporting in the controls and an
overestimation of the difference between the
groups.
A pre-tested questionnaire was used.
Methods used to train interviewers and to
avoid interviewer bias have not been men
tioned. The definition of abortion, missed
periods and delayed periods used for the
purposes of the study have not been men
tioned. Misclassification between the three
could possibly occur. The findings were: The
non-response rate was 22 per cent, within the
limits of what had been considered in sample
size determination.
There were 275 live births and 13 still
births in the population after the gas leak.
The birth rate .was stated to be 33.68/1000
population and was said to be comparable
with the national birth rate. However births
for only 10 months were taken to calculate
the rate. Normally a period of 12 months
is used and hence the rate calculated would
be an underestimation. It is also the crude
birth rate, not being standardised for the age
and sex structure of the population. The still
birth rate post exposure was found to be
47.27/1000 live births. However live and still
births together should be taken in the deno
minator. The rate then is 45.25/1000 births.
No comparison with national, regional or
study based still birth rates has been made.
The overall spontaneous abortion rate
after the gas leak was 370.96 which was
statistically very significantly higher than the
spontaneous abortion rate of 32.178 before
the gas leak.
A second important finding is that the
rate of spontaneous abortions in women
who conceived after the gas leak is again
statistically highly significantly greater than
the abortion rates before the gas leak. The
increase being about 5 times greater than
before the gas leak.
The overall foetal death ratio was statis
tically significantly increased in the year
following the gas leak in comparison to the
previous year.
While past obstetric history, parity, period
of gestation at the time of abortion, etc, were
measured they were not taken into considera
tion in the analysis. These are important
interactive and confounding variables.
Changes in regularity of the menstrual cycle,
delayed and missed periods, length of cycle ■
and type of flow, were also found to be.
statistically significantly different before and
after the gas leak.
Case Referent Study of Watering
of Eyes
Andersson et al [1986] conducted a case
referent study of persistent eye watering. An
eye hospital started in Bhopal in response
to the disaster was used as the source of
cases and controls. Dvo consecutive retros
pective series of clinical records were drawn
for outpatients on whom exposure data were
available. This would be a source of selec
tion bias as it is probable that exposure
status may not have been recorded equally
in the exposed and non-exposed groups. The
method by which exposure was assessed and
recorded has not been mentioned. The fin
dings were:
Table 3: Comparison of Significant SymptomsReported by Individuals in JP Nagar and
Anna Nagar
SI
No
Symptoms
JP Nagar
(Per Cent)
Anna Nagar
(Per Cent)
P Value
*
(a)
1
2
3
4
5
6
Skin problems
Bleeding tendency
Headache
Muscle ache
Impotence
Anxiety/depression
29.05 (43)
9.45 (14)
66.89 (99)
72.97 (108)
8.10 (12)
43.92 (65)
11.59 (16)
2.89 (04)
42.02 (58)
36.23 (50)
0.72 (0!)
10.14 (14)
<0.01
<0.025
<0.001
<0.001
< .05
«0.001
Notes'. Numbers of cases are shown in brackets.
* (a) Values were calculated by X2 method.
Table 4: Comparison of Non significant Symptoms Reported by Individuals in JP Nagar
and Anna Nagar
SI
No
Symptoms
Blood in sputum
2 Fever
3 Jaundice
Blood in vomit/stool/malena
5 Vomiting
JP Nagar
(Per Cent)
Anna Nagar
(Per Cent)
P Value*
(a)
10.13 (15)
27.70 (41)
0.67 (01)
12.16 (18)
11.48 (17)
7.24 (10)
28.98 (40)
00
10.14 (14)
5.79 (08)
NS
NS
NS
NS
NS
Notes-. Numbers of cases are shown in brackets.
*(a) P Values were calculated by x2
Source-. Patel A and Patel A [1985].
August 25, 1990
1907
Gas exposed people were three times more rabbits. A dose ranging study in human
lenses were incubated with MIC.
likely to present with watering eyes (odds volunteers has been referred to by the
Salmon et al [1985] reported that at low .
ratio -OR- 2.96, 95 per cent confidence in ACGIH (American Conference of Govern
concentrations in rats MIC caused severe
terval - CI - 2.3 : 3.4) and nearly 4 times mental Industrial Hygienists). There were no
sensory irritation with slow, irregular
more likely to present with watering and at effects at 0.4 ppm but exposure to 21 ppm
breathing and the production of a sedative
least one other irritant symptom (burning, was unbearable
effect. At higher concentrations this was
Mention has been made of the intense ir
itching, redness) (OR 3.8,95 per cent CI 3.12
masked by arousal resulting from respiratory
- 4.4). There was no association between ex ritation caused to eyes, nose and the throat.
distress. Eye damage was always confined
posure and refractive errors (OR 1.16, 95 per Kimmerle and Eben [1964], studying MIC
to the epithelial layer with most severity at
cent CI 0.83 -1.9).
toxicity by inhalation exposure observed
intermediate exposures suggesting that at
There is no explanation for the symptom that it was highly irritating to skin and
high doses some protective response was
of persistent watering of the eyes. The report
mucosa and that it produced pulmonary
evoked. Urinary thiocyanate levels in the ex
suggests tear film instability due to long oedema. There was little published material
posed were lower than in the controls. They
term effect of exposure on epithelial matura on the effects of sublethal doses, dose observed a dose dependent response and
tion or abnormality of the mucus compo response and metabolic/chemical breakdown
supported the use of death rates and in
nent of the tear film which is derived from
products of MIC.
cidence of pulmonary damage as a crude in
the epithelium itself and from conjunctival
Post-Disaster. Several toxicological studies dex of exposure in epidemiological studies.
goblet cells.
on different animal models have been con
Nemery et al [1985] reported that at very
In summary, the epidemiological investi ducted after the disaster. Because of the high concentrations (10 mg/L for 15 mins)
50 per cent of the rats died. The lungs were
gations conducted have studied different short life span of the animals used, each
aspects of the health impact of the disaster animal year being equivalent to several years enlarged with air. Gross oedema or haemor
at different points in time (see Table 9). They. of human life, an estimate of long-term ef rhage was present only in 2 rats killed after
vary in methodology used and critical com fects of exposure can be made relatively ear exposure. The main effects of low concen
ments regarding this aspect have been given ly. Experiments and pathological investiga trations of MIC on the respiratory tract was
above. They were conducted in difficult cir tions not ethical or permissible to be con to injure the proximal airways with little
cumstances and despite some methodo ducted on humans can also be performed. alveolar injury. At high concentrations lung
logical limitations they all record very The main limitation of animal studies parenchyma was also damaged wi(h resulting
serious effects on the health of those expos however, in general is that extrapolation of interstitial and alveolar oedema, inflamma
ed. They support clinical findings of multi- results to humans has to be made with cau tion and haemorrhage Though there was
systemic and long-term effects. However, tion because of the differences in the complete destruction of bronchiolar epithe
some of the important findings from these biological systems. Another limiting factor lium, repair took place However despite
studies, that may provide clues for etiology, to be borne in mind in this particular case rapid resolution, they found isolated foci of
is that in all the animal experiments con more recent injury in animals killed 2-3
if followed up are:
weeks after exposure They found MIC to
(A)
The varying pattern of morbidity in ducted so far, only pure MIC has been used
clusters at different distances away from the as the agent of exposure. In Bhopal under be a respiratory irritant, i e, both a sensory
the prevalent conditions of high pressure and (stimulation of nerve endings in the nasal
factory in the acute phase. This was not just
in magnitude of effect, but there were quali temperature and in the presence of catalysts mucosa) and pulmonary irritant (impact on
tative differences of differing symptomato other chemical reactions could have occurred lower respiratory tract).
with the formation of other chemicals.
Ferguson et al [1986] im mice experiments
logy (Andersson et al) in different clusters.
This points to the possibility of the role However the advantage is that these experi also found MIC to be a potent sensory and
ments can indicate lesions attributable to pulmonary irritant They have considerable
played by different chemicals. Follow up
studies should look at different clusters over MIC. They can be used to support/explain experience in working with isocyanates and
epidemiological observations and similarly have found MIC to be the most potent
time.
(B)
The presence of a percentage or pro epidemiological data can provide clues for pulmonary irritant they have tested in the
portion of individuals with multisystemic experimental work. The objective of both isocyanate series. They found that the RD
symptoms in the absence of lung disease endeavours together being to explain 50 (the concentration evoking a 50 per cent
(Patel et al) in the sub-acute phase This sug mechanisms/pathogenesis to the extent decrease in the respiratory rate) and the RD
gests that severe lung damage may not ac necessary for rational interventions in the 50 TC (the RD 50 in tracheally cannulated
treatment and/or rehabilitation of victims mice) was separated only by a factor of 1.5.
count for all the chronic effects.
Thus a concentration capable of evoking in
(C)
Significantly higher adverse outcome and in the prognosis of their condition.
The method of MIC exposure used in tense sensory irritation of the eyes, nose and
of pregnancy in exposed women conceiving
animal studies has been by inhalation, with throat is dose to that capable of inducing
after the disaster, compared to controls.
Congenital abnormalities also need to be doses varying between experiments. They all pulmonary irritation. MIC is thus classified
tried to simulate the possible dose range that as a respiratory irritant They found it to be
studied. This very serious observation points
could have existed during the Bhopal seven times more potent than chlorine
to the presence of continuing toxicity.
disaster.
Luster et al [1986] found a steep dose
Infants, pre-school and school age children,
Harding et al [1985] reported the develop response for toxicity. During 90-day recovery
a vulnerable group, have not been studied.
ment of lens opacities or cataracts when rat studies epithelial injury generally resolved,
Respiratory disability has not been studied
at the population level. Natural history of
Table 5: Findings i r R Bang’s Study
the morbidity and the excess mortality that
Chi Square
Exposed
Control
continues to occur also remain to be studied.
Group
Group
VII
Experimental Studies
Pre-Disaster. Data on the toxicology of
MIC was scarce at the time of the disaster.
Median lethal doses in animals were availa
ble, e g, it was 5 ppm for 4 hours by inhala
tion in the rat. In another experiment a dose
of 62.5 ppm for 4 hours killed all the expos
ed rats. Corneal injury has been recorded in
1908
Total no studied
114
Pelvic exam done
72 (63%)
Leucorrhoea
65/72 (90%)
PID
57/72 (79%)
Cerv erosion/endocervicitis
54/72 (75%)
Excess menstrual bleeding since exposure 27/87 (31%)
Suppression of lactation
16/27 (59%)
104
52 (50%)
14/52 (27%)
14/52 (27%)
23/52 (44%)
1/81 (1-2%)
2/16 (12%)
—
51.67
34.67
1139
26.19
10.17
The differences are all highly significant (P < 0.001).
Economic and Political Weekly
August 25, 1990
but prominent fibrosis developed in the walls
of the major bronchi. They reported no in
jury to the spleen, liver, kidney, thymus or
brain. Haematological values except for
slightly increased haematocrit were within
the normal range They found humoral im
munity to be unaffected. In spite of a 30 per
cent suppression in T cell lympho-proliferative response they found host response
resistance not affected.
Fowler and Dodd [1986] studied rats, mice
and guinea pigs. Gassert [1986] observed
that this study was the most comprehensive
inhalation study of MIC to date. It was pro
duced some years before the Bhopal disaster
under private contract 48 with Union Car
bide but was not published until 1986. It pro
vided evidence of bronchiolitis obliterans in
guinea pigs (only) exposed to 10.5 and 5.4
ppm MIC for six hours. They also noted
dose related lesions in the respiratory tract.
No deaths occurred in animals exposed to
1 or 2.4 ppm MIC. The majority of deaths
for 10.5 and 2’0.4 ppm occurred through post
exposure day 3; at 5.4 ppm deaths occurred
throughout the 14 days. Deaths were at
tributed to pulmonary vascular alterations.
ICMR studies [1985] found that the cherry
red appearance of the blood could be due
to the direct action of MIC (by carbamylation) and need not necessarily be due to
cyanide or carbon monoxide. Carbon
monoxide poisoning was ruled out. Analysis
of human tissue by gas chromatography in
dicated the presence of monomethylamine.
On animal studies they found that MIC had
an LD 50 dose of 85 mg in mice, but with
thiosulfate therapy it shifted to 195 gms. For
Table 6: Rate of Spontaneous Abortion
BEFORE AND AFTER GAS LEAK
Before
After
404
310
Total conceptions
13
No of abortions
115
32.178/1000 370.96/1000
Abortion rate
conceptions conceptions
rats the figures were 270 and 344 respectively.
Normal rabbit lungs weighed 6 gms, follow
ing MIC exposure they weighed 29 gms and
had a large number of haemorrhagic pat
ches. When given sodium thiosulfate im
mediately after MIC exposure the lungs
weighed 24 gms but the appearance was nor
mal. With pure MIC they also found a dose
dependent response in the respiratory tract.
They found that MIC had bactericidal
activity.
Salmon [1986] also reported that MIC
could produce a reddish tinge to blood.
However differences could be detected on
spectrometric analysis.
Varma et al reported adverse effects on the
oestrus cycle and fertility in male and female
mice.
Gassert et al [1986] reported on a
14-month follow up of rats exposed to MIC.
Two exposed rats died at 6 and 8 months
following sudden onset of respiratory dis
tress. Six rats killed at 14 months revealed
a history of mild respiratory infections. Mild
interstitial fibrosis in the peribronchiolar
region was present in all exposed rats. A
notable finding was that MIC exposed
animals had four times the amount of lym
phoid aggregates found in control animals
adjacent to the bronchiolar airways. A mild
infiltrate of eosinophils was present in the
bronchiolar mucosa. Eosinophil and lym
phoid infiltrates were found in the mucosa
of the conjunctiva of the eyelids and perilimbal regions. They state that long-term
changes in the eyes and lungs may result
from a single two-hour exposure to acute
sublethal dose? of MIC vapours and that the
immune system is most.probably directly in
volved. They suggest that lymphoid
hyperplasia may be due to persisting ex
posure related antigens or to an increased
susceptibility to other, immunostimulating
agents following MIC exposure.
Thus animal experiments reveal that MIC
is extremely toxic on inhalation—being a po
tent respiratory irritant. Chronic morbidity
Table 7: Abortion Rate in Conceptions before GL Aborted before GL and abortion Rate
in Conceptions after GL
Conception
BGL
Abortion
BGL
Abortion
Rate
Conception
AGL
Abortion
AGL
Abortion
Rate
13
32.178/1000
Conceptions
310
45
145.16/1000
Conceptions
404
(BGUbefore gas leak, AGDafter gas leak).
Table 8: Foetal Death Ratio before and after Gas Leak
Quarter
January-March
April-June
July-September
Number
Delivered
(LB + SB)
30
87
56
1984
Number
Aborted
FD
Ratio
Number
Delivered
1985
Number
Aborted
FD
Ratio
2
12
3
6.66
13.79
5.35
76
77
94
27
24
20
35.52
31.16
21.27
(LB - live births, SB - still births; FD ratio - foetal death ratio).
Note: The foetal death ratio has not been defined but appears to be the number of abortions
per 100 live and still births.
Economic and Political Weekly
Aiigust 25, 1990
and a continuing increase in mortality has
been reported in the exposed animals. The
studies suggest three possible mechanisms
by which this may occur: (a) due to long
term sequelae of severe lung damage caused
by the direct toxic or irritant effects of the
chemicals, (b) due to damage to the im
munological system, (c) due to systemic toxi
city caused by mechanisms as yet unknown.
VIII
Discussion
The discussion on methodological points
will cover the following areas: a) the ex
posure variable, b) the population at risk,
c) the health outcomes, d) confounding
variables and e) sources of bias.
Exposure Variable
Results from the few early studies con
ducted, together with experience of physi
cians and social Workers in Bhopal and toxi
cological studies in animals indicate that the
exposure has resulted in long-term adverse
effects on health. These findings point to the
need for long-term follow-up of the victims.
As a first step valid measurements of ex
posure need to be evolved.'
(a)
Defining Exposure: It is necessary in
the conduct of epidemiological studies in
Bhopal to have a working definition of the
exposure variable. Indicators or measures of
the degree of exposure are also needed to
estimate possible dose-dependent responses
in the outcome variables of mortality, mor
bidity and disability.
Previous studies have used the following
as indicators of exposure: post-exposure
mortality rates in defined localities as
reported by the state government study fin
dings have shown that these did provide a
rough estimate of exposure in different
localities. The rates found in the studies
were, however, much higher than the rates
reported by the government. Issues'concerning mortality rates have been discussed
earlier: A combination of death in the family
or exposure-related mortality rates along
with grades of morbidity as a measure of
exposure; one study found that immediate
post-expdsure hospitalisation rates were also
related to the degree of exposure.
(b)
Variability in Exposure. Epidemiological
studies reveal that control areas 10km away
from the factory have been mildly exposed.
Studies have also shown a variability in the
picture of morbidity in different localities
as well as variability in individuals or groups
of people living in the same locality. Besides
differences in individual susceptibility ac
counting for some of the variability, both
the above observations suggest that the
factor of ‘exposure’ needs to be considered
more carefully. The two important issues to
be considered are: the area and hence the
population exposed may be larger than the
accepted 2,00,000, several variables which
determine the exposure level for an
individual—results from the various studies
have indicated that these are: (1) distance
1909
from the factory at which the individual was
at the time of the disaster, taking into con
sideration the direction of the wind; (2) type
of housing; pucca (well built), kutcha
(without brick and cement), presence of
gaps/holes letting in air (3) action taken at
the time of the disaster, viz, a) measures of
exposure to the atmosphere: kept all doors
and windows closed and remained indoors,
opened doors and windows, stayed in the
house, went out, remained in the area; (b)
measures of exertion: left area, walked, left
area, ran, left area, cycled, left area, used
motorised transport; (c) use of neutralising/protective measures: used a wet cloth
over the face covered face with a blanket,
went in a direction opposite to that of the
wind.
Thus a single parameter by itself, e g,
distance away from the factory, may not
reflect the true exposure status of the in
dividual which would also depend on other
actions that the person took at the time of
the disaster. This could be one of the reasons
to explain the variability in mortality and in
the pattern and degree of morbidity in dif
ferent individuals even in the same locality.
Other-factors like age, level of nutrition and
general resistance, presence of other diseases,
etc, would also play a role. All the above will
have to be considered in studies of morbidity
as well as in determining priority groups of method—in this case blood samples will be
people who would need greater care and needed—have the drawback of increased
follow up.
nonresponse. Besides this, increased costs,
(c)
Exposure at individual and population the need for investigators who have requisite
level: Mortality rates could be a measure cf skills, the availability of laboratory facilities,
exposure to classify localities and areas, i e, etc, will have to be considered. Studies car
they could be used as indicators of degree ried out so far have shown that the use of
of exposure at the population level. While crude morbidity and mortality rates have
the other factors outlined above could be served as markers of degree of exposure.
used as measures of the exposure status of Salmon et al [1985] have confirmed this on
individuals.
the basis of experimental studies. With a lit
(d)
Measurement (assessment) of ex tle refining as suggested above, standardisa
posure: History taking is the traditional tion and pretesting, questionnaires could
medical method of determining the exposure continue to be used to measure the degree
status of an individual. However in Bhopal of exposure.
a large population has been affected. Several
studies into the health effects will need to
Population at Risk
be conducted over a long period of time and
The population at risk would comprise all
several interviewers will be involved. To en
sure comparability between studies and con those who were exposed to the agent and
sistency over a period of time, a standard, who could potentially' manifest adverse
repeatable and valid method of determina health outcomes as a result of the exposure.
tion of exposure should be used. A standar It would form the denominator in calcu
dised questionnaire, using the factors lating exposure-related rates of morbidity
discussed earlier would provide a simple, in and mojtality for the population. Various
expensive, non-invasive tool of investigation. subgroups of this population could also be
There have been attempts to develop studied, e g, according to age, sex, socio
biological markers of exposure, e g, an economic status, degree of exposure, etc.
tibodies or enzyme-related makers. They are Epidemiological profiles for groups broadly
still in the experimental stage and will have classified as severly, moderately and mildly
to be field-tested. However, any invasive exposed could be built up. Factors discuss-
Table 9: Summary of Epidemiological Studies Conducted in Bhopal—Methodological Aspects
Type of
Study
Place
Person
Sample
Size
Severely +
moderately
+ mildly
exposed
areas
General
population
Severely +
moderately
exposed
areas
FebruarySeverely
March 1985 exposed +
control
areas
General
population
March
1985
Severely
exposed +
control
areas
General
population
>10 yrs
of age
September
1985
3 severely
exposed
areas
Pregnant
women
out of
general
population
261 exposed, Opportuni- 64 per cent 3 ophthal
91 unexposed Stic sample, at follow up mologist in
persons
i e, as many
terviewers,
attempts to
as could be
maintain
examined
uniformity in
history
taking and
examination
Pre-designed
700
Random
?
households sampling
question
naire, trained
investigator
114
Self selected Pelvic exam 1 gynae
exposed,
cologist in
sample,
not done
104 un
vestigator,
women
in 43.2
exposed
routine
attending
per cent
persons
field based
history
taking and
Ob/Gyn
clinical exam
clinics
180
Random
29 per cent Pre-designed
in exposed, questionnaire
persons
sampling
in each
15 per cent with defined
parameters,
in control
group
1 training of
group
investigators
22 per cent ■Pre-designed,
8165
Random
pre-tested
persons
sampling
question
in 1632
naire,
households
? training of
investigators
Time
Investigator
Focus
of Study
r Andersson
et al
Eyes, general Population December
based,
1984, and
morbidity
clusters +
February
controls, +2 1985
month follow r
up
2 D Banerji
et al
Mortality,
general
features
3 R Bang
Women’s
Clinic
reproductive based case
health
series in
exposed +
control
areas
4 A Patel
et al
General
health
5 Sathyamala
6 Andersson
et al
1910
Population January
based, cross- 1985
sectional
Population
based, cross
sectional,
exposed +
'control
areas
Outcome of Population
pregnancy
based,
crosssectional,
historic
control
Watering
of eyes
November Eye
Case
1985hospital
control,
record based January 1986
Womenreproductive
age group
Eye
989
patients
from general1
population
Sampling
Method
Those with
recorded
exposure
status
NonResponse
—
Economic and Political Weekly
Study
Instrument
Hospital
case
records
August 25, 1990
etl under exposure variable will have to be
considered.
Numbering of all the households to create
a sampling framework was done shortly
after the disaster. Since a relatively small
population has been affected add there is a
need for long-term follow-up, a population
register or case registers could be maintained
on computer after a census of the exposed
population.
This would provide a good base for
follow-up studies.
Health Outcome
exposure; and latent period, which is the
(d)
Misclassification of exposure status or
period after causation before the disease is of outcome (if the diseased condition is un
detected.
diagnosed or misdiagnosed) will enhance or
Early studies may thus miss still evolving decrease the association depending on the
disease conditions which could be picked up direction of the misclassification. In Bhopal
by prospective longitudinal studies or epide this is very likely when using routine sources
miological monitoring systems.
of data, as many medical professionals deal
(c)
Complementary causes or predisposing ing with a previously unknown situation,
factors would play a role in the development have tended to use the nearest known
of the disease outcome by increasing the diagnosis to fit the presenting symptoms and
susceptibility of individuals. People with a signs. This re-emphasises the need to have
larger set of complementary causes would a working definition of the outcome for
need a smaller dose of exposure to complete documentation and study.
a sufficient cause and result in a diseased
(e)
The non-response rate has been found
condition [Rothman 1986]. Exposure to the to be quite high (20-29 per cent) in all the
toxic chemicals may unmask or exacerbate studies conducted in Bhopal. Besides alter
existing disease, e g, chronic bronchitis,
ing the sample size this would also affect the
asthma, TB, etc. These would be considered composition of the sample, depending on
confounding factors in the analysis of the characteristics of the non-responders.
studies. But, from the point of view of the Allowance for non response should be made
health condition of the people and for the in determination of sample size and also in
provision of health care services, their budgeting for time and finances to allow for
presence would cause the individual to be more intensive follow-up of a percentage of
placed in a priority group.
the non-responders.
(a)
Mortality rates/standardisation:
The number of deaths following the dis
aster would have to be related to the exposed
population to derive crude rates. These could
be standardised for age and sex by com
parison with a standard population of
similar socioeconomic status, and Standar
dised Mortality Ratios (SMRs) could be
calculated. The time period during which
deaths are enumerated would have to be con
(f) Observer bias leading to a bias in
sidered in the calculation of exposure-related CONFOUNDING VARIABLES AND SOURCES
history-taking, recording, interpretation of
of Bias
mortality rates. As with morbidity this could
Socioeconomic status is closely related to findings or in diagnosis may occur. The fac
be calculated for the acute, subacute and
tors
that play a role specifically in Bhopal
long-term phases. Rates for different exposure and to outcome and would be a
confounding factor. Stratification in design are: Those who believe that all is well in
localities should also be calculated.
These rates could be calculated using or group matching could be used to account Bhopal try to underplay or explain away the
routine sources of data. However in the for this. Age and sex would also have to be symptoms of the people. This is evident in
longitudinal study, life table analysis could considered. In the Bhopal situation, smok the attitude of many who attribute every
be done. There should be a good reporting ing, exposure to smoke or air pollution in symptom to the presence of chronic diseases
system for deaths in the exposed and control the home (cooking on smoky fires) or at or as psychosomatic symptoms or as com
populations. Staff and investigators should work, nutritional status, presence of chronic pensation malingering. On the other hand
be trained in the use of the International diseases, e g, TB, trachoma, asthma, chronic those who-believe that a conscious anti
Classification of Diseases and if necessary bronchitis would be interactive factors which people crime has been committed in Bhopal
suitable, standardised criteria could be evolv would have to be measured and allowed for may let their beliefs affect reporting or
interpretation of what the people say.
ed for the classification of deaths. Autop in the analysis.
The above factors could be reduced by the
Several sources of bias have to be con
sies should be preformed in a sample of
deaths among the exposed group, as is the sidered: (a) Stewart [1985] has raised the training of interviewers and in the use of
issue of ‘survivor bias’ in follow up studies blind techniques when possible in certain in
requirement in any medico legal case.
vestigations,
e g, in reading X-ray films, etc.
(a)
Assessment criteria-. This has been the of survivors of the atomic bomb explosion
first time that a whole population has been in Hiroshima and Nagasaki. This could oc Keeping investigators blind to exposure
exposed to high concentrations of these cur in any cohort of people surviving a status is not possible.
(g)
Measurement bias would be important
chemical agents. The exposure has, there major catastrophe. The parent population
fore, resulted in a group of symptoms and loses a high proportion of vulnerable indi to keep in mind especially when .using in
signs which together do not fit easily into viduals—the very young, the old and the strumentation for lung function tests. Stan
dardised
instruments and techniques are
established disease entities. This new disease sick. Thus when comparisons of mortality
complex would have to be named appro are made with a control group in follow-up available. The instruments should be cali
priately, e g, the ‘Bhopal Toxic Gas Syn studies there will be an underestimation of brated and maintained to give accurate and
the effect. One may get a normal death rate reliable readings over a period of time.
drome’. For the purpose of epidemiological
studies working case definitions of this in the survivors, though it may actually be
Suggestions
slightly raised, This is similar to the bias
disease complex would have to be developed.
Several research projects, involving
This would have to be done based on the caused by the “healthy worker effect” in
different specialities, are being undertaken
studies of occupational groups. This factor
clinical experience of medical professionals
in Bhopal and elsewhere, on various aspects
treating the exposed population together would have to be kept in mind in long-term
of the disaster. As outlined earlier there is
with the help of epidemiologists to ensure studies in Bhopal.
a need for supportive epidemiological
'There
(b)
would be a selection bias in
simple, standard criteria which can be ap
studies, especially those that are population
plied in the field. It would basically com hospital or clinic based studies due to self based.
prise of groupings of characteristic symp selection of people attending these services.
In Bhopal a cohort of people have
With the plurality of services and factors of been exposed at a point of time to chemical
toms and signs.
(b)
There may be a lag period between the accessibility this would be important in agents. There is a need to study:
Bhopal.
The
utilisation
of
health
services
in
exposure and some pathological conditions
(1)
the range of health effects stemming
the subacute phase as reported by Banerji from the exposure,
which have not as yet manifested. Rothman
[1985] states that one must allow for the et al [1985] shows that this occurs.
(2)
the natural history of these health
following: a biologically appropriate induc
(c)
Bias due to migration of people into effects.
tion time during which a sufficient cause and out of the population, new births and
An epidemiological study is basically an
becomes complete. This may be quicker for deaths, all of which would affect the baseline exercise in quantifying disease occurrence
heavy exposures and slower due to interac population have been considered earlier in . and using a logical method in deriving intion with other factors for lower doses of the report.
ferences/explanations to account for varia-
Economic and Political Weekly
August 25, 1990
1911
lions in disease distribution by relating them
be done locally, with details of the baseline to be used. These would include question
to putative causes. In this particular situa population. Differences in the prevalence of naires, clinical examination, lung function
tion, where the exposure has defined time
symptomatology between the exposed and
tests, etc. The parameters to be measured at
and place characteristics, though the com control groups, as found in previous studies, entry and follow-up should be specified.
position may be uncertain, observational
should be used for the calculation. The level
Numerous studies of diseases of rhe respi
follow-up or longitudinal studies seem
of statistical significance and power required
ratory system and its risk factors have been
logical. Here the study population are
for the study should be decided. The high
conducted. Instruments which are valid and
selected with reference to their exposure
non-response rate as found in previous reliable are available. Three standard ques
status.
studies and possible dropout rates should be tionnaires nave been developed for the study
The application of case control studies,
considered.
of respiratory epidemiology by the British
where the study population are selected with
To ensure representativeness and to avoid Medical Research Council, US National
reference to their disease status, would be
bias, population based, random sampling Heart and Lung Institute (NHLI) and the
limited. The disease outcome in Bhopal, is
should be used. With this method the pro American Thoracic Society. A suitable one
not a well defined entity and is still evolving.
bability of selection into the sample is the could be combined with general health ques
The prevalence of what has occurred, is not
same for all individual units. Though the tionnaires. Standardised methods for spiro
rare, but affects 30-60 per cent of the severely
sampling framework has been set up, it metric lung function tests are also available.
and moderately exposed population. Also,
could be rechecked keeping in mind the Random and systematic sources of error in
a large proportion of the local population
discussion of the popula'ion at risk. The measurerifent must be minimised.
of similar socioeconomic background have
(8)
Other factors to be considered are the
method used in the cross-sectional and
been exposed to the agent, to some degree.
longitudinal studies would have to be a training of investigators, pilot testing and
Cross sectional studies in the subacute
planning for the follow-up of a percentage
house-to-house survey.
phase have provided prevalence rates of
Community meetings as in the study by of non-responders.
various symptoms and have also indicated
(9)
Analysis: In a longitudinal study an
Patel, el al, should be conducted with the
areas of importance. A repeat cross sectional
people to inform them of the study, discuss unbiased estimate of the relation between ex
study could give prevalence rates of symp
with them the need for continued study, posure and outcome is obtained. The relative
toms and signs post exposure. It could pro
risk
(incidence
rate in the exposed/incidcnce
reasons for random sampling, etc.
vide age, sex and area specific distribution
(3)
Ethical aspects: Obtaining consent rate in the unexposed) and absolute risk (in
of tl]e “Bhopal toxic gas syndrome”. Rela
from study participants and maintenance of cidence rate in the exposed-incidence rate in
tionships with respects of the exposure
confidentiality of patients records should be the unexposed) can be calculated. It would
variable could also be tested. Cross-sectional
be more useful to work out person years of
planned for.
studies using exposed and control groups,
(4)
Study population: Besides the general risk and calculate the force of mortality/
a variant of case control studies, could be
adult population, 'infants, preschool and morbidity or the instantaneous mortality/
used for analytical purposes, to study the
school age children should also be con morbidity rate. The risk of .developing a
relationship between symptoms or groups of
sidered. This group has not been studied in particular outcome (death/disease) can be
symptoms and exposure.
tjie studies reviewed. The advantages of this estimated for a variety of initial charac
Longitudinal Study: A cross sectional
group are that they would have had no teristics, c g, distance from factory, action
study should form the baseline for a pros
serious exposure to smoke (though passive taken at the time of disaster, main presenpective, longitudinal study. Important points
smoking would have to be considered) and ting-symptom in the acute phase, etc
(10)
Difficulties: Dropouts causing attrition
in the conduct 'of a longitudinal study are
occupational pollutants. Chronic disease
now considered.
would also be minimal. Their respiratory of the sample are io be expected. Every ef
(1) Objectives: The hypothesis should be
systems are also more sensitive to insults fort to get a good follow-up should be made
Substantial
loss to follow-up may raise
explicitly stated. There is a need to define
which makes it easier to detect adverse ef
the time period of the study. This would be
fects. It has been found that children can doubts the validity of the results as bias
selected based on biologic assumptions of
carry out spirometric lung function tests • would be introduced ,if the loss is correlated
the disease outcome and its relationship with
from about seven years and can manage a with both exposure and disease
It is important also to maintain consistent
the exposure. The broad pbjectives could be:
single measurement of PEFR at five years
criteria and techniques for measurement
(a)
to study the prevalence/incidence of [Florey and Leeder 1982].
the ‘Bhopal toxic gas syndrome'.
(5)
Control population: An unexposed or throughout the study period. This is in view
(b)
to relate symptoms/signs observed at minimally exposed population is needed for of the fact that turnover in staff and
the start or appearing during the course of
comparison. It should be comparable in availability of newer instrumentation and
the study, to various aspects of the exposure.
terms of broad socio-economic characteri techniques will occur over time '
A longitudinal study is also a major
(c)
to study the natural history of the stics. It would provide an estimate of disease
condition—its severity, fatality, the impact
rates expected to occur in the absence of undertaking in terms of resources—per
sonnel, facilities, finances, etc. The
of therapy, etc.
exposure.
Other specific areas to be studied are
(6)
Measuring the exposure and outcome seriousness of the situation, however, de
(a) the percentage of exposed individuals
variables: The main issues regarding these mand this effort, which would be best con
with multisystemic symptoms and signs in
variables have been discussed. Working ducted under the auspices of the state health
the absence of lung findings, (b) levels of criteria/case definitions for the assessment authorities and the ICMR.
urinary thiocyanate in the exposed and con of exposure and outcome need to be defined. Multiple or Serial Cross-Sectional Studies:
trol population, (c) prevalence of psychiatric
Several types of outcome can be observed, Difficulties inherent in the conduct of cohort
disorders in the two groups, (d) outcome of
e g, post exposure mortality, specified studies have led to the use of multiple cross
pregnancy in the years following the disaster.
decrease in lung function, onset and fre sectional studies. This would be carried out
The specific parameters of these outcomes
quency of respiratory infections in addition on random samples of the population at dif
would have to be evolved locally.
to those mentioned under specific objectives. ferent points in time. In Bhopal they would
(2) Sample: Small clusters in different
Sub-classification into definite, probable and be able to show if th?re are changes in
localities could be selected to be able to study
possible ‘cases’ could be made. Criteria and prevalence from one survey to another.
the variation in outcome in the different
methods of assessing the exposure and out However, since the same individuals would
localities. Other aspects of the exposure
come variables should be the same in both not be followed up, the natural history of
variable would also have to be measured in
the disease will not be studied. Changes in
the exposed and control groups.
the individuals in these clusters.
(7)
Examination techniques: Simple, valid, population structure in the intervening
Sample size determination would have to
repeatable, field tested instruments will have period could cause a change in the measure
1912
Economic and Political Weekly
August 25, 1990
•of outcome. The sampling method, method
of data collection and analysis and response
rate should be comparable al each examina
tion. Comparison of mean values or fre
quencies of variables such as age and sex
could give an idea of changes occurring in
the population structure. Sample sizes will
be larger than for cohort studies because the
greater power of tests of difference between
paired observations in the same individual
cannot be exploited [Florey and Leeder
1985]. Independent non-governmental
groups could probably undertake this study
design.
A detailed longitudinal study with inten
sive efforts to obtain a good response rate
and follow-up need be done only for a small
sample of the exposed cohort. The setting
up of an epidemiological monitoring unit
should be considered for the entire exposed
population. This would be based on routine
records from hospitals and health centres
regarding admissions and deaths. It would
necessitate the building up of an efficient
system of recording, reporting and analysis.
A special census of the exposed population
could be conducted and a method of iden
tification of exposed individuals evolved.
The system would be able to pick up impor
tant changes in morbidity or mortality on
which appropriate action could be taken.
IX
Conclusion
The Bhopal disaster has been a human
tragedy of immense dimensions. The suffer
ing caused is incalculable. Important tasks
remain ahead for the provision of the best
possible care for the victims and for the
prevention of such events in the future.
There is a need, first, for the measure
ment, understanding and documentation of
the impact of the disaster on the health of
those exposed, so as to be able to provide
rational care. It is necessary also to docu
ment the seriousness of the effects so as to
prevent an easy erasure from human memory
of the event. Epidemiologic skills could help
in this effort as described in this report.
At the present time it is known that similar
small-scale ‘technological disasters’ occur
frequently. Larger scale disasters could also
occur. Hence, along with the deeper causes
of these disasters being tackled, there is a
need to have a strategy to deal with such
events.
Outlines for this are as follows:
It is necessary to have epidemiological
data for an adequate understanding of the
effects on human health. This would include
data regarding the numbers and demogra
phic structure of the population at risk, the
age/sex/area distribution of the fatalities if
they occur, and similar data 'regarding
morbidity.
Through collaboration between clinicians
and epidemiologists, it would be necessary
to evolve simple, standard criteria for assess
ment and documentation of morbidity.
Similarly, a method to assess exposure
needs to be evolved.
Economic and Political Weekly
Collaboration and communication bet
ween administrators, service providers and
researchers is important.
Close contact and communication with
the affected people is the most important
factor. In the absence of this, one could easi
ly slip into esoteric, theoretical exercises,
which are meaningless to the problem at
hand.
These efforts have to be seen in the con
text of the broader issues raised by such
events. In Bhopal, these would include: the
economic relationship between multina
tionals and countries of the .third world
which determine factors like technologies
and safety systems used; the exploitative
relationship with the workforce and the local
community to maintain high profit margins;
the siting and safety systems of hazardous
chemical plants; legislation regarding and
implementation of safety controls; the
workers, and communities, right to informa
tion; the role of pesticides; and the accep
table limits to the chemicalisation of our
world. The true causes of the disaster and
the scope for preventing such events in the
future, lie in the matrix of these issues.
(Concluded)
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Haastrup P, (1984): ‘Indoor Fatal Effects of
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‘Penetration of Methyl Isocyanate through
Accidents, 5, 279-290.
Organic Vapour and Acid Gas Respirator
Harding J J and Rixon C K, (1985): ‘Lens
Cartridges’, Am Ind Hyg Assoc J, 48(4),
Opacities Induced in Rat Lenses by Methyl
Isocyanate’, Lancet, March 30, 1985, 762.
315-323.
Higgins M W and Keller J B, (1970): ‘Predic Nagrik Rahat aur Punarvas Committee (Nagrik
study) (1985): Medical Survey on Bhopal
tors of Mortality in the Adult Population
Gas Victims, in association with the Volun
of Tecumseh-Respiratory Symptoms,
tary Health Association of India, Delhi and
Chronic Respiratory Disease and Ven
The Bhopal Relief Trust, Bombay, March
tilatory Lung Function’, Arch Environ
Health, Vol 21, 418-424.
1985.
Nemery B, et al, (1985): ‘Effects of Methyl Iso
Indian Council of Medical Research/(1985):
cyanate on the Respiratory Tract of Rats’,
Health Effects of Exposure to Toxic Gas at
Bhopal. An Update on ICMR Sponsored
Br J Ind Med 42, 799-805.
NIOSH (abstract), (1977): Organoisocyanates
Researches, March 10, 1985.
in Information Profiles on Potential
Ibid, (1985): ‘Minutes of the Third Meeting of
the Working Group on Thiosulfate Therapy
Occupational Hazards, NIOSH contract
of the MIC Exposed Population’, April 4,
No 210-77-0120, 265-275, October 1977.
1985.
Ibid, (1985): ‘Minutes of the Review Meeting Parnell H A, (1986): ‘Perspectives in the
of ICMR Sponsored Researches on Health
Development of Asbestos Litigation and Its
Effects of Exposure to Toxic Gas at Bhopal’,
Future Implications ’, Am Ind Hyg Assoc
May3-4, 1985, Bhopal.
J, 47(11), 708-711.
Joffe M, (1985): ‘Biases in Research on
Patel A and Patel A, (1985): The Bhopal
Disaster Aftermath: An Epidemiological
Reproduction and Women’s Work’, Int J
Epid 14(1), 118-123.
and Socio-Medical Survey, Medico Friend
Kapila M, (1986), An Epidemiological Report
Circle, pp 1985.
on the Health Consequences of the Lake Peto R, et al (1983): ‘The Relevance in Adults
Nyos Disaster, (Volcano), mimeograph,
of Air Flow Obstruction, but not of Mucus
Yaounde and Cambridge, Min of Pub Hlth,
Hypersecretion to Mortality from Chronic
and ODA, UK.
Lung Disease—Results from 20 years of
Prospective Observation’, Am Rev Resp Dis,
KimmcLC A and Kimmel G L (1986): ‘In
teragency Regulatory Liaison Group
128, 491-500.
Workshop on Reproductive Ibxicity Risk . Phoon W O, et al, (WHO task force), (1986):
‘Carbamate Pesticides: A General Introduc
tion’, Environmental Health Criteria, 64,
pp'137. International Programme on
Chemical Safety (IPCS), WHO, Geneva.
Rinsky, et al, (1986): ‘A Mortality Evaluation
of Employees with Potential Exposure to
MIC’. J Occup Med (letter), 28(3), 243.
Rosling H, (1986): ‘Cassava, Cyanide and
Epidemic Spastic Paraparesis—A Study in
Mozambique on Dietary Cyanide Ex
posure’, pp 52, Uppsala University, Sweden.
Rothman K J, (1986): Modern Epidemiology,
pp 358, Little Brown and Company.
Rye A W, (1973): ‘Human Responses to Iso
cyanate Exposure’, J Occup Med, 15(3), i
306-307.
Salmon A G, et al, (1985): ‘Acute Toxicity of Methyl Isocyanate: A Preliminary Study of ’
the Dose Response for Eye and Other Ef
fects’, Br J Ind Med, 42, 795-798.
Salmon A G, (1985): ‘Does Acute Toxicity
Testing Tell Us Anything Useful?’ Methyl
Isocyanate as a test case, Br J Ind Med, 42,
577-578.
Sangster B and Cohen H, (1985): ‘Medical
Aspects of Environmental PollutionEnvironmental Incidents in the Netherlands
1980-84’, Clinical Toxicol, 23, (4-6), 365-380.
Sango C R L and Skarping G, (1986): ‘Deter
mination of Isocyanate and Aromatic
Amine Emissions from Thermally Degrad
ed Polyurethanes in Foundries’, Am Ind
Hyg Ass J, 47(10), 621-628.
Siesjo B K, (1985): ‘Oxygen Deficiency and
Brain Damage: Localisation, Evolution in
Time and Mechanisms of Damage’, Clin
Toxicol, 23 (#-$), 267-280.
Simmonds J, (1987): ‘Europe Calculates the
Health Risk’, New Scientist, April 23, 1987.
Special Supplement (1986): ‘Health Effects of'
Volcanoes: An Approach to Evaluating the •
Health Effects of An Environmental
Hazard’, Am J Pub Hlth, supplement, 76, *
pp 90.
Stewart A, (1985): ‘Detection of Late Effects
of Ionizing Radiation: Why Deaths of ABomb Survivors are so Misleading’, Int J
Epid 14 (1), 52-56.
Tamashiro H, et al, (1985): ‘Mortality and Sur
vival for Minamata Disease’, Int J Epidem,
14 (#0), 582-588.
Teague H J, (1985): ‘Cyanide Poisoning of
Bhopal Victims(?)—A Hypothesis’, Un
published article. ?
Traver G A, Cline M G, and Burrows B, (1979):
‘Predictors of Mortality in Chronic
Obstructive.Pulmonary Disease—A 15 Year
Follow-Up Study’, Am Rev Resp Dis, 119,
895-902.
»
Vincent W 1 Ketcham N H, (1980): ‘A NewFluorescence Procedure for the Determina- .
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*
Economl
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Economic and Political Weekly
August 25, 1990
INDIAN
ASSOCIATION
OF
OCCUPATIONAL
HEALTH
ANNUAL REPORT—1975
Council 1975
Notice of the Annual General Body Meeting
Minutes of the last Annual Geneal Body Meeting
held at Bombay on 30. 3. 1975
Hony. General Secretary’s Report for 1975
Council - 1976
COMMUNITY HEALTH CELL,
47/1, (First Floor)St. Marks Road
BANGAtOTE-560 001
INDIAN ASSOCIATION OF OCCUPATIONAL HEALTH
CENTRAL COUNCIL 1975
OFFICE BEARERS
President
Vice Presidents
Hony. General Secretary
Hony. Joint Secretary
Hony. Treasurer
Hony. Editor Journal I. J. I. M.
Hony. Journal Secretary
Dr. P. V. Thacker
Dr. G. Gopalraj
Brig. H. M. Gangopadhyay
Dr. P. K. Biswas
Col. S. L. Chandha
Dr. M. R. Bhatt
Dr. B. B. Chatteljee
Dr. B. Roy
Ahmedabad
1. Dr. S. C. Mahadeviah
2. Dr. L. G. Doshi
(Br. Secy)
Andhra Pradesh
1. Dr. J. R. Bhate
2. Dr. N. C. Mukherjee
3. Dr. B. Prabhakara Rao
(Br. Secy.)
Asansol
1. Brig H. M.
Gangopadhyay
2. Dr. D. P. Mukherjee
(Br. Secy.)
Assam
1. Dr. M. S. Kachari
2. Dr. J. C. Barua
(Br. Secy.)
Baroda
1. Dr. M. R. Chitle
2. Dr. S. K. Mehta
3. Dr. P. C. Bhatt
(Br. Secy.)
Bihar Coal Fields
1. Dr. A. S. Mandal
2. Dr. P. Prasad
3. Dr. A. N. Shaw
(Br. Secy.)
Bombay
1. Dr. P. V. Thacker
2 Dr. M. R. Bhatt
3 Dr. C. V. Talwalkar
4. Dr. C. P. Sadarangani
5. Dr. R. C. Panjwani
(Br. Secy )
Calcutta
1. Dr. B. Bhattacharya
2. Dr. P. K. Biswas
3. Dr. J. C. Nag
4. Dr. S. K. Roychowdhury
5. Dr. N. Pal Chowdhury
(Br. Secy.)
Delhi
1. Col. S. L. Chadha
2. Dr. H. C. Govel
3. Dr. B. N. Bhattacharya
(Br. Secy.)
Howrah
1. Dr. B. Bhar
2. Dr. S. C. Bej (Br. Sec.)
Jamshedpur
1. Dr. L. R. Agarwal
2. Dr C. D. Sinha
3. Dr. A. R. N. Prasad
Karnataka
1 Dr. R. K. Bhagwan
2. Dr. V. Balakrishna
3. Dr. K. V. Subramanyam
Kerala
1. Dr. M. N. Shenoy
2. Dr. T. B. F. Moniz
(Br. Secy.)
Pune
1. Col. S. K. Chib
2. Dr. R. K. Bhatra
(Br. Secy.)
Thana Kolaba Branch
1. Dr. R. B. Pradhan
2. Dr. M. A. Chitnis
(Br. Secy.)
Ex-Officio Members
2. Past Presidents
1. Dr. P. B. Bharucha
2. Dr. J. C. Kothari
Tamil Nadu
1. Dr. C. K. Ramchandar
2. Dr. G. Gopalraj
3. Dr. S. Bhoopathy Vijay
Kiishna
4. Dr. M. K. Mani
5. Dr. P. P. Santanam
(Br. Secy.)
Co-opted Members
Dr. S. Chakraborty
Dr. Harwant Singh
INDIAN ASSOCIATION OF OCCUPATIONAL HEALTH
NOTICE
The Annual General Body Meeting of the Indian Association of Occupational
Health for the year 1975 will be held at 4 P.M. on 11.1.76 at Vigyan Bhavan,
New Delhi.
Agenda
1.
To confirm the Annual Report for 1974.
2.
To receive, consider and confirm the proceedings of the last Annual General Body
Meeting held at Bombay on 30.3.75.
3.
To receive, consider and adopt the Annual Report for 1975.
4.
To receive, consider and adopt the audited accounts of 1975. (As the meeting is
being held in early January the Hony. Treasurer may not be able to have
the Accounts audited in time for the meeting).
5.
To pass the Budget for 1976.
6.
To appoint Auditors for the year 1976 and to fix their remuneration.
7.
To consider any resolutions brought forward by the Central Council Members
and/or individual members.
8.
To transact the following business :
(i) Election of the Editor and the Associate Editor Journal Secretary of The
Indian Journal of Industrial Medicine.
(ii) Election of Trust Committee.
(iii)
(iv)
(v)
Ratification of Office Bearers and Central Council Members for 1976.
Installation of the President Elect 1976.
Any other business with the permission of the chair.
Calcutta
Dated 20th Nov. 1975.
P. K. Biswas
Hony. General Secretary.
INDIAN ASSOCIATION OF OCCUPATIONAL HEALTH
ANNUAL GENERAL BODY MEETING :
HELD AT MAFATLAL SABHAGRIHA ON 30TH MARCH 1975.
MEMBERS PRESENT
Name
1. Dr. C. V. Talwalkar
2. Dr. Harwant Singh
3. Dr. S. K. Chatterjee
4. Dr. P. K. Ghosh
5. Dr. J. C. Laskar
6. Dr. S. Chakraborty
7. Dr. H. N. Chitnis
8. Dr. N. Ginwalla
9. Dr. A. K. Sen
10. Dr. G. Arjundas
11. Col. S. L. Chadha
12. Grp. Capt. J. K. Sehgal
13. Dr. Hem C. Govel
14. Surg. Commander.
N. B. Idnani
15.
16. Dr. P. D. Joshi
17. Dr. A. N. Shaw
18. Dr. A. M. Mehta
19. Dr. K. C. Jain
20. Dr. C. G. Nataraj
21. Dr. S. R. Pat ward han
22. Dr. T. B. F. Moniz
23. Di. M. N. Shenoy
24. Dr. V. P. Pathak
Branch
Bombay
Name
29. Dr. J. C. Nag
Branch
Calcutta
30. Dr. A. K. Banerjee
31. Dr. J. R. Bhate
Howrah
Hyderabad
Calcutta
Assam
Calcutta
32. Dr. M. B. Go verdhan
33. Dr. M. K. Thacker
34. Dr. K. A.
Bombay
Turiambak Rao
35. Dr. C. K. Ramchandar
36. Dr. N. Rajagopal
Karnatak
Bombay
Tamil
Nadu
Ahmedabad
Tamil Nadu
37. Dr. G. R. Kamat
38. Dr. B. B. Joshi
Delhi
..
Bombay
39. Lt. Col S. K. Chib
40. K. K. Vadhera
41. Dr. J. J. Merchant
42. Dr. K. N. Shah
43. Dr. M. A. Chitnis
44. Dr. S. M. Bopardikar
45. Dr. S. A. Kelkar
Dhanbad
Bombay
Pune
Tamil Nadu
Bombay
Kerala
Bombay
25. Dr. J. Fonseca
26. Dr. L. Desouza
27. Dr. N. M. Pant
Bombay
28. Dr. B. Prabhakara Rao
Andhra
Pradesh
2
46. Dr. R. R. Phanse Kar
47. Dr. S. M. Pet he
48. Dr. Mrs. Krishna
49. Dr. S. N. Sodah
Bombay
Pune
Bombay
Pune
Bombay
,,
,,
,,
50. Dr. N. R. Nimkar
51. Dr. M. L. Gadgeel
Jamshedpur
52. Dr. C. D. Sinha
Bombay
53. Dr. N. V. Gulvady
54. Dr. P. C. Mehta
»
,,
55. Dr. M. C. Narawane
56. Dr. R. B. Pradhan
57. Brig. H. M. Gangopadhyay Assansol
Name
58. Dr. M. J. Saldanha
59. Dr. V. S. Srivastava
60. Dr. D. R. Sen
61. Dr. A.. C. Basu
62. Dr. G. G. Davay
63. Dr. P. C. Bhate
64. Dr. S. K. Mehta
65. Lt. Col. R. K. Kochtrar
66. Dr. A. N. Dandekar
67. Dr. J. V. Telang
68. Dr. N. C. Mukherjee
69. Dr. J. R. Mehta
70. Dr. J. C. Kottari
71. Dr. B. K. Jani
72. Dr. L. G. Doshi
Name
Branch
Bombay
Direct
76. Dr. M. P. Hirve
77. Dr. S. D. Pradhan
Bombay
Bombay
Delhi
78. Dr. R. C. Panjwani
79. Dr. D. Rajaram
80. Dr. G. D. Bhatia
81. Dr. C. P. Sadarangani
82. Dr. V. R. Jayawant
83. Dr. S. Bhar
84. Di. J. K. B. Tavaria
85. Dr. M. B. Adagra
86. Surg. Comendr.
T. D. Masilamani
87. Dr. H. S. Captain
88. Dr. A. S. Khullodkar
89. Miss M. S. Kotnis
90. Dr. K. H. Jagasia
91. Dr. M. R. Bhatt
92. Dr. P. K. Biswas
Branch
Bombay
Baroda
Pune
Bombay
Andhra
Pradesh
Bombay
Ahmedabad
73. Di. M. C. Dutta
Andhra Pradesh
74. Dr. R. Lobo Mendonca
Bombay
75. Dr. Ratan Singh
Andhra Pradesh
Bombay
Calcutta
Minutes of the Annual General Meeting of the Members of the I.A.O.H. held at
Mafatlal Sabhagriha Bombay-25 on Sunday 30th March 1975.
Dr. P. V. Thacker presided.
After having ascertained the quorum he called the meeting to order.
Condolence : Before transacting the business as per the Agenda the house stood
in silence for a minute to pay respects to the memory of the following members who
passed away since the last general body meeting.
Dr. A. Venkataraman—Senior Vice-President. Tamil Nadu.
Dr. S. D. Donde, Past President, Bombay Branch.
A resolution of condolence was adopted and it was further resolved to send copies
of the same to the bereaved families.
The President then informed the members that Dr. P. B. Bharucha whom we
had elected as President once again at Bangalore, had on account of his pre-occupation
with Smallpox Eradication work in Bihar, requested him in October 1974 to take over
the duties of the President and that he had by his letter dated 26th February 1975 sent
in his resignation which the Council at its 4th Meeting held on 28th March had accep
ted, recording the services rendered by Dr. Bharucha to the Association. The members
approved of the action taken by the Council. Similarly, Dr. Prasad, the Honorary
General Secretary had also for the same reason handed over his charge to Dr. P. K.
Biswas from July 1974 onwards, but Dr. Prasad technically was still in the office. He
had regretted his inability to attend the meeting.
The President then took up items on the Agenda.
Agenda Item 1—Confirmation of the Minutes of previous General Body Meeting held
on 10.2.74.
Dr. P. K. Biswas informed the members that since Dr. Prasad had not sent the
above minutes to him, these could not be presented.
During the discussion Dr. J. C. Kothari stated that both Dr. Bharucha and
Dr. Prasad while passing on their offices had not taken the Council members into con
fidence by sending them even a formal letter by way of information.
It was a matter
of regret that the minutes of the General Body meeting held a year ago were not avail
able even till today. He suggested a procedure to be laid down requiiing the office
bearers to inform the council members whenever they were unable to function and
that while handing over the office, they must hand over the necessary papers to their
successors.
Brig. Gangopadhaya (Asansol), Drs. Rajgopalan (Tamil Nadu) Laskar (Assam)
and Merchant and Gulwandi (Bombay) also participated in the discussion giving vari
ous suggestions to overcome the above difficulties. Summing up the discussion the
President agreed that non-availability of these minutes was irregular and requested
the general body to condone the same under the circumstances narrated above. He
added that owing to an unprecedented situation this year even the joint Secretary was
not able to function during the last month. The only course open now was to request
the incoming general secretary to obtain a copy of the minutes from Dr. Prasad and
place the same before the 2nd Council meeting from the year 1975 for approval
and thereafter present these at the next annual general body meeting to be held
in 1976 for confirmation. Proposed by Dr. S.K. Mehta and seconded by Dr. Chaddha
this proposal was adopted unanimously
Item 2—Hony. General Secretary’s Annual Report.
The President informed that similarly the Annual Report for 1974 was not pre
pared either by the General Secretary or by the Joint Secretary and hence the same
could not be circulated along with the notice. The Honorary Jt. Secretary then read
out a brief report prepared by him. Proposed by Dr. S. K. Chatterjee and seconded
by Dr. Talwalkar this report was adopted unanimously. Dr. Biswas was however
requested to circulate a detailed report as early as possible.
Item 3—Audited Statement of Accounts.
Presenting the audited statement of accounts for 1974, copies of which were
circulated to all the members attending this meeting, Dr. Bhatt stated that against the
item Sir Ardeshir Dalal Memorial Lecture, a sum of Rs. 100/- was yet payable to Dr. C.
K. Ramchandar and that this amount would be paid during the current year. He
further informed the members that Dr. Ramchandar had desired to donate this amount
to “Dr. K. M. Bhansali Memorial Fund” with an addition of Re. 1/- from his own.
Members greeted this announcement and appreciated Dr. Ramchandar’s gesture.
Dr. G. D. Bhatia and Dr. Sadarangani desired to know the propriety of
Dr. Bharucha’s signature on the statement since he was no longer the President.
Dr. Bhatt replied that the cyclostyled copies circulated were prepared about 2 weeks
ago whereas Dr. Bharucha’s resignation was accepted only 2 days ago at the 4th Coun
cil Meeting. He added that the original statement approved at the 4th Council meeting
held on 27th March were signed by Dr. Thacker as President. Thereafter the state
ment of accounts was approved, as proposed by Dr. S. K. Mehta and seconded by
Dr. S. Chakraborty.
Item 4—Draft Budget
|
Draft budget as presented by the Hony. Treasurer in absence of the Honorary
Secretary was circulated among the members and adopted. Proposed by Dr. Chitnis
and seconded by Dr. S. K. Chatterjee.
Item 5—Appointment of Auditors.
As the auditors have necessarily to be from the place where the Treasurer’s office
was located, this item was postponed until the election of office bearers was gone
through, thereafter proposed by Dr. S. K. Mehta and Seconded by Dr. B. K. Jani
M/s G. S. Sadashivan, Chartered Accountants, Bombay were appointed as auditors
for 1975 on the same remuneration as in the previous year.
Item 6—Dr. S. K. Mehta’s Resolution and Item 7(i) Ratification of the Election of Office
Bearers.
The President informed that the 4th Council meeting after a good deal of deli
berations had come to the conclusion that the election of office bearers for the year
1975 as conducted by the Joint Secretary has not been in order. Even though the
election procedures as recommended under the revised constitution were not approved
at the annual general meetng held at Bangalore, the second council meeting had deci
ded to include the outgoing Council members in the electoral college and had thus
enlarged the same. Some branches had taken objections to the procedure adopted
as it was in their opinion undemocratic. Under the unprecedented circumstances
narrated above and also taking a note of the fact that a resolution submitted by one
of the members (Dr. S. K. Mehta) which had been duly circulated to all the the members
and put on the Agenda of the Annual General meeting, the Council decided that the
General Body meeting of the members be requested to elect office bearers for the year
6
I
1975 from amongst the Council members for 1975. He then read out the Council’s
recommendation on the subject which is reproduced below :
“As the last general body meeting held at Bangalore did not approve of the
various changes incorporated in the revised draft constitution and as no further action
had been taken by the Rules Revision Committee «ince then, the election of the Office
Bearers for 1975 should have been conducted as per the existing rules. Since the elec
tions conducted have not been as per the existing procedures, the Council could not
accept the same.
In view of the extra ordinary circumatances thus created and taking a note of
the fact that conducting the elections for 1975 once again would involve time
and money, the Council recommends to the annual general meeting to elect the office
bears for the year 1975 out of the Council members for the year 1975. In view of the
above decision all full members of the Indian Association of Occupational Health
present and voting at the general body meeting will form the electoral college”.
The above resolution of the Council was put before the meeting from the chair
and was passed unanimously. Thereafter the President requested the 3 members of
the election committee viz. Dr. Arjundas, Dr. L. D’Souza and Dr. P. K. Ghosh (in
place of Dr. B. Bhar who was not able to attend the meeting) to conduct fresh elections
for all the vacant posts of office bearers viz. President, 2 vice-Presidents, Honorary
General Secretary, Honorary Joint Secretary and Honorary Treasurer and himself
stepped down from the Chair.
Dr. Aijundas taking the chair invited nominations from the floor for the above
post one by one.
President : Proposed by Dr. M. R. Bhatt (Bombay) and seconded by
Dr. Subramanium (Karnataka). Dr. P. V. Thacker was declared elected unopposed.
Senior Vice-President : Proposed by Dr. S. K. Mehta (Baroda) and seconded
by Dr. B. K. Jani (Bombay), Dr. Gopalraj was declared elected unopposed. Dr. P.
K. Biswas proposed by Di. C. K. Ramchandar, seconded by Dr. M. R. Bhatt. Dr.
Biswas however declined to accept the nomination.
Vice-President : Proposed by Dr. C. K. Ramchandat (Tamil Nadu and Dr. M.
R. Bhatt (Bombay), Brig. Gangopadhaya was declared elected unopposed.
7
Honorary General Secretary : There were two nominations :
(i) Dr. P. K. Biswas—proposed by Dr. J. C. Nag and seconded by Dr. A.
K. Sen (Bombay), (ii) Dr. S. K. Mehta, proposed by Dr. P. C. Bhatt (Baroda) and
seconded by Dr. G. D. Bhatia.
Voting was carried out by ballot. Dr. Arjundas while distributing the Ballot
papers reminded the members present more than once that only the full members of
the Association and those who had paid their subscription for 1974 were eligible to
vote. The result of the ballot was 45 in favour of Dr. Biswas and 38 in favour
of Dr. Mehta with one invalid vote. Dr. Biswas was thereafter declared elected.
Honorary Joint Secretary proposed by Dr. C. K. Ramchandar and seconded by
Dr. Chakraborty. Col. Chadha was declared elected unopposed.
Honorary Treasurer : There were two nominations :
(i) Dr. M. R. Bhatt proposed by Di. C. K. Ramchandar and seconded by Dr. L.
G. Doshi, (ii) Dr. S. C. Bej proposed by Dr. Banerjee, seconded by Dr. J. C. Nag.
Di. Banerjee thereafter withdrew his nomination of Dr. Bej and Dr. M. R. Bhatt
was thereafter declared elected unopposed.
On completion of the election work Dr. Arjundas on behalf of his committee
handed over the chair to Dr. P. V. Thacker after thanking the members for
their cooperation.
Agenda item 1 (i) and (ii)
The names of the newly elected office bearers for 1975 having thus been
announced, Dr. P. V. Thacker the President elect was thereafter installed as President
for the year 1975.
The President and other office bearers thanked the members for
electing them.
Agenda item 8—Any other business with permission of the Chair.
The President put before the members the following resolution of the Council
adopted at its 4th meeting held on 27.3.75.
8
“This Annual General Meeting of the members of the IAOH HELD at Bombay
on 30 March 1975, having taken note of the fact that the clauses pertaining to the
(i) Election of office-bearers and (ii) Composition of the Central Council as contained
in the draft of the revised Rules and Bye-laws, having not been approved at the Gene
ral Body Meeting held at Banglore on 10.2.1974, and further that the Rules Revision
Committee entrusted with this task has not been able to finalise these items so far,
hereby resolves that :
The election of office bearers for the year 1976 and for future years be held as per
the procedures laid down under items 10 and 11 of the old Constitution, and that any
difficulties that may arise in interpreting these clauses arising out of errors grammatical
and/or otherwise be interpreted as per procedures and conventions prevailing in the
past.
[t is further reiterated that the office beraers for the Central Council should
always be elected on democratic lines i.e. to say, from amongst the members who are
going to form the Council for that particular year. This is the spirit and essence of
the bye-laws Nos. 10 and 11 under the old Constitution.”
Dr. P. K. Ghosh stated that since the above Resolution has not been circulated
to the members in advance, it could not be considered at this meeting.
The President explained that as this was a Resolution from the Council arising
out of its discussions at a meeting held only two days ago, it evidently could not be
circulated in advance. It however, would be in order to discuss the matter. The
resolution did not envisage iany change in the constitution of the Association but was
only a reiteration of the existing laws and was meant for giving guidance to the future
council with regard to conduction of election so that unprecedented situation in which
we found ourselves today may not be repeated.
Dr. C. K. Ramchandar supporting the resolution explained at length the situa
tion which had necessitated the election of the Office Bearers from the floor this year.
He added that members were aware that election procedures as submitted in the re
vised draft constitution have not been approved by the General Body at Bangalore
and that the Rules Revision Committee has not been able to come out with any recom
mendation on the subject. Some branches had given their opinion that the election
of office bearers should be on democratic lines from amongst the new council members
and which in fact, is the position today as per the relevant constitutional clauses exist9
ing. If we have to wait for clarifying the position until the next General Body meeting,
he was afraid we may find ourselves in the same predicament. Dr. S. V. Bhatt and
Dr. L. D’Souza spoke supporting adoption of the resolution. Dr. Ghosh desired
that his objection be recorded and demanded a poll which was carried out by show
of hands. There were 83 in favour of the resulution and 4 against. The resolution was
thereafter declared approved.
The President then placed before the House the following Resolution submitted
by Dr. C. K. Ramchandar and seconded by Dr. S. V. Bhatt:
“Notwithstanding anything said, done and recorded, and notwithstanding any
thing provided for in the laws, bye-laws, established procedures and conventions, and
in view of an unprecedented predicament, the election of office bearers having been
carried out by the General Body as per recommendation of the Council for 1974 after
according its approval to this procedure, the General Body hereby records its opinion
that the election of the Office Bearers for 1975 carried out at its meeting held on 30.3.75
at Bombay is final and unchallengeable in any manner. It further records that as the
election rules have now been revised the Rules Revision Committee is hereby dissolved.
The resolution was approved unanimously.
NEXT ANNUAL CONFERENCE
The President announced that Delhi Branch has invited the next Annual Con
ference and the Council has provisionally accepted the invitation subject to approval of
the geneial body meeting. He added that this will be a unique occasion and would
give us an opportunity to project our image with the government circles in the capital.
Members accepted the invitation wholeheartedly and thanked the Delhi Branch for
the same.
Dr. L. G. Doshi, Ahmedabad Branch, stated that his branch was preparing to
host the 1976 conference, but in view of the importance of Delhi as a venue for the
next Conference, his branch would now like to invite the members for the 1977 con
ference. Dr. Doshi’s invitation was accepted and the President thanked him on behalf
of all the members.
The Honorary General Secretary announced that he has just received a com
unication from 15 doctors in the Thana region proposing to revive the Thana Branch
10
with effect from this year. This matter would be taken up in the first Council meeting
of the 1975 and all assistance will be rendered to these members to form an active
branch in that area.
The Hony. Gen. Secretary thanked the Bombay Branch for agreeing to holded
the Annual Conference at a very short notice and for their hospitality and Kindness
extended to all the members attending the Conference.
Dr. P. K. Biswas
Hony. General Secretary
HONY. GENERAL SECRETARY’S
ANNUAL REPORT
For the Year 1975
1975 has been a year of progress and consolidation for the Association. The
Declaration of the Emergency in the country and the subsequent emergence of disci
pline and hard work in its wake has helped the Association in its pursuit of Scientifi
work amongst “people at work”. The Social awareness of providing an adequate
occupational health service to industries mines, plantations and offices has also con
tributed to its growth and utility. The Hony. General Secretary takes this opportu
nity in thanking the Hon. Health Minister, the Hon. Labour Minister. Senior
officers of the Ministries of Health and Labour of Govt, of India C.S.I.R., I.C.M.R.
The Directors and staff of the National Institute of Occupational Health Ahmedabad.
All India Institute of Hygiene and Public Health Calcutta, the Central and Regional
Labour Institutes, the Labour and Health Departments of the State Governments
the I.M.A. and the various voluntary agencies for all the help and assistance rendered
to the Association.
XXVI Annual Conference
The 26th Annual Conference and the 23rd Annual Convention of the Bombay
Branch was held at oberoi Sheraton Hotel and Matatlal Sabagriha Bombay between
28-31ts March 1975.
The Scientific Sessons were well planned and evoked keen in
terest amongst the speakers and the participitants. The warm hospitality of the
Bombay Branch will be remembered by all the members and their families attending
the conference.
The Sir Ardeshir Dalal Memorial Lecture “Dust is Dangerous” was delivered by
Dr. S. H. Zaidi Director, Industrial Toxicalogy Research Centre, Lucknow. In his
erudite lecture Dr. Zaidi traced the role of dusts in causing health hazards and occupa
tional diseases. He described the relation of malnutrition and infection to silicosis
and ended his lecture by suggesting ways and means of preventing these diseases.
The authors of the following 2 papers have been judged as the joint recipients
of the Bel-Ind-Med Award 1974.
1.
“Effects of Exposure to mercuray in Caustic Soda Plants in Maharashtra ” by
Drs Haiwant Singh and V. P. Gupta.
and
12
2.
“Follow up behaviour of Byssinosis and chronic Bronchitis” by Drs. S. R. Kamat,
V. Y. Salpekar, D. D’Sa, H. Singh., A. L. Sadekar and G. R. Kamat.
The work of the Association is incorporated in the work of the following
Subcommittees :
Scientific Subcommittee Members elected arc :
1.
Dr. S. K. Roy Choudhury (Calcutta)
2.
3.
S. Chakravorty (Convenor)
Dr. R. Mazumder
4.
5.
6.
Dr. P. K. Biswas
Dr. C. P. Sadarangani (Bombay)
7.
8.
9.
Dr. B. Prabhakara Rao (Andhra Pradesh)
Dr. P. P. Santanam (Tamil Nadu)
Dr. K. V. Subramanyam (Karnatak)
Dr. S. K. Mehta (Baroda)
During the year the Scientific Subcommittee met regularly and finalised its report
on the Pre-employment Medical Examination.
The Sub-Committee has begun work on “Survey of Periodic Health Exa
mination” which will continue through out the year.
Journal Subcommittee
Members elected are :
Dr. B. B. Chatterjee (Calcutta) Editor
Dr. R. Mazumder (Calcutta) Associate Editor
Dr. B. Roy (Calcutta) Journal Secretary
Dr. B. Bhattacharjee (Calcutta)
Dr. A. L. Mukherjee (Calcutta)
Dr. P. K. Biswas (Calcutta)
Dr. B. B. har (Howrah)
Dr. C. V. Talwalkar (Bombay)
Col S. L. Chadha (Delhi)
Dr. M. P. Prabhakar (Tamil Nadu)
The Journal Committee published 4 issues of the Journal during the year.
The
Editor has tried to publish the maxiumm number of scientific articles and papers-
13
received by him within the limited resources available to him.
Members from all
So that
over India are earnestly requested to secure advertisements for the Journal.
it may become financially self-sufficient. To facilitate regular receipt of the journalst
The Journal Secretary requests all Branch Secretaries to keep him informed of new
subscribers and changes in addresses of members.
Association’s Policy Subcommittee
Members elected are :
Dr. C. K. Ramchandar (Tamil Nadu) Convener
Dr. P. V. Thacker (Bombay)
Dr. J. C. Kothari (Bombay)
Dr. G. Arjundas (Tamil Nadu)
Dr. P. K. Ghosh (Calcutta)
Brig H. M. Gangopadhyay (Asansol)
Dr. S. S. Verma (Delhi)
Mr. K- Narasimha Raju (Andhra Pradesh)
Dr. G. R. Dholakia (Baroda)
Terms of reference of the Sub-Committee are :
(a) -To implement ILO Recommendations.
(b) To advise Employee’s State Insurance Scheme’s Policy in respect of Occu
(c)
(d)
pational Diseases.
Factories Act possible revision infuture.
Past recommendations of the Association and their follow up.
The Sub-Commit ee is pursuing in advising the Association in attaining the
above objectivictes.
XVIII. International Congress on Occupational Health held in Sept ’75 at Brighton
England
The following members attended the above congress.
Dr. P. V. Thacker (Bombay)
Dr. P. K. Ghosh (Calcutta)
Dr. S. K. Mehta (Baroda)
Dr. R. C. Panjwani (Bombay)
Dr. B. Bhar (Howrah) and
Dr. A. K. Sen (Calcutta)
Dr. P. K. Ghosh and Dr. S. K. Mehta read papers in the conference
14
Permanent Commission on Occupational Health.
It is a matter of great pride and honour for the Association that its President
Dr. P. V. Thacker is the first Indian to be elected on the Permanent Commission on
Occupational Health. This election took place duiing the XVIII International
Congress on Occupational Health.
Membership
During the year both Branch and Direct Membership have increased from the
previous year.
Branchwise membership position is given below
Total
No. of Members
Branch
H
L
F
A
I
Ahmedabad
—
—
—
—
—
—
—
31
32
28
13
24
30
108
97
63
17
29
10
93
26
—
Andhra Pradesh
Asansol
Assam
Baroda
Bihar Coal Fields
Bombay
Calcutta
Delhi
—
—
—
—
31
34
28
13
5
2
3
—
16
2
6
1
10
—
1
—
—
—
4
35
32
130
101
69
18
12
—
—
—
44'
10
105
26
17
—
—
—
123
16
—
1
19
73
9
824
Howrah
Jamshedpur
Kerala
Karnataka
Pune
Tamil Nadu
Tbana-Kolaba
Direct
Total
—
—
—
3
—
1
—
—
—
—
—
—
—
—
—
4
2
—
—
—
—
106
16
18
1
10
731
1
—
—
—
—
—
—
—
INDIAN ASSOCIATION OF OCCUPATIONAL HEALTH
Financc
The able work of the Hony. Treasurer is reflected in the Statement of Acco,
for the currenl year.
CENTRAL COUNCIL MEMBERS 1976
All the Branch Secretaries have co-operated by sending hal
the Centre’s Subscription for the year within 30th June.
(To be ratified by The General Body)
Election of Office Bearers for 1976
There was unanimity in the nominations for the posts of the President and
Presidents and hence no election was necessary.
Chatterjee
This angurs well for the smooth-), j_j
ning of the Association.
parikh
Jr. L. G. Doshi
(Br. Secy.)
Andhra Pradesh
1. Dr. N. C. Mukherjee
2. Dr. J. R. Bhate
3. Dr. B. Prabhakara Rao
(Br. Secy.)
Asansol
Baroda
1. Dr. S. K- Mehta
2 Dr. D. V. Vyas
3. Dr. P. C. Bhatt
(Br. Secy.)
Bihar Coal-fields
1. Dr. P. Prasad
2. Dr. A. S. Mandal
3. Dr. A. N. Shaw
(Br. Secy. )
Calcutta
1. Dr. M. K. Basu
2. Dr. S. Chakraborty
3. Dr. J. C. Nag
4. Dr. B, Roy
5. Dr. N. Pa. Chandhuri
6. Dr. P. K. Biswas
Delhi
1 Dr. B. Bhattacharya
(Br. Secy.)
2. Dr. H. C. Govel
3. Col. S. L. Chadha
3rd Eastern Regional Conference
3rd Eastern Regional Conference was held this year at Gauhati on 22-23rd I»m
The Assam Branch is to be congratulated on arranging an interesting Scientific rr- M^5'gK^iarl
cultural programmes.
(Br. Secy.)
*
Activities of the Branches
All the Branches pursued their usual activities in holding lectures.
Sciqjfnay
The H. P. Dastur Memorial Medal donatecDr. M J Saldhana
V. Talwalkar
Jamshedpur Branch was awarded to Dr. S. N. Sharma.
Sr. J. C. Kothari
Symposia and clinical meetings.
i’r. C. P. Sadarangani
Formation of a New Branch
Thana-Ko'aba Branch with 16 members was formed in April 1975.
We ?r’ R’
)r M R. Bhatt
come them amongst our midst and wish them all success for the future.
Central Council Meetings
The 2nd and 3rd
Central Council Meetings were held in
Howrah
1. Dr. B. Bhar
2 Dr. S. C. Bej (Br. Secy.)
Madras
Ahmedabad respectively. The President and the Hony. Gen. Secretary atte1 i.‘
both the meetings and helped to Strengthen the liasion between the Centre ant hCpPRr Bharucha
Branches.
’
A R N praSad
C.K. Sengupta
The Hony. Gen. Secretary gratefully acknowledges the help and guidance r
ceived fsom the President Dr. P. V. Thacker the Hony. Treasuier Dr. M. R. I
Tamil Nadu,
1. Dr. C. K. Ramchandar.
2. Dr. M. K. Mani
3 Dr. S. Bhoopathyvijaya3. Dr. K. Venkata Rao
Krishna
4. Dr. Ravifeayan
4. Dr. K. S. Krishnagopal
5. Dr. K. v. Subramanyam
5. Dr. P. P. Santanam
Karnataka
1. Dr. V. Bala-Krishna
2. Dr. R^Bhagwan
the Editor Dr. B. B. Chatterjee the Journal Secretary Dr. B. Roy the Hony. Jf
tary Col. S. C. Chadha the Past Hony. Gen. Secretary Dr. A. R. N. Prasad, C
Council Members and Bsanch Secretaries for the smooth running of the Assc
Colcutta
P. K. Bisw-
20th Nov. 1975.
Hony. GenerafSecret)
Pune
COUNCIL MEMBERS NOT RECEIVED
Ex-Officio Metnders
Immediate 2 Past Presidents
Editor
Journal Secretary
16
1. Dr. P. V. Thacker
2. Dr. P. B. Bharucha
To be elected at AGBM
To be elected at AGBM
List cf publications c-f Dr.M.K.Ghakrabcrty,
Scientist * 3* , Central Mining Research Station,
BBSSARCH PAPERS :
1.
Relative Importance of Different Heat-Stress indices in the
Assessment cf Physiological Strain of work in Indian Mines Presented at the Physiology Section of the 61st Indian
Science Congress Session at Nagpur, 1974.
2.
Metabolic Cost of Coal Miners’ Work in India - Presented
at the Physiology Section of the 61st Indian Science Congress
Session at Nagpur, 1974.
3.
pne’snoc onio sis Pre bl as in Indian Mines . Presented at the
IV international pneumoconiosis Conference, Bucharest,
27 September - g October 1971 (
4.
Effect cf Heat Stress in Repetitive Mining Wr?rk . proc; cf
the Symp. on ‘Health in Relation to VJcrfc and Feat Stress in
Places of Wcrk’ organised by the National Institute of
Occupational Health, Ahmedabad, bald in January, 1972, p.lll.
5.
3nvironment.il Stresses and their effects on Miners’ Work Presented at the Seminar c.n Ergonomics, Organised by the
Ufa Science Centre, Calcutta University in Fteb.1972 - Proc.
under publication.
8.
Physiological study on a coal cutting machine - Presented at
the Seminar on Ergonomics, organised by the life Science
Centre, Calcutta University in Feb. 1972.
7.
pneumoconiosis ^search in India with Special Reference to
Mines - Presented at the Seminar c-n ‘Man at Vfolfc
*
, organised
by the Central Labour Institute, Bombay In April, 1972.
Prcc.under publication.
8.
Comparison of physical working capacity and physiological
work lead of Indian and Swedish Miners - Presented at the
Seminar on ‘Man at Work
*
organised by the Central Labour
institute, Bombay in April 1972. Proc, under publication.
9.
Changes in Chemical Constituents of Blood 5n Comparison to
other Physiological Respcnses in Mining Operations - Ind.
Jour. Indust. Med. Deer. 1971.
10.
Air Pollution Problem in Mining Industry - Proc. Seminar on
Pollution and Hu^an Environment, Organised by Tliaba Atomic
Research Centre, Bombay, 1970, p.397.
11.
Full Shift Dust Exposure In Indian Coal Mines - Ind. Jour. Indust.
Med., 16, 113, 1970.
12.
Changes of Ventilatory Function amongst Stackers and non-smokers Ind. Jour. Physiol, and. pharmaccl. 14, 165, 1970.
13.
Hazards of Dust In the Manufacture of Refractories - Ind.
Jcurn. Industr. Med. 17 , 74, 1971.
14.
Bleed lactic Acid in Comparison to other Common Physiological
Responses in Determining the Heaviness cf Mining Work - Presented
at the physiology Section of the Indian Science Congress
Session in 1971 and accepted for publication ty the Ind.Journ.
Physloliflst and Pharmacologist.
fem
(first
-S 2
15.
Physico-Chemical Properties of Goldmine Dust in Relation to
the Nature of Silicosis Caused by Its Inhalation - Ind. Journ.
Industr. Med. 15, 815, 1969.
16.
Comparison of Some Sc da-Lime Preparations for Suitability of
Use in Breathing Apparatus - Journ. Mines, Metals <S- Thiels,
1969, Nov. p.391.
17.
Study of Sidero-Silicosis Problem in an Iron Ore Mine Research Paper No. 54, Reference GMRSLH4/54, 1972.
18.
Recent Trend of Blinking on bust problem in Mines in Relation
to the Minerals Involved - Jour. Mines, Metals and Fuels, 16,
299, 1968.
19.
Dust problem under Diverse Occupational Situations - Ind. Jour.
Indust. Med. 14., 147, 1968.
20.
Environmental Stresses Limiting the Working Efficiency of Indian
Miners - 12th Indian Standard Convention, Bhubaneswar, 14-21
Dec., 1968.
21.
Industrial plumbism and Its Control - IM. Jour. Indust. Med.,
14, 1, 1968.
22.
Respiratory Function in Indian Miners
Med., 14, 167, 1968.
23.
Ah Integrated Approach to the Assessment of Environment Work
Stress in Mining
Ind. Jour. Indust. Med., 13, 118, 1967.
24.
Measurement of Residual Volume - Ind. Jour. Physiol, and
Allied Sc., 21, 14, 1967.
25.
Some Important problems of Health Associated with MinersJWork Ind. Journ. Industr. Med., 13, 1, 1967 (P.P.Chowdhury Memorial
Lecture).
26.
Physiological Com pari son of Standard Exercise Tests - Ind. Journ.
Physiol, and Allied sc., 20 , 31, 1966.
27.
Aerobic Working Capacity of Indian Miners - Proc, Sjhnp. onlHuinan Adaptability to Environments and Physical Fitness
*
Ed. M.S.Malhotra, Defence Institute of Physiol, and Allied Sc.,
Madra s, 1966, p. 107.
28.
Pulmonary Function Tests : III. The Effect of Respiratory
Fraqueacy on Determination of Maximum Breathing Capacity:
Ind. Jour. Physiol, and Allied Sc. , 19, 73, 1965.
29.
Pulmonary Function Tests:
II. Maximum Breathing CLapacity and Its Relation to Timed
Expiratory Capacities : Ind. Jour, Physiol, and Allied Sc.,
18, 87, 1964.
30.
Pulmonary Function Tests:
I. Lung Volumes and Capacities of Indians in Health:
Ind. Jour. Physiol, and Allied Sc., 18 , 35, 1964.
*
31
Manganese in Normal and Excessive Intake: Ind. Jour, Indust.
Med., ID, 110, 1964.
32.
An Industrial Hygiene Survey in a Lead Snelting Factory:
Ind. Journ. Industr. Med., 10, 145, 1964.
33.
Observations on the Physiological Responses in Mine Rescue
Work: Ind. Jour. Indust. Med., 9, 156, 1963.
Ind. Jour. Industr.
— 2 3 I34.
Certain Aspects of Environmental Health Conditions in Indian
Mines - A Study : Ind. Jour. indust. Med. , 9, 91, 1963.
35.
Atmospheric Pollutions - A Study in Calcutta : Ind. Jour.
Med. Res. 50 , 295, 196 3.
36.
a Preliminary 'Work on Assessment of Dust Hazard in Indian
Mines : Ref. Hl/2, Central Mining Research Station, Dhanbad,
November, 1961.
37.
Report of Manganese Poisoning Enquiry Committee 5 published
by the Ministry of Labour & Employment, Govt, of India, 1960.
38.
Atmospheric Pollution . Is it a Health Problem in Calcutta? *
Journ. Science Club, 13, 39, 1959.
39.
Air Pollution in Calcutta s Proc, of the Second Asian Conf.
Occup. Health, November 14,23, 1958, p.114.
40.
Air Pollution - The problem in Industrial Cities : Ind. Jour.
Indust. Med., 3, 1, 1257.
41.
The Toxicity of Tris (Beta-Chloropropyl) Thio Phosphate Report of Kettering Laboratory, University of Cincinnati,
Ohio, U.S.A., 1957.
42.
The Immediate Toxicity of 1, 2, 3 Trichloro - 4. 6 - Dinitro
benzenes Report of the Kettering Laboratory, University of
Cincinnati, Ohi r>, U. S. A., 1955.'
43.
The Toxicity of Dicapryl Diglycollate and of Several Related
Compounds - Report of She Kettering Laboratory, University of
Cincinnati, Ohio, U.S.A., 1955.
44.
Study of the Occupational Lead Hazards in Select Indian
Industries : Ind. Journ. Med., Res. 38 , 429, 1950.
45.
Study of Occupational Lead Hazard in two Electrical Accumulator
Industries : Ind. Med. Gazette, 87, 114, 1952.
46,
An Investigation of Occupational Lead Hazard in Indian Workers Thesis submitted to Calcutta University in 1951 which enabled
me to get D.Phil.(Sc.) degree of that university.
47.
Hazards of Manganese Ore DUst in Indian Mines - Ind. Mining &
En.gg, Journ,, Sept. Oct., 1969, p.149.
48.
Characteristics of Refractory Dusts in Relation to Silicosis
Hazards to the Exposed Workers - Proc. V. Asian Conf. Occup.
Hl th, Bombay, 1968, p.62.
49.
Physiological Limit for Sustained Work of Indian Miners.
Proc. V. Asslan Conf. Occup. Hlth., Bombay, 1968, p.193.
50.
What is to be Measured in Dust for Control of Health Risk? Second Tech.Conf.on Mining - Ventilation Engineering & Mine
Environment, Ind.School of Mines, Dhanbad, 1968.
51.
Dust Problem in Coal Washeries - Presented at the Annual
Conference of the Indian Association of Occup.Health, 1972.
52.
Physiological Cost of Some Ancillary 'Work in Connection with
the Safety Measures in Coal Mining - presented at the Annual
Session of Ind. Assoc. Occup. Hlth., held at Hyderabad, 1973,
53.
D«st as Air pollution problem m Mines & Washeries - Presented
at the Annual Session of Ind. Assocn. Occup. Hlth., held at
Hyderabad, 1973,
REVIEW PAPERS AND ARTICLES $
1.
Thermal Pollution and Its Impact on Nature and Man - Republic
Day Special Issue, 1973, Not/ Sketch, Ehanbad.
2.
Review cf Air Pollution Control Measures in India - Report on
the Regional Seminar on Air pollution Control held at Nagpur
4.15 December, .1972 - WHO Project SEARO, 0150, 1973.
3.
Environment and Health - Republic Day Special Issue, 26th January,
1974, The New Sketch, Dhanbad.
4.
Research on Safety in Minos in India - Safety in Mines, Souvenir,
Stn^arenl Colliery Company Ltd;, p.44,
5.
Sir Ards shir Dalal Memorial Lecture - ’Industrial Dust - Its
Properties and Measurement for Control of Health R5.sk
*
- Ind.
Jour. Indust. Med. 16, 41, 1970.
6.
Evaluation of Inhalation Hazard from Assessment, of Environmental
Dust Ind. Jour. Occupl. Health, 11, 139, 1968.
*
7.
Man in Relation to the Environment, H® Lives in or Creates by
His Activity: Bihar Factory Inspection. Service Assoc., Jovr.,
January—June 1,A 2, 1968, p.8.
8.
Pneumoconiosis Problem in Indian Mines; Mines Safety News 3, 7,
3967.
9.
Consideration of Human Factors in Industrial Plannings Coal &
Steel, 6, 13, 1967.
10.
Breathing Apparatus in Mine Rescue Work and Fire Service-} Jour.
Mines, Metals & Fuels, 14, 369, 1966.
11.
Pneumoconiosis as an Occupational Health Problem: Souvenir,
All India Med. Conf. 42nd Session, Dhanbad, 1966, p.71.
12,
Certain Important Factors in the Consideration of Industrial
Health and Efficiency: Pat. J. Med, 43, 395, 1966,
13.
Work Physiology - Its Application in Industry for Increased
Efficiency, Ind. Jour. Indust. Med. 11, 135, 1965.
14.
Industrial Dust and Its Assessment: Jour. Mines, Metals and Fuels,
12, 267, 1965.
15.
Health Hazards in Mining Industry: Metal and Minerals Review, 4,
35, 196 5.
16.
Special Health problems in the Mining Industry : Jour, Mines,
Metals & Fuels, 12, 105, 1964..
17.
Industrial Toxicology ana Its Recent Trend : Ina. Journ. Indust.
Med., 10, 1, 1964.
18,
Health Hazards in Mines: Coal & Steel, 3, Novr.1, 1963.
19.
Plan to Reduce Mining Health Hazard Needed: Indian Manufacturer,
2, 12, 1961.
20.
Dust Problem in Coal Mines: Jour. Mines, Metals & Fuels, 9,1,1961.
21.
A Mathematical Model for Measuring Mass/Nunber Index of Respirable
Air-Borne Coal Dust: Jour.Mines, Metals & Fuels, July 1970,
p.359.
22,
Dimension of a Gravimetric Coal Dust Collecting Sampler: Jour.
Mines, Metals & Fuels., May, 1971, p.143.
-i 5
23.
Problem of Fatigue in lining Industry: The New Sketch, 26th
January, 1971, Special Number.
24.
Da";'“rs from Dust in Mines: The New Sketch, CSIR Jubilee
Sup pl erne nt, Aug. 1968, p. 23.
25.
Bnvitcnmar.tsl Stress and Mining Work: The Coalfield Times,
CSIR Silver Juhilee Supplement, Aug. 1968, p.9.
26.
Refractory Dusts and Silicosis Hazards, Swasth Find, 13, 198, I960
CJ’frXJL LABOUR INSTITUTE
SIOII, BOMBAY - 22.
Lis? cf rj: :arch reports publi.d lsd
t.
Investigation on the incidence of occupational diseases in the manufacture
of dichrcmate and in the mining and concentrating of chromite (1953).
2.
Environmental and hfedical studies in the storage battery industry (1953).
3.
Silicosis in Mica Mining in Bihar (1953)
4.
Health hazards in Mica Processing (1954)
5.’
Vital Capacity of the lungs of silica and fire-clay brick worJcers in
Bihar with special reference to dust exposure, exercise tolerance test
and incidence of silicosis (1954).
6.
Cardiac response to effort of silica and fire-clay brick workers in
Bihar.
Results of exercise tolerance test with special reference to vital
capacity measurement and incidence of silicosis (1954).
7.
Preliminary study on thermal environmental conditions in two typical
cotton ’leaving sheds in a textile mill, in Delhi (1954).
8.
Silicosis amongst supervisory staff in Mica mining in Bihar (1955).
9,
Accidental deaths from insecticidal fumigant mixture of ethylene dichloride
and carbon tetrachloride 3 ; 1 (1955).
10.
Silicosis in metal grinding ( scissors and razor grinders in Meerut),(1955)
11.
Silicosis in the pottery and ceramic industry(1956).
12.
Silicosis amongst hand drillers in mica mining in Bihar, (1956)
13.
Vital capacity of the lungs of workers in ceramics and potteries industry (1956)
&
14.
Cardiac response to efforts of workers in ceramics (1956).
15.
Silicosis in the female (1956).
16.
Report on thermal stress in textile industry, 1957.
17.
Survey of carbon disulphide, hydrogen sulphide and sulphur dioxide hazards
in the Viscose Rayon Industry in India, 1959.
18.
Health hazards during
19.
Pneumoconiosis in the Coal Mines in Jharia and Ranigunj Coal Fields,(1961)
20.
Silicosis Hazards in a Lead and Zinc Mine in Rajasthan,(1961)
D.D.T. manufacture(1959).
21.
An Industrial Hygiene study in a Ferro Manganese Plant, 1962.
22.
Body Measurement of Male Workers in Textile Mills in Bombay; by Dr. A.K. Sen
Gunta and Dr. B.H. Sen, 1964.
23.
Heart Rate Response in wearing of variety of Industrial Protective face masks by Dr. 3.K. Chatterjee, 1964.
2.
24.
Assessment pf Morklbsd and Thermal Stress on relation to'Physiological
tesponses of Workers in a cotton textile mill in Bombay - by Dr-. I. N.
Sen, Dr. S. K. Chatterjee^ P.JT. Saha and A. Subramanian,(1964.)
25.
Assessraerit of Workload and Thermal Stress in relation to Physiological
Responses of forkers in a Soap Fact’ ry in Bombay - by Dr.
Jen,
Shri ?.
Saha and Shri .A. Subramaniam (1964).
26.
Vascular Fatigue luring transport of load in the Horizontal Plane - by
Dr.
Qipta and Privanedozent Dr. Ing. W. Rohmert (1934). ■
27.
Rationalisation of Work Period and test Pduse in a Steel Rolling Mill
in Bombay - by Dr. R. ’I. Sen,
Chatterjee, Shri P.’-T. Saha &.
Dr. J.C. Fletcher.
28.
Studies of Attitude and forale in three units of large chemical process
undertaking - by Dr. l.H. Jones, Dr. T, Ganguly & Dr. G.E, Sequerra (1964).
29.
Study on the Attitudes of- Officers towards changes in Management Practices
in a Textile’-Factory - by Dr. H.G. Maule & Dr. ?. Ganguly■ (1964)
30.
Medical and Environmental study in a plant manufacturing D.D.T. (1965).
31.
Investigation of Occupational-Hearing Impairment and Moise in a Nitric
Acid Plant, (1965).
32.
A study on Manage tent Morale in a private industrial undertaking - by Dr. H.C.
Maule & Dr. T. Ganguly (1965)
33.
A Study of
Road Accidents in B.E.S.T. undertaking - by Dr. 0.
Ganguly
and Shri R. 0. Kasbekar.
34.
Visual Performance of Workers in Textile and Engineering Trades - by Dr. MiN.
Gupta and Dr. Harwant Singh (1966).
35.
1 study on Attitude and Morale.
Its impact on Personnel Relation and
Recruitment in an Engineering undertaking
36.
- by Dr. O.M. Ganguly (1967).
A study on Attitude and Morale of Employees at Dalmia Cement (Bharat) Ltd.
Trichy - by Dr. O.N; Ganguly & R.G. Kasbekar (1938).
37.
Body Measurements of Indian Workeirs in relation to sitting arrangement
Part I - Study in a Radio Manufacturing Factory in Bombay - by Shri P.’J. Saha
(1968).
38.
■
Body Measurement of Indian Workers in Relation to Sitting Arrangement :
Part II- Study in a Pharmaceutical Factory in-Bombay - by Shri P.-T. Saha (1968)
39.
Study of Parathion Exoosure in Formulation Process - By Dr. S.K. Chatterjee
and R. A. Ballare, (1968).
40.
Report on cases of Dermatitis of Industrial Workers by Dr. S.K. Chatterjee
and Dr. S.E. Merchant, (1968).
41.
Occular Effects and Visual Performance in Welders by Dr. I-I.N. Gupta and
Dr. Harwant Singh, (1968).
42.
A comparative Study of Attitude and Morale of the employees in 3 Divisions
of a large Industrial Comdex - by Dr. 0. ’.I. Ganguly, R.G. Kasbekar and
S.
V. Diwaker (1969).
45.
Studies on Absence from Work - by Dr. O.N. Ganguly, J. 3. Bartlett &
11. C-. Kasbekar (1970).
44.
Physiological Evaluation of the jobs of Doorman of the Cokeoven Battery
of a Steel Plant - by Shri P.W. Saha (1972).
45.
Ttermal Stress in Textile Mills in Vidharbha - by P. N. Saha & Dr. S.K. Das
4G.
A study of Personal Factors contributing to the causation of Hoad .Accidents
in Tamil Nadu State Transport - by Dr. O.N. Ganguly & S. K. Bhattacharya,
(1972).
47.
Assessment of Health Status of Foundry Workers
Dr. 3. K. Das & 3. K. Dangwal (1972).
43.
Report on the investigation of study on .'Dermatitis in an Engineering indus
try - by Dr. Harwant
49.
- by Dr. S. Bhar, P.’I. Saha
Singh & Dr. 3. Bhar.
A Study of Management Moral in an Iron & Steel Industry - by O.N. Ganguly
& H. G. Kasbekar.
STANDARD MOTE ON INDUSTRIAL MEDICINE DIVISi'cn
(as on 1st January, 1974)
1.
FUNCTIONS
1.1.
The main functions of this Division are:
to carry out research, surveys and studies on health
i)
hazards and occupational diseases;
to promote awareness of occupational hazards and
ii)
measures to combat them;
to render technical advice regarding occupational
iii)
health aspects to industry, mines, plantations
and
Docks;
to provide training facilities for Medical Inspectors
iv)
of Factories and others;
v)
to assist the Chief Inspectors of Factories on
Industrial Health problems.
1.2.
These
involve occupational history taking,
clinical
examination/and 'bio-chemical examinations, wherever necess
ary, of workers exposed to various toxic and other occupa
tional hazards.
2.
FACILITIES
2.1.
The laboratory is well equiped with special equipments for
conducting studies on
(1) Noise problem
3.
(ii)
Visual acuity
(iii)
Pulmonary functions
(iv)
Neuromuscular reactions.
STUDIES & SURVEYS
3.1.
Studies and Surveys carried out during 1973.
1)
A survey on Health Hazards of Mercury' was carried out at
m/b.
Century Chemicals, Kalyan.
CEIL
a.
2)
A study cri Health Hazards of pesticides was carried out at M/s
Khandesh pesticides Ltd., Dharangaon.
3)
A study on health Hazards of pesticides was carried out at M/s
SANDOZ Ltd., Thana.
4)
A survey on the suspected health Hazards in the sewage treat
ment plant at the Air-India Building, Nariman Point was carried
out.
Necessary recommendations were made to the management.
TRAINING
4,
4.1.
The following groups/individuals received training on various
aspects of occupational health during 1973,
1)
Dr. U.Sit Than Oo. Medical Inspector of Factories, Burma, on
occupational Health, Efealth Hazards and Factory Inspection. ■
2)
A group of 4 Trainees from Iran for 3 days in Occupational
Health Hazards.
3)
About 100 under graduate medical students in 3 batches from
the
G.S. Medical College, Bombay, on Occupational Health.
4)
Sixth Refresher Course on Occupational Health organized by this
Division for medical officers concerned with Occupational Health.
5)
Seventh Refresher Course on Occupational Health Organised by
this Division for the medical officers concerned with Occupational
Health.
6)
A total of 6 probationers from the Tata Administrative Services in
batches of two at a time, on Occupational Health.
7)
A group of 8 Safety Inspectors attending a
certificate course
in Safety of the Cochin University.
8)
Thaining in Industrial Medicine to 7 post-graduate medical
officers from the firmed Forces Medical College, Poona (D.I.H.
course) for one week.
9)
Mr. Samraveera, Inspector of Factories, Ceylon, a trainee
sponsored by I.L.O. was given a short training in Occupational
Health.
3:.
The following lectures/talks were delivered during the year
4.2.
1973 by the officers of this Division.
1) "Noise-its effects on man" to a group of middle management
personnel, attending a course in Industrial Ergonomics orga
nized by this Institute.
"Jfealth Hazards" to a group of middle management personnel
2)
attending a course in Industrial Safety organized by this
Institute...1.
Lectures on the following subjects were delivered by the
3)
officers of this Division during the 6th Refresher Course on
Occupational Health conducted by this Division.
1) Poisoning by Phosphorus and its compounds
4)
ii)
Noise-its effects on man
iii)
Pneumoconiosis and occupational Lung diseases
iv)
Asbestosis
4) The following lectures were delivered by officers of this
Division during the training course for factory inspectors.
i)
Occupational Diseases.
ii)
Activities of the Industrial Medicine Division
iii)
Noxious Gases
iv)
Noise Control, practical evaluation.
5)
Health Hazards of "Copper," "Mercury," "Arsenic" and "Lead
Oanpounds" and "Emergency measures and first aid in controlling
poisoning by pesticides" to a group of manufacturers of pest-
cides and others attending a course on "Hbalth Hazards of
pesticides and their control."
6)
"Effect of Noise on Man" to the
participants of the course
on Industrial Fatigue and Rest Allowances.
7)
"Occupational Health" to the participants of the Course on
Modern Aids to Managements.
8)
"Industrial Injuries and Compensation" to the trainees of the
Degree Course on Physiotherapy at the All India Institute of
Physical Medicine and Rehabilitation, Bombay.
4<
9)
"Hearing Conservation Programme and Audiometry" to the part
cipants of the Course on Industrial Noise.
"Health Hazards" to a group of senior management personnel of
10)
Small Scale Industry attending a Course on Industrial Safety.
Lectures on the following subjects were delivered by the offi
11)
cers of this Division during the 7th Refresher Courses on
Occupational Health Conducted by this Division.
Pneumoconiosis and Occupational lung diseases
i)
ii)
Workmen's- Compensation Act
iii)
Poisoning by Mercury
iv)
History of Occupational Health
v ) Hazards of lead.
The following lectures were delivered by officers of this
12)
Division during the Hird Training Programme on Hazards in
Chemical Industry for Factory Inspectors :
i)
Dust Hazards
ii)
Occupational lung Diseases
Occupational Dermatitis.
iii)
4.3.
Officers of this Division participated, in the following
Seminars and presented papers in seme.
i)
Seminars on "Physical Medicine and Rehabilitation" at New
Delhi.
ii)
Udaipur.
iii)
Paper on 'Evaluation of Industrial Injuries’.
Conference of the Association of Physicians of Ijidia at
Paper on 'Asbestos and its Health Hazards'.
ML;.India Conference of Indian Association of Occupational
Health at Hyderabad.
Papers on
'Investigation of Dermatitis
in an-' Engineering Industry’ and on 'Environmental Noise
in a power Plant’.
iv ) Seminar on Air Pollution Control Techniques.
v)
Medical Symposium on Oceanography sponsored by the Indian
Nhvy.
UNIVERSITY OF POONA
Ordinances & Regulations for the diploma in IndustrialHealth (D-I.H.)
0.33A.1
No candidate shall be admitted to the course for the
Diploma in Industrial Health (D.I.H.) unless he ;
(i) has passed the M.B.B.S. degree examination of this
University or an examination of any other staturoty University
revognised by this University as equivalent thereto.
(ii) has completed such period of postexamination, pre
degree compulsory housemanship or internship which entitles him
to the award of the Degree of Bachelor of Medicine and Bachelor of
Surgery as required by and to the satisfaction of this University,
where applicable.
(iii)
has taken the said degree and
(iv)
has acquired registration as a medical practitioner
according to the rules in force for full registration under the
Maharashtra State Medical Council 6r any other Medical Council und
the Indian Medical Council Act prior to registration with this
University for the said Diploma course.
0.33A.2.
A candidate admitted to the said Diploma shall
(i) comple a course of study as prescribed for the Diplont
for a period of not less than four academic terms after rs-gistration for the course with the University of Poona under a recognis .c
teacher. Two of the above four terms shall be spent in a recogni--=
resident or full-time post in Industrial Health or Public Health
or Preventive and Social Medicine or equivalent, in a recognised
institution. However, if a candidate has already held a resident
post or equivalent as stated above in a recognised institution
for a period of one year, he or she may be permitted to register s
for the said Diploma, granting exemption of two academic terms and
be permitted to appear for the examination for the Diploma on
satisfactorily completing the prescribed course for the Diploma f<
not less than two academic terms, and
(ii) complete a course in General Medicine for a period of
not less than 3 months under a recognised teacher at a recognised
institution concurrently or after completion of the prescribed
course for the Diploma. This however, does not apply, bo a.candid
who has done a resident post in General Medicine for a perioa oi
not less than three months each prior to registration in a recogx;
sed institution under a recognised teacher.
.... 2/_v urfttTH CELL
' r
Marks3oa<i
47/1, (First
0(n
'
*
BANG
0
- 2 -
R.33A.1
The syllabus for the diploma shall be as under sI-
Int x oduc t i on
12.
3.
II-
Course objectives
History of Public health and industrial health
Role of preventive medicine with special
reference to occupational health.
Biostatistics
The role of statistics in preventive medicine
Collection and presentation of data - tables and diagrams
Average -mean, median, modegeometric mean
variability - range, mean deviation, standard deviation,
coefficient of variation, etc.
5.
Theories of probability.
6.
Binomial, poison, normal and other distributions
7.
Simple tests of significance regarding means and
proportions - standard error of mean, standard error of
proportion, standard error of difference between two
means, standard errors of difference between two
proportions, t-tests, X
test, etc.
8.
Correlation and regression equation - corelation
coefficient.
9.
Sampling methods
10.
Principles and methods of clinical trials, and
prospective and retrospective studies.
11.
Population census and demography
12.
Vital statistics - measures of fertility, birth rate,
fertility rates, gross and net reproduction rates, etc.
13.
Vital statistics - measures of mortality, death rates,
infant mortality rates, standardised and specific deathrates, life tables, occupational mortality rates, etc.
14.
Health statistics - morbidity statistics, statistics of
maternal and child health, reporting, interpretation, eve
15.
Interpretation of numerical data and statistical
fallacies.
Nutrition
1.
2.
3.
4.
Ill
1.
2.
3.
4.
5.
6.
7.
8.
9.
Principles of dietary requirements and planning
of balanced diet.
Chemistry of food
Physiology of food
Nutritive value of foods and processing of food
Ration scales - principles and.planning.
Food preservation - refrigeration, dehydration,
canning, pasteurization, etc.
Food inspection, food laboratory, legal procedures.
Malnutrition and undernutrition
Nutrition and diet surveys.
- 3 -
IV.
V.
Public Health Administration.
1.
2.
Principles of public health administration
Organization of health services in India - central,
state and municipal (including two weeks attachment to
the office of Medical Officer of Health, Poona
Municipal Corporation, Poona, and office of the
Director of Public Health, Government of Maharashtra,
Poona).
3.
4.
5.
6.
7.
8.
9.
Health aspects of the five-year-plans
Community development programmes
International health organizations
Hospital administration (and visit to a hospital)
Port and aerodrome health administration
Health organization in the armed forces
Public health and sanitary laws, social security, etc.
Public Health Chhmlstry
Chemical analysis of water
Detection and estimation of poisonous metals in water
Chemical analysis of trade affluents and sewage
Food adulteration, preservatives and colours
Industrial laboratory techniques including the
environmental and ‘'threshold level" studies.
1.
2.
3.
4.
5.
VI.
Health Education
12.
3.
4.
5.
6.
VII.
Maternal and Child Welfare
1.
2.
3.
4.
5.
6.
7.
VIII.
Objectives, principles and scope of health education
rhe learning process - incentives to learning
Methods and media
©valuation, testing, and analysis of the results
Education of special groups
Field work and public speaking.
Care of the mother
Uare of the infant
C-are of the toddler
Csre of the child in general
Care of the school child
Easily planning.
ie\d work and- visits to the clinics and institutions.
Sociology, Social Anthropology, Hunan Ecology and Basic
psychology.
IX.
Genetics
1.
Principles of genetics
2.
Haredixy in relation to health and disease.
X.
Epidemiolo^f
1.
2.
Definition and scope
Principles and uses of epidemiology
4.
Statistical methods in epidemiology.
3.
gos^haggtd^^environmental factors in
... 4/-
- 4 XI.
Communicable Diseases
1.
2.
3.
XII.
Non-communicable Diseases
1.
2.
3.
4.
5.
6.
7.
8.
XIII.
Epidemiology, control and precaution of accidents
Ischaemic and hypertensive heart diseases
Hypertension
Cancer
Mental health
Peptic ulcer
Diabetes qiellitus
Obesity.
Microbiology and Immunology
1.
2.
3.
XIV.
Epidemiology, control and prevention of common
communicable diseases - air-borne, fat
alimentary tract infections, contact diseases>
arthopod-borne diseases, zonotic infections, etc.
Disinfection and disinfestation
Clinical work in infectious diseases.
Principles and general considerations of bacteriology ,
mycology, vfroldgy, protozoology, entomology,
helminthology, etc.
Principles and general considerations of serology
and immunology,
Occupational infections - brucellosis,, anthrax,
tetanus, etc.
Environmental Sanitation
Water supplies
Disposal of waste products including industrial wastes
Housing including town planning with special
reference to industrial .towns.
4.
Hural plannihg.
5.
Slum clearance
6.
Air pollution
7.
Ventilation, noise, lighting etc.
8.
Field work and visits for study of sanitation.
1.
2.
3.
XV.
Applied Physiology
1.
2.
3.
4.
•5.
6.
7.
8.
XVI.
Physiology of thermal regulation
Comfort zones and thermal comfort standards
Physical environments in relation to health and
disease of worker, e.g., temperature, humidity, air
velocity and other climatic factors.
Physiological principles of air-conditioning.
Ventilation and effects of dust control.
Lighting and illumination, noise and
vibrations, ana high and low pressures.
Ionizing radiations and their affects and measurements.
Principles of equipments design (ergonomics)
Visit td Primary Haith Centra.
5/-
XVII.
Industrial Psychology
1.
2.
3.
4.
5.
6.
7.
8.
XVIII.
Industrial Hygiene
1.
2.
3.
4.
XIX.
2.
3.
4.
5.
6.
7.
XXI.
Hygiene of work environments
Toxic vanours, fumes, mists and dusts
Disposal of industrial and radioactive wastes
Air sampling and measurement of noise,
dusts, lighting, etc.
Industrial Hazards
1.
XX.
Selection of personnel.
Intelligence, and aptitude tests
Rest intervals, hours of worK, boredom
and discomfort in relation to industrial fatigue.
Human and interpersonnel relationship.
Job analysis and placement of the workers.
Time and motion study.
Vocational guidance.
Load carriage, muscular work, fatigue and ergometry.
Physical, chemical, biological
and psychological hazards
Toxic agents in industry, their modes of entry and
toxic effects (physiological and pathological)
Industrial toxicology
Hazards of dust, noise, and radiations in industry.
Industrial accidents and safety
Personal protective measures.
Control and prevention of the industrial hazards.
Occupational Diseases and Industrial Medicine
1. Common occuuational diseases - etiology, symptomatology >
pathology, diagnosis, treatment and prevention.
2.
Incidence of occupational diseases in India and in
the world.
3.
Miner’s health problems.
4.
Industrial hospitals - surgical and medical emergencies.
Industrial Law
1.
2.
3.
4.
5.
6.
7.
Industrial legislation and labour relations
The industrialist, the state and the worker
Labour unions and labour welfare.
History of industrial laws in India and abroad
Factory and mine inspection system.
Social security and eimskiajraxnfc employee’s state
insurance scheme.
Creche and other welfare activities.
6/-
® » 6 .
XXII.
Industrial Health Services
!•
S'
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Planning and organization of industrial health
services.
In relation t0 "anagement
industrial hygienist, and other personnel.
Industrial.Health surveys.
Health education-in industry.
Nutrition of workers, dietary defLatencies,
organisation of canteen and mid-day lunch.
Maintenance of health and sickness records.
Occupational mortality and morbidity rates
Measurement of health of workers
Absenteeism in industry.
Principles of disablement and rehabilitation, and
services.
Implementation of national health prognammes in
industries, including family planning.
Routing and periodic medical examination of workers
Research - basic and applied in industrial health.
XXIII. Clinics.
1. Traumatic surgery and orthopaedics
2. Chest diseases
3. Ophthalmology
4. Dermatology.
5. Ear, nose and throat cjonditions
6. Radiology
7. Oommunicable diseases
8. Dentistry.
XXIV.
Attachment to mine
1.
2.
3.
4.
5.
6.
7.
Work environments in mines
Health hazards and the preventive
measures taken in mines.
Organization of occupation health services
for the miners.
Industrial hygiene services in the mines
Welfare services for the miners.
Laws and le’gis.1 ative measures pertaining
to health of mihars.
Research activities of the Mining Board.
XXV.
Visits to Shift the Industrial and other Health Establishments
and Institutions.
1.
2.
Central Labour Institute.
Light and heavy engineering, chemical factory,
glass factory, food canning and processing factory.
Visit to Employee’s State Insurance Scheme Office.
XXVI.
XXVII. General Medicine as related to Industrial Health.
R. 33 A.2.
The scheme of the examination shall be as follows
The examination consist of three papers of 100 marks each,
and a clinical practical and oral examination carrying 200 marks.
Part A.
Industrial Health Paper I
3 hours 100 marks
a.
Biostatistics and nutrition
b.
Public health administration
c.
Industrial Law, Social security and labour relations
d.
Occupational health services
e.
Environmental sanitation and Industrial hygiene
f.
Industrial psychology
g.
International health and labour organizations
Industrial Health Paper II
a.
b.
c.
d.
e.
f.
3 hours
100 marks.
Social sciences
Epidemiology and control of communicable
and non-communicable diseases,
Industrial toxicology
Applied physiology
Public Health chemistry
Health education.
Industrial Health Paper III
a.
Industrial health hazards
b.
Occupational diseases
c.
Practice of industrial medicine
f.
Safety in industry
e. Genetics
3 hours
100 marks.
Part B
i.
Clinical and Field Work
a. clinical examination
b. day-book and field inspection
examination
Marks 100
it.
Oral and practicals -an oral and practical examination.
Mirks. 100
- 8 0.33A.3.
No candidate shall be allowed to appear for the said
Diploma examination unless he produces certificates of satis
factory attendance and study of subjects prescribed for the
course for the required period.
0.33A.4
A candidate who has xfcxx satisfactorily completed terms for
M.D. branch V (Preventive and Social Medicine) may be allowed to
appear for the examination for the Diploma in Industrial Health
without keeping fresh terms.
0.33A.5.
A candidate who has once satisfactorily kept terms for
the said Dipqonia course and has either f ailed at the■examination
or did not appear therein, need not keep fresh terms again for
appearing or reappearing at the examination.
-
0.33A.6.
A candidate who has passed D.P.H. examination of Poona
University or any other equivalent examination of another Univer si
recognised by the Poona University may be given exemption of one
academic term of Industrial Health Diploma course (which is commo;
with Diploma in Public Health course). ■
; .
0.33A.7. .
Notwithstanding anything contained in the foregoing, a
candidate who has practised in the speciality for a period of not
less than seven years previously may" be permitted as a special
case by the Academic Council on. the recommendation of :the.Faculty
of Medicine to appear for the said ^iploma examination-without
keeping the necessary terms. Such a candidate shall appear•for
the whole examination.
R.33A.3.
„
P?ss the examination a candidate .shall obtain a minimum
of
marks in each of the following heads separately and
simultaneously.
' '
,1.
2.
3.
Theory .
.
Clinical and field work.
Oral and practical.
R.33A.4.
Those of the successful candida-tes obtaining 75% marks
separately in part A (Theory) and part B (clinical, field work,
oral and practical taken together), shall be declared to have
passed the examination with distinction, provided that the
candidates pass at the first attempt.
MHS/-
'DlR.E.C, to z? y
Pl> 0LiC
5c Uoous
r! Ef) L th
?A
INDIA
In India postgraduate training in public health is available at 8 institutions.
Five institutions are departments of medical colleges and arc academically
attached to the respective universities. One of these—the Department of Preventive
Medicine of the Armed Forces Medical College, Poona—falls within the authority
of the Ministry of Defence of the Government of India; its chief administrative
officer is the Commandant, Armed Forces Medical College, Poona. The other
3 institutions function under the jurisdiction of, and arc financed by, the Central
Government. The medical colleges are directed by a Principal or a Dean, and the
departments of social and/or preventive medicine by a Professor, who is Head
of the department. The departments are concerned with both undergraduate
and postgraduate training in public health.
The All India Institute of Hygiene and Public Health in Calcutta is a constituent
college of the University of Calcutta. The Institute is self-governing and is financed
by the Central Government. At present it has 10 sections that impart training
in public health to physicians and other health personnel. In addition, the Institute
conducts pure and applied research in public health and evolves methods of
utilizing the findings of research in public health practice. It is also one of the
3 Central Family Planning Institutes and serves the country’s Eastern Region.
At the head of the Institute is a Director.
The Calcutta School of Tropical Medicine (one of the colleges affiliated to
the University of Calcutta) provides postgraduate training in tropical medicine
and hygiene and assists and advises medical practitioners, institutions, and
governmental and other organizations in dealing with various problems related
to tropical diseases. The School is headed by a Director.
The National Institute of Health Administration and Education, New Delhi,
is academically attached to the University of Delhi and operates under its jurisdic
tion. The Institute is financed by the Ministry of Health of the Government of
India. At the head of the Institute is a Director.
Courses offered
The following courses are organized:
(1)
Diploma in Public Health (D.P.H.); the course is offered at all the insti
tutions, with the exception of the Calcutta School of Tropical Medicine and the
National Institute of Health Administration and Education, and is of 10-12 months’
duration.
(2)
Doctor of Medicine in Community Health; the course is offered at the
National Institute of Health Administration and Education at New Delhi and
lasts for 2 years.
— 64 —
COJWlWUWJTy MrniT,.
47/’-<f-SX
CEl/
J
INDIA
65
(3) Doctor of Medicine (Preventive and Social Medicine), offered at the
Armed Forces Medical College, Poona.’
(4)
Doctor of Philosophy (Public Health) (Ph.D.), offered at the Armed
I orces Medical College, Poona.
(5) Doctor of Science (Public Health); this degree, conferred by Calcutta
University, is awarded to holders of the D.P.H. subsequent to their obtaining
a bachelor’s or licentiate's degree in medicine and surgery (M.B., B.S. or L.M.S.)
and after at least 2 years of regular training in a recognized institution in some
special public health project previously approved by the Faculty of Medicine,
or at least 3 years’ work in any other approved laboratory in some special public
health subject previously approved by the same Faculty.
(6)
Diploma in Tropical Medicine and Hygiene; the course lasts for 9 months.
(7)
Diploma in Clinical Pathology; the course lasts for 12 months.
(8)
Diploma in Laboratory Techniques; the course lasts for 12 months.
(9)
Licentiate in Tropical Medicine and Public Health; the course lasts for
9 months.
(Courses (6)-(9) arc offered at the Calcutta School of Tropical Medicine.)
(10)
Diploma in Industrial Health; the course lasts for 10 months and is
offered at the Armed Forces Medical College, Poona, and at the All India Institute
of Hygiene and Public Health, Calcutta.
(11)
Diploma in Maternity Health and Child Welfare; the course lasts for
10 months.
(12)
Diploma in Health Education; the course lasts for 12 months.
(13)
Diploma in Dietetics; the course lasts for 10 months.
(14)
Diploma in Nutrition; the course lasts for 10 months.
(15)
Diploma in Health Statistics; the course lasts for 12 months.
(16)
Licentiate in Public Health; the course lasts for 10 months.
(17)
Master of Engineering (Public Health), requiring 2 years of training
(including 1 year of theoretical and practical instruction plus 1 year of supervised
practice).
(IS) Master of Veterinary Public Health; requiring 2 years of training (1 year
of theoretical and practical instruction at the All India Institute of Hygiene and
Public Health, and 1 year at the Indian Veterinary Research Institute).
(19)
Certificate in Public Health Nursing; the course lasts for 10 months.
(20)
Certificate for Health Nursing Supervision; the course lasts for 3 months.
(21)
Course for District Family Planning Officers; the course lasts for4 weeks.
(Courses (11)-(21) arc offered at the All India Institute of Hygiene and Public
Health, Calcutta.)
1 The course leading to the degree of Doctor of Preventive and Social Medicine is also
offered at the Topiwala National Medical College, Bombay, and at the S.M.S. Medical
College, Jaipur.
66
WORLD DIRECTORY OF SCHOOLS OF PUBLIC HEALTH
(22)
Certificate Staff College course for assistant and deputy directors of
health services, officers in charge of defence health services, etc. The course,
organized by the National Institute of Health Administration and Education,
New Delhi, lasts for 8-10 weeks.
The academic year begins in June-July and ends in April-May.
The following paragraphs relate particularly to the courses leading to the
Diploma in Public Health and to the degree of Doctor of Medicine in Community
Health.
Conditions of admission
There is no age limit for admission to the D.P.H. course but applicants should
preferably be below 40 years. Admission is open to medical graduates from a
recognized Indian institution, or to holders of equivalent qualifications, who
have completed at least 1 year (but generally 2 years) of practical work in the
field of public health or general medicine. There is no entrance or medical
examination. Candidates are selected on the basis of merit, preference being
given to those sponsored by the Government, local authorities, etc. In some
instances the students enrolled are health authority personnel who have been
required by their employers to take the D.P.H. course. Civilian candidates seeking
admission to the course offered at the Armed Forces Medical College, Poona.
should apply to the Commandant of the College, through the Registrar, University
of Poona. At a number of schools the facilities available would allow for a greater
intake of students.
The admission requirements for the course leading to the Doctor of Medicine
in Community Health are the same, except that candidates are required to have
performed 4 years of field work (or 2 years if they already hold a postgraduate
diploma) after obtaining the basic medical degree.
Tuition fees are charged; for the academic year 1970-1971 they amounted to
405 rupees for the D.P.H. course and 370 rupees for the M.D. in Community
Health course. Foreigners are eligible for enrolment.
Curriculum
The following is an outline of subjects studied in the course leading to the
Diploma in Public Health: health organization and related subjects (viz., public
health administration, public health law, principles of public health, sociology,
social anthropology, psychology, family planning, health education, economics,
international port administration, municipal corporations, and primary health
centres); statistics (viz., biostatistics, biometry including statistics, vital statistics,
and statistical methods); epidemiology (including human ecology, communicable
diseases, infectious diseases hospitals, tuberculosis control, and venereal diseases
control); environmental health (viz., environmental sanitation, industrial hygiene,
occupational health, sanitary engineering, physiological hygiene, and applied
physiology); and microbiology (viz., entomology, bacteriology, protozoology,
helminthology, public health chemistry, parasitology, virology, and serology).
Also: nutrition; genetics; problems of disablement, etc.
INDIA
67
The curriculum of studies leading to the degree of Doctor of Medicine in
Community Health is as follows: health organization and related subjects
(including health administration principles and practice, medical care, public
administration, hospital administration, and research in administration); stat
istics; and epidemiology. Also: health education; health economics; and social
sciences.
The subjects studied in the course leading to the Diploma in Tropical Medicine
and Hygiene include tropical medicine and hygiene, tropical pathology and bacteri
ology, and medical parasitology and entomology.
Instruction is theoretical and practical and includes, in addition, clinical
training, 1 month's experience in rural public health practice, an industrial tour,
and field visits.
Most of the teaching institutions have their own rural health centres; some,
such as the All India Institute of Hygiene and Public Health, have an urban
health centre for the students’ field training. The National Institute of Health
Administration and Education in New Delhi utilizes a whole district with its
complex of community health services in an adjoining State, health service facilities
in the metropolis of Delhi, and the rural health training centres of local medical
colleges for the practical training of the students.
Examinations
There is an examination at the end of the course conducted by a Board of
Examiners, whose members include external examiners. (In Calcutta the examin
ation is conducted by the University of Calcutta.) The examination consists of
written and oral tests, and field and practical work in class, and covers 4 groups
of subjects. The written test lasts 3 hours for each group of subject. In order to
pass, the candidate must obtain a mark of at least 50% for each group (twofifths in the written test, two-fifths in the oral, and one-fifth in the field and prac
tical work).
Candidates who fail to pass in any one of the 4 groups may be re-examined in
that group on payment of the prescribed fee. If they fail in more than one group
they are obliged to take all the written papers again at the subsequent examination.
Qualification
The candidate who has completed the course of study and passed all the
requisite examinations is awarded the Diploma in Public Health, the Doctor of
Medicine in Community Health, or the Diploma in Tropical Medicine and
Hygiene, as the case may be.
In India possession of the Diploma in Public Health or the degree of Doctor of
Medicine in Community Health is essential for all senior posts in the public
health services, for research and consultative appointments, for specialists in
public health in the Armed Forces and the Indian Railways, and for teaching
posts in social and/or preventive medicine above the rank of Assistant Professor.
68
WORLD DIRECTORY OF SCHOOLS OF PUBLIC HEALTH
Name ami address
ANDHRA
Department of Postgraduate
Public Health
(D.P.H. Course)
Osmania Medical College
Osmania University
Hyderabad
DELHI
National Institute
of Health Administration
and Education
E-16, Greater Kailash-I
New Delhi 48
KERALA
Department of Preventive
Medicine
Medical College, Trivandrum
Kerala University
Trivandrum
MAHARASHTRA
Department of Preventive
and Social Medicine
Grant Medical College
Byculla
Bombay 8
Department of Preventive
Medicine
Armed Forces Medical
College
Poona 1
UTTAR PRADESH
Department of Social
and Preventive Medicine
K.G. Medical College
Lucknow
WEST BENGAL
All India Institute of Hygiene
and Public Health
110, Chittaranjan Avenue
Calcutta 12
Calcutta School of Tropical
Medicine
Chittaranjan Avenue
Year public
health course
started
Academic year 1970-1971
No. of teaching
staff
1960
7 ft
39 pt
1969
21 ft
No. of students
in all courses
No. of students
in public health
14
14
29 m (N)
4
1
1962
14
1 502
6
1915
5
1 511
2
1959
14 ft
30
15
1963
20 ft
12 pt
16 m
3
1933
112 ft
184 m (N)
69 f (N)
3f (F)
46
1921
0?
71
1973 - HINDUSTAN YEAR-BOOK - Pare 404
PUBLIC HEALTH
MINISTRY OF HEALTH—Matters connected with health fall largely
in the State field. The Central Government’s functions in respect
of matters in the State List are the co-ordination of policy and
planning, the collection and exchange of information, expert
technical assistance and advice on matters relating -o hospitals,
medical education. Local Self-Government or water-supply schemes
and guidance on o£her matters of country-wide interest, such
as drug legislation, prevention of food adulteration or control
of epidemics. The Centre is diroctly responsible for State subjects
in the Union Territories of Andaman and Nicobar Islands and
Laccadive, Minicoy & Amindivi Islands. The Central Government
also administer a number of important training institutions and
other establishments in various places.
THE MINISTRY of Health and Family Planning deals with all
matters relating to Health (inclusive of drugs control and
prevention of food adulteration). It also deals with the national
watersunply and sanitation scheme. The important subjects which
are dealt with by the Central Government pertain to post-graduate
medical education; the promotion of special studies in medicine
and nutrition: port and airport health organisation; International
Sanitary Regulations and India’s relations with the W.H.O., etc.
CENTRAL HEALTH SERVICE - has been constituted with a view to
att acting better medical personnel to man the posts under the
Central Government and other participating bodies by providing
uniformity of standards, pay scales and other conditions of
service of medical and public health personnel.
DRUG MANUFACTURE & CONTROL
TEE CONTROL over the quality of drugs imported, manufactured,
sold or distributed in the country is exercised under the Drugs
Act, 1940, as amended in 1955, 1960, 1961 and 1962 and the Rules
framed thereunder. The State Governments are responsible for the
control over the quality of all drugs manufactured, sold or
distributed in the country. The Government of India have powers
to keep a check on the quality of imported drugs. The Drugs
Technical Advisory Board, constituted under the Drugs Act, 1940,
is an important statutory body, advising the Central and State
Governments on technical matters arising out of the administration
of the Drugs Act. The DRUGS CONSULTATIVE COMMITTEE is a statutory
committee appointed under the Drugs Act to advise Central and
State Governments and the Drugs Technical Advisory Board and on
matters tending to secure uniformity throughout India in the
administration of this Act. The first INDIAN PHARMACOPOEIA was
published in 1955. The CENTRAL DRUGS LABORATORY, CALCUTTA, is
a statutory institution set up under the Drugs Act of 1940, which
analyses and tests samples of such drugs as are sent to it and
performs other functions of the Central and State Governments.
MEDICAL STORES ORGANISATION has depots in Madras, Calcutta, Bombay
Hyderabad and Kamal for supplying mainly hospitals and dispensarie
run by the State Governments, local bodies etc. The factories
of the Organisation manufacture a.large number of drugs and
dressings. It has also a repair workshop. The training of trade
representatives are givn in Government Laboratories. STATE PHARMACY
COUNCILS have been constituted in several states. The Drugs and
MAGIC REMEDIES (OBJECTIONABLE ADVERTISEMENTS) Act, 1954, which
came into force on the 1st April, 1955, prohibits the publicaticu
of advertisements relating to sexual stimulants, alleged magic
cures for veneral diseases peculiar to women.
^(Firs
;
cm
2
2
EXPORT OF PHARMACEUTICALS
EXPORT ACTIVITY in the field of pharmaceuticals is of comparatively
recent origin. Although the manufacture of pharmaceuticals in
the country started nearly 60 years ago, till 1950 the progress
was limited. However, the industry registered a phenomenal growth
thereafter. Exports of pharmaceuticals consist of basic drugs,
intermediates, and fine chemicals including quinine salts which
are exported exclusively by the government.
LABORATORIES AND DEPOTS
B.C.G. VACCINE Laboratory, Guindy, Madras - was established in
1948 by the Central Government with the help of UNICEF and
WHO and is the world's largest vaccine producing centre. The
Laboratory supplies tuberculin and B.C.G. Vaccines.
CENTRAL DRUGS Laboratory, Calcutta - is a statutory laboratory
set up under the Drugs Act to analyse and test samples of drugs
which may be sent to it by the Central Government and to carry
out other functions as may be assigned to it by the Central and
State Governments.
CENTRAL FOOD Laboratory, Calcutta - has been set up by the Central
Government under the Prevention of Food Adulteration Act 37 of
1954 for analysis of food samples, investigation for the purpose
of fixation of standards of any article of food, etc.
CENTRAL RESEARCH Institute, Kasauli - was established in 1905 and
supplies vaccines of TA3, cholera, rabies, etc.
HQFFKINE INSTITUTE, Bombay - manufactures sulpha drugs. The main
functions of the Institute are medical research, training of
research workers, supply of vital biologicals and diagnosis aids
to the medical profession. The Institute is run by the Government
of Maharashtra and collaborates with such national and Internationa
organisations as the Indian Council of Medical Research, the
WHO and the Rockeffeller Foundations.
INDIGENOUS SYSTEMS OF MEDICINE
THE GOVERNMENT of Indiahave decided to recognise only the modem
system of medicine. But the well-settled policy of the Government
is to give all possible help and encouragement to the indigenous
and homoeopathic system of medicine and incorporate contributions
of approved value from them in the existing system of medicine.
THE CENTRAL COUNCIL OP AYURVEDIC RESEARCH has been set up in
pursuance of one of the recommendations of K.N. Udupa Committee.
set up in 1959. The CENTRAL INSTITUTE OF RESEARCH IN INDIGENOUS
SYSTEMS OF MEDICINE has been functioning since August 24, 1953 at
Jamnagar with a hospital and an outpatient department. A new
Sidnha unit was started in theyear 1956-57. A post-graduate
training centre in Jamnagar'and another research centre at
Banaras Hindu University on Ayurveda have been started. State
Boards have been set up in almost all States for the regulation
of practice in indigenous system of medicine. INDIA'S first
Ayurveda University was inaugurated on 6th January 1967 at,Jamnagar
Gujarat. The survey of Medical Plants Units at Hardwar and,
Ranikhet (U.P.) conducts surveys and collect specimens of plants
and seeds from the Himalayan and sub-Himalayan regions.
3
THE GOVERNMENT of India have purchased land at Kothrud, near Poona,
to establish a Central Herb Garden and Museum of Drugs. This garden
and-Museua which is known as the Jawaharlal Nehru Ayurvedic Medicinal
Plants Garden and Herbarium was inaugurated on November 14, 1964.
IN 1955, the Government of India approved a five-year Degree course
in homoeopathy. There are over 30 institutions imparting training
in homoeopathy, and some are recognised by the State Boards.
THE UNANI Advisory Committee has also been formed.
HEALTH PLANNING COMMITTEES
THE VARIOUS Committees for the promotion of health in India are
mentioned below:
MEDICAL COUNCIL OF INDIA - was reconstituted in 1960 under the
Medical Council Act of 1956. The Council, inter alia, is
responsible for the maintenance of the Indian Medical Register tehich
contains the names of all medical practitioners who are enrolled
on the State Medical Registers and who possess any recognised
medical qualifications under the aforesaid Act.
CENTRAL COUNCIL OF HEALTH - was started to August 9, 1952 under
Article 263 of the Constitution. It considers and recommends
board lines of policy in regard to matters concerning public health in
all its aspects.
INDIAN NURSING COUNCIL - was inaugurated at Delhi on May 19, 1949.
One of the main functions of the Council is to lay down minimum
standards for the training of nurses. The Indian Nursing Council
has been vested with the power to inspect training institutions
and examinations. The main object of the Council is to lay-down
miHlfflHH-staHdapd-ef-the-training-ef-nu? establish a uniform
standard of training for nurses, midwives and health visitors, etc.
CENTRAL COMMITTEE FOR FOOD STANDARDS - The main functions of the
Committee are to advise the Central and State Governments on
matters arising out of the administration of the Prevention of
Food Adulteration Act, 1954 and to carry on other functions enumerated
in the Act.
STATE MEDICAL COUNCILS - which began to function in 1942, are now
functioning in all the States. The State Councils keep registers
of qualified practitioners, supervise medical education and inspect
examinationsj exercise disciplinary powers over medical practitioners,
and also advise the State Governments in regard to recognistion
of various medical qualifications.
PHARMACY COUNCIL OF INDIA - is a statutory body constituted under
Sec. 3 of the Pharmacy Act of 1948. Its functions are to regulate
the profession and practice of pharmacy, complete enforcement of
the Pharmacy Act, the furtherance of training in pharmacy and
educating the public about the profession.
DENTAL COUNCIL OF INDIA - with the passting of Indian Dentists
Act of 1948, the Council was inaugurated on May 14, 1949 for the
development of dental training and practice of the profession through
the establishment of the Dental Councils at the Centre and the in the
States.
ALL INDIAN COUNCIL OF POST-GRADUATE MEDICAL EDUCATION - has been
constituted to prescribe standard for post-graduate medical
education in the Universities and offer suggestions to evolve
univormity of standards throughout the country.
....4
4
NATIONAL NUTRITION ADVISORY COMMITTEE - was set up in I960 in pursuance of
the recommendation of Rome Conference of F.A.O. in 1957. It formulated that the
member Governments should take implementing policies and plans relating to food
production and due account of the national need of the population in settling
and consumption including international trade in food.
THE CENTRAL MEDICO-LEGAL ADVISORY COMMITTEE - was set up in 1955 to advice the
Central and State Governments on matters pertaining to medico-legal procedure
and practice in India and to promote the development of new and modern
techniques in the field of medico-legal work.
FOOD ADULTERATION
The PRBVBNTIION OF FOOD ADULTERATION ACT, 1954 and its Rules are in operation
throughout the country.lt provides for severe punishment to offenders and
prohibits the manufacture, imports or sale of adulterated food articles.The
CENTRAL COM ;ITTEE FOR' FOOD STANDARDS and the CENTRAL FOOD LABORATORY have
been established in Calcutta.
CONTROL OF DISEASES
NATIONAL MALARIA ERADICATION PROGRAMME - The Government of India launched a
National Malaria Control Programme in 1955, which was converted into National
Malaria Eradication Programme in April 1958. Malaria eradication programme is
a phased campaign consisting of an intensive period of spray operation for
at least 5 to 5 years. The programme is being asisted by the WHO and USAID.
At present, 595.250 units each covering a population of 1.5 to 1.5 million are
functioning in the country. The NATIONAL INSTITUTE OF COMMUNICABLE DISEASES is
responsible for research and for the training of staff in methods of malaria
eradication. 6 regional coordinating organisations have been established at
Bangalore, Baroda, Bhubanewswar, Hyderabad, L„cknow and Shillong.
NATIONAL FILARIA CONqROL PROGRAMME - launched in 1955» comprises mass administ
ration of drugs to people in filaridus communities and adoption of anti-mosquito
measures.At present, 6 Headquarters units, one each in Andhra. Pradesh, Madhya
Pradesh, Goa, Mysore and Kerala are functioning in the country.As a result of
the surveys, it is estimated that over 15.6 crore pe-sons live in filarious areas
of the country.A centre for practical demonstration and field training is
functioning at Kozhikode and a new training centre has been started at
Rajahmundry.There are 4 research-cum-training centres in Rayavaram (A.I.), in
Uttar Pradesh and in Madhya Pradesh. Recently one
A t'pe and one B type
Filaria Control Units were established at Udipi in Mysore and at Broach in
Gujarat respectively bringing the total number of units functioning in the
country to 90.
VENERAL DISEASES - It has been established that about 5 p.c. of the population
suffer from syphilis and an equal p.c. from gonorrhoea.Free supply of VDPL
antigen and vials of PAM are made to various V.D. clinics. PAM ^s an imported
item.A Central V.D. Advisory Committee was also constituted dur?ng 1965-64.
142 V.D. Clinics have been established in the country.
YAWS - Yaws temas are continuing their operation in the Spates of Madhya
Pradesh, Andhra Pradesh, Orissa and Maharashtra.
NATIONAL TUBE CULOSIS CONTROL PROGRAMME - National T.B. survey completed in 1958
showed that nearly 50 lakh persons suffer from active or probably active T.B.
The WHO and UNICEF render assistance in the 'orm of BCG kits, vehicles,
etc. The T.B. Association of India is the largest voluntary org.misa1 ion in the
country. Since its establishment in 1959, it has been engaged in anti-T.B. work.
T.B. Hospital, Mehrauli Road, New Delhi is administered by the Association.
The research on T.B. is being undertaken at the T.B. Chemotherapy Centre,
Madras and T.B. Research Unit, a department o? the Union Mission Tuberculoses,
Arogyavarsm, Madanapalli. 552 R.B. Clinics are presently functioning in the
country. There are now 216 BCG teams. 15 demonstration and training centres’
have been established. Training is also imparted in other instituions and centres.
..5
5
3 mobile X-ray units have been procured and have since been supplied to Agra, Madras
and Calcutta. A National T.B. Institute has been started since March 1959 at
Bangalore with the assistance of WHO and UNICEF, There are 140 sanatoria and hospit
als, 427 clinics, 152 wards and over 36,581 beds available for T.B. patients.
LEPROSY - The Leprosy Control Programme was laucnhed in India in 1954-55. Nearly
one-fifth of the world’s 11 million lepers live in I„dia. The number of leprosy
cases in India is now estimated at about 25 laksh. Andhra Pradesh, Bihar, Kerala
Madhya Pradesh, Tamil Nadu and certain parts of Maharashtra, Uttar Pradesh and
West Bengal are areas of high incidence. 221 Leprosy Control Units, 1,396 Survey
Education and Treatment Centres, 12 Training Centres and 32 Voluntary Agencies
are functioning in the country. Some of the important centres of leprosy treatment
are: 1. Gandhi Memorial Leprosy Foundation Centre, Chilakala Palli (Andhra Pradesh)
2. Central Leprosy Teaching And Research Institute, Chingleput (Tamil Nadu);
3.
Lady Willingdon Leprosy Sanatorium Chingleput; (4) Silver Jubilee Children's
Clinic Saidapet (Tamil Nadu).. Voluntary organisations are: Mission to Lepers,
Hind Kusht Nivaran Sangh, Maharogi Seva Mandal, Gandhi Memorial Leprosy
Foundation, Ramakrishna Mission and Vidarbha Maharogi Seva Mandal.
CHOLERA - 5 institutions are producing cholera vaccine in the country. One Central
and 3 Regional Offices, one each in Maharashtra, Orissa and West Bengal are being
set up.
TRACHOMA - The Trachoma Control pilot Project was established in Aligarh on 1st
December, 1959, for the preparation of topographical map op trachoma in I„dia.
The National Trachoma Control Programme was launched by the Government of India
with effect from March 30, 1963INFLUENZA - influenza vaeeiHssxandxsaaksximxxxipMXHxiksexxfitkHdxaixiisxBxnu^xEtHXB
centre was opened in 1950 at the Pasteur Institute, Connoor. A pilot plant, set
up there in 1954, produces influenza vaccine and seeks to improve the method of
its manufacture.
CANCER - The Government utilizes all cancer research institutes of the country
for the treatment and research on cancer.Cancers research can-tro^Bombay
and treatment are bei g carried on by the Indian Cancer Research Centre, Bombay,
Chittaranajan National Cancer Research Centre, Calcutta, Tata Memorial Hospital,
Bombay and Cancer Institute, Madras. Cobalt Beam Therapy U^its are available
in 18 hospitals in the country.
THE NATIONAL SMALL POX ERADICATION PROGR .MME was laucnhed in 1962. Under this
programme, 154 eradication units are working in the country.Four institutes located
at Patwadnagar (U.P.), Guindy (Tamil Nadu), Belgaum and Hyderabad were settled
were selected for the production of freeze dried vaccine.
MEDICAL RESEARCH
Medical research in thecountry is organised largely through the Indian
Council of Medical Research, founded in 1912 in New Delhi. The Council^plays a
significant role on adi aiding, promoting and coordinating scientific research
on human diseases, their causation, prevention and cure. The research works are
done through the Council’s several permanent research institutes, research
units, field survey, research service units and a large number of ad-hoc research
enquiries financed by the Council in Medical Colleges, research institutions,
University Science Departments, etc. It maintains Cancer Research Centres,
Tuberculosis Chemotherapy Centre at Madras, Virus Research Centre at Poona,
Nutrition Research Laboratory at Hyderabad and Blood Group Reference
Centre at Bombay.
THE field stations, one at Sagar in Mysore State and another at Vellore in
Tamil Nadu State, of Virus Research Centre, Poona are functioning for
investigations on specific problems. The VRC has been recognised as a Collaborating
Laboratory of the WHO for arboviruses.
Caloric intake - of food per adult in Punjab, Himachal Pradesh, Madhya Pradesh
and si Vest Bengal is about 3,000 while in other states it ranges from 2,000
to 2,050 Kerala having the lowest with only 1800 oalaries.
...6
6
MEDICAL EDUCATION A ITO TEAININC
Medical Education in general is the responsibility of the States, The Government
of India's interest is limited to the promotion of higher studies and spedific
schemes of research and specialised training.
There are at present 97 medical colleges, 15 dental colleges and 11 institutions
for training in the allopathic system of medicine.
CENTRAL HEALTH EDUCATION BUREAU - established in November 1956, coordinates and prom
tes health education in the country. !■(. functions through two main Media and
Methods Divisions. The Media Division is completed with the exception of Museum
and Exhibition units. Under the Methods Division the training and research
units are functioning. There is a separate unit for school Health Education, It
also produces 2 quarterly bulletins and 2 monthly magazines and maintains a
film library.
ALL INDIA INSTITUTE OF MEDIAL SCIENCES, NEW DELHI - was set up in 1956 under
an Act of Parliament and enjoys the status of an institution of national importance
It was set up with a view to (i) attaining self-sufficiency in post-graduate
mediail education (ii) developing patterns of teaching to demonstrate a high
standard of medical education and (iii) bringing together in one place educational
facilities of the highest order. The Institute has an Undergraduate Medical
College with 50 annual admissions. There are 175 post graduate students on the
roll in various specialities.
TRAINING AND RESEARCH IN MEDICAL STATISTICS - This scheme provides for training
in "Medical Statistics" at the All India Institute of Hygiene and Public Health,
Calcutta and in Medical Records Keeping" at the Christian Medical College and
Hospital, Vellore.
MODEL VITAL HEALTH STATISTIC? UNIT, NAGPUR - started functioning in 1957.
FOREIGN SCHOLARS AND FELLOW IN INDIA - India is providing facilities for higher
training in medicine, public health and allied subjects to the students from foreign
countries, mostly from Africa and Asia.
POST GRADUATE MEDICAL (INCLUDING DENTAL) SDUCATTON IN MEDICAL INSTITUTIONS - This
scheme envisages allotment of 25 new departments for teaching post graduate medical
(including dental) students in various medical colleges in the country.The selected
candidates are awarded a monthly stipend of Rs.200.
POST GRADUATE CENTRES - There is an institute of Post graduate Medical Education
and Research at Chandigarh and anothe one at Calcutta set up by the respective State
Governments. The Jawaharlal Institute of Post graduate Medical Education and
Research at Pondicherry was started on July 15, 1964. With 450 beds, it started
functioning from 5rd April, 1966.
POST GRADUATE MEDICAL EDUCATION: Delhi Scheme - Post graduate courses in Medicine
surgery, gynaecology, paediatrics, etc. 12 courses are being conducted in Delhi
hospitals, etc. The stipend for these courses are Rs.200 per month.
ADMISSION OF.STUDENTS BELONGING TO THE UNION TERRITORIES TO MEDICAL COLLEGES Arrangements are being continued for the admission of students belon~sng to
Union Territories which do not have medical colleges and students belonging to other
categories to medical colleges.
ADMISSION TO MEDICAL COLLEGES UNDER THE GOVERNMENT OF INDIA CENTRAL SCHOLARSHIP
SCHEME - Students of Indian origin domiciled abroad and foreign students ar admitted
to various medical colleges in the country for which seats have been reserved.
REFR SHER COURSES FOR CENTRAL MEDICaL PRACTIONERS — This schemchad been included as
a central scheme in the third plan.
LADY HARDING MEDICAL COLLEGE & HOSPITAL, NEW DELHI - is a leading medical college
for women in the country.
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7
KALAVATI SARA:' CHILDREN'S HOSPI'AL, N W DELHI — is a constituent unit of
the Lady Hardinge Medical College & Hospital, New Delhi with 68 beds, for
medical cases, with a department of Physical Medicine and Rehabilitation for
training treating cases of paralysis and rehabilitating them.The institution
imparts paediatric teaching to the undergraduate medical student'- of the
Lady Hardinge Medical College and to the student nurses of the same College
and Hospital, to the Public Health Nnrsing students of the Lady Reading
Health School and to the students of the Midwifery Sisters' and Midwifery
tutors ’ course of the College of Nursing.
LADY READING H ALTH SCHOOL AND RjSMCHAND LOHIAINFANT WELFARE CENTRE, NEW DELHI
- The school conducts certificate course in Public Health Nursing of 10 months'
ducation and Integrated Health visitors' course of 2y years, duration.
PHYSIOtherapy School and Training Centres at the K.E.M. Hospital, Bombay - A
physiotherapy training and service centre at the K.E.M. Hospital, Bombay
has been establ" ;-hed by the Government of I„dia under an agreement with the
WHO in collaboration with the Government of Maharashtra and the Municipal
Corporation of Bombay. The centre is equipped with one ultra vibrator,
DHANVANTARI MEDICAL COLLEGE, PONDICHERRY - this college had started functioning
in 1956. It is affiliated to the University of Madras.
COLLEGE GF NURSING, NEW DELHI - was established in 1964 and is affiliated to
the Delhi University. It prepares students for the following, courses Master of Nursing, BSc. (Hons.) in Nursing, Ward Sisters course, Sister
Tutors course, Midwifery tutors c urse, and nursing administration.
THE CHILD GUIDANCE CLINIC AT THE COLLEGE OF NURSING was started in 1955
as a part of psycholog teaching department to provide B.Sc. (hons.) Nursing
students with, clinical experience in child growth and development, with special
experience in child growth and development, with special reference to
emotional problems. 14. also provdes free service.
TRAINING OF NURSE AND AUXILLIARY NURSE-MIDWIVES, HEALTH VISITORS AND DAIS The total number of training centres run by voluntary organisations with
Central assistance was 42. Central assistance is given to the State Governments
at the rate of RS.25O per dai trained for the six month course designed to
orient the indigenous dais to modern techniques of asepsis.
THE central medical library of the directorate General of Health Serviceswas
declared as the National Medical Library with effect from 7th April, 1966.
MEDICAL RELIEF
The total number of institutionsunder the central government health scheme
is now 6':. There are 2,66,200 beds in the country.
Medical relief, Sanitation & Public health in the Union Territories - The
Central Government is directly concerned with the provisions of medical
relief in the Union Territories.
Health Insurance scheme which provides, inter alia, medical benefits to
industrial workers under Employees' state Insurance Act, 1948, now covers
over 20.18 lakhs workers in the country.
Contribution Health Service scheme cane into opeation on 1st July, 1954
and was confined first to Delhi & New Delh only and serves Central Government
employees. The Scheme has been extended to Bombay from November 1963.
Safdarjang Hos ital, New Delhi - was taken over by the Government of India
on 1st March 1954. The present bed strength of the Hospital is 1,062 and
the number of medical officers 250.
WILLIKDDON HOSPITAL AND NURSJKg HOME, NEW DELHI - was taken over by the government
of India on 1st June, 1954. The present bed strength of the Hospital is 326
A course of regular general nursing was started in this hospital on 1st May, 1963.
The Hospital has been recognised for Diploma in Anaesthesia and for the
M.D. degree of the Delhi University.
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LAL RAM SARUP T.B. HOSPITAL, NEHOZAULI (DELHI) - is administered by the
T.B. Association of India. 1^ is being maintained largely with the grants of
the Government of India.
POLICE HOSPITAL, DELHI - has 50 beds.
POOH HOUSE HOSPITAL, DELHI - caters to the inmates of the Poor HQuse, who
are detained theere under the Beggers Act, 1959.
IRWIN HOSPITAL, NEW DELHI - has 1,068 beds. The Ro pi tai has a programme
for the training o." Laboratory Assistants, Radiographers, S+udent Nurses,
Student Nurses, and Postgradute students.
GOVTND BALLABH PANT HOSPITAL, NEW DELHI - was commissioned on the 3rd June
1964 and pro ides for indoor treatment facil ties in Neurology, Neuro-surgery,
Cardiology Cardio-vascular surgery, Psychiatry; Gastroentrolog and Haematology
An Orientation course in Hospital administration was started on 1st July
1964. This is the first course o'1 its kind in Asia.
HOSPITAL FOR MENTAL DISEASES, RANCHI - is one of the famous mental hospitals
of India under the Government of Ir,dia. The bed strength is distributed among
various States.
COUNTESS OP DUFFERIN'S FUND - This Fund, vests in the Central Government under
the countess of Dufferin’s Fund Act, 1957. The Fund is utilised towards grant
of scholarships to women students for medical and nursing education.The income
derived from the assets or the Fund is estimated at about Rs.60,000.
UNION MISSIONT BERCULOSIS SANATORIUM, AROGYAVARAM, MADANAPALLI - The Central
Government met from 195& to 1965, 50 p.c. of the recurring expenditure of
the two departments of this Sanatorium. A Children's Ward and a Thoracic
Surgical U'it were established with the assitance of the Government of India.
INTEGRATION OF PUBLIC HEALmH WITH Ths basic course in Nursing - Under this
scheme nurses training schools of the state governments and voluntary
organisations are getting Central assitance.
PRIMARY HEALTH CENTRES- constitute the focal points in the rural areas
for providing preventive and curative health services in an integrated
form. The main sevices provided b the Centres are medicalcare, material
and child health services including school health, health educationo control
of communicable diseases, environmental sanitation advice and assitance,
collection of vital statistics and family planning.There are 5,092
such centres in the country.
FINANCIAL ASSISTANCE TO VOLUNTARY MEDICAL INSTITUTIONS are given.
NATIIQNAL CLEANLINESS DAY AND CHILDREN'S DAY CELEBRATIONS were inaugurated
on 2nd October, I960 and 14th November, I960 respectively. Anti-leprosy Day is
observed on Mahatma Gandhi's martyrdom day, the 30th January.
WATER SUPPLY AND SANITATIONS—The National Water Supply and Sanitation Programme
launched in 1954, is continuing. Most of the 369 urban water supply schemes,
100 urban drainage schemes and 348 rural water supply and sanitation schemes,
estimated to cost Rs.102.17 crores, have been completed. A drinking water Board
was set up in 1963.
INSTITUTES & TRAINING CENTRES
All India Institute of Hygiene and Public Health, Calcutta - was established
in 1932 with the aid of an endowment from Rockefeller Foundation.The objects
of the Institute are - 1. the training of public health personnel, 2, qualifying
students for public health diploma and 3. pursuits of research on several
aspects of public health, including study of diseases liko malaria, etc. The
Institute functions as a Yellow Fever Vaccine Centre for the distribution of
vaccine to different centres.
Rural Health Unit & Training Centre, Singur (West Bengal) - functions as the
rural practice field for students of the All India Institute of Hygiene & Public
Health.
9
9
National Institute of Health Administration and Education, Delhi - was
registered on the 24th September, 1964. A grant of $1,246,000 has been made by the
Ford Foundation to the Central Government for providing intial support to this
Institute and the Central Family Planning Institute over a 5-year period.
Central Family Planning Institute, New Delhi - was established in 1962 mainly
for the advancement of knowledge in various aspects of the Family Planning movement in India. In order to facilitate expeditious achievement of its objects
the Government of India registered this Institute on 20th November, 1964. The
Institute has six divisions, such as Administrative, Education, Training and
Social Services, etc.
Urban Health Centre, Chetla, Calcutta - this Health centre, apart from
producing comprehensive healt' services, functions as a training centre for
for the students of various medical institutions in its activities.
Central Research Institute, Kasauli (1906) - provides facilities for research.
Vaccines and sera manufactures by the I„stitite are cholera, TAB., Antirabic,
Antibiotic (animal) and Antirabic (dog) vaccines, Anti-venom Serum, Diphtheria
Antitoxin. Normal Horse Serum, Tetanus Toxoid, Antirabic Serum and curative
vaccines are also manu actured here. The Institute has following 6 sections:
(1) bacterial vaccine, (2) biochemistry, (3) biological, (4) serum concentration,
(5) rabies and (6) antibiotics.
All-India Institute of Physical Medicine and Rehabilitation, Bombay - which
was started as a joint venture of the Central and the ^ombay Governments,
Bombay Municipal Corporation and the UNICEF, was taken ov r by the Government
of India on October, 1961. It imparts post-graduate instruction in rehabilitation
of the disabled, in Physio-Therapy, Occupational Therapy and other services,
etc.
All India Institute of Mental Health, Bangalore - was inauguration on August 6,
1954. Besides promoting post graduate studies and research in mental health,
it advises the Government of India and the States on the organisation of mental
health service and acts in co-ordination wit' national and international agencies
on mental health. In 1955, the course 'or the Diploma in Psychological Medicine
and the training course in Clinical Psychology have been started at the Institute.
All India Institute of Speech and Hearing, Mysore - was established on 9th
August, 1965 to provide training and research facilities for Speech Pathologists
and Audiologists. It is financed by the Govt, of India.
Central Leprosy Teaching and Research Institute, Chingleput - is controlled
by the Government of India. Activities of the Institute include tr atment e£
and welfare activities for the patients and training of personnel and research.
Department of Serologist and Chemical Examiner to the Government of India,
Culcutta - carries on medicolegal analysis of blood and semen and other stains
on exhibits seized in connection with the prosecution of criminals and
manufactures ampoules of V.D.R.I. antigen and requisite quality of buffered
saline dilluent.
National Institute of Communicable Diseases, Delhi - The Malaria Institute of
India was converted into this Institute on August 21, 1962. The official
inauguration took place on July 50, 1963. The Institute is tho main centre
for research and training in the field of communicable diseases. 1^. has
6 divisions.
National T.B. Training Institute, Bangalore - was inaugurated in 1959. It has
a training course for B.C.G. workers.
Pasteur Institute of Southern I^aia, Coonoor - manuractur s influenza vaccine
on a pilot basis, carries on research on the value of antibiotic serum and its
production on a pilot basis and carried on studies in rabies, influenza, respirator
and intestinal viruses, syphilis and small pox. The special laboratories
designed for the production of live polio virus vaccine have been furnished and
fitted up. The Institute was established in 1907.
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Rural Health Training Centre, Najatgarh, Delhi - performs a three-fold
function: service, training and research.
Vallabhbhai Patel Chest Institute, Delhi - has been establishedmainly
for conducting research in diseases of the chest and in training doctors
in the line. Successful candidates receive the Diploma in Tuberculosis and
Chest Diseases (D.T.C.D.) from the Delhi University.
INDIA
INDIA
I.
1.
ORGANISATION OF OFFICIAL SERVICES
Assignment of Responsibility
(c)
The Union of India comprises 17 states and nine union terri
tories.
Under the Constitution of India the legislative list is
classified into three categories: the union list - subjects in
respect of which legislation can be enacted and enforced only by
the Union; the state list - subjects in respect of which legisla
tion can be enacted and enforced by the states individually; and
the concurrent list - subjects in respect of which both the Union
and the states can legislate, but should, however, the Union enact
legislation on any of these subjects, that enactment becomes
applicable to all the states but the enforcement of the legisla
tion still remains the responsibility of the states.
Factories, boilers, electricity and welfare of labour,
including conditions of work and social security fall within the
concurrent list.
In respect of those subjects where uniformity
in the application of the statutory provisions is considered
essential, legislation is usually enacted by the Union, which
becomes binding on the states.
(a)
Industrial Establishments
The industrial establishments are governed by the provisions
of the Factories Act, which is a union legislation administered
directly by the state governments through the inspectorates of
factories.
The Act-empowers the state governments to frame
detailed rules for the effective administration of the Act.
Each
state has framed its own rules under the Factories Act based on
the model rules prepared by the central organisation of the Chief
Adviser, Factories (now Directorate General Factory Advice Service
and Labour Institutes), thus further ensuring uniformity in the
application of rules.
(b)
The Union has under consideration a separate enactment to
provide for the safety and health of workers employed in building
and construction industry and to regulate their conditions of
work.
Construction Work(Building and Civil Engineering)
The building construction industry and works of engineering
construction have not as yet been brought under any legislative
enactment.
Projects under the Five-Year Plans, comprising most
of the activities which fall under the category of works of
engineering construction, are government projects and are carried
out under the supervision of governmental agencies.
The Central
Water and Power Commission, Ministry of Irrigation and Power, has
issued a Safety Manual. This Manual contains detailed instructions
to be followed on all construction projects for the prevention of
accidents and for ensuring uniformity and safe operating procedures
on all construction works.
The Manual is more of a code of
practice to be observed by all authorities, officers, employees
and contractors of construction projects.
The responsibility to
see that the provisions of the code are followed is placed on the
persons in whose jurisdiction the works are carried on.
Shipbuilding and Ship Repairing
Constructing, repairing, refitting, refinishing or breaking
up of ships or vessels are covered by the provisions of the
Factories Act and the responsibility for the enforcement of the
provisions covering them rests with the state factory inspectorates.
(d)
Docks
The safety and health of workers employed in docks are
covered by the Indian Dock Labourers' Act, 1934 and the Indian
Dock Labourers' Regulations, 1948, which were enacted to give
effect to the I.L.O. Convention concerning Protection against
Accidents to Workers Employed in Loading and Unloading Ships.
The Dock Labourers' Act is, however, limited in scope, as it
applies only to work which is required for or is incidental to
the loading or unloading of cargo or fuel into or from a ship when
it is done on board the ship or alongside it.
This left out a
large number of workers employed in the docks.
This lacuna has
now been rectified by framing a separate set of regulations Dock Works (Safety, Health and Welfare) Scheme, 1961 - making use
of the provisions of the Dock Workers (Regulation of Employment)
Act, 1948.
All these measures concerning the safety and health
of dock workers are administered by the Centre through the dock
inspectorates under the administrative control of the organisation
of the Chief Adviser, Factories (now Directorate-General, Factory
Advice Service and Labour Institutes).
(e)
Electrical Stations
Electrical stations are 'factories' as defined under the
Factories Act but, unlike the practice in many countries, the
factory inspectorates do not include electrical inspectors as a
specialist service within the inspectorate.
The Indian Electricity
.Act and the electricity rules framed under the Act, both union
enactments, apply to all places where electricity is generated,
transmitted, transformed, distributed or used.
The Act and rules
are administered by a separate body of electrical inspectors also
under the administrative control of the state governments.
(f)
Shops and Commercial Establishments
The working conditions of employees in shops and commercial
establishments are governed by the Shops and Commercial Establish
ments Act enacted by the individual state governments and admini
stered by an inspectorate of shops and commercial establishments
under the control of the state government.
The main provisions of
the Act relate to hours of work, payment of wages, holidays and
leave, and employment of children and young persons.
The provisions
of the Act are very limited in scope and do not specifically deal
with safety and health
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COMMUNITY HEALTH CELL
<42/1,(First Floor)St. Marks Road
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BANGAiO.TE • 560TMM
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INDIA
development of new processes of manufacture, the factory inspection
services felt themselves unequal to the task before them and had
to be strengthened by the addition of specialists drawn from
different professions and disciplines.
It was soon realised that
the inspection services, however well-equipped and organised
alone could not effectively deal with all the problems that they
were confronted with: recourse had necessarily to be taken to
obtain the oo-operation of scientists and technical experts, as
also the help and assistance of technical and scientific organisa
tions, research institutions and various other agencies, including
trade unions and trade associations for the evolvement of measures
for mitigating the hazards met within modern manufacturing
industries.
This has resulted in the drawing up of specific
regulations or codes of safe practices, covering a variety of
industries and industrial processes.
This trend of development
has been brought out in the suggested headings for the note under
which advance information is requested from the governments. Though
this indicates the logical development to fulfil its responsibilities,
the inspectorates face serious difficulties.
Today, particularly
in the developing countries, a more or less psychological atmosphere
has been created for industrialisation.
While this is good in
itself, there seems to be little appreciation of the need for con
current activities in the social field as affecting industry.
So
much so, there is not the same' sympathy and understanding of labour
problems, the emphasis being more on economic development, and often
it is considered that the social aspects could take their place
later.
But, unfortunately, because of competing demands on the
meagre resources, development towards this end has been slow.
In
all development projects that we see today, unless the activities
are stimulated almost under forced draught, little progress is
possible.
If this has been the case in economic development
programmes, one can appreciate what efforts would be needed to ensure
development in the social sphere.
VII.
INDIA
environmental conditions.
Then again, with the emphasis on
productivity, perhaps an ergonomics approach to the problem of
factory inspection will be more meaningful.
The measures taken
for ensuring the safety and health of workers should, at the same
time, help to reduce the physiological cost of work so far as the
worker is concerned, thus enabling him to produce more with the
same effort.
This in turn will mean that the inspectorates would
comprise specialist services covering a variety of disciplines.
POSSIBLE DEVELOPMENTS AND CHANGES IN OFFICIAL
SERVICES DURING THE NEXT TEN YEARS
For this we have to consider the changing pattern of indus
trialisation during recent years.
With the rapid technological
developments there has been a breakthrough from the traditional
form of manufacture; newer types of industries such as dyestuffs,
petro-chemicals, metallurgical and chemical process industries
have come into being.
In most of these newer industries, the
problem of safeguarding of plant and equipment is of less signi
ficance than the operating procedures.
The accepted inspection
procedures do not really and fully meet the situation.
If the
inspection services have to make definite contribution to the
safety and health of the man-at-work, more detailed knowledge of
the operating procedures would be necessary on the part of the
inspection services to enable them to discuss and advise on pre
ventive measures.
Further, the hazards, mostly chemical and
toxic, would not be apparent during inspections and the inspectors
would have to be provided with facilities to evaluate toxic and
other hazardous contaminants in the working atmosphere and other
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INDIA
INDIA
developments in the field, but also to carry out studies on its
own to provide information based on conditions as they exist in
the country.
Further, the particular area where assistance would
be welcome seemed to be in respect of specialist services which
did not exist then in any of the state factory inspection services.
Therefore such specialist services were gradually developed and
when these services became more and more acceptable, the Central
Labour Institute was set up with these specialist services forming
its various divisions, so that working as units of an integrated
institute they could bring to bear upon the subject a multi
disciplinary approach.
The Central Labour Institute comprises
the following eight divisions:
With the increase in the tempo of industrialisation, there
has been a heavy demand for engineers, and since industry offers
better conditions of service and emoluments, suitably qualified
personnel is not attracted by inspectorate's offers.
Thus, in
most of the state factory inspectorates the actual staff, to a
large extent, falls short of the sanctioned strength.
(ii
Industrial Safety, Health and Welfare Centre;
Industrial Hygiene Laboratory;
Staff Training Centre;
Productivity Centre:
Occupational Physiology Section;
Industrial Psychology Section;
Library-cum-Information Centre; and
Training Centre.
As an extension of the activities of the Central Labour Institute,
three regional labour institutes have been set up at Calcutta,
Kanpur and Madras.
These institutes are modelled on the pattern
of the Central Labour Institute, though the facilities provided
are on a reduced scale.
The central agency is a co-ordinating body but control to a
certain extent is exercised indirectly by providing information
on modern developments in the field of industrial safety and
health, organising facilities for the training of inspectors, by
convening conferences of chief inspectors of factories to discuss
problems of mutual interest and carrying out industrial hygiene
surveys to evaluate working conditions and specific health hazards
in operations.
II.
(a)
ROLE OF GENERAL INSPECTORATE
Recruitment and Training
By and large the general body of inspectors are engineers by
profession.
Except in the case of inspectors in the very junior
cadres, they are recruited through the state public service
commissions and at the Centre through the Union Public Service
Commission.
The recruitment rules prescribe in detail the
academic qualifications and experience required and applications
are called through public advertisements in the newspapers.
Generally the newly recruited inspectors are attached to their
senior officers as understudies for a year or two.
Opportunity
is also taken for further training by directing the newly recruited
inspectors to attend the Factory Inspectors' Training Course
organised biennially by the Directorate General Factory Advice
Service and Labour Institutes.
122
A qualified engineer finds, when joining the factory
inspectorate, that the experience to be gained in the department
is of not much use to him elsewhere, and that opportunities for
promotion are limited, compared to those in the engineering
services.
Thus, during the first few years of service the turn
over of the personnel is rather heavy.
(b)
Delimitation of Duties
The factory inspectorates function as a general inspectorate
and except for the geographical distribution based on the
importance of the area as an industrial centre to which an
officer may be posted, there is no specific delimitation of duties.
III.
ROLE OF SPECIALIST SERVICES
The staffing in the state factory inspectorates has followed
the traditional pattern.
In the early stages of development of
the inspection services, when mechanical power was mainly used in
manufacturing operations, the emphasis was more on the guarding
of machinery and general improvement of the physical working con
ditions and as such, mechanical engineering was obviously con
sidered as the desirable qualification for an inspector of
factories.
When electricity came to be introduced in a large
measure as motive power and in manufacturing operations bringing
in its train various types of electrical hazards, electrical
inspectors as a specialist service within the inspectorate was
not thought of but a separate electrical inspectorate was set up
outside the department.
The same has been in the case of steam
boilers and steam pressure vessels where again a"separate
inspectorate was set up charged with the responsibility of
ensuring the safety in the operation of steam boilers and steam
pressure plant.
Now the need for specialist services within the
inspectorate is being increasingly felt and steps are being taken
to set up such services in the factory inspectorates, in the
medical and some of the newer fields of activities.
(a)
Recruitment and Training
The position is the same as explained in 11(a) above.
(b)
Delimitation of Duties
The position is the same as explained in 11(b) above.
(c)
Laboratory and Research Work
At present industrial hygiene laboratories exist in only two
state factory inspectorates.
With their meagre equipment they are
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INDIA
not now in a position to undertake any major field studies; they
confine their activities to providing assistance to the inspector
ates in their day-to-day inspection problems.
iv.
(a)
DELEGATION OF SELECTED TOPICS AND DUTIES
local Authorities
So far as delegation of duties to local authorities is con
cerned, it is limited to the inspection of health provisions of
the Factories Act and for this purpose the medical officers of the
public health departments and the state medical services are
qualified as inspectors of factories and/or certifying surgeons.
(b)
Authorised Bodies or Associations
None at present.
(c)
Authorised Individuals (Technical Experts)
None at present.
V.
(a)
CO-OPERATION WITH NON-OFFICIAL SERVICES
Employers' Organisations and Trade Unions
At the national level, close co-operation with employers'
organisations and trade unions is maintained through the Indian
Labour Conference and the Standing Labour Committee and the
industrial committees covering the more important industries.
The subjects discussed include problems relating to factory
inspection, working conditions, safety, health hazards and welfare.
This in turn helps the inspection services at the state level to
follow up some of the decisions arrived at these conferences or
committees.
No formal machinery exists for the day-to-day
contact between the factory inspectorates and the employers'
organisations or trade unions, except when specific complaints or
suggestions are brought to the notice of the inspectorates.
(b)
Insurance Associations
The factory workers are covered by a national health insurance
scheme - the Employees' State Insurance Scheme operated by the
Employees' State Insurance Corporation.
The Corporation as well
as the Standing Committee of the Corporation are tripartite bodies
in which employers, labour and the central and the state govern
ments are represented, and matters relating to safety and health
do find a place in their deliberations.
(c)
Professional Associations
The Society for the Study of Industrial Medicine (India),
with its branches in almost all the states maintain close liaison
with the factory inspectorates.
124
INDIA
(d)
Universities and Research Associations
In recent years the vocational training and higher techno
logical institutes have recognised the need for training in safety
and assistance is being sought by teaching institutions for the
preparation of syllabus for training in safety.
In some of the
higher technological institutes and vocational training centres
regular programmes are presented by the Central Labour Institute
and the regional labour institutes, in addition to the various
programmes sponsored through the National Productivity Council
and local productivity councils.
(e)
Voluntary Associations for Safety and Health
Close contact has been maintained by the central organisation
with the activities of the Indian Council of Medical Research,
particularly on problems of occupational health; in co-operation
with the Council, research projects have also been undertaken.
There are a number of voluntary associations concerned with
accident prevention, but their activities are confined to traffic
safety.
The Bombay Safety Council, a body which was recently
set up, is doing yeoman service in the field of industrial accident
prevention and works in close co-operation with the central
organisation.
In fact, much of their training activity has been
made possible because of the facilities provided by the Central
Labour Institute.
The need for a voluntary agency to supplement the activities
of the official agencies has been keenly felt and a President's
Conference on Industrial Safety was convened in December 1965.
Following this a National Safety Council has been set up.
The
Central Labour Institute is providing all the assistance necessary
in its formative stages.
(f)
Others
The factory inspection services also maintain close contact
with the various professional bodies such as the Institute of
Personnel Management, the National Productivity Council, local
productivity councils, and the various trade associations.
VI.
MAIN TASKS AND PROBLEMS FACING
The problems that the inspection services in this country
face at present are the same through which the inspection services
in the industrially advanced countries have had to pass through.
With the changing situation in industry, the character of the
factory inspection services has had to be modified from time to
time.
In the earlier years of industrial development, the factory
inspection services were more concerned with the safeguarding oi
machinery, plant and equipment; it was later, with the recognition
resultin’ from analysis of accident records that the human factor
entered in a majority of accidents, thus thfe guarding of machinery
and education in caution became the two significant factors in
accident prevention.
With the increase in mechanisation and the
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INDIA
(g)
Agriculture and Forestry
There are at present no statutory provisions regulating
health, safety and working conditions of workers employed in
agriculture.
Agricultural operations cover the entire country
and most of the agricultural operations are carried on in the
traditional way using hardly any mechanical equipment.
However,
so far as the health and welfare of workers in the plantations
are concerned, they are covered by the Plantation Labour Act, 1951.
The Act applies to all tea, coffee, rubber and cinchona plantations.
Provisions relating to safety do not figure in the Act, since, at
present, hardly any mechanical equipment is used.
However, the
processing establishments come under the scope of the Factories Act.
(h)
INDIA
The majority of the inspection services have a decentralised
administration with a headquarters office and other offices,
variously designated as branch offices, district offices or circle
offices.
Some of the medical inspectors are officers of the state
public health departments seconded to the factory inspectorates
and revert back to their parent departments on completion of their
tenure.
The others join the inspectorates and are more or less
permanent officers there.
(ii) Mines■
The department is headed by the chief inspector
of mines, assisted by an additional chief inspector with a fairly
strong specialist staff at the headquarters office in Dhanbad
(Bihar).
The field work of this organisation is conducted from 13
Mines
regional offices situated at different centres of mining activity.
Mines are a subject under the union list and the safety and
welfare of workers in mines are covered by the Mines Act, which
is administered by the chief inspector of mines, who is under the
direct administrative control of the union government.
2.
Outline of Structure of Labour Inspectorates Arrangements for Central Control and Co-ordination
(a)
Outline of Structure
Each regional office is under a regional inspector assisted by one
or more inspectors and/or assistant inspectors.
Ten of the 13
regional offices are grouped into four inspection zones.
There are two electrical ispection circles to administer the
Indian Electricity Act in mines all over India.
Some survey
staff is posted at. two zonal offices.
The specialist staff includes:
(i) Factories.
Each state has an inspectorate of factories
with the requisite engineering and other staff for administration
of the Factories Act and other labour laws.
The headquarters of
the inspectorates are normally located in the state capitals.
The chief inspector of factories in most states is a
technically qualified officer.
All the inspectorates have on
their staff technically qualified engineers.
In addition, there
are:
-
medical inspectors (ten) in seven states (none in any
union territory);
-
whole-time certifying surgeons - one in each state;
-
women inspectors in factories - in five states;
-
inspector for notified factories - in two states;
-
chemical inspectors - one each in two states;
-
technical inspectors of factories (textile) - in two states;
- statistical inspectors - in two states;
- legal assistants - one each in two states.
120
-
technical staff for processing of applications;
-
special investigation staff for special mining problems
of ventilation, gas, coal, dust, roof control in respect
of deep and gassy mines;
-
medical inspectors;
-
statistical inspectors;
-
law officer;
-
surveyor with 12 survey teams;
-
barrier survey scheme staff.
(b)
Arrangements for Central Control and Co-ordination
The organisation of the Chief Adviser, Factories (now Directorate
General Factory Advice Service and Labour Institutes) was set up
as a co-ordinating body to deal with all questions relating to the
administration of the Factories Act and the rules framed thereunder.
The organisation functions as an integrated service to advise
industry and other interests concerned with matters relating to
health, safety and welfare of workers.
However, it was soon felt
that for the organisation to effectively function as a co-ordinating
body for the state factory inspection services and to advise on the
enforcement of the safety and health provisions of the Factories
Act, it would have mot only to keep itself abreast of modern
121 -
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Worker’s Health is Industries’ Wealth
Department of Community Medicine
St. John's Medical College and Hospital,
BANGALORE-560 034.
Occupational Health aims at the promotion and maintenance of
the highest degree of physical, mental and social well-being of work
ers of all accupations; the prevention among workers of departures
from health caused by their working conditions; the protection of
workers from risks resulting from employment factors adverse to
health; the placing and maintenance of workers in occupational
environments appropriate to their physiological and psychological
make-up, and, to summarise, “THE ADAPTATION OF WORK
TO MAN AND OF EACH MAN TO HIS JOB.”
Like the very few institutions in India rendering care in the field
of Occupational Health, St. John’s Medical college, through its
Ross Institute Unit (a branch of the Ross Institute of Tropical
Hygiene, London), provide comprehensive health services to indus
tries. These services include pre-employment screening of workers,
periodical review of the health status of employees especially in
relation to occupational hazards, first-aid training, advisory services
to factory managements, research and training. Further, with the
support and backing of facilities at St. John’s Medical College
.Hospital, follow up and comprehensive medical care is available in
'almost all specialities and superspecialities of scientific medicine.
The hospital is particularly well equipped and excellently staffed and
provides, under one roof, many services that are not easily available
elsewhere in Bangalore: echocardiography, computerised stress ECG
testing, ultrasound, gastrointestinal endoscopy, cystoscopy and trans
urethral resection of prostate, cystometrography, kidney dialysis,
retinal angiography and photocoagulation, electoencephalography,
electromroneurography, angiography, cryosurgery, radioimmuno
assay, etc. In collaboration with the United Planters Association of
South India, the Ross Institute has done extensive work with regard
to the healh status of tea plantation workers.
The following occupational health services are provided to
Industries in Bangalore :
-■ Pre-placement Medical Examination
- Periodical Medical Examination - for workers and executives
- Safety Education
- Safety Health
- Curative health care
Medical eithcs requires that confidentiality be maintained regarding,/■
the patient’s medical condition. It is therefore necessary for each
employee referred for these services to submit to the Ross Institute
a declaration that he has no objection to his medical data being
submitted to his employer.
Only then can the Department of
Community Medicine send periodical reports to the management on
the health status of its employees and the factors that need to be
considered for improvement of health and productivity.
PRE-PLACEMENT MEDICAL EXAMINATION
Pre-employment check-up involves screening of the prospective
employee’s health for his suitability for employment in that
industry and for the particular nature of work contemplated. The
examination is arranged on specified dates fixed in consultation with
factory management. Tuesday and Thursday afternoon, between
2 p.m. to 4 p.m. are preferred.
Pre-employment screening entails the following :
Physical examination
Rs. 20/Blood counts (HB, TC, DC, ESR) Rs. 20/Urine - Routine and Micro
Rs. 10/VDRL
Rs. 15/Sr. Cholesterol
Rs. 20/Chest X-ray
Rs. 45/-
Rs. 130/-
Additional tests such as ECG, Stool examination, etc.
also be undertaken on payment of an additional charge.
2
may
PERIODICAL MEDICAL EXAMINATION — WORKERS
Keeping in veiw of the report of the pre-placement medical
examination, periodical medical examination of workers is advocated
once a year (less or more frequently in certain industrial settings, if
desired) during fixed months in a year.
The following regimen is recommended for periodical medical
review of workers :
Q
Physical Examination
Complete blood count (Hb, TC, DC,
ESR)
Urine routine and Micro
Stool Micro
Serum Cholesterol
20/-
Blood Sugar-post-prandial
ECG
Chest X-ray
15/30/-
20/10/-
5/20/-
45/Rs.
165/-
As with pre-employment check-ups, periodical medical examina
tions are undertaken after prior appointment, on dates conve
nient to the Factory and the Department of Community Medicine.
The recommended days are Tuesdays and Thursdays between 2 p.m.
and 4 p.m.
EXECUTIVE HEALTH CHECK-UPS
Executives in industries are particularly prone to the effects of
stress insomnia, backache, duodenal ulcer, hypertension, angina,
myocardial infarction. Further,
several other diseases such as
diabetes, cancer, glaucoma, cervical spondylities, rheumatoid arthri
tis, arteriosclerosis, etc. first make their appearance during the
middle-age years. Many of these diseases, if detected early, can be
arrested, thus reducing morbidity and permitting the executive to
devote his attention to more productive issues. Beyond instituting
early treatment for these diseases, periodical medical check-ups serve
3
to draw awareness of the executive to hazardous occupation factors
and leads to change in attitudes and habits that have a long term
positive effect on health and productivity.
St. John’s Medical College Hospital is particularly equipped to
carry out health screening programmes for executives. Beyond the
regimen recommended for workers, executives may be advised to
undergo some of the following investigations depending on the symp
toms : glucose tolerance test, estimation of blood urea, blood uric
acid and serum triglycerides, X-ray of cervical region, computerised t
stress ECG testing, specialised radiographic procedures. These in
vestigations, coupled with competent medical advice, can go a long
way in ensuring timely medical care, increased concentration at work
and higher output of executives.
SAFETY HEALTH
This is a consultancy service extended by the occupational
health specialists of our department to industries in order to ensure
a healthy occupational environment. Also, consultancy services are
provided to existing institutions to improve their occupational
environment. These services are rendered by prior agreement. The
cost varies depending on the amount of input involved from the Ross
Institute Unit with respect to inspection, time and staff utilised,
hours of work, investigations carried out.
These consultancy services include :
To improve General Health
To improve Occupational
Environment
Nutrition Services
Building Design
Communicable Disease Control
Environmental Sanitation
Mental Health
Maternal and Child Health
Health Education
General House Keeping
General Ventilation
Mechanisation
Substitution
Dusts
Enclosures
Natural Family Planning
4
Isolation
Counselling
Local Exhaust Ventilation
Protective Devices
Environmental Monitoring
Research
Organisation of Food
Preparation, Consumption,
distribution on mass scale
Ergonomics
SAFETY EDUCATION
Education about common health problems, common industrial
hazards, health facilities available for the industrial workers, etc is
an integral part of any occupational health programme. Keeping
this in view, the department imparts education by multi-media
approach on a continued basis, coupled with pre and post evaluation
to apprise the management of industries on the impact of such an
education.
The services include :
— Film / Video programmes
— Pamphlet and booklet distribution
— Seminars / discussions
— Demonstration on the usefulness of protective devices in par
ticular settings.
RESEARCH
Without research no occupational health service can be effective.
The department
undertakes
research
activities in specific
industrial settings giving priority to following projects :
— Sickness, absenteeism
— Analysis of accident register — risk management
— Knowledge attitude and practice study of employees with respect
to :
5
Health
Health facilities
Occupational Health Hazards
Family Planning
Prevention of Accidents
Use of protective devices
—Ergonomics
—Mass catering in Industries.
For further Information, kindly contact
Dr. Kishore Murthy
Lecturer,
Department of Community Medicine,
St. John’s Medical College,
Sarjapur Road, Bahgaiore-560 034.
(Phone : 565435)
6
ELY ASH - an environment and health perspective.
A Toxics Link Briefing paper
September 1997
Contents
2
Introduction
Thermal power plants and fly ash
What is fly ash?
3
Fly ash disposal
3
Land Usage
Water Usage
Toxicity and Health Impacts
7
Fly ash in surface and ground water
Fly ash in ambient air
Let's And a solution
11
Clean it
Use it
Is flyash utilisation environmentally safe?
Or economically viable?
Or constructively stable?
Annex 1 Environmental Impacts of coal fired thermal power plants
13
Annex 2 Renewable Energy Scenario
14
Annex 3 Examples of uses of fly ash a. International b. India
15
References and contacts
Author Madhumita Dutta
Editors Rachel Kellett, Ravi Agarwal
Design Rachel Kellett
Acknowledgements
Toxics Link wish to thank the following people for helping us prepare this first TL Briefing paper: Ravi Agarwal,
Nityanand Jayaraman, Prof K.C. Sahu, Amitab Mathur. Bob Edwards
About Toxics Link
We are a group of people working together in India for environmental justice and freedom from toxic pollution. We
have taken it upon ourselves to collect and share information about the sources and dangers of poisons in our
environment and our bodies, and about clean and sustainable alternatives tor India and the rest of the world.
We have an information Exchange in Delhi which provides information (electronically and on paper) and networks
groups working on similar toxics issues.
Fly astt - an environment and health perspective © Toxics Link September 1997
Why fly ash?
A city like Delhi produces more fly ash than it does municipal waste; and
just from three sources, its thermal power plants. Nationally we produce
60 million tonnes of it annually compared to 13 million tonnes of
municipal waste and 5 million tonnes of hazardous waste. Multiply that
with the number of years we have been generating power thermally, and the
quantities will boggle the mind. While urban and municipal wastes have
merited the attention of all, fly ash has been literally left abandoned. Where
does it go? It is dumped everywhere, on land, in water, in front of peoples
homes, and is so fine that it can penetrate deep inside ones lungs.
Why is there so much apathy towards this residue of coal burning? The.
general belief is that it is inert, non-toxic, harmless, and an almost ready to
use construction material. Is that really so? Toxics Link set out to examine
the issue, especially in the light of the increasing number of thermal power
plants being planned in India presently, and found the issue to be more
complex than meets the eye. Not only did available research point to the
potential hazards of fly ash, but also that its utilisation was not necessarily
as easy as it is made out to be. The following paper is based on both
national and international data and concludes that much more work is
required to be done before solutions to this monumnetal problem are
available.
yoxics Link
Toxics Link Exchange Delhi
c/o Room 1001 10th Floor
Antariksh Bhawan
22 Kasturba Gandhi Marg
New Delhi 110001
Tel:+91 11 332 8006
e yoxics Link
eU@ti.unv.emet.in
Fly ash - an environemnt and health perspective. Toxics Link September 1997
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1. Introduction
Thermal power plants and fly ash
Sixty million tonnes of fly ash is produced in
India per annum from the seventy five coal
fire-d thermal power plants (TPPs) [Vimal.
1996# I ]. For every mega waft of power being
generated approximately 0.6 to 0.7 tonnes of
ash is created every'day [Raju. 199662], Delhi
alone contributes nearly 5600 tonnes of fly ash
every day from its three thermal power plants
[Damandeep. 19976’31.
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Currently India's total installed capacity for
electricity' generation is 83.288 mw (year
1996). Out of which, coal fired thermal power
plants contribute 53.819 mw. in other words
around 65%. The World Bank estimates coal
based power generation to increase by 81.000
mw by 2010 [WorldBank. 199664], This
amounts to an additional load of 56 million
tonnes of fly ash to be dealt with per year.
With these concerns. Toxics link started its
investigation on fly ash. What happens to all
the fly ash accumulating over years? How and
where is it disposed? On land, in water? How
much land is required for the disposal? How
much water is required? Is it toxic? Does it
affect ground water, surface water? Can fly ash
be utilised? If so. how. and is it 'safe'?
Table 1: India power sector (as on 31.3.1996)
Sector
Thermal
hydro-electric
Installed capacity (in mega watt)
53.819
i
20.976
gas-fed
6,268
nuclear
2,225
Total
83.288
Source [BHEL (Bharat Heavy Electrical Limited,#5 ]
Despite this monumental generation of fly ash.
it appears that international lending agencies
and the Indian Government aren’t fully
prepared to appreciate the magnitude of the fly
ash problem. The Government is drawing up
plans to expand coal-based generation capacity
with loans from the World Bank [World Bank.
199664], Under the ninth five year plan (19972002) a large share of investments for the
power sector will come from the private sector,
both domestic and foreign. Guidelines have
been suggested for "the participation of private
sector in renovation and modernisation of
thermal and hydel power projects''! Parikh.
*6],
1997
On the other hand, investments in clean and
non-fossil fuel-based technologies have been
insignificant despite their low fly ash
generation potential. Even the Global
Environment Facility, whose mandate it was to
promote non-conventional energy as a means
to curbing greenhouse gas emissions, has
posted an abysmal track record. During the
financial year 1995-1996. the GEF approved
S34.2 million in grants for fossil fuel-based
projects as against S18.4 million for renewable
energy technologies [Imhof. 199767], In a
recent report produced by Institute for Policy
Studies ct al reveals that "the world bank has
lent close to S10 billion toward the continued
use of fossil fuels just since the 1992 climate
convention was signed by a majority of
world's leader” [Wysham, 199768].
Disposal of fly ash is extremely water- and
land-intensive, leading to diversion of fertile
lands and unsustainable water usage. It also
causes displacement of people since large
tracts of land are acquired for fly ash disposal.
besides leading to air, water and soil
contamination. Studies indicate ground water
contamination due to leaching of heavy metals
present in the fly ash.
Experts have predicted possible human health
effects, like permanent respiratory disorder on
inhalation of metals present in fly ash,
especially by persons living in the vicinity of
disposal sites.
|
Some experimental measures are however
being tried out to utilise fly ash. Govennent is
investigating schemes for manufacturing
bricks, constructing buildings, embankments,
roads etc., using it.
Our investigation revealed a lack of data in
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crucial areas—namely, the environmental and
health effects associated with the disposal or
utilisation of fly ash. This paper outlines some
of the environmental issues concerned with fly
ash and hopes to generate some debate as well
as demand for further discussion and
investigation.
Fly ash - an environment and health perspective. Toxics Link September 1997
2. What is fly ash?
Fly ash is a by-product of the coal-combustion
process in thermal power plants. TPPs
currently consume an estimated 150 million
tonnes of coal (60 percent of total coal
production in India), which is likely to increase
to 187.5 million tonnes (75 percent) by 2001
[Vimal. 1996#!].
The amount of ash generated in a TPP depends
upon two factors — the ash content of the coal
and the type of boiler used. The coal used in
Indian TPPs usually has a high ash content,
ranging between 35 percent and 55 percent.
toxic trace elements [Sivakumar. ! 996# 10].
Therefore, the trace elements are found to be
concentrated largely on the surface of fly ash
particles.
Table 3:
Major and Trace elements in fly ash of Indian
thermal power plants
Elements
Arsenic
Cone, in ppm
11.0
Gold
1.7
Barium
828
Bromine
17
Cerium
155
Cadmium
About 20 percent of the non-combustible
components of the coal is converted into
bottom ash and 80 percent into fly ash
[Agarwal, 1996//9J. Fly ash is carried up the
chimney stack along with lire combustion gas
and is captured by an electrostatic precipitator
[Vimal, 1996#!].
Fly ash consists of finely divided particles
with sizes ranging from 120 micron to less
than 5 micron. It is composed of oxides of
iron, silicon, aluminium, magnesium, calcium,
sodium and potassium.
Table 2: A typical composition of fly ash
9
Chlorine
890
Cobalt
23.6
Chromium
Cesium
120
10
Copper
100
Europium
1
Iron
47,000
Hafnium
9
Mercury
0.1
4
Iodine
Potassium
Lanthanum
8800
78.5
Lutetium
0.61
Sodium
811
Nickel
150
Lead
35
Constituents
% Amount
Rubidium
87
Silicon
50-58
Selenium
27
Aluminium oxide
16-31
Iron oxide
6-20
Silicon
Antimony
270,000
1
Titanium oxide
Phosphorous oxide
1,5-2
Samarium
11 6
2-2.5
Strontium
240
Calcium oxide
0.8-4
Titanium
9500
Magnesium oxide
1-4
Sodium oxide
0.8-2
Potassium oxide
0.7-1
Sulphur oxide
Traces
Chlorine
Traces
Note: ppm-parts per million
[Negi & Meenakshy (1991) and Nandagaonakar (1991)]
Source: [BHEL (Bharat Heavy Electrical Limited, #5]
Along with oxides, fly ash contains toxic trace
elements such as antimony, arsenic, beryllium.
cadmium, fluorine, lead, mercury, selenium.
thallium and vanadium [Agarwal. J996#9],
The oxides of iron and aluminium present on
the surface of the fly ash particles attracts these
3.
Fly ash disposal
Like all waste, disposal of fly ash is expensive.
It is estimated that almost as high as 2 percent
of the cost of a TPP goes into disposal of fly
ash [Vimal, 1996# I], Transportation is a main
Fly ash - an environment and health perspective. Toxics Link September 1997
component ot it. l or example, the government
alone spent Rs 700 crores in 1995. mainly for
moving fly ash from the site of generation to
the disposal site [TOI. 1995 #12],
Disposal sites may be on-site or at a distance.
Normally they consist of'custom built’ ponds
which require large amounts of both land and
water.
Land Usage
,
Table 4:
Status of fly ash production and land area
required for its disposal by some of the Indian
Thermal Power Plants for the year 1995-96.
Name of Plants
Installed
capacity (mw)
Kota. RSEB
As a thumb rule, for every mega watt of
installed capacity, approximately 0.8 to I acre
of land can be used to dispose fly ash
generated over 25 years, provided the material
is allowed to accumulate to a height of 8 to 10
meters. [Sahu. 1994# 14],Therefore the
estimated land requirement for the 75 existing
TPPs amounts to nearly 54.000 acres.
In practice however, there is a lot of disparity
between this 1:1 mw to acre ratio, as can be
seen in Table 4-5. which lists the land required
by the Super and other thennal power plants.
This could be due to various factors -
850
Ash
production
(tonnes)
Ash
pond
(acres)
9.72,982
1045
Hasbeo. MPEB
840
13.55,641
Satpura, MPEB
1142.5
23,58,466
560
787
300
Amar Kantak, MPEB
Sanjay Gandhi. MPEB 420
3;37,078
24
4,25.837
247
3,61,355
Santaldih, WBSEB
530
480
2,81,610
79
4941
Khaperkheda. MSEB
420
8,40,000
Bandel, WBSEB
865
Paras, MSEB
62.5
48.645
72
Parlivaijnath, MSEB
690
9,69,300
1190
Nashik, MSEB
910
15,21,545
1760
Note:
RSEB Rajasthan State Electricity Board,
WBSEB West Bengal State Electricity Board.
MPEB Madhya Pradesh Electricity Board.
•
a The type of coal used and boiler type.
MSEB: Maharastra State Electncity Board.
•
b. Ash ponds are over utilised or
Source: Malewar G.U. "Fly ash research at Marthwada
Agriculture University (MAU) Parbhani."
•
c. Dumping of ash is beyond / outside the pond
Table 3
Actual acquired land by some of the ‘super1
thennal power stations in India (1985)
TPP
Installed
Ash pond size ratio
capacity (mw) (acres)
Farakka
Korba
2500
2267.46
2500
6570.2
Koradi
1080
Singrauii
1050
Vindhyachal 1260
1:0.3
434.72
1:2.4
2964
1:0.3
5434
1:0.2
Source: [Thakre, 1996 #11]
In West Bengal, acute shortage of land has
made it almost impossible to find adequate
space for fly ash dumping [Tapan. 1997=15],
As a case in point the proposed and
controversial 1000 mw Cogentrix thermal
power plant in Karnataka has asked for 1.300
acres of land, out of which 46% of the land i.e.
600 acres, is marked for fly ash disposal.
Because of land scarcity and the land turning
unproductive, the Ministry of Environment and
Forests “has become strict in granting
permission to TPPs for acquisition of more
land for ash disposal" [Thakre. 1996 #11J.
As a way out. sanctioned lands are sought to
be used further by constructing tall bunds for
accommodating more ash being generated.
This may have serious environmental effects
since it can lead to a more concentrated
leaching of heavy metals into the ground
water, (see Section 4).
Fly ash - an environment and health perspective. Toxics Link September 1997
cogentrix - pushing environmental carrying capacity
In a recent move on the 29 August 1997, the Division Bench of the
Karnataka High Court dissmissed the Public Interest Litigation against
the Cogentrix thermal power project filed by Janajagriti Samithi and
former environment minister Maneka Gandhi. Though it has asked
the Ministry of Environment and Forests and the Karnataka State
Pollution Control Board to consider the environmental concerns
raised in the litigation within 3 months.
The 1000 mw Cogentrix thermal power station proposed for
Karnataka's Dakshina Kannada district by the US based Cogentrix
Energy Inc., has been in the eye of storm since early 90s, when the
Karnataka government gave its go ahead to the company. The
proposed site of the plant at Nandikur, three kilometers inland from
the Arabian sea, is known for its magnificent biodiversity and lies
within an area nch in marine fisheries, and known for its agricultural
and horticultural productivity.
The same site, in two earlier occasions, was found unsuitable for
siting of thermal power plants on the ecological and economic
grounds.
In 1995, the Mangalore Power company, a subsidiary of Cogentrix
Inc. acquired 2,02,401 acres in Udupi taluka for setting up 4 x 250 mw
coal based TPP. When in operation, the Cogentrix plant is expected
to use 5,300 tonnes of imported coal daily. The power station will
generate an estimated 685 tonnes of fly ash, and 70 to 80 tonnes of
sulphur dioxide will be released into the atmosphere every day
[Goswami, 1995 #18],
Understandably, the project has drawn the ire of fisherfolk and
horticulturalists who feel that the emissions (solid, liquid and air
borne) threatens their livelihood resource base. Dakshina Kannada,
an ecologically sensitive coastal district has become a major centre of
industrial investment since beginning of this decade, and it is felt that
addition of any new industry, especially the ones like thermal power
plant might cause irreversible damage to the already threatened
ecology of the area.
Forfurther information on Cogentrix comacl:
Bangalore Support Group: 153, 5th Main. 4th Block. Banashankari 3rd Stage.
2nd Phase Bangalore 560 085 Telefax: 91-80-2262571 Email:
admin dleo. ilhan. crnet. in
Fly ash - an environment and health perspective. Toxics Link September 1997
BSES, threatening Dahanu ecological fragility?
Dahanu. a small and quiet taluka in the Thane district of Maharashtra, is rich
in marine life and famous for its chikoo and guava production. In the late
1980's, the World Bank proposed funding Brihan Mumbai Suburban Electric
Supply Ltd's (BSES) 500 mw coal based thermal power plant in Dahanu for
electricity supply to the ever expanding 14 million people in Bombay, and with
an expansion plan of ZOOOmw in future
Alarmed locals fearing possible environmental damage to the ecologically
fragile area, formed a group Dahanu Taluka Environmental Welfare
Association (DTEWA) to stop the plant from being set up. DTEWA petitioned
to the Bombay high court in 1989 challenging the siting of the BSES plant, A
senior advisor from the ministry of environment and forests in 1991 and
before that the head of the Thermal Power Plant Committee surveyed the
area and found the area environmentally as well as economically unsuitable
for setting up a TPP.
Despite this evidence, and the revolt of the local people, the Maharashtra
State government gave the clearance, and BSES was built.
Undeterred by this blatant environmental threat, the DTEWA fought to
preserve the taluka and in 1991. in a land-mark judgement, Dahanu was
declared an ecologically fragile area. This meant “no polluting industries
would be allowed to come up in a buffer zone of 25 km around Dahanu"
Furthermore, the Coastal Regulation Zone Rules of 1991 imposed restrictions
on development within the high tide line [Menon, 1997 #41]
DTEWA continued to question the environmental performance of BSES. In
1996 the matter was brought up in the Supreme Court, which ordered an
independent investigation to be carried out by NEERI to determine the
environmental performance of BSES.
NEERI investigations showed
• The location of the plant itself violates the sensitive area classification of
the MEF's guidelines (1984) for siting of industries.
• The TPP with its construction activity was blocking the free flow of the sea
water into the creeks, which had reduced the phytoplankton variety in the
creek by 69%, fish variety by 64% and prawn variety by 66%. Furthermore the
proportion of fish in a harvest had reduced from 41% to 12%, prawn- from 9%
to 0.5%, while trash fish had increased from 38% to 84%.
•
There can be accidental escape of fly ash slurry into the creeks.
• BSES's emission of particulate matter was found to be 134 mg/cubic
meter and 117 mg/ cubic meter from its two units, whereas the permissible
limit set by the State government is 100 mg/cubic meter, exceeding which the
plant should shut down. It was also observed that BSES had not installed
Flue Gas Desulphurisation (FGD) plant, for control of sulphur emission, as
directed by the state and central government
The Supreme Court took note of all these points observing the ecological
fragility of Dahanu and ordered BSES
• a to shift to natural gas from coal; b. irfstall FGD plant; c. remove
obstructions to free flow of water into the creek, d. end the practice of
disposing fly ash (more than 3.000 tonnes a day) into the wetland, and e. not
to expand beyond 500 mw in Dahanu
DTEWA says to date there is no sign of any of the above being implemented.
So despite the clear and strong SC ruling, they must campaign further for its
implementation. [Irani,N. 1997 #13]
l-or further tnfonpation on Dahanu contact’
Nergis Irani Katy Rustom. Dahanu Taluka Environment Welfare Association. I’aki.
Ambaipada. 1 iahanu Road 40T602. Tel 02528 22688. entail merchamink.ml.at.com
Ry ash - an environment and health perspective. Toxics Link September 1997
I he land for fly ash disposal is often prime
agricultural land. Kolaghat Thermal Power
Station in \\ est Bengal reportedly dumps fly
ash on adjoining farmlands at Kolaghat "This
is unique instance of inappropriate use: while
fertile soil is being used for making bricks, fly
ash is being used in farmlands", says Subrata
Sinha, former deputy director of Geological
Sun ey of India. [FE news service. 1996=16],
Faced with scarcity of land, thermal plants.
especially those located in cities, often pump
their ash slurry directly into nearby rivers or
streams [Sahu. I994#I4]. For example, the
Ennore Thermal Power Station in Chennai,
Tamil Nadu, which generates 3, 000 tonnes of
ash per day. flushes the ash out into the Ennore
creek. [Subramanian. 1997# 17],
Ehe Brihan Mumbai Suburban Electric Supply
Ltd's plant located in the eco-fragile’ Dahanu
taluka of Maharashtra, dump their ash in a
nearby wetland. The plant is surrounded by
creeks on three sides and is located on
reclaimed wetlands between Savta and Dandi
creeks. It produces fly ash at the rate of 2.830
tonnes day and bottom ash at around 707
tonnes /day : both are disposed in a slurry form
in 913.9 acres of wetland embanked for fly ash
disposal. According to National
Environmental Engineering Research Institute
(NEER1), the accidental escape of fly ash
slurry into the creek is also not ruled out [Irani.
N.
1997 #13]. This can cause toxic effects on
aqauticlife. (see Section 4)
Leaking of fly ash slurry' from ruptured pipes
as described in a Singrauli report by Peter
Bosshard can lead to even large land areas, at
times agricultural land, being converted to ash
ponds . "A pond of ash slurry which co\ ered at
least three hectares of rice fields near Judi
village. The pond had been created by ruptured
ash pipes leading from the Vindhyachal STPP
to the existing ash dikes"(Bosshard. 1997
= 19|.
In coastal regions or flood belts, fly ash from
thermal power plants is dumped in the flood
plains changing their natural topography. "A
far graver hazard is the dumping of fly ash in
flood plains. These are low lying regions that
routinely absorb rain water and reduce the
intensity of floods" Dhrubojyoti Ghosh, an
;
I
i
i
,
t
environmental engineer and UN Global 500
laureate, points out. "This leads to the filling
up of the natural depression of the plains that
contain the water, thus reducing the natural
capacity of the region to mitigate floods"! FE
newsservice. 1996#16],
|
Water Usage
Fly ash. along with bottom ash is disposed off
using cither the wet method (sluny form) or
dry method into ash ponds [Vimal. 1996= I ].
In India. 80 percent of fly ash is disposed off
in a shiny (or wet) fonn. In this case water is
used to aid transportation down the pipes
and/or to keep it from blowing into the
ambient air.
Disposal of fly ash in a sluny form requires
large amount of water. Typically, the water to
ash ratio in a slurry is 9:1. For example, a 210
mw TPP (BadarpurTPP in Delhi, for instance.
has two units each of 210 mw installed
capacity) would require a total 400 cu.m/hr of
water to dispose fly ash in a slurry fonn
[BHEL (Bharat Heavy Electrical Limited,#5 ].
(The remaining water is used in the boiler,
auxiliary cooling water system, condenser
cooling, air conditioning, coal dust
suppression, ventilation, service and drinking
[Agarwal, 1996#9].)
Because of the high water requirement. TPPs
are usually located near rivers for easy access.
In some cases, especially in the absence of
other sources, tapping of ground water is
restored to. This bears an additional load on
the water resources by either reducing the
availability of water downstream (in the case
of river-based Plants) or by depleting the
groundwater table.
4.Toxicity and Health Impacts
Around 10% of ash generated by TPPs is
released in the ambient air from the chimney.
increasing the suspended particulate matter in
Fly ash - an environment and health perspective Toxics Link September 1997
I he land for fly ash disposal is often prime
agricultural land. Kolaghat Thermal Power
Station in West Bengal reportedly dumps fly
ash on adjoining farmlands at Kolaghat. ‘This
is unique instance of inappropriate use: while
fertile soil is being used for making bricks, flv
ash is being used in farmlands", says Subrata
Sinha, former deputy' director of Geological
Survey of India. [FE news sen ice. 1996“ 16]
Faced with scarcity of land, thermal plants.
especially those located in cities, often pump
their ash slurry directly into nearbv rivers or
streams [Sahu. 1994# 14], For example, the
Ennore Thermal Power Station in Chennai.
Tamil Nadu, which generates 3, 000 tonnes of
ash per day, flushes the ash out into the Ennore
creek. [Subramanian. 1997# 17],
Tlie Brihan Mumbai Suburban Electric Supply
Ltd's plant located in the ’eco-fragile’ Dahanu
taluka of Maharashtra, dump their ash in a
nearby wetland. The plant is surrounded by
creeks on three sides and is located on
reclaimed wetlands between Savta and Dandi
creeks. It produces fly ash at the rate of 2.830
tonnes/day and bottom ash at around 707
tonnes /day : both are disposed in a slurry form
in 913.9 acres of wetland embanked for fly ash
disposal. According to National
Environmental Engineering Research Institute
(NEER1), the accidental escape of fly ash
slurry into the creek is also not ruled out (Irani,
N. 1997 #13]. This can cause toxic effects on
aqautic life, (see Section 4)
Leaking of fly ash slurry; from ruptured pipes
as described in a Singrauli report by Peter
Bosshard can lead to even large land areas, at
times agricultural land, being converted to ash
ponds . “A pond of ash slurry which covered at
least three hectares of rice fields near Judi
village. The pond had been created by ruptured
ash pipes leading from the Vindhyachal STPP
to the existing ash dikcs"[ Bosshard. 1997
M9|.
In coastal regions or Hood belts, fly ash from
thermal power plants is dumped in the flood
plains changing their natural topography. "A
far graver hazard is the dun,ping of fly ash in
Hood plains. These are low lying regions that
routinely absorb rain water and reduce the
intensity' of floods" Dhrubojyoti Ghosh, an
environmental engineer and LN Global 500
laureate, points out. "This leads to the filling
up of the natural depression of the plains that
contain the water, thus reducing the natural
capacity of the region to mitigate floods j FE
newsservice. 1996=16].
Water I sage
Fly ash. along with bottom ash is disposed off
using either the wet method (slurry form) or
dry method into ash ponds (Vimal. 1996= I)
In India. 80 percent of fly ash is disposed off’
in a slurry (or wet) form. In this case water is
used to aid transportation down the pipes
and/or to keep it from blowing into the
ambient air.
Disposal of fly ash in a slurry' form requires
large amount of water. Typically, the water to
ash ratio in a slurry' is 9:1. For example, a 210
mw TPP (Badarpur TPP in Delhi, for instance.
has two units each of 210 mw installed
capacity) would require a total 400 cu.m/hr of
water to dispose fly ash in a slurry' form
[BHEL (Bharat Heavy Electrical Limited.=5 ].
(The remaining water is used in the boiler.
auxiliary cooling water system, condenser
cooling, air conditioning, coal dust
suppression, ventilation, service and drinking
[Agarwal. I996#9].)
Because of the high water requirement. TPPs
are usually located near rivers for easy access
In some cases, especially in the absence of
other sources, tapping of ground water is
restored to. This bears an additional load on
the water resources by either reducing the
ax ailability' of water downstream (in the case
of river-based Plants) or by depleting the
groundwater table.
4.Toxicity and Health Impacts
Around 10% of ash generated by TPPs is
released in the ambient air from the chimney.
increasing the suspended particulate matter in
Fly ash - an environment and health perspective. Toxics Link September 1997
the air. The rest 85% -90% of ash is collected
in the ash ponds [Sahu. 1994# 14],
Fly ash in surface and ground water
Potential ground water and surface water
contamination by the leaching of the toxic
metals in the fly ash from the fly ash ponds is
under extensively research.
An international literature survey of the studies
conducted on potential ground water
contamination around ash ponds in UK, USA.
Poland, done by Prof Manoj Dutta from Indian
Institute of Technology (IIT), Delhi and D.S.
Sivakumar from Consulting Engineering
Services, Delhi, shows leaching of heavy
metals into the ground water and soil
[Sivakumar, 1996# 10], The major factors
influencing the release of contaminants from
ash and into the groundwater include quality of
coal, source of water, pH, time, soil
attenuation capacity, release mechanisms,
solubility controlling mechanisms, long term
weathering etc.
Laboratory studies reveal the possibility that
toxic metals, confined to the surface of the ash
particle, can be easily mobilised from the
particle surface and pollute the surrounding
water bodies even by mild acid rain which is
characteristic of a thermal power plant region
due to the emission of sulphurous gases [Sahu
1994# 14],(See Annex: 1 Environmental
impacts of thermal power plants)
Scientist are of the opinion that field studies
have to done to predict accurately the potential
of groundwater contamination around ash
disposal sites. Says Sivakumar and Dutta.
“Field sampling of ash, soil, leachate water and
groundwater are the only reliable tests for
assessing potential groundwater
contamination.” But in case of insufficient
field studies, results from laboratory tests and
studies can not be ignored.
Some field studies conducted in the US and
also in India reveal the possibilty of surface
and groundwater contamination.around ash
ponds. For instance, a US field study
conducted at a coal fired thermal power station
adjacent to lake Michigan, revealed an increase
in the concentration of heavy metals in the soil
around ash ponds due to leaching of the metals
from the ponds [Sivakumar. 1996# 10].
Ecologists at the Savannah River Site are
finding high levels of heavy metals in animals
exposed to coal fly ash left over from burning
coal at the federal reservation. "We have
observed effects on many biological systems
of tadpoles exposed to the heavy metals.... We
think cadmium is causing them to have central
nervous system problems" [Rowe ct al 1997.
#42],
In India a study by Prof K C Sahu from IIT.
Bombay on the Talcher thermal plant in
Orissa which generates 3.000 tonnes of ash
every day. found: “. . .even if only 15% of the
toxic metals are leached out, the adjacent
Nandira river will receive 208 kg of iron. 56
kg of zinc. 45 kg of copper, 5 kg of cadmium.
56 kg of nickel, 4.6 kg of uranium. 16.5 kg of
thorium. 60.6 kg of chromium and 11.2 kg of
cobalt per day, all in a mobile state”. Prof K C
Sahu concluded “The long term impact of such
an addition is little understood” [Sahu.
1994# 14],
Another ground water test conducted at Motera
ash pond site and other surrounding areas near
the Sabarmati thermal power station near
Ahmedabad, recorded fluoride content of over
1.85 ppm as against the permissible limits of
6 ppm to 1.2 ppm [Misra, 1997 #20].
0.
Chronic or acute exposure to fluorides is
known to cause fluorosis. [Sax.=21 ] a
debilitating ailment that usually weakens the
bone structure, especially among children.
A report by Peter Bosshard on Singrauli-The
Singrauli Experience' also acknowledges the
potential groundwater contamination by heavy
metals from the fly ash slurry [Bosshard. 1997
#19].
The above mentioned problems are further
aggravated by repeated dumping of ash on the
same land. It will “intensify the leaching into
ground water stratum. But, unfortunately, this
problem has not yet attracted the attention of
researchers in India” [Thakrc, 1996 #11].
Fly ash in ambient air
Inhalation of metals present in fly ash released
into the air is said to be more harmful than
Fly ash - an environment and health perspective. Toxics Link September 1997
ingestion by way of food or water [Kharc.
1990 =22].
Ash collected in the ash ponds spreads in the
ambient air tn the form of fine particles by
surface wind as the pond starts drying up. As a
rule, the ash ponds are supposed to be kept
moist, but often TPPs do not maintain the
moisture content of the ash ponds.
These finer particles of fly ash at e a greater
source of concern. The concentration of the
metal increases as the size of the fly ash
particle becomes smaller. On inhalation the I
to 10 nucron size particles ate trapped in the
nasal mucus, 75% of which is normally
swallowed. When these particles reach the
stomach most of the tnciais are extracted by
the gastric juices and could easily enter the
body fluids.
Submicron or particles smaller than 1 micron
enter deep into the lungs and are deposited in
the alveolar walls where the metals could be
transferred to blood plasma across the cell
membrane. Silica in the fly ash particle can
cause silicosis [Sahu, 1994214],
The health effects range from permanent
respiratory disorders, aggravation of ailments
like asthma, bronchitis and even lung cancer
due to prolonged inhalation of fly ash [Misra.
1997 220],
Toxicity of heavy metals, some of which are known to be present in fly ash are given in the following
Table 6: Threshold Limit Values (TLV) and Toxicity of some Heavy metals
Elements
TLV (air)
mg/cu.m
| TLV (water)
| mg/1
Copper
02
Lead
0.15 in 8 hours
H
j__
i 0.05
Zinc
| Toxicity
J_______________________
| Wilson disease, liver problem
| Nephritis (Kidney disease), convulsion, insomnia, headache, muscle pain,
encephaiopaiiiy
Chloride 1
Zn fume 5
Zn-stearata 10
Cadmium
Fever, Tremor
0.1 to 0.05
0.005
Mercury
0.01
Kidney damage, high blood pressure. Cd-ring teeth, ttai4tai, skeletal
deformation, impairment of bone marrow, aging, carcinogenic.
0.005
Neurological and kidney damage, Minamata (fisease (crippling)
Molybdenum
5 to 10
< 0.005
Pulmonary disorders
Arsenic
0.002 to 025
<0.03
Dermatitis cancer, perforation of nasal septum, conjunctivitis, heanng loss.
black foot disease. Hyperkeratosis.
I
| carbonyl 0.007
Nickel
< 0.005
Carcinogenic (skin), Carbonyl poisoning
Chromium
| 0.1 to 0.5
<0.05
Dermatitis, Skin cancer
Manganese
| 0.3 to 10
dust 0.05
| <0.05
j <0.1
____ | Metal 1.0
Vanadium
Tin
organic 0.1
Respiratory inflation, cardiovascular disease, may be carcinogenic
Pneumoconiosis, Stannosis, Neurological damage.
|
I
I Sno2
I inorganic 2
I
Parkinson disease, Manganism, Respiratory disorder. Pneumoconiosis
|
|
Source: [Sahu 1992W31
Fly ash - an environment and health perspective. Toxics Link September 1997
Singrauli - energy capital, future desert
Singrauli is a remote area on the border of Madhya Pradesh and Uttar
Pradesh, and until the early 1960s, it was richly forested with
abundance of wildlife. People living there were self sufficient, tribal
groups, living off the land. In 1970's the region experienced a spate of
'intensive economic development' Since 1977, the World Bank has
extended loans for setting up TPPs, transmission lines and a coal mine
in Singrauli. With the construction of a large Rihand reservoir, followed
by eleven coal mines, six thermal power plants, and several industrial
complexes, Singrauli today is considered to be the energy capital of
India.
This rapid development of power plants, mines, factories and influx of
migrant workers led to severe rupture of social ties and physical
environment of Singrauli. So far, about three lakh people have been
involuntarily resettled in the area. A World Bank report in 1992 obsen/ed,
''unemployment, particularly of the original local population, inadequate
resettlement and rehabilitation compensation, inadequate sanitation and
pollution of drinking water sources and degradation of forest resources "
Since 1980s many NGOs - Indian and international - have been involved
in Singrauli, campaigning for the social justice of the local people, trying
to get them fair and just compensation. They have documented many
cases of polluted rivers and streams, contaminated wells, and
widespread sickness among locals and their cattle. According to them,
"an analysis of food crops in the Singrauli area revealed mercury (See
Annex 1) contamination above levels of concern and high fluorine and
chromium levels."
The World Bank and the power plants have done and are still doing
environmental studies in the area, but their results are hardly ever
revealed to the NGOs [Bosshard. 1997 #19],
For further information on Singrauli contaclMadhu Kohli, c'o GKSS, Village Mitihini. P. O. Bijpur. Dist. Sonehhadra. I htar
Pradesh. Fax 0544562168
10
Fly ash - an environment and health perspective, Tones Link September 1997
5. Let’s find a solution
Rather than wean ourselves away from fossil
fuel and move towards renewable energy
alternatives (sec Annex 2). or look at ways of
not producing fly ash and eventual elimination
of these problematic wastes, we seem to be
investing more and more in answering the
wrong question— “How to deal with fly ash?”,
rather than "How not to generate fly ash?".
Clean it
The Indian government is experimenting with
the much touted "clean coal" technologies
peddled by northern mining interests. One such
technology involves the use of washed coals;
claimed to reduce the ash content in the coal.
But how much ash content is reduced by coal
washing, and at what costs is left unanswered.
Some experts are of the opinion that “ash
content, which is an intrinsic property of coal,
is reduced marginally by coal washing". And
also the other obivious problem of effluent
from coal washries has been left unaddressed.
In fact the central Ministry of Environment and
Forests plans to issue directives for use of only
washed coal in thermal power plants.However,
nothing to that effect has happened as yet.
Moreover at present there are no washeries for
washing non-coking coal (coal used in TPPs)
in India. “In 1988, the Ronghe Committee
appointed by the Planning Commission had
recommended that coal to be supplied to new
power stations located more than 1000 km
away from the coalfields, should be
beneficiated to reduce the ash content to about
34%. Baised on this recommendation, the
government has sanctioned five non-coking
coal washeries with a total capacity of 24
metric tonne (MT) per annum”|Parikh.
1997#6],
Other ‘clean coal’ technologies, like
‘gasification’ also claims to lower the ash
content of coal. The Department of Science
and Technology (DST) of the Government of
India is working on different clean coal
technology projects. “India will be
implementing clean coal technologies by 21st
century,” says Dr Malti Goel of DST. On the
economics of it, she said, “Though it's
expensive ... we still have to adopt them. Apart
from ensuring cleaner production it would
mean higher efficiency of the coal which in
turn means less coal consumption" [Goel.
]997 #24].
However, these technologies, still represent a
back-end approach to pollution. And they are
not cheap.
Use it
The promotion of fly ash as a construction
material has been around in the North for over
10 years, and is now gaining momentum in
India. At present only 3 to 5 percent of fly ash
is used for construction in India, compared to
20% in the US (the rest is disposed in landfills
or surface impoundments) [Wysham. 1997
#25].
Annex 3 lists some examples of international
usage of fly ash in construction.
The Fly Ash Mission was set up in 1994 as a
technology project undertaken by Technology
Information Forecasting and Assessment
Council of the Department of Science and
Technology (DST), to advise government and
help form policies for gainful utilisation’ of
fly ash.
According to the DST, the Fly Ash Mission is
working with the Central Road Research
Institute and both are “engaged in various
projects for gainful utilisation of fly ash. These
include - land-filling; manufacture of fly ash
bricks, portland pozzolona cement, fly ash
blocks, light- weight aggregates and concrete."
With the Supreme Court directive for the
closure of all brick kilns in Delhi using top soil
by June 1997, there might be a possibility of
rising demand for fly ash, at least in Delhi.
[Damandeep, 1997#29). Annex 3 also lists
some of the current uses for fly ash in India,
which range from: Okla flyover and
Nizamuddin bridge embankments; human
dwellings in Panipat; fly ash bricks for roads;
and in agriculture for its micro-nutrients.
Is fly ash utilisation environmentally safe?
Fly ash utilisation is being promoted as an
“eco-friendly solution". It is certainly a use of
an otherwise useless and potentially hazardous
waste. We have not found anv data to indicate
Fly ash - an environment and health perspective. Toxics Link September 1997
-...
<33®!
any environmental problems with fly ash
utilisation. This could be a result of inadequate
focus on the problem. But nor have we found
any data that actually absolves fly ash products
of potential environmental contamination. In
fact, most proponents of fly ash products do
not seem to have given this aspect any serious
thought. Studies examining the environmental
and health effects due to leachates from such
applications are hard to come by. “At the
moment we are in the process of studying
whether utilisation of fly ash will have any
human health or environmental effects or not.
We are generating data for 3 years after which
we can confidently say that fly ash is
environment friendly” says Vimal Kumar
Director of Fly Ash Mission [Vimal,
1997436],
Strangely, without having enough scientific
data to back up their claims, fly ash mission
and other such agencies are promoting the use
of fly ash extensively ! “Whatever data we
have indicates that fly ash utilisation will not
have any adverse effects whatsoever” [Vimal,
1997436]. And “whatever studies and data” is
being generated is inaccesible as they are yet to
be published.
The Bureau of Indian Standards (BIS) has
formulated some basic standards for fly ash
utilisation in bricks, cement, admixture for
structural mortar and concrete, which gives
specifications for strength and durability of the
products but none of them give any
specification for radiation; or leaching of
heavy metals from fly ash.
"We are formulating radiation standards of fly
ash for different usage which will be
incorporated in the already existing BIS
standards", informed Kumar [Vimal,
199743^, Countries like Denmark have
already set tules which stipulates putting a 0.2
metw layer of gravel over fly ash when used as
foundation to reduce radiation from fly ash
[Ppvl. 1997437], "But in India radiation from
fly ash is not really a problem" [Vimal.
1997436], No official standards exist for
dumping of fly ash in landfill^ despite
scientific studies strongly indicating the
leaching of heavy' metals from ash ponds into
the ground water.
12
Surprisingly, the US Environment Protection
Agency (EPA) has no guidelines on fly ash
from coal combustion. Regarding the use of
fly ash. a 1993 US EPA report notes that “fly
ash is a legitimate concern if applied directly
to agricultural soil, but when used as a
constituent of concrete it tends to become
immobilized" [Kniffin, 1997-44],
Or economically viable?
Economically, fly ash bricks are said to be
10% - 15% costlier than the usual bricks.
Transportation costs are a major impediment to
fly ash usage. The brick manufacturer has to
pay not only the transportation cost of fly ash
from the thermal power plant but also service
charges to the power plant authority [Krishna -murthy, 1997438]. So much for the ‘polluter
pays’ principal, this actually taxes the user
instead of the polluter!
Or constructively stable?
One study points out potential construction
problems associated with fly ash-based bricks
or mortar. When fly ash comes in contact with
water, tire alumino-silicate along with sodium,
potassium and calcium in the ash particle
forms a thin layer of polysialate (zeolite
structure) - mineral layer — over the ash
particle ox er a period of time. This formation
of mineral lay'er on the ash particle surface in
the brick is likely to decrease the inter
particular cohesion between the ash particles
leading to the weakening of the brick in due
course. Structures built with such bricks may
collapse as the bricks start losing internal
strength. Experiments are continuing to
confirm this phenomenon [Sahu. 1997434],
A EPA report (1983) says that fly ash has been
"used in construction of very large buildings in
the United States, including the Sears Tower in
Chicago. In contrast, Maria Pellegrano, a
researcher for Rachel's Environment and
Health Weekly, says “eventually the ash will
leach out of the bricks (especially the toxic
components). The bricks will eventually come
apart.” Going further, she says “the use of ash
in bricks is another example of placing the
problem on the next generation” [Kniffin.
1997444],
Fly ash - an environment and health perspective. Toxics Link September 1997
Annex 1
Environmental Impacts of Coal Fires Thermal Power Plants
Studies and research world wide has shown coal f ired thennal power plains cannot generate electricity
without creating environmental pollution in one form or another, be it air. water or soil.
The major impact ofTPPs are to the climate change caused by emissions of carbon dioxide. Other
impacts arc from particulate matter (fly ash), sulphur dioxides, nitrogen oxides, carbon dioxide.
carbon monoxide, hydrocarbons and trace elements.
a.
Sulphur dioxide and Nitrogen oxides.
"Sulphur dioxide and nitrogen oxides from power plants combine w ith moisture in the atmosphere to
produce acid rain, which can reduce crop yield, slow tree growth, kill fish and amphibian species, and
destroy vital organisms in the soil” [Salzman. 1994#39], Estimates reveal that a super thennal power
plant using even nonnal or low' sulphur coal will emit about 100 tonnes of sulphur dioxide a day
ISaliu. 1994# 14],
b.
Carbon dioxide
Carbon dioxide, a heat trapping gas. causes the earth's temperature to rise, "triggering increases in the
intensity and frequency of tropical stonns. floods and droughts, as well as rising sea levels." In the US
power plants emit more carbon dioxide than vehicles or any other single source. Interestingly, the
existing regulations relating to power plants in the US have not even regarded carbon dioxide as a
pollutant [Salzman Jason. 1994&39].
The amount of carbon dioxide emitted from TPPs depends upon the carbon content of coal. "With
65% carbon content in the coal, a 500 mw TPP would release 8,500 tonnes of carbon dioxide per dav"
[Agarwal. I996#9|.
c.
Nitrogen Oxides, hydrocarbons and particulates
Nitrogen oxides, hydrocarbons, and particulates can increase already existing respiratory' illness.
impair breathing and cause coughing in humans apart from reducing visibility in specific locations.
d.
Mercury emisions
Coal fired TPPs are a mojor source of mercury emission in the air.TPPs are " the largest anthropogenic
source in the US of airborne mercury pollution, with an estimated emission rate of 117 tons per year
[US EPA 1993] Mercury is a deadly heavy metal that accumulates in the body and causes birth
defects. A report prepared for the International Joint commission formed between the US and Canada
lists mercury' as a persistent toxin and calls for "virtual elimination of mercury emissions because of its
potential for poisoning of great lakes and the food chain therein" [Salzman. 1994^39].
Reports from Singrauli, which has six TPPs. reveal "average mercury concentration in food crops to
be sixfold higher than the maximum level as defined by the US Fish and Wildlife Sen ice. The TPPs
release 720 kg of mercury per annum" [Bosshard. 1997 =19],
e.
Temperature change etc in surrounding water
The intake and outflow of cooling water from TPPs is also a cause of concern as they threaten aquatic
life by altering water temperatures and decelerating river flow.
f.
General wastes
Waste from 1‘PPs contain ash laced with arsenic, barium, cadmium, chromium, lead, mercury' and
radioactive isotopes that can potentially contaminate aquifers [Salzman. 1°94«?9].
Fly ash - an environment and health perspective. Toxics Link September 1997
13
Annex 2
Renewable Energy Scenario
The estimates of Ministry of Non Conventional Energy Sources show India has a potential for
generating 126.000 mw of energy from renewable sources. This would feed 1.5 times the amount of
energy presently required (84,000mw). That’s the theory. In practice at present the total installed
capacity of renewable energy in India is 919.2 mw or 1.5% of the total power generation capacity of
the country. Installed capacity of renewable energy is projected to rise to 1,400 mw by end of 1997, in
fact the Government of India has an ambitious plan under the ninth five year plan (1997-2002) to
increase this figure to 3,000mw.
Estimates of potential for Renewable Energy
Sources/Technology
Approximate potential
Biogas Plants(no.)
12,000,000
Biomass
17,000
Improved woodstoves (no.)
Solar Energy
120,000,000
20 mw/sq.km
Small Hydro
10,000
Wind Energy
Ocean Thermal
20,000
50,000
Sea wave power
20,000
Tidal Power
9,000
Source:(MNES,1997#40)
Unfortunately, the laws and regulations governing power generation and distribution, (namely the
Indian Electricity Act 1910; Electricity (supply) Act 1948, together with the periodic modifications of
these acts), do not mention explicitly or encourage renewable energy sources. Funds for the promotion
of renewable energy technologies are meagre compared to conventional energy sector. In the eighth
five year plan (1992-97) renewable energy sector was allocated Rs 857 crores, which was about 0.8%
of the total funds allocated to the energy sector.
Cumulative capacity of renewable sources (till march 1996)
SdurcesTTechnology
Units
732 mw
Small hydel
Biomass through cogeneration
121 mw
29 mw
Biomass through combustion
Biomass through gasifier
22 mw
Solar photovoltaic
5.2 mw
Source:(MNES, 1997#40)
Experts feel the development of renewable energy sources has suffered from many institutional.
technical, financial and economic constraints. Lack of awareness among the people due to limited
information flow from the government agencies has led to a pre conceived notion that renewable
energy technologies are only meant for demonstration projects and are not feasible for power
generation in large scale. The case is quite similar in the US, where the electricity produces show
reluctance to invest in clean renewable energy sources and “are proposing to build massive new
generation of fossil fired power plants over next 20 years.” Renewable energy sources accounts for
only 5% of the new and proposed power plant capacity between 1990 and 2014 in the US “The
addiction to fossil fuels is as intense as ever with renewable being ignored” [Salzman, 1994439],
14
Fly ash - an environment and health perspective. Trades Link September 1997
Annex 3
Examples of uses of fly ash - a) International
•
ReUse Technology, Inc, a wholly owned subsidiary of Cogentrix Energy, is one of the major companies in
the US promoting ash utilisation. It has an installed capacity for taking and converting coal ash into
commercial products to the tune of over one million tonnes per year [India Ash Products, #26 ].
•
A proposal by a US based company to make houses using fly ash in the Philippines is under consideration at
the moment. Basic Industry Technology Inc , a California based company in the US, has proposed to build
low income housing in the Philippines using coal fly ash Its being promoted as house for the poor, jobs for
the unemployed etc. The plan is to mix the ash with wheat, rice, straw and cotton waste to make the housing
material [Leonard, I997#27],
•
Israeli scientists have developed a park near Tel Aviv using fly ash and waste water from a thermal power
station. "A 17 meter high embankment built from coal ash shields the park from the ugly sight of the thermal
power station
Some 4.20 lakh cubic metres of ash has gone into making the barrier, which has now
been covered with soil and landscaped with shrubbery, waterfalls and promenades" [TOI, 1997
*28],
b) India
•
Central Road Research Institute (CRRI), Delhi along with Fly ash Mission has constructed embankments
using fly ash at the Okhla flyover bridge, Hanuman Setu and plans are also underway to use fly ash for
building the embankment at the Nizammuddin bridge in Delhi CRRI has also constructed road at Raichur
(Karnataka) using fly ash.
•
CRRI plans to construct human dwellings over the abandoned ash ponds in Panipat. A two room dwelling
unit has already been constructed as a part of a demonstration project by the Fly ash Mission [Fly ash
Mission, #30],
•
India is getting financial and technical assistance from countries like Germany, Holland and Japan for making
fly ash bricks. For example in West Bengal there are proposals to set up plants for manufacturing fly ash
bricks with foreign assistance which "would have wide application in the constructions of walls, footpaths,
platforms, paving of roads
", [Tapan, 1997 #15],
•
The Institute for Solid Waste Research and Ecological Balance has recently modified its Fal-G technology, a
<small scale technology which is widely used to make fly ash bricks using fly ash, lime, gypsum and ordinary
portland cement [Chandrashekar S., 1997 #32],
•
CRRI has come up with a new “interlock block” technology for construction of roads, service lanes and
pavements. It is described as, “these square or rectangle shaped concrete blocks, which are made of fly ash
or concrete and are easy to use, economical and environment friendly, are laid in such a manner that they get
interlocked” [TOI, 1997
*31].
•
DLF, one of India's major real estate and construction company has recently developed a building material
using fly ash. Claiming it to be ‘eco-friendly, lighter and cost effective than bricks', the 'cellular lightweight
concrete’, as it's called, uses some "unique" foaming agent imported from Germany for mixing fly ash with
cement, sand and water. This material uses more than 25% of fly ash. The company further claims that due to
its lighter weight, this material accounts for nearly 40% reduction in the weight of the construction, the
buildings made of this material are earthquake resistance even in highly seismic zones [DLF Press release.
1997 #33],
•
Fly ash is also being promoted for use in agriculture as it contains micro nutrient heavy metals like nickel
cadmium, zinc and also macro nutrients such as potassium, oxides of nitrogen, phosphorous, sulphur. But all
this is presently restricted to laboratory or field studies [Sahu, 1997
*34].
The Thappar group of industries has submitted a proposal worth Rs 70 lakhs to the Fly Ash Mission for using
fly ash in Eucalyptus plantation in Orissa. The proposal is under consideration at the moment [ per.
comm.#35],
'
Fly ash - an environment and health perspective. Toxics link September 1997
15
References
1. Vimal Kumar. (1996). Fly ash utilisation A mission mode approach. Ash Ponds and Ash Disposal Systems V. S Raju, M.
Dutta, V. Sehadri, V.K Agarwal & V Kumar(eds). Delhi, Narosa Publishing House
2. Raju, V. S. (1996) Fly ash: Technology options for converting a liability into an asset Ash Ponds and Ash Disposal Systems
V. S. Raju, M. Dutta, V. Sehadri, V.K. Agarwal & V. Kumar(eds). New Delhi, Narosa Publishing House: 390.
3. Damandeep Singh. (1997). Gasp! Fly ash posing a serious health hazard. The Indian Express. New Delhi
4.
World Bank (1996). India's Environment- Taking stock of plans, programs and priorities.
5.
Bharat Heavy Electrical Limited, Government of India Undertaking {Information collected from BHEL)
6.
Parikh Jyoti, Kankar Bhattacharya, B Sudhakar Reddy, Kirit S Parikh (1997) Energy System Need for new momentum. India
Development Report 1997. Kirit S. Parikh (ed). Delhi, Oxford University Press. 78-79.
7.
Imhof, A. (1997). Aiding global warming, Aid Watch.
8.
Wysham, D. (1997)., Institute for Policy Studies, Washington.{Personal communication}
9.
Agarwal. S. K. (1996). Industrial Environment Assessment and Strategy, APH Publishing Corporation.
10. Sivakumar, D. S., M. Dutta. (1996). Assesement of ground water contamination potential around ash ponds through feild
sampling: A sample. Ash Ponds and ash Disposal Systems. V. S. Raju, M. Dutta, V. Seshadri, V.K. Agarwal & V. Kumar (eds).
New Delhi, Narosa Publishing House.
11. Thakre, Rekha (1996). Ash disposal on land: Environmental concerns and land management strategies. Ash Ponds and Ash
Disposal Systems. V. S. Raju. M. Dutta. V. Seshadri, V.K. Agarwal & V. Kumar (eds). New Delhi, Narosa Publishing House: 284.
12. TOI, 1995, Times of India, New Delhi
13. Irani. Nergis.(1997), Dahanu Taluka Environment Welfare Association. {Personal communication}
14. Sahu. K. C. (1994). Power plant pollution’ cost of coal combustion The Hindu Survey of the Environment, 1994
15. Tapan, D. (1997). Many fly ash bricks projects to come up in Bengal. The Hindustan Times. New Delhi
16. News service, Financial Express. (1996). WBPCB wants policy on fly ash disposal. The Financial Express.
17. Subramanian (1997) , FLOAT.{Personal communication}
IS.Goswami, A. (1995). The Price of Power. Down To Earth: 22.
19. Bosshard, Peter (1997). The Singrauli experience: A report of an NGO fact finding tour to the World Bank projects of
Singraui/lndia. Switzerland, Berne Declaration.
20. Misra .Leena (1997). Fly ash cremates the city's health. The Times of India. Ahmedabad.
21. Sax, N. Irwin, Richard. J. Cruise. Hazardous chemicals desk reference. New York, Van Nostrand Reinhold company.
22. Khare, D. K., Shrivastava, Y. R. (1996). Management of ash ponds and ash mounds for pollution control in coal-cased
thermal power stations. Ash Ponds and Ash Disposal Systems. V. S. Raju, M. Dutta, V. Seshadri, V.K. Agarwal & V. Kumar
(eds). New Delhi, Narosa Publishing House: 265,270.
23. Sahu, K. C., Godgul, Geeta (1992). Heavy Metal Pollution from Industrial Wastes. Maeer's Mit Pune Journal.
24.
Goel, Matti. (1997), Department of Science and Technology, Government of India. {Personal communication}.
25.
Wysham, D.(1997), Institute for Policy Studies. {Quote from: The Environmental costs of electricity. 1990. Pace University
centre for environmental studies}
26.
India Ash Products, Ltd. Ash Utilization plan and marketing study.
27.
Leonard, A. (1997), Multinationals Resource Centre, USA. {Personal communication).
28.
TO! (1997). Beauty from Waste. Times of India. New Delhi: 10.
29.Damandeep Singh. (1997). Turning fly ash into environment friendly product. The Indian Express. New Delhi.
30. Fly ash Mission, Technology Project in Mission Mode, TIFAC, Government of India .
31. TOI (1997). New technology to build roads. Times of India. New Delhi: 4.
32. Chandrashekar, S. (1997). New fly ash tech saves on lime. The Economic Tines. New Delhi
33 Press release, DLF (1997)
34 Sahu, K.C. (1997). {Personal communication}
35.
Personal communication with official of Fly Ash Mission (1997).
36.
Vimal Kumar. (1997). Fly Ash Mission. {Personal communication}
37.
Povt, R. (1997).Ministry of Environment and Energy, Danish Environmental Protection Agency.(Personal Communcation).
38.
Krishnamurthy. R. (1997). Ash Utilisation Division, National Thermal Power Company (Personal commumcatron)
39.
Salzman Jason, Sallie Schullinger 4 Ken 5Jump. (1994). A new generation of fossil fired power plants, Greenpeace
40.
MNES (1997). Annual Report, Ministry of/Ion conventional energy sources 1996-97.
16
jjjyj||»h - an environment and health perspective. Toxics Lnk September 1997
41.
Menon M (1997). Dahanu The war is not over. The Hindu Survey of the Environment'97
42 Chnstopher L Rowe, et al 1996 Freshwater Biology "Oral Deformities in Tadpoles associated with coal ash deposition"
Savannah River Ecology Laboratory. Vol. 36 PP. 723-730
43. US EPA 1993 (US EPA, “National Emission Inventory of Mercury and Mercury Compounds: Interim Final Report." EPA453/R-93-048, US Environmental Protection Agency, Research Triangle Park. NC. December 1993, at 4-2)
44. Kniffin. Kevin M (1997). Multinationals Resource Centre, USA. {Personal communication}.
Fly ash - an environment and health perspective. Tokfc* Link September 1997
17
Preliminary enquiry into the health problems of the people
of the villages living in and around the SIPCOT Chemical
IndList.daJ Estate, Cudda.iore,
Report of the visit to Cuddaior© SiPCOT.
Dr.R.Sukanya. MD (Community medicine). Public Health specialist
T'MQ 'tillages. Sonnanchavadi and Eachangadu were vested an. 21st and
ZZ ,<7cibbei ZuvZ. Ti'ie purpose ufiita visit was.
1.
to establish perceived morbidity of the villagers and the kind of problems
attributed to environmental pollution
2.
to understand the impact of any such environmental hazard oh the lives of
the people.
Men and women in the villages were interviewed either in groups or as key
informants.The findings based on the preliminary interviews are presented.
SonnanchavadL Semmankupnam Panchayat, Cuddalore
Sonnanchavadi a small village with about 80 households is situated about 15 km
from Cnddafore town, on the Chennai-Chidambaram highway, and on the banks
of the Uppanar River. The units situated nearby are :
a) Pioneer Miyagi Chemicals (P) Ltd.: They manufacture Ossein and Di
calcium phosphate using crushed bones, hydrochloric acid and lime.
bl Atofina Peroxides India Ltd: Manufacture organic peroxides, phosphorous
acide (by product), lauroyl chloride, benzoyl peroxide, using as taw
material lauric acid, dimethyl phthalate, methyl ethyl ketone, benzoyl
chloride. 2-phenoxyethyl chloroformate. methane, secondary butyl and 2ethyl hexyl chloroformate.
cl Bayer Sanmar Ltd: Manufacture thermoplastic polyurethane using as raw
material polyester polyol, polyether polyol, dianol, 1,4 butane diol, dimethyl
diphenyl diisocyanate, adipic acid
Sonnanchavadi is a fishing village. The villagers make their living by fishing in
the Uppanar river and selling in the nearby villages and town. Most of them
have thatched houses and use firewood for fuel. Most of the women are
housewives but some of them also sell fish. The families are of poor
socioeconomic status and even the women’s self-help groups are defunct.
Occupational health problems among fishermen
Since September 18. 2002. the men in the village are without work after they
developed scalding skin lesions while fishing in the river. From September 1,
2002. the fishermen of Sonnanchavadi and nearby Sangolikuppam started
experiencing severe itchy skin lesions on both their upper limbs and on their
chest and abdomen. From the respondents’ descriptions, (he lesions
progressed from reddish papular itchy lesions to bleeding, eczematous
skin.with the skin peeling off in severe cases. On the day of visit, almost a
month later, examination revealed that the lesions were healing with black
pigmentation, scaling and wrinkling of skin. They were distributed on the
flexural aspects of both the arms (more on one side for some people), near
the elbow and on the dorsal aspect of the feet.
One fisherman, who is handicapped, complained of skin lesions on his thighs
and buttocks. Unlike other fishermen, who cast their nets standing, this
person sits crosslegged on the kattumaram while fishing.
An elderly fisherman had thick blackish plaque-like skin lesions (lictienification
of lesions') at similar sites on the limbs and bod?/. The lesions have .persisted
for more than 6 months despite the fact that he has stopped fishing and
hasn’t entered the river during the period.
According to the villagers, the skin lesions appeared insidiously and was
aggravated upon repeated contact with the contaminated river sludge and
water from the fishing nets during their fishing activity. The lesions occurred
on sites when the nets comes in contact with the body as it is removed from
the water.
Two women, who had entered the river to help in fishing, also had similar
lesions.
The nature, onset and distribution of the skin lesions in the fishermen suggest
that, it is Irritant Contact dermatitis quite likely caused by some chemicaks) in the
polluted river. The fact that only those who had entered the river - predominantly
men and two women - have these symptoms, and that the lesions are located
on those places on the body which comes in contact with contaminated sludge or
water from the nets, leaves little room for doubt that the condition is caused and
aggravated by the pollutants in the river.
Pioneer, which manufactures Ossein by dissolving bones in hydrochloric acid,
has been identified by the villagers as a point source of the pollution that caused
the recent episode of skin diseases. According to a New Jersey Department of
Health factsheet. "Contact [with Hydrogen Chloridel can cause severe skin burns
and severe bums of the eyes, leading to permanent damage with loss of sight.
Exposure to dilute solutions may cause a skin rash or irritation.” [Source:
Factsheet on HCI from the New Jersey Department of Health. Occupational
Health Services. Nev,/ Jersey. USA. February. 1989. See Annex 11
HAZARD SUMMARY
* Hvdrogen (’’Monde can affect you when breathed tn.
* Breathing the vapor can irritate the lunes, and cause bronchitis. Higher exposures can
cause a build-up of fluid in the lungs (pulmonary edema), a medical emergency.
* Continued contact with dilute solutions may cause a skm rash or irritation.
* Hydrogen Chloride is a CORROSIVE CHEMICAL and contact can cause eye damage
that could lead to blindness It can also cause severe skin bums
* Exposure can irritate the mouth, nose, and throat. Long-term exposure may cause
erosion of the teeth.
(Source: Factsheet on HC1 from the New Jersey Department of Health. Occupational Health Services. New
Jersey. USA. February. 1989]
The villagers reported that they hadn’t gone fishing in over a month (since
September 18) after the district Collector expressed his inability to help them and
asked them to quit fishing in the river.
Quality of Medical Cafe
Medical care offered to the affected victims was far from satisfactory. On perusal
of the few prescriptions given at the PHC. Karaikadu. it was obvious that the
history and diagnosis were not noted. Only Silver sulphadiazine (given for burns)
and Povidone iodine (antiseptic) have been given as local application. Some
antihistaminics (for itching) and vitamin tablets were also given. None of the
villagers had gone to a private practitioner due to the expenses involved. It is
obvious that the PHC was not fully equipped to treat this occupational health
problem and the lack of medical documentation of such an incident in the
prescriptions is cause for grave concern.
State of Genera! Health
Sonnanchavadi villagers consume fish caught from the Uppanar and report
strong smells from the cooked fish. The smoke and associated stench from the
nearby factories also cause respiratory difficulty, suffocation and headache
among women and men. Mothers say that their children are undernourished and
weak. They notice remarkable improvements in their children’s health whenever
the children stay in a relative’s house even two villages away.
The environmental impact on the children's health is compounded by the fact that
younger children are unable to adequately express their problems.
Fachannartu Ki.iriikariii PainchayatCu.c5daS.ore
Eachannadu is sandwiched between SPIC Pharmaceuticals on one side and
many other smaller chemical units on the other side, including Asian Paints.
Vanavil Dyes. Tagros Chemicals and Shasun Chemicals. There is a continuous
stench from the nearby factories. Depending on the source and type of emission.
the smells vary -rotten-egg. burnt material, paint thinner or nail polish etc. Most
of the villagers are daily wage labourers, earning a livelihood from agriculture,
construction or through temporary contract work in nearby factories. Men usually
find work on an average for 10-15 days in a month.
There are 150 households living in mostly thatched and tiled houses and use
firewood for fuel. There is a high rate of indebtedness with average debts ranging
unto Rs15.000 oer family.
Two women from two self-help groups were the key source of information. They
spoke about the general health problems of all age groups. General complaints
included burning and watering of eyes in all age groups, diminishing vision,
headache, dizziness and feeling of suffocation and respiratory difficulty among
the women and men.
Children are not healthy and are plagued by frequent episodes of Upper
Respiratory infections (cough and cold). The general well being of the children
under 5 years old is not satisfactory. Some houses with children under 5 were
visited. Mothers complained that their wards suffered from frequent colds,
especially running noses every other week. Every episode of an Upper
Respiratory infection poses an increased risk of spread to the lower respiratory
tract and ears leading to deafness. At least two companies in the near vicinity of
the village manufacture antibiotics and other drugs, including penicillin. Given
that these companies have teen identified as among the notorious polluters (air
and water) by the villagers, the risk of antibiotic resistance to penicillin and
cephalosporins among the children is a matter of grave concern. The cost of
medical treatment for the children ranged from Rs. 100-500 for every episode.
A 40-year old woman supplying tea to a nearby factory for the last fifteen years is
suffering from symptoms of acute onset breathlessness relieved only with
treatment in a hospital. This is a probable case of asthma. A more thorough
investigation may be conducted to see whether more cases of similar asthma are
reported in the village. Occupational or environmental exposure to discharges
from pharmaceutical factories - like the Penicillin unit - could increase the
chance of allergic drug-induced asthma.
Case
Mr.Pachaiappan. age 50. was a contract worker in SPIC when he developed
progressive skin lesions on his Right foot and the toes started shrinking. His work
involved standing in effluent treatment plant sludge and loading it into a truck. He
4
was operated and his toes removed. The company through the contract agent
met his hospital charges and gave him Rs.10.000 as compensation. No proper
rehabilitation was attempted and presently, he has lost his ability to earn a
livelihood and is in need of physiotherapy and crutches.
Ms. Anialai. employed previously at SPIC. suffered a fall that injured her neck
and paralysed her right upper and lower limbs. SPIC met her hospital charges
and provided some monetary compensation. Currently, she is house-ridden, has
developed contractures of both lower limbs and the suture wound on the right
side of the neck is infected. Anialai reports that she was sent back without proper
treatment at the Cuddalore General hospital as she lacked previous medical
records.
Conclusion and Recommendations
Chemical pollution of the River Uppanar and of the general environment has
clearly degraded the quality of life of the villagers of the two hamlets visited Sonnanchavadi and Eachangadu.
In the fishing village of Sonnanchavadi. chemical contamination of the river
poses a serious and ongoing occupational health threat. The fact that the
villagers have been forced to stop fishing - and suffer wage losses - is a
violation of their fundamental and constitutionally guaranteed right to livelihood.
Immediate steps need to be taken to compensate the fisherfolk for their loss due
to their inability to fish. Steps also need io be taken to prevent any further
pollution of the river and to make the polluters pay for its clean-up.
Health problems among people due to exposure of environmental' toxins is an
important public health problem. Threat of emerging antibiotic resistance, eye
problems, chronic compromise of lung functions, high morbidity among children.
lack of proper medical care and rehabilitation, medical apathy are all highlighted
in the case studies from Eacahngadu.
The health effects among women remain difficult to account for. As caretakers of
the men and children, the health of the family takes priority over their personal
health.
There is a need for a comprehensive health assessment of the villagers and
workers of the SIPCOT industries. Accessibility. Availability and Quality of
medical care for the people in the villages and factories are important issues to
be addressed. The findings of any Environmental impact assessment done
should be shared with all people. There is a need for all local doctors to be
proactive in identifying occupational and environmental health problems and
providing care and seeking justice forthose impacted by pollution.
There is an urgent need to take active measures to stop the contamination from
the nearby factories and to restore the quality of the water to prevent further
damage to health of all.
HAZARDOUS SUBSTANCE FACT SHEET
RIGHT TO KNOW PROGRAM
NEW JERSEY DEPARTMENT OF HEALTH
Common Name:
HYDROGEN CHLORIDE
CAS Number:
DOT Number:
7647-01-0
UN 1050 anhydrous
UN 1789 solution
RTK Substance number:
Date: February 1989
1012
Revision:
First
HAZARD SUMMARY
* Hvdrogen Chloride can affect vou when breathed in.
* Breathing the vapor can irritate the lungs, and cause bronchitis.
Higher exposures can cause a build-up of fluid in the lungs (pulmonary
edema), a medical emergency.
* Continued contact with dilute solutions may cause a skin rash or
irritation.
» Hvdrogen Chloride is a CORROSIVE CHEMICAL and contact can cause eye.
damage that could lead to blindness.
It can also cause severe skin
burns.
’ Exposure can irritate the mouth,
nose,
and throat.
Long-term
exposure mav cause erosion of the teeth.
IDENTIFICATION
Hvdrogen Chloride is a colorless gas with a strong odor.
It usually
exits in a solution named Hydrochloric Acid.
It is used in metal
processing, analytical chemistry and making other chemicals.
REASON FOR CITATION
* Hvdrogen Chloride is on the Hazardous Substance List because
regulated bv OSHA and cited bv ACGIH, DEP, DOT, NFPA and EPA.
* This chemical is also on the Special Health Hazard Substance
because it is CORROSIVE.
List
HCW TO DETERMINE IF YOU ARE BEING EXPOSED
T Exposure to hazardous substances should be routinely evaluated.
This
mav induce collecting air samples.
Under OSHA 1910.20, vou have a
legal right to obtain copies of sampling results from vou employer.
If
vou think vou are experiencing anv work-related health problems, see a
doctor trained to recoqnize occupational diseases.
Sheet with vou.
* ODOR THRESHOLD =0.71 ppm.
» The odor threshold onlv serves as a warninq of
smellinq it does not mean vou are not beinq exposed.
WORKPLACE EXPOSURE LIMITS
OSHA: The leqal airborne permissicle exposure limit
to be exceeded at anv time.
ACGIH: The recommended airborne
not be exceeded at anv time.
exposure
limit
is
Take
exposure.
(PEL)
5
this
Fact
Not
is 5 ppm not
ppm which
should
WAYS OF REDUCING EXPOSURE
» Where possible, enclose operations and use local exhaust ventilation
at the site of chemical release.
If local exhaust ventilation or
enclosure is not used, respirators should be worn.
« Wear protective work clothinq.
* Wash thorouqhlv immediately after exposure to Hvdroqen Chloride.
* Post hazard and warmnq information in the work area.
In addition,
as part of an onqoinq education and traininq effort, communicate all
information on the health and safety hazards of Hvdroqen Chloride to
potentially exposed workers.
This Fact Sheet is a summary source of information of all potential and
most severe health hazards that may result from exposure.
Duration of
exposure, concentration of the ■ substance and other factors will affect
vour susceptibility to anv of the potential effects described below.
HEALTH HAZARD INFORMATION
Acute Health Effects
The tollowinq acute (short-term) health effects
or shortly after exposure to Hvdroqen Chloride:
may
occur
immediately
* Contact can cause severe skin burns and severe burns of the eyes,
leadino to permanent damaae with loss of siqht.
* Breathinq the vapor, can irritate the mouth, nose, and throat.
Hiqh
Levels mav irritate the lunqs, causinq couqhinq and/or shortness of
breath.
Hiqher exposures can cause a buildup of fluid in the lunqs
(pulmonary edema), a .medical emerqencv.
Chronic Health Effects
The tollowinq chronic (Lonq-term> health effects can occur at some time
after exposure to Hvdroqen Chloride and can last for months or years:
Cancer Hazard
* There is limited evidence that workers who are manufacturing Hydroqen
Chloride have an increase of respiratory cancers.
7
' Manv scientists believe there is no sate level of exposure to a
carcinogen. Such substances mav also have the potential for causing
reproductive damage in humans.
Reproductive Hazard
* According to the information presently available to
Department of Health, Hvdrogen Chloride has not been
ability to affect reproduction.
the New Jersey
tested for its
Other Long-Term Effects
* Hvdrogen Chloride mav cause erosion of the teeth.
’ Exposure to dilute solutions mav cause a skin rash or irritation.
* Very irritating substances mav affect the lungs.
It is not
whether Hvdrogen Chloride causes lung damage.
known
MEDICAL
Medical Testing
For those with freguent or potentially high exposure (half the TLV or
greater), the following are recommended before beginning work and at
regular times after that:
Lung function tests.
If symptoms develop or overexposure
useful:
is
suspected,
the
following may be
* Consider chest x-rav after acute overexposure.
Anv evaluation should include a careful history of past and present
symptoms with an exam.
Medical tests that look for damage already done
are not a substitute for controlling exposure.
Request copies of vour medical testing.
information under OSHA 1910.20.
You have a legal right to this
Mixed Exposures
Because smoking can cause heart disease, as well as lunq cancer,
emphysema, and other respiratory problems, it may worsen respiratory
conditions caused bv chemical exposure.
Even if vou have smoked for a
Iona time, stopping now will reduce vour risk of developing health
problems.
WORKPLACE CONTROLS AND
PRACTICES
Unless a less toxic chemical can be substituted for a hazardous
substance, ENGINEERING CONTROLS are the most effective way of reducing
exposure.
The best protection is to enclose operations and/or provide
local exhaust ventilation at the site of chemical release.
Isolating
operations can also reduce exposure.
Usinq respirators or protective
equipment is less effective than the controls mentioned above, but is
sometimes necessary.
In evaluatinq the controls present in vour workplace, consider: (1> how
hazardous the substance is, (2) how much of the substance is released
into the workplace and (3) whether harmful skin or eye contact could
occur.
Special controls should be in place for highly toxic chemicals
or when siamficant skin, eve, or breathing exposures are possible.
In addition, the followina control is recommended:
* Where possible,
automatically punp liguid Hvdroqen
drums or other storage containers to process containers.
Good work PRACTICES can help to reduce
followina work practices are recommended:
hazardous
Chloride
exposures.
from
The
* Workers whose clothing has been contaminated by Hydrogen Chloride
should chanae into clean clothing promptly.
* Contaminated work clothes should be laundered bv individuals who have
been informed of the hazards of exposure to Hvdroqen Chloride.
'* Eve wash fountains in the immediate work area should be provided for
emergency use.
« If there is the possibility of skin exposure, emergency shower
facilities should be provided.
* On skin contact with Hvdroqen Chloride, immediately wash or shower to
remove rne chemical.
* to not eat, smoke, or drink where Hvdroqen Chloride is handled,
processed, or stored, since the chemical can be swallowed.
Wash hands
carefullv before eating or smoking.
PERSONAL PROTECTIVE EQUIPMENT
WORKPLACE CONTROLS ARE
BETTER
THAN
PERSONAL
PROTECTIVE
EQUIPMENT.
However, for some qobs (such as outside work, confined space entry,
lobs done onlv once in a while, or lobs done while workplace controls
are being installed), personal protective equipment may be appropriate.
The followina recommendations
every situation.
are onlv guidelines
and mav not apply to
Clothing
* Avoid skm contact with Hvdroqen Chloride.
Wear acid-resistant
aioves
and clothina.
Safetv equipment suppliers/manufacturers
can
provide recommendations on the most protective glove/clothing material
for vour operation.
* All. protective clothina (suits, aioves, footwear, headgear) should be
clean, available each dav, and put on before work.
* ACGIH recommends natural rubber or neoprene as protective materials.
Eve Protection
’ Wear splash-proof chemical qoaqles and face shield when working with
liguid, or aasproof aoaales when using the qas, unless full, facepiece
respiratory protection is worn.
Respiratory Protection
IMPROPER USE OF RESPIRATORS IS DANGEROUS.
Such equipment should onlv
be used it the employer has a written program that takes into account
workplace conditions, requirements tor worker training,
testing and medical exams, as described in OSHA 1910.134.
respirator
fit
* Where the potential exists
for exposures over 5 ppm,
use an
MSHA/NIOSH approved full facepiece respirator with an acid qas canister
which
is
specifically
approved
for
Hydrogen
Chloride.
Increased
protection
is
obtained
from
full
facepiece
powered-air
purifying
respirators.
’ If while wearing a filter, cartridge or canister respirator, you can
smell, taste, or otherwise detect Hvdroqen Chloride, or in the case of
a full facepiece respirator vou experience eve irritation, leave the
area immediately. Check to make sure the respirator-to-face seal is
still good. If it is, replace the filter, cartridge, or canister.
If
the seal is no longer good, vou mav need a new respirator.
» Be sure to consider all potential exposures in your workplace.
You
mav
need
a
combination
of
filters,
prefilters,
cartridges,
or
canisters, to protect against different forms of a chemical (such as
vapor and mist) or against a mixture of chemicals.
* Where the potential for high exposures exists, use a MSHA/NIOSH
approved supplied-air respirator with a full facepiece operated in the
positive pressure mode or with a full facepiece, hood, or helmet in the
continuous flow mode.
* Exposure to 100 ppm is immediately dangerous to life and health.
If
the possibility of exposures above 100 ppm exists use a MSHA/NIOSH
approved self contained breathing apparatus with a full facepiece
operated in continuous flow or other positive pressure mode.
QUESTIONS AND ANSWERS
0: If I have acute health effects, will I later get chronic health
effects?
A: Not alwavs.
Most chronic (long-term) effects result from repeated
exposures to a chemical.
Q: Can I get long-term effects without ever having short-term effects?
A: Yes, because long-term effects can occur from repeated exposures to
a chemical at levels not high enough to make vou immediately sick.
0: what are mv chances of getting sick when I have been exposed to
chemicals?
A: The likelihood of becoming sick from chemicals is increased as the
amount of exposure increases.
This is determined bv the length of time
and the amount of.material, to which someone is exposed.
0: When are higher exposures more likelv?
A: Conditions which increase risk of exposure include dust releasing
operations (grinding, mixing, blasting, dumping, etc.), other physical
and
mechanical
processes
(heating,
pouring,
spraying,
spills
and
evaporation from large surface areas such as open containers), and
"confined space" exposures
(working inside vats,
reactors,
boilers,
small rooms, etc.).
Q: Is the
residents?
risk of getting
sick higher
10
for workers than
for coirtnunitv
A: Yes.
Exposures m the community, except possibly m cases of fires
or spills, are usuallv much lower than those found in the workplace.
However, people in the community mav be exposed to contaminated water
as well as to chemicals in the air over long periods.
Because of this,
and because of exposure of children or people who are already ill,
community exposures mav cause health problems.
The following information is available from:
New Jersey Department of Health
Occupational Health Service
Trenton, NJ 08625-0360
(609) 984-1863
Industrial Hygiene Information
Industrial hygienists are available to answer your questions regarding
the control of chemical exposures using exhaust ventilation, special
worK practices, good housekeeping, good hvgiene practices, and personal
protective eguipment including respirators.
In addition, they can help
to interpret the results of industrial hvqiene survey data.
Medical Evaluation
If vou think vou are becoming sick because of exposure to chemicals at
vour workplace, vou mav call a Department of Health physician who can
help vou find the services vou need.
Public Presentations
Presentations and educational' programs on occupational health or the
Right to Know Act can be organized for labor unions, trade associations
and other groups.
Right to Know Information Resources
The Right to Know Infoline (609) 984-2202 can answer questions about
the identity and potential
health effects of chemicals,
list of
educational
materials
in
occupational
health,
references
used
to
prepare the Fact Sheets, preparation of the Right to Know survey,
education and training programs,
labeling reguirements,
and general
information regarding the Right to Know Act.
Violations of the law
should be reported to (609) 984-5627.
DEFINITIONS
ACGIH is the American Conference of Governmental Industrial Hygienists.
It recommends upper limits (called TLVs)
for exposure to workplace
chemicals.
CAG is the Carcinogens Assessment Group of the federal EPA.
A carcinogen is a substance that causes cancer.
The CAS number is assigned
identify a specific chemical.
bv
the
11
Chemical
Abstracts
Service
to
A combustible substance is a solid, liquid or qas that will burn.
A
corrosive
substance
is
a
qas,
liquid
irreversible damaqe to human tissue or containers.
or
that
solid
causes
DEP is the New Jersey Department of Environmental Protection.
DOT is the Department of Transportation,
requlates the transportation of chemicals.
the
aqency
federal
EPA
is
the
Environmental
Protection
Aqencv,
responsible for requlatinq environmental hazards.
the
that
aqency
federal
A fetus is an unborn human or animal.
A flammable substance is a solid,
easi.lv and burn rapidlv.
vapor or qas that will iqnite
liquid,
The flash point is the temperature at which a liquid or solid qives off
vapor that can form a flammable mixture with air.
IARC is the
croup
that
potential.
A miscible
anotlier.
International Aqency for Research on Cancer, a scientific
classifies
chemicals
accordinq to
their cancer-causinq
substance
is
a
liquid
that will evenly dissolve in
or qas
mq/ro3 means milliqrams of a chemical in a cubic meter of air.
measure of concentration (weiqht/volume).
It is a
MSHA is the Mine Safetv and Health Administration, the federal
that peculates mininq. It also evaluates and approves respirators.
aqencv
A mutaqen is a substance that causes mutations. A mutation is a chanqe
m the aenetic material in a bodv cell.
Mutations can lead to birth
defects, miscarriaqes, or cancer.
NCI is the National Cancer Institute, a
the cancer-causinq potential of chemicals.
federal
aqencv that determines
NFPA is the National Fire Protection Association.
substances accordinq to their fire and explosion hazard.
It
classifies
NIOSH is the National Institute for Occupational Safety and Health.
It
tests equipment, evaluates and approves respirators, conducts studies
of workplace hazards, and .proposes standards to OSHA.
NTP is the National Toxicoloqv
reviews evidence for cancer.
Proqram
which
tests
chemicals
OSHA is the Occupational Safetv and Health Administration,
and enforces health and safety standards.
ppm means parts of a substance per million
measure of concentration bv volume in air.
parts
of
air.
and
which adopts
It
is
a
A reactive substance is a solid,
explosion under certain conditions
substances.
A teratoaen
fetus.
is
a
that
substance
TLV
is
the
Threshold
recommended by ACGIH.
Limit
liquid or aas that can cause an
or on contact with other specific
causes
Value,
birth
the
defects by damaging
workplace
exposure
the
limit
The vapor pressure is a measure of how readily a liquid or a solid
mixes with air at its surface.
A higher vapor pressure indicates a
hiqher concentration of the substance in air and therefore increases
the likelihood of breathing it in.
“EMERGENCY
I N F O R M A T I 0 N <««««
Common Name: HYDROGEN CHLORIDE
DOT Number:
UN 1050 anhydrous UN 1789 solution
DOT Emergency Guide code: 15/60
CAS Number:
7647-ul-u
I
I Hazard rating
I NJ DOH
I
NFPA
1 FLAMMABILITY
1
1
0
1
(REACTIVITY
1
1
0
1
I CORROSIVE
I CONTAINERS MAY EXPLODE IN FIRE
I POISONOUS GASES ARE PRODUCED IN FIRE
Hazard Rating Kev: 0=mimmal; l=sliqht;
2=moderate; 3=senous; 4=severe
FIRE HAZARDS
*
Hvdroqen
Chloride
is
non-combustible,
but
contact with
metals
produces Hvdroqen cas, which will increase, the chance of an explosion.
* Extinguish fire using an aqent suitable for type of surrounding fire.
* POISONOUS GASES ARE PRODUCED IN FIRE including Chlorine and Hydrogen
Chloride.
* CONTAINERS MAY EXPLODE IN FIRE.
’ If employees are expected to fight fires, thev must be trained and
eguipped as stated in OSHA 1910.156.
SPILLS AND EMERGENCIES
If Hvdroqen Chloride
steps:
solution is spilled or leaked,
» Restrict persons not wearing protective equipment
or leak until clean-up is complete.
13
take
the
following
from area of spill
« Collect
containers.
collection.
material m a convenient manner and deposit in sealed
If necessary, dilute and/or neutralize the material before
If Hvdroqen Chloride qas is leaked, take the followinq steps:
» Restrict persons not wearinq protective equipment from area of leak
until clean-up is complete.
» Ventilate area of leak to disperse the qas.
* Stop flow of qas. If source of leak is a cylinder and the leak cannot
be stopped in place, remove the leakinq cylinder to a safe place in the
open air, and repair leak or allow cylinder to empty.
* It mav be necessary to contain and dispose of Hydroqen Chloride as a
HAZARDOUS WASTE.
Contact vour Department of Environmental Protection
(DEP) or vour reqional office of the federal Environmental Protection
Aqencv (EPA) for specific recommendations.
FOR LARGE SPILLS AND FIRES immediately call your
can request emeroencv information from the followinq:
fire
department.
You
CHEMTREC: (800) 424-9300
NJDEP HOTLINE: (609) 292-7172
Other:
HANDLING AND STORAGE
» Prior to workina with Hvdroqen Chloride you should be trained on its
proper handlmq and storaqe.
’ Hvdroqen Chloride must be stored to avoid contact with ZINC, BRASS,
GALVANIZED IRON,
ALUMINUM,
COPPER and COPPER ALLOYS since violent
reactions occur.
* Hvdroqen Chloride is not compatible with bases.
Store cylinders at
temperatures under 125 deqrees F <52 degrees C) .
* Store in tiqhtlv closed containers in a cool, well-ventilated area
awav from WATER and HEAT.
* Hvdroqen Chloride iqnites in the presence of fluorine and metal
carbides.
FIRST AID
In NJ, POISON INFORMATION 1-800-962-1253
Other:
Eye Contact
* Immediately flush with larqe amounts of water.
Continue without
stopping for at least 30 minutes, occasionally lifting upper and lower
lids. Seek medical attention immediately.
Skin Contact
* Ouicklv remove contaminated clothinq.
Immediately wash
larqe amounts of water. Seek medical attention immediately.
14
area
with
Breathina
* Remove the person from exposure.
* Beam rescue breathina if breathina has stopped and CPR if heart
action has stopped.
* Transfer prompt!v to a medical facility.
* Medical observation is recommended for 24 to 48 hours after breathing
overexposure, as pulmonary edema may be delayed.
PHYSICAL DATA
Vapor Pressure: Greater than 1 mm Hq at 68 deqrees F (20 degrees C)
Water Solubilitv: Highly soluble
OTHER COMMONLY USED NAMES
Chemical Name:
Hydrochloric Acid
Other Names and Formulations:
Anhydrous Hvdrochloric Acid; Chlorohydric Acid; Muriatic Acid
Not intended to be copied and sold for commercial purposes.
NEW JERSEY DEPARTMENT OF HEALTH
Riaht to Know Program
CN 368, Trenton, NJ 08625-0368
(609) 984-2202
15
OH - M ■
health
fs
yy
/JHX
I IBflSI
|V
‘
•
rnedico fr'end circle
[organization & bulletin off ins]
326, V Main, 1st Brock
Koiamangala, Bangaioro-560034
work- place
COUNTERFACT NO. 4
A CED HEALTH CELL FEATURE
The health of workers in the country,
be they urban or rural, organized or
unorganized,
housewives
or
clerks,
has been largely ignored. In the press
one finds only occasional reports on
isolated
cases
of
mining accidents
or pesticides poisoning of agricultural
workers. Information on the prevalence
and extent
of ■ occupational
diseases
.is
also insufficient and cases are
grossly under-reported.
This May Day
"Counterfact" takes up
the question of occupational
health,
and focusses on the conditions of factory
workers. We shall
first examine the
legislation
covering worker's
health,
its
implementation
and the reality
of occupational health in India today.
This is followed by a case study on
one of the commonest work-related disea
ses: occupational dermatitis.
Rapid industrialisation has its bipro
ducts. One of these is the deterioration
of occupational health.
In a system
where labour is but a commodity to
be purchased, new products and processes
. can only result in worker's
facing
fresh risks of work-related disease.
Preventive health measures are naturally
opposed by industry as they cut into
profitability.
Existing
legislation,
while setting some safety standards,
concentrates on providing medical bene
fits and compensation for damage done.
A factory inspector usually comes in
while checking on accidents or cases
already reported, rather than implemen
ting preventive measures.
Besides exposure to specific occupational
hazards, ..the'factory worker is the victim
of a larger degenerating health environ
ment. He or she normally stays • in a
crowded chawl or filthy slum, and is
therefore, exposed to all kinds, of commu
nicable
diseases.
Undernourishment,
a
direct
consequence of .subsistence
living, further increases' vulnerability
to disease.' At the factory a worker
is exposed to. at ■ least one or two df
the following health hazards:
* Physical hazards from heat, pressure,
light,
noise,
vibration,' radiation,
electricity etc.
* Chemical hazards from dust,
gases,
vapours,
acids,
alkalis
solvents
etc. •
•
;
* Biological ’ hazards
from infective
and parasitic agents.
For example,
workers may
contract anthrax - a
disease of horses, goats and sheep
that is transmitted . by tiny spores ..
in animal products and Sy contact
with the animal itself.
* Mechanical
hazards
from protruding
and moving parts of machines.
The Law and Occupational Health.
The Directive Principles of State Policy,
in the Constitution of India calls on
the government
to direct its policy
"towards securing that the health and
strength of workers are not abused and
the citizens are not forced by economic
necessity to enter avocations unsuited
to their age and strength." It also
directs the states to "make provisions
for securing • just and humane conditions
of work."(1) .
However, there is no comprehensive legis’-
lation which deals in detail with prob
lems
of occupational
health
in the
country. The 3 Acts, which come anywhere
near translating these principles into
practice are:
1) The Factories Act of 1948.
2) The
Employees
State
Insurance Act
of 1948 (ESIA) and
3.) The Workman' s Compensation Act of
'1923 (WCA)
A review of these 3 Acts shows that
a large number of workers .are■not inclu
ded in its- purview and therefore can
be exposed to any amount of hazards
without hindrance.- .The . Factories Act
covers manufacturing units using power
with JO- or; more workers, dr units not
using power with 20 or more workers
(Miners
come under a. separate Act;
restaurant and hotel, workers now come
under
the
preview of the
Factories
Act). The ESIA which does not distinguish
between powered and non-powered units,
covers those having 20 or more workers.
The Workmen.'s Compensation Act includes,
besides the above, others such as miners,
shipcrew, construction workers, firemen
and plantation workers.
From the coverage- of the Acts, it is
.evident that workers in small sweat
shops all over the country, construction
workers and- those contracted by outside
contractors within the
larger
units
are not protected at all by the Factories
Act or.the ESIA.
The agate workers of Khambhat, Gujarat,
who cut, grind, polish and carve agate
stories into ornamental items, are one
example of this. Every year they produce
■finished goods worth 10 to 12 lakh
rupees which are exported to the USA
and Africa. As they work at home, the
entire
family is exposed to silica
dust,
which
is
responsible
for^ the
high incidence of various lung diseases.
One • such survey of agate workers puts
the
incidence of
these diseases at
63.5% compared to 35.6% in the control
group. Even children as young as 11
years were found to be suffering from
serious
lung diseases.
Because
their
workplace does hot get qualify as a
"factory" as defined in the Acts, agate
Workers cannot even hope for any legal
aid or compensation.(2) •
The Factories Act
Chapters III, IV & V of the Act prescribe
certain broad guidelines for preventive
health
care
in
those manufacturing
units specified earlier. However, they
set no specific standards and regula
tions
for
protecting the health of
workers. This and the granting of exemp
tions in some cases has been left to
the discretion of the state, governments.
Thus the guidelines are more like general
recommendations.
In the sub-section on dusts and fumes;
for example, the Act states that "effec
tive measures shall be taken to prevent
its
inhalation
and
accumulation
in
any workroom, and if any exhaust appli
ance
is
necessary for this purpose,
it shall be- applied as near as possible
to the point of origin of the dust,
fume or other impurity.."(3) The specific
"effective- measures", and the number
of exhaust fans required are determined
by the Factory Inspectorates of each
state.-
Similarly on the subject of "disposal
of wastes and effluents", the Act states
that
effective arrangement
shall
be
made in every factory... so as to render
them
(wastes and effluents) innocuous
and for their disposal". (4) The regula
tions prescribing the "effective arrange
ments" are again left to the state
governments.
In
its
chapter dealing
with
special
provisions,
the
state
governments are
left to devise and
apply specific rules to
"any facto
ries, or class or description of facto
ries in which the manufacturing process
exposes workers to
"serious risk of
I bodily, injury, poisoning or disease."(5)
The Maharashtra government in its Facto
ries Rules of 1963 (considered to be
■one' of the'most rigorous among the vari
ous states) has classified 21 processes
as
"dangerous operations"
(See table
1 ), and detailed regulations pertaining
to each of these have been prescribed.
Enforcement of the Factories Act.
Although the rules are rigorous, the
enforcement mechanisms,
the personnel
and their functioning leave much to
be desired. The Factories Act provides
-that each state is to have a Chief Ins
pector of Factories, who is the primary
enforcing, authority.
Chief Inspectors,
advised by the Directorate General of
Factory Advice
Service,
may propose
amendments in addition to the existing
‘legislation. The Chief Inspectors staff
..comprises Certifying Surgeons and Ins
pectors.
Cerifying Surgeons examine all factory
workers
and
supervise
the
diagnosis
and treatment of occupational diseases.
They are also responsible for determining
the health, hazards in any new manufac
turing process or of any new substances
used on the shop floor. For Maharashtra,
there are only two Certifying Surgeons
and one of them is also one of three
Medical
Inspectors
in the
state.(6)
Within the category "Inspectors" there
are those
responsible
for enforcing
safety
standards,
working hours and
ensuring the general welfare of workers,
and there are Medical Inspectors, speci
fically
responsible
for
monitoring
the health of workers.
Inspectors are supposed to visit every
factory in the state at least once a
year.
They may
conduct
spot-checks,
tests and interviews with workers out
of the ear-shot of managers. They may
also examine any document relating to
the factory.
In most states.
Factory Inspectorates
are chronically under staffed and ill-
equipped to inspect and maintain occupa
tional
health and safety standards.
While the
Labour Minister Conference
ten years ago recommended that there
be an inspector for- every 150 factories
in a state,
today an inspector has
to cover at least doubt this number.
In certain states like Bihar, one inspec
tor has to visit 1,100 factories per
year.(7 )
In Maharashtra, the most industrially
advanced state with about 19,000 facto
ries, there are only 96 inspectors. (8)
In addition
there are three medical
inspectors and a fourth post is still
unoccupied (of the three filled posts,
one had been vacant- for over ten years
has
been
filled only
recently) . (9)
According to Dr. Surendra Nath of the
Central Labour Institute, Medical Inspec
tors are poorly paid and there are
few avenues
for promotion - Medical
Inspectors, are hardly ever
promoted
to the
post . of Chief Inspector . (10)
Furthermore, workers, doctors and social
workers allege that there is little
commitment, on the part of inspectors
to improving the health status of wor
kers . Workers often complain of collusion
between the management and inspectors,
and have even levelled change's of corrup
tion. In one asbestos company, workers
claim that for many years now, a certain
high
ranking official
in ■ the state
health administration has been passing
off cases of asbestosis as tuberculosis,
and other lung ailments.(11) The obvious
conclusion is that the management .finds
it cheaper to purchase the official
concerned, than to pay the heavy compen
sation that an honest verdict on- his
part would entail.
Some multinational
corporations have
taken advantage of our lax enforcement
of occupational
health
standards. ;In
mid-1981.
New Scientist
reported on
poor working conditions in the asbestos
units
with multinational .‘corporation
connections.
Though they took
"every
- 4 precaution for workers safety and health
in their own countries (asbestos workers
in the West have been active in pressing
for more
stringent regulations),
the
units
in
India had undertaken
very
few
anti-pollution or
dust
control
measures".(12)
Another important trend is the farming
out of certain dangerous parts of the
manufacturing process to the ancilliary
or
small scale sectors.
Being small
unorganised units,
these escape the
umbrella of the Factories Act.
The Employees State Insurance
The Workers Compensation Act.
Act
and
These two Acts of the Union of India
as well as the Insurance Acts of the
states deal with the curative and compen
sation aspects of the problem of occupa
tional hazards.
The Employees State Insurance Act (ESIA)
established the Employees State Insurance
Corporation (ESIC) to provide certain
benefits in case of sickness, maternity
and employment injury to workers whose
monthly income is less than Rs.1000(in
the kinds of units specified earlier).
Sick leave without ' loss of wages is
also
ensured
in case of employment
injury, in which are included physical
injuries, the 22 occupational diseases
in th
e
*
Factories Act
(Table 2) and
1. Coal Miner's Preumoconiosis - accumalation of coal dust in the lungs.
2. Telegraphists cramp.
3. Bagassosis - accumulation of sugar
cane fibres in the lung during the
processing of sugar cane.
4. Compressed air illness - as a result
of working in factories using proces
ses with air under high pressure.
Occupation dermatitis is not included
in . this Act's
list of diseases fpr
which medical
benefits are obtained,
although other skin diseases including
chrome ulceration (formation of holes
and cracks in the skin due to chemicalchroniate
and bichromate-exposure)
and
skin cancer are mentioned. Given that
occupational
dermatitis
is
included
in the Factories Act's list of diseases,
its omission in the ESIA is puzzling.
The ESIA consists of member nominated
by the central government, those repre
senting each state government and union
territory,
representatives of employees
and employers, and the medical profes-r
sion. A smaller group, chosen from the
members of the Corporation listed above,
constitutes the
"Standing Committee,".
This Committee implements the ESIA with
the help of officers at the state level.
Its finances are drawn from compulsory
monthly contributions by employers and
employees.
Those not covered under the ESIA (such
as miners, ship crew construction wor
kers,
firemen and plantation workers)
but earning less than Rs. 1000/- per
month can claim compensation for 'injury
during employment'
(as defined in the.
ESIA) under the Workmen's Compensation
Act of 1923.
Occupation Health - The Reality.
Laws and enforcement mechanisms notwith
standing,
occupational
health
levels
in India have barely improved. Dr. Surendra
Nath, Deputy Director (Medical) of the
Central Labour Institute (CLI) has dis
cussed current
studies in his paper
"Occupational Diseases in
Industries-.
a review."(13) The results of over a
dozen research projects on noise levels,
silicosis, dermatitis and benzene poison
ing, to mention a few, present a very
sobering picture of occupational health.
in India. In the dermatitis study, for
example of 2,129 workers examined, 63.17%
were affected with "various types of
skin lesions". Research involving 3,792
textile workers reveal that 29% suffer
from various grades of byssinosis, as
against the earlier figure of 12% obtai
ned in a study conducted by two hospitals
and the CLI in Bombay during 1970-75.(14)
- 5 -
Reasons for the low levels of occupa
tional health are hot difficult to
find.. We have already seen how existing
legislation
is
not
comprehensive and
how implementation of the law is a
farce.
In addition,
information about workrelated health hazards is not freely
available to workers,
either because
it does not exist or is concealed,
or. because it is not considered suffi
ciently important to educate workers.
In several cases,
the effects of a
particular chemical or of dust in the
workplace may not appear for years.
Sometimes, , as in the case of the nuclear
industry,
radiation effects may only
appear much later,
in the offspring.
Moreover,
in a
country like
India,
where workers may suffer from ill health
■ due to poverty,
it is difficult to
distinguish
between
a
work-related
disease and one connected to the workers
living
environment.
What
is
clear,
however,
is that occupational health
hazards
exacerbate
already existing
low levels of health. Thus the condition
of a textile worker, already suffering
from
tuberculosis,
may
deteriorate
further because of exposure to cotton
dust.
While managements, medical inspectorsand
others are quick to assert that "educa
tion" will do much to improve existing
occupational
health
levels,
the very
information required for this education
is not made available to workers. Inves
tigatory and
advisory
institutions
like Bombay's Central Labour Institute
(CLI)
conduct
detailed
research on
health
hazards
in certain
factories
(often ' at the management behest). The
results of such research, along with
recommendations made by the CLI are
strictly
confidential.
One
copy is
sent
to
the management
and another
to the Inspectorate of Factories of
the state concerned. The latter then
determines
which recommendations
are
realistically
enforcable.
Copies
of
research reports, with the name of the
factory neatly deleted, are made avail
able to the public later.
In addition, knowledge of certain chemi
cals and manufacturing processes are
considered "trade secrets" and the mana
gement is reluctant to divulge these.
Workers are rarely informed of the poten
tial hazards of their work before deci
ding to take up a job. And even if they
were, it is unlikely that this would
influence their acceptance or rejection
of a job. A job applicant makes the
decision to accept a job for reasons
of economic need, job availability and
his or her capabilities and preferences,
rather than on the basis of health and
safety considerations.
Some studies have even shown that workers
are aware of the health hazards at their
workplaces, but feel they have no option.
In Mandsaur district Madhya
Pradesh,
workers in the state pencil industry
have a high
incidence of silicosis.
They admitted that they knew of the
dangers of their jobs, but were forced
to work in this industry as there was
no alternative means of livelihood.(15)
Workers are also given incorrect informa
tion on the prevention of occupational
health
hazards.
Milk is provided to
workers exposed to lead as a means of
countering
lead poisoning.
Milk was
once thought to help accumulate and
immobilise lead in the bones. However,
Mr. Chakravorti and Dr. Bhar of the
Directorate General of Factory Advice
and Labour Institutes have written :
"The
prophylactic efficiency of milk
as an antidote for lead poisoning has
never been demonstrated unequivocally;
on the other hand, some studies rather
indicate that milk may facilitate lead
absorption...
As
a
general
principle
in the prevention of occupational poiso
ning,
no beverage or medicament (for
example vitamin C for benezene exposure..
jaggery for dust exposure, etc.) should
- 6 -
ever'be considered an adequate substitute
for
effective
technical control of
the hazard".(16)
All of the above, point to a lack of
commitment to the health of working
people. And with labour such a cheap
and readily available
commodity,
why
should a manager care if a worker was
coughing all night? There is a headon collision between the management's
primary quest for profit and the inte
rests of workers.
Preventive measures to minimise health
hazards like masks and special clothing
are an added expense and if managements
can cut1 corners,
they will —unless
challenged.
The challenge will have to come from
workers and their unions. Support action
by health groups and concerned profes
sionals including journalists is also
necessary.
They could
form citizens
and workers health and safety groups
to monitor risks on the shopfloor and
demand
legal
action.
Major demands
could be the 'right to know' the kind
of toxic substance used in the workplace
and legislation to tackle the problem
of occupational hazards comprehensively.
On the other hand, workers will also
have to be vigilant to ensure that
their demands
for better health and
safety provisions do not lead to increa
sing mechanisation followed by retrench
ment.
hospital
for treatment. The skin on
his entire face and body was rough,
dry and full of scales. When exposed
to sunlight, it would itch. He suffered
from no other disability. He had been
working as a watchman at a chemical
factory for over fifteen years. He repor
ted that the gate he guarded was near
the
chemical processing unit of the
factory, and that he had a history of
occupational
dermatitis.
He had come
to the hospital without the knowledge
of his employers. He reported that there
were other people at his work place
who had the same skin diseases. As the
watchman's
condition was
severe,
he
was hospitalized and after a while his
skin cleared up. He asked the management
if he could be paid compensation, since
he was not provided safety measures.
The management was unwilling to pay
compensation and asked him to resign
if he did not want to work under the
given circumstances. The watchman chose
to continue at his job.
What is occupational dermatitis?
Occupational
dermatitis,
the disease
which the watchman was suffering from,
is an inflammation . of the skin. The
skin becomes swollen, red, tender anditchy. It oozes and later becomes scaly.
Sometimes bacteria invade the affected
skin and produce boils and spots. Derma
titis only involves the skin and is
not contagious.
How is it caused?
Ultimately, the only lasting solution
lies in actual workers' participation
in the management of the shopfloor,
if not collective ownership. Organising
workers
around occupational
health
may prove to be one more effective
way to do this.
Case
History - Occupational Dermatitis.
A few months
to the skin
ago a male patient came
department of a public
Occupational dermatitis is caused as result
of the handling and exposure to thousands
of chemicals. Some of these, called pri
mary irritants (alkalis and acids, for
example) affect that part of the skin
with
which they come into contact.
There are also certain substances that
remove natural oils from the skin. These
include
certain
solvents;
thinners;
degreasers like paraffin and turpentine
and tars and coal products.
In addition there are certain substances
that -produce an allergic reaction in
a particular worker,
although others
may not be affected by it.
Physical
agents can also harm the skin, causing
disease.
These
include
heat,
cold,
water, sunlight. X-rays and other radia
tion, soot, dust and grit (especially
when this gets between the skin and
clothes and causes friction).
Mechanical damage is yet another cause
of . occupational
dermatitis.
At work
the -skin is subject to the formation
of. thousands of little punctures and
minute injuries.
Certain oils and watery fluids make
the skin soft and permeable and the
cells below the outer layer of the
skin
lose
their protective
function
and become vulnerable
to
bacterial
invasion and disease.
Industries in which occupational derma
titis occurs
Occupational dermatitis is one of the
commonest industrial diseases. Workers
in chemical and plating factories and
in the textile mills are very susceptible
to the disease.
In paint factories,
solvents in the paint cause dermatitis.
This is also true in printing presses,
and the skin is further irritated by
the use of lead,
tin, and antimony
types.
In
addition,
workers in engineering
units are highly prone to dermatitis
because of their exposure to cutting
and lubricating oils and degreasers.
Finally,
with the increasing use of
chemical
additives
in the
food and
confectionery
industries,
there
is
a high incidence of dermatitis among
workers in these factories.
Workers in these factories will have
to be vigilant about any new substances
or process used on the shopfloor and
obtain information about the possible
health hazards.
If any infection of
the skin or allergic reaction occurs,
medical authorities must be consulted
at once. At the same time legal action
can be taken as dermatitis is included
in the list of occupational diseases
in the Factories Act.
Workers
suffering
from occupational
dermatitis are not
entitled to any
medical
benefits and sickness
leave
by the Employees State Insurance,’Corpora
tion. Nor are they eligible for any
remuneration under the Workmen1s Compen
sation Act. Thus, workers have to resort
to either private doctors or government
dispensaries
for
treatment and like
the watchman, they are forced to return
to work as soon as possible or face
unemployment.
- 8 -
Accidents at the workplace
*
According to latest figures, (See graph)
No of fatal accidents increased from 248 in 1950 to 806 in 1980
No of nonfatal accidents increased from 76,000 in 1981 to 3,55,000 in 1980.
an increase of 393%
*
Most of the increase cannot be attributed to the greater numbers of factories & workers. Accor
dingly to Mr. Nair of the Central Labour Institute, while daily employment went up by 120%
between 1951 to 1980
fatal accidents went up by 225%
and non-fatal accidents
by 393%
*
The Factories Act provides that all injuries that keep workers from work for over 48 hours
must be reported to the inspectors. In reality, only 65% of such cases are reported.
*
The Act also asks managements to provide
- One first aid box for 150 workers
- Separate Ambulance Room, with nurse where there are 500 workers or more.
- Safety Officers where there are 1000 workers or more.
*
Despite all this,
- The workers Compensation Board pay out 1.5 crore Rs. a year as compensation for injuries.
- The ESIC pays Rs. 120 crores a year
- Other insurance companies pay Rs. 30 crores
Adding other costs like damage to machinery & loss of production. The loss works out to
Rs. 2000 crores a year (according to the Loss Prevention Association of India).
The "accident-prone" industries
Abstracted from: "Workplace accidents are increasing" by R.R. Nair in Science Today, September
1982, p. 35 - 37.
- 9 Table 1.
'Dangerous Operations" according to the Maharashtra Factories Rules, 1963.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
Manufacture of aerated waters and processes incidental thereto.
Electrolytic plating or oxidation of metal articles by use of electrolyte containing chromic acid or other
chromium compounds.
Manufacture and repair of electric accumulators.
G lass manufacture.
Grinding or glazing of metals.
Manufacture and treatment of lead and certain compounds of lead.
Generation of gas from dangerous petroleum as defined in the petroleum Act.
Cleaning or smoothing of articles by a jet of sand, metal shot or grit or other abrasive propelled by a blast of comp
ressed air or steam.
Liming or tanning of raw hides and skins and processes incidental thereto.
Manufacture of chromic acid or manufacture or recovery of the bichromate of sodium, potassium or ammonium.
Manufacture or manipulation of nitro or amino compounds.
Handling and manipulation of corrosive substances.
Manufacture of bangles and other articles from cinematograph film and toxic and inflammable solvents.
Processes involving manufacture, use or evolution of carbon disulphide and hydrogen sulphide.
Manufacture and manipulation of dangerous pesticides.
Compression of oxygen and hydrogen produced by electrolytic process.
Manufacture and manipulation of asbestos.
Manufacture and manipulation of manganese and its compounds.
Carbon-disulphide plants.
Benzene.
Process of extracting oils, wax and fats from vegetable and animal sources in Solvent Extraction Plants.
Table 2.
The Occupational Disease included in the Factories Act.
1.
Poisoning by Lead and its compounds.
2.
Lead tetra-ethyl poisoning.
3.
Phosphorous poisoning.
4.
Mercury poisoning.
5.
Manganese poisoning.
6.
Arsenic poisoning.
7.
Poisoning by nitrous fumes.
8.
Poisoning by benzene and its compounds.
9.
Carbon disulphide poisoning.
10.
Poisoning by chromium.
11.
Anthrax - a disease transmitted by contact with animals and animal products ; often contracted by workers in'the
glue and fertilizer industries.
12.
Silicosis - accumulation of silica dust in the lungs.
13.
Poisoning by chlorine, fluorine, iodine and bromine gases and their compounds.
14.
Diseases due to radioactive substances - e.g. those contracted by X-ray technicians.
15 Skin cancer.
16.
Toxic anaemia.
17.
Toxic jaundice due to poisonous substances.
18.
Oil acne or dermatitis (skin diseases) due to mineral oils and their compounds.
19.
Byssinosis - accumulation of cotton dust in the lungs.
- 10 20.
21.
22.
Asbestosis - accumulation of asbestos fibres in the lungs.
Dermatitis caused by contact with chemicals and paints.
Deafness caused by high noise levels at the workplace.
References
Constitution of India, article 39E & article 42.
Chandra, Harish, Clerk, 6.H. and Raslogi. S.K., "Plight of Agate Workers in Gujarat"
in Science Today, December 1982, p. 46.
3) Factories Act, 1948,.Section 14, p. 10, Maharashtra edition, 1982.
4)
Ibid, section 12, p 9-10. (My brackets).
5) ibid, section 87, p 41.
6) Personal communication with Dr. GG. Davay, Medical Inspector of Factories 4 Certifying
Surgeon, Factories Inspectorate, Government of Maharashtra.
7) Nair, Prabhakar, "Petty Cover-ups and Puerile Antics" In Science Today, April 1982, p. 38.
8) Personal communication with Dr. GO. Davay - see note (6)
9) Nair, Op. cit., p. 38.
10)
Personal communication with Dr. Surendra Nath, Deputy Director (Medical), Central Labour Institute, Bombay.
11)
Personal communication with workers in an asbestos workers union.
12)
Rele, Subhash, "Asbestos1 Kiss of Death" in the Daily, March 11th. 1983.
13)
Nath, Surendra "Occupational Diseases in Industries - a Review" in
Inoan Journal of Occupational Health, p. 203 - 210.
14)
Shenai, V.A., "The Scourge of Cotton Dust" in Science Today, February 1978, p. 28.
15)
Chakrapani, S., 'Dust Pollution in the State Pencil industry - a Health Hazard"
Association for Voluntary Action, New Delhi.
16)
Bhar, S. and ,Chakravati, S., "The Lead Hazard" in Science Today, June 1982, p. 31.
1)
2)
ABOUT
CED
The Centre for Education 4 Documentation (CED) is an independent non-profit organisation
involved in research-cum-action oriented programmes, catering to the need of scholars, profes
sionals, students, development workers and other concerned individuals.
Established in 1978, and registered under the Societies and Public Trusts Acts, the CED collects,
collates researches and disseminates information on a wide range of subjects of social importance.
Besides conducting and initiating independent studies, the CED organises seminars and workshops
on related topics and houses a library of books and a collection of clippings from a wide spectrum
of newspapers, magazines, journals, both from India and abroad.
Above all, the CED provides a focal point for like-minded individuals and groups to interact with
one another in order to relate theory to experience and action, in their .respective areas of
involvement.
THE CED HEALTH CELL specialises in documentation and dissemination of information concerned
with health issues. It is in touch with other similar groups In various parts of the country.
Our address :
Centre for Education 4 Documentation,
3, Suleman Chambers,
4 Battery Street,
Behind Regal Cinema,
Bombay 400 039.
Tel : 220019
(Open 11.00 a.m. to 7.00 p.m. on weekdays. Fridays 11.00 a.m. to 2.00 p.m.)
rossj?'"T|,(.
*
acettPATE'
'J
'Stfjofrfs M=
* c
b r.'GAs. R •
•) '
f
KNOW YOUR RESEARCH CENTRE
CENTRAL MINING RESEARCH STATION, BRANBAB, 1972.
( Council of Scientific & industrial Research )
The need for a centralised agency for systematic research in the varied problems of
mining industry in India was felt long before independence. The enlarged activities in the
field, after independence, necessitated the establishment of a separate research unit for
co-ordinating and
undertaking research into all the aspects of efficiency, safety and
A formal proposal for setting up of a mining research station was mooted
out in 1948. The proposal was duly considered and supported by the CSIR and the Coal
Board of India and finally the Central Mining Research Station came into existence towards
health in mines.
the end of 1955-
It started functioning actively in 1961.
Central Mining Research Station at Dhanbad is concerned with all scientific research
and development work associated with mine working, mining methods, safety in mines,
efficiency of mining operations and health hazards of mine workers- This includes work on
development of equipment and appliances useful for mining industry and standardisation
of products going in the mining operation
CMRS engages itself into the research of both
coal and metal ore mining. The work of the Station is undertaken on the basis of project
oriented programme, broadly divided into four fields, viz. (i) Mine Technology ; (ii) Mine
Safety ; (iii) Mine Engineering; and (iv) Mine Health Studies.
Brief Description of Work in Progress
In the field of mine technologv, some of the main research and investigational
problems are on (a) mine subsidence by in situ measurements and equivalent material
model study ; (b) strata movements and strata control in mine roadways in connection
with longwall workings and bord and pillar workings ; (c) behaviour of rocks under
compression and instrumentation for the measurement of stress in situ; (d) introducing
roof bolting in Indian mines as an effective system of roof support; (e) study of the strength
and workability of coal ; (f) possibility of improving the operating efficiency and economy
of hydraulic sand stowing installation in mines; (g) introduction of pneumatic stowing in mines
for the first time in India; (h) adjustment in the stock of sand of different ropeway
schemes of Coal Board ; (i) operational research on different aspects of mining to increase
2
(
the
2
)
efficiency of mining operations and (j) loss of coal associated with Bord and Pillar
workings
Latest addition in this field is the development of efficient blasting system for winning
the minerals.
These investigations, carried out in a number of mines, have been helpful in increasing
efficiency of mining operations.
In the field of mine safety, the major activities includes (a) investigation of ventilation
conditions in mines and reorganisation of ventilation system with a view to ensuring better
working condition for mine workers; (b) investigation of mine fires and spontaneous
heating of coals; (c) study of gas emission from coal seams and coal dusts ; (d) investigation,
development and testing services in respect of mine safety equipment ; (e) collection and
analysis of mine air/gas samples, samples of mine dust, stone dust, mine water etc., (f) studies
on corrosion and its prevention in coal mines, pyrite mines, zinc mines, etc.
The programme in the field of mine engineering covers (I) investigation, development
and testing of wire ropes; (2) testing of roof supports such as hydraulic props, friction
props and timber props; (3) non-destructive testing of colliery equipment; (4) metallographic
and chemical analysis of steel wire ropes and mining components; (5i investigation on
suspension gear components; (6) testing of mine cables and (7) study of earthing
electrical systems in mines.
for
Work in the field of mine health includes investigations into occupational diseases
among mine workers.
Electrophoresis of serum-proteins and study of sickle cell traits in
coal miners form a part of the investigations to determine the effects of coal mining on
human system. Investigation in this field also cover (a) physiological studies on environ
ments and work-stresses on the miners in connection with different mining operations;
(b)
air-borne dust survey in coal mines and other metal mines such as manganese, zinc,
iron and gold mines ; cement factories, refractories and coal washeries etc. where dust in
the air is a problem; (c) dust loading and particle size measurements in kilns of cement
factories; (d) studies on air-pollution around chemical plants due to Nitrous fumes, Sulphur
dioxide fumes etc and (e) studies of pneumoconiotic lungs using Electron Microscope.
Know-How Developed
There are 66 items (processes/products) designed/developed at CMRS and 36 patents
have been filed. Three patents namely— (1) Remote convergence indicator ; (2) Remote
indicating hydraulic load cell; (.3) Process for the manufacture of Carbon Monoxide Detector
Tubes have got Invention Promotion Board’s Award. The last mentioned patent has also
gone into commercial production. A bench model Methanometer, useful for very quick
and accurate estimation of minute quantities of Methane gas in mine air samples has been
developed and a few instruments have been fabricated for the industry on request.
Most of the processes developed by CMRS are being utilised by the scientists in
their research/investigation programmes in mines.
Know-how for the following items developed by CMRS, some of which are noted
below may be usefully utilised by the industry :
1) Methanometer for detecting methane gas
2)
Device for measurement of displacement between two points I P No- 98143
3)
4)
Suspension type convergence indicator I. P. No. 98144
Improved type convergence recorder I. P. No. 98145
5i
Friction prop—I-P No.100489
r
6)
7)
»)
9)
10)
11)
12)
13)
14)
15)
16)
17)
18)
19)
20)
Modified expansion shell type roof bolt—I. P. No. 104389Remote indicating hydraulic load cell—I. P. No. 104524Lever-roller extensometer—I. P. No. 104525.
Remote indicating convergence indicator—I. P. 104526Remote indicating hydraulic load cell using electrical resistance strain gauge —LP.
No. 104527Vernier type convergence indicator—I. P. No- 104864Improved wedge and split type roof bolt—107830.
Mechanical area integrator -1. P. No. 69619.
A safety device for cages or lifts in case of winding rope—I- P. No. 97123.
Electrical relay tester—I. P No. 113744
Cable fault locator—I. P. No. 113745.
Mine ventilation slide rule—I- P. No. 11-541
Automatic lubricator for winding rope in service—I P. No. 122718.
A hydraulic prop incorporating a load indicating device—I. P- No- 124957A process for the preparation of Hydrogen-sulphide detector tube—I- P.
No. 110409.
Sponsored Investigations :
Most of the projects undertaken at the CMRS are aimed at helping the industry,
directly or indirectly, in increasing the production of coal and other minerals- In addition
to its own projects the Station has been taking up specific problems at the instance of and
with the financial participation of industries. The stability of mine pillars at Zawar mines
for the Hindustan Zinc Ltd., Strata Control investigations in pyrites mine for M/s. Pyrites,
Phosphates and Chemicals Ltd., Strata Control investigations in tunnels for the Yamuna
Hydel Project, Dehra Dun and Giri Hydel Project, Nahan, study on the suitability of coir
matting as barricading material during sand stowing for Coir Board, Ernakulam, are some
of the projects undertaken on behalf of industry and other organisations.
Consultation and Advisory Service :
Consultation and advisory service to industry with regard to mine working, roof
bolting, ventilation studies, dust problem etc. has been a regular feature of Research Station.
Some of such consultation services provided recently are reported below :
(a1)
Strata Control
1. Surakachar Colliery
2. Amjhore Pyrite Mines
3. Bhurkunda Colliery
4. West Chirimiri Colliery.
1. Monidih Project
2. Manganese Ore (India) Ltd.,
3. Hutti Gold Mines Co. Ltd.
1. Rajhara Iron Cre Mines (H. S. L-, Bhilai'.
1. South Kujama Colliery
2. Girimint Collierv.
(b>
Roof Bolting
(c)
(d)
Efficient blasting system
Investigation of winding shaft
(e)
(f)
1. Amlabad Colliery.
Gas emission
Reorganisation of Ventilation system 1. Kargali Pits.
2. Kustore Colliery (Raniganj Coal Association
Ltd. , Dhanbad.
Dust and particle size measurements
1- M/s. Associated Cement Co. Ltd.,
in kilns of Kymore Cement Works.
Bombay.
Dust survey in Reclamation tunnels
1. M/s. National Mineral Development
of Bailadilla Iron Ote Project
Corporation LtdOther than the above, CMRS has also offered consultancy and advisory services on
model study, strength of coal, barricading materials for stowing, subsidence, hydraulic and
pneumatic stowing, mine fire, in situ non-destructive testing of wire ropes and other mining
components, airborne dust survey in mines, refractories and other industries and air
pollution around mines and factories for NCDC, NMDC, PPC, HZL, HCL, Bharat Gold
(g)
(h)
(
4
)
Mining Pvt. Ltd., Bharat Coking Coal Ltd., IBM, Indian Copper Corpn., Manganese Ore
India Ltd., TISCO, IISCO, Bird & Co., Andrew Yule and Co-, Indian Detonators Ltd.,
Indian Explosives Ltd-, Fertilizer Corpn. of India Ltd., ACC and manufacturers of
indigenous flameproof equipment, intrinsically safe equipment, wire ropes and other mining
components and others.
CMRS conducted investigations regarding Mine Subsidence at Sudamdih Colliery
during 1969 and 1970 on behalf of National Coal Development Corporation. The mine
has large quantity of coal below the railway line, the extraction of which presented a
problem. On the basis of the report provided by the CMRS, the extraction is being done
safely below the railway line since the last six months.
Analysis and Testing Facilities :
CMRS has developed admirable facilities for testing of material and equipment for
mining industry. This has become helpful not only in the efficient and safe working in
mines but also has been instrumental in developing indigenous industries for the manu
facture of standard mining equipment and allied products which hitherto had to be imported.
The laboratory is fully equipped to carry out tests on flame proof electrical equipment
for use in gassy mines and other such locationsEquipment tested include motors,
transformers, switch gears, fans, etc. Electrical appliances and circuits are tested for
intrinsic safety. Dust-tight electrical equipment are tested for safety against hazards from
inflammable and explosive dusts. Facilities for gallery testing of permitted explosives
as also new developed explosives for use in coal mines, are available. Delay detonators
for use in gassy mines are tested for their incendiary, storage and electrical characteristics.
Prototypes of electrical detonators manufactured in the country are investigated and
approved for use. Testing for fire resistance property of conveyor belt, ventilation ducting
and brattices as per the standard specifications is undertaken. Assistance is rendered by
way of testing, calibrating and servicing of miners’ safety torches, methanometers, miners’
helmets, flame safety lamps, cap lamp bulbs and batteries and testing of mine fans,
anemometers, velometers, etcThe 5C0 tonnes horizontal tensile testing machine, available at CMRS is utilised
for development and testing of wire ropes used in mining and allied industries. It has also
been helpful in promoting the indigenous production of wire ropes by improving their
quality. Recently, the facility has been utilised by the industry in the manufacture of
‘‘Stud Link Chains’’ of 54 mm. dia with a breaking load of over 200 tonnes for ocean-going
vessels and ports and “Short Link Chains’’ of 63 mm. dia with a breaking load of 275
tonnes for heavy duty cranes of Indian Railways.
Training ;
CMRS has facilities for training of personnel from Mining Industry particularlv for
testing and analysis of mine gases, mine dust and stone dust.
Publications and Dissemination of Information ;
Besides the annual report, the CMRS has been releasing technical reports and
research papers from time to time containing information regarding the results of research
done and the achievements of the institution. 52 such papers/reports have been published
so far- The papers are circulated to concerned organisations in research, industry and trade.
Press releases on CMRS activities are issued and write-ups are sent to journals and souvenirs.
The research and development work is also published in Indian and foreign scientific
and technical journals. Due publicity is also done through the media of Press and parti
cipation in symposia, seminar, etc Annually two “Open Days” are organised when the
laboratory is open to visitors to acquaint themselves with the activities and achievements
of the Research Station (Adapted from Information Newsletter, Industrial Liaison &. Exten
sion Service, Council of Scientific &. Industrial Research Rafi Marg, New Delhi, Vol. 10,
No. 1, June 1971, p- 7.)
! Circulated on
August 5, 1972
Printed at The New Sketch Press, Dhanbad and Published by Director,
Central Mining Research Station, Dhanbad.
'^GTrTOTE UNIT C
X
HEALTf
St. JOhnTS^edical College
BANGALCRE-560034.
lOidt tin eo-nipluiLutts
'Dittato-c, &JIUTI&
MAKING MINES SAFER AND PRODUCTIVE
MINERALS play an
important role in the indus
trial development
of a
country.
The progress of
mineral industry is very
much dependent on safe
and efficient mining which
in turn is based on impro
ved
techniques,
better
equipment and appliances
and safety and health of the
miners. A formal proposal
for setting up of a Mining
Research
Station
was
mooted in 1948. The propo
sal was duly considered and
supported by the CSIR and
the Coal Board of India,
and finally
the
Central
Investigation work on Roof Bolting for
Mining Research Station
making a mine safer and productive.
Jeanne into existence towards the end of 1955. It started functioning
actively in 1961 at Dhanbad,
CMRS is concerned with all scientific research and development
work associated with mine working, mining methods, safety in
mines, efficiency of mining and health hazards of mine workers.
This includes work on development of equipment and appliances
(Extracted from “Science Aids Industry" published by the CSIR, New
Delhi, on the occasion of celebrating Twentyfifth Independence Jayanti).
community health cell
/1»(Fi.'stFloor)3c. Marks doad
BAAlGAt-Oac-s^OOl
(
2
)
useful for mining industry and standardisation of products going in
the mining operation.
The research covers problems of coal and
metal mines. The work of the station is undertaken on the basis of
project-oriented programme, broadly divided into four fields, viz,
(i) Mining technology, (ii) Mine safety, (iii) Mine engineering, and
(iv) Mine health.
Activities
Roof bolting has been introduced in Indian mines as an effective
system of roof support. Studies have been made in 52 mines covering^
coal mines, copper mines, gold mines, pyrites and manganese mines.
Besides a large measure of safety factor, the economic benefits due to
bolting are quite substantial and encouraging.
Investigations have been done on the performance of hydraulic
stowing plant in various mines and suggestions made to increase the
efficiency of various operations in stowing and eliminating pipe jams
or barricade bursting thereby reducing the cost of stowing. Suitability
of other materials such as boiler ash, fly ash, pyrite cinders, etc., for
stowing has been studied as a substitute for sand. CMRS investi
gation on blasting in an iron ore mine in public sector undertaking
has made it possible to increase the productivity per drill hole from
550 tonnes to about 1150 tonnes of ore which would be a
considerable saving in drilling and blasting cost.
CMRS investigations on the use of coirmatting as barricading
material during stowing operations in a mine revealed its suitability
with a saving of 63 percent in cost of barricading materials. CMRSj
has also designed a suitable support system for the barricades.
Bearing Strength of Mine Floor and Roof
CMRS has been conducting studies on strength characteristics
of coal and rocks. A new method for determining the strength of
coal and rock has been developed. The data will be useful in the
design of mine pillars, selection of suitable coal getting machines and
improving efficiency of blasting.
(
3
)
Mine Safety
In the field of mine
safety, the major activities
include (a) investigation of
ventilation conditions in
minesand re-organisation of
ventilation system with a
view to ensuring safety of
mines and better working
conditions for mine workers,
(b) investigation of mine
fires and spontaneous heat
ing of coals, (c) study of
gas emission from coal
seams, (d) development and
testing services in respect
of mines safety equipment
and miners’ safety equip
Flameproof testing of electrical equipment
ment, (e) collection and
for use in mines
analysis of mine air/gas
samples, mine dust, stone dust and mine water samples and (f) studies
on corrosion and its preventions.
The programme in the field of mine engineering covers
(i) investigation, development and testing of wire ropes, (ii) testing
of roof supports such as hydraulic props, friction props and timber
props, (iii) non-destructive testing of colliery equipment, (iv) metallo-
* graphic and chemical analysis of steel wire ropes and mining
4P
components, (v) investigation on suspension gear components,
(vi) testing of mining cables and (vii) study of earthing for electrical
systems in mines.
Work in the field of mine health includes (i) assessment of
airborne dust during various industrial operations in collieries and
around factories, (ii) pollution of air around factories and chemical
plants due to sulphur dioxide fumes, nitrous fumes, etc., (iii) dust
loading and particle size measurements in kilns of cement factories,
(
4
)
(iv) investigation into the incidence of pneumoconiosis amongst mine
workers, (v) physiological studies on environments and work stresses
on the miners in connection with different mining operations and
(vi) study of pneumoconiotic lungs using electron microscope.
There are 66 items (processes/products) developed at CMRS
and 40 patents have been filed. Three patents namely, (1) Remote
Convergence Indicator, (2) Remote Indicating Hydraulic Load Cell,
(3) Process for the manufacture of carbon monoxide detector tubes,
have got Invention Promotion Board’s Award. The item mentioned
at No. (3) has gone into commercial production.
Analysis and Testing Facilities
CMRS .has developed facilities for testing of materials and
equipment for mining industry. The 500 tonnes horizontal tensile
testing machine available at CMRS has heen helpful in the develop
ment and testing of wire ropes, and heavy duty chains useful for
mining and allied industries.
Issued on 2 October 1972
Printed at the New Sketch Press, Dhanbad and
Published by Director, Central Mining Research Station, Dhanbad.
Introduction
01 ISA (Occupational Health and Safety Association) is a registered non-governmental
organization engaged in occupational health^nd safety of workers. Set up by Raghunath
K'lanwGT s mschnnicQl technician in a Gujarat power station in 1998 the organization is
building multiple coalitions among factory workers, health officials and lawyers to raise
awareness of preventive measures and to lohhv for reform of worker health and safetv
i---- - ivagiiuiiaui
...... a*i. ivianwai
----- artcan
A
laws.
io an n&nvis.a
rciivw.
~ ---------
’
There are mors th5m 1,5 million workers in India engaged in the generation and
distribution of electricity. IjespitFoeing branded as a 'hazardous industry • by tne Factory
Act of India, power plants have yet to define health and safety regulations for their
workers. Nor iias mere oeeii any organizes citizen action to get tne mouStry to account
for the health and environmental costs of its profit making operations. Through OHS A,
Raghunath F.fanwar is building an environment where workers are both aware of
occupational health risks and abie to influence their working conditions.
uACn^iuuiiii to the earher project
Thermal power is India's chief energy source. The total installed capacity stood at
101,153.6 N4AV. Most of this installed capacity' is under government control. The use of
coai for electricity generation in India is projected to rise by 2.1 percent per year.
Thermal power plants (TPPs) need large tracts of land, which has led to serious issues of
agricultural land acC|Uisition and displacement.
power plants spew a broad range of toxic substances into the air. Included among these
are known carcinogens such as mercury, heavy metals, dioxin, furans and PCBs. Also, fly
aou gviiviaivu num uiviiiiai puvtvi plants has large environmental impacts, leading to
leaching of trace elements, m particular heavy metals, into surface water and ground
water. For every megawatt of power being generated appmvimately n,A tn 0 7 tnnnes. of
ash is produced every day and needs acres of land for disposal.
Worker s face ongoing and severe occupation hazards from noise, coal dust, and other
toxic fumes. Their homes and families on the other hand are subject to the plant's
environmental impacts. Also many workers are not on regular rolls, and do not enjoy
health and insurance benefits. They are often retrenched, left to fend for themselves to
suffer the effects of poor health and no savings. Women arc worse sufferers, both owing
to dual burdens of managing home and livelihoods but also owing to poorer nutritional
status. The continuing dependence on the power plant becomes an unhealthy cycle, which
becomes difficult to break out of.
What are the multitudes of impacts, which emanate from such an activity? To study this
using a multi-disciplinary approach and with the participation of the affected community
OHSA has partnered with 3 organizations. The study: ‘ Occupational Health in the CoalPower Industry of India: An Innovative Approach To Change Industrial Systems For
Economic Growth With Social .Justice’ will look at the health, environment, socio
economic and legal impacts of coal- based thermal power plants on workers and the
^surrolindins community. The location of the study is Ahmedabad and Gandhinagar
Gujarat at two power plants: Gujarat Electricity Board and Ahmedabad Electricity
Company.
Project Details:
The research, Occupational Health in the Coal-Power Industry oflndiat An Innovative
Approach To Change industrial Systems Tor Economic Growth W ith Social Justice " was
9 collaborative effort of 4 organizations that were- working in related areas of socioeconomic lights issues. They all had pooled iogethei their skills, peispectivcs,
experiences and resources to make the study rigorous and multi-dimensional.
> A comprehensive study of occupational health and safety, community health and
environmental impacts around coal based thermal power plants
<
RcvOmiucnuativiis to policy makers, enforcement agencies for taking affirmative
steps ibr implementing and improving the working conditions within the plants,
rr»ifinrr»tir»rr liool+h
*nin1
ar»xrirr»r»m<
impact ornnnri
tharmol nnivor rxlonfc
x Recommendations for shifting to cleaner fuels for power generation
j**
To survey ar
* d study Health, Safety and Environment and working condition
affecting the workers of some more Thermal rower Plants and pollution impact
by these power plants on community at large.
To moire a set of recommendations to improve the working conditions inside the
power stations and minimize the pollution effect.
To disseminate the findings of the study to the communities, and policy makers
and as well as to the workers and trade unions in the other thermal power plants in
Methodology:
The project will have two mam components:
iiauuiig auu oissciiimaiion of findings through meetings ano workshops ano
awareness camps
Tn past we had surveyed two thermal power plants of Gujarat and revealed number of
inside workers prevailing inside power plants and indirect polluting effect in workers and
community. This was survey created an impact. After the publication of this study, GEB
bee introduced medical examination for their workers. Till today about 500 workers have
already undergone medical examination and 86 workers of AFC, who were found
suffering from one or the other diseases, have requested to EST for medical
compensation. An important trade Union organization having 54,000 members, have
shown interest m this study and promise to help for further study.
For environmental pollution, we will take the help of environmental experts end for
health uf wuikcis uud safety uf wuikcis. We will take the help uf medical piufcssiunals
and safety expert.
The workers would be interviewed through 3 mode! questionnaire based on health
environmeni and safety questions. This may bring awareness among workers and
members of community regarding their health and safety and these workers and members
of community can brmg pressure on employers and ‘die go vernment to take remedial
action.
Estimated expenses to run training center
2. Office Staff
(a) Coordinator
tbt Office in charoe
\C) Computer operator
Rs.5000.00
Rs 7500 00
Rs. 2500.00
Rs. 13000.00 per month
3. Electricit” Telephone internet etc
Rs. 3000.00 p<
4 Train Transport expenses of coordinator
Rs 10000 00 ner month
kJUAlJLVJLlUl J ,
Rs. 30000 00
r>.. onnnnnn„...... ........ 4k ..
_____ «v..
±xo. jvuuv.vv pui tuuuui a iz. luuuiiia.
For 36 month ( Three ''ear
Rs 30000 00x36 =
Rs 10 80 000 00
Estimated expenses in respect of protects to be under taken.
1. Workers training : 12 programme
During 36 month : Ks.4,000.uu per programme for
12 programme Rs. 4,000.00 x 12 —
2. Training of lawyers and agents insurance company
vOrpOiauvil v pfvgiaiilulC uui'iilg 3v ulOilth
R.s. 48 000.00
Rs '1000.00 per month
Rs.4,000 x 6
Rs. 24,000.00
j. For lucuicdi professionals 6 programme during
months Rs.5.000.00 per programme.
Rs. 5 000 x 6
R.s. 30 000.00
Tuial
Rs.1,02,000.00
Ks II) XII IHHIIHI t/kji Ye?rs.,„
Rs 1,02,000 00 for 3 years
N R This training centre will cover two states named, Gujarat and Rajasthan
Background; Asbestos related deaths are beginning to emerge au epidemic in United
States and Europe but m India due to lack of registration of workers, one fails to gauge
and used indiscriminately for decades nil rhe Supreme Court of India intervened.
Union ot India, the Supreme Court gave directions to the effect that asbestos lactones
the work place at all stages, insure health coverage with Employees’ State Insurance Act
or otherwise, protect health hazards of small-scale factories and compensation to the
Institutes (DGFASLI), die Ministry of Labour, Government of India says, no safe use of
asbestos is possible because even after safety gears were provided there was no material
the lactones Act, 1948.
status?
Civil society groups are gathering evidence of workers suffering from asbestos related
already succumbed to tins disease. Some are still ahve with general physical discomfort
encounter with several types of respiratory ailments. The National Human Rights
Commission (NHRC) has been approached to take into cognizance the plight of the
being organized hr Tokyo (GAC2004), Mi, Mangabhai Patel, a victim person is being
taken to the Congress to represent the case of asbestos workers. The GAC-2004 is being
and furore issues of combating asbestos-related health risk.
Intervention required: The victim reonires financial support to reach Tokyo for GAC-
F.stimated expenditure for Manpahhai
Ag, aaa
o. Train. Tickets to and (rn AJimedabad to Delhi
Rs. 2,000.00
Rs.
300.00
”
Lvugiiig uc DOHTulHg at New Delhi
Rs. 1,400.00
”
Expenses to obtain VISA, at Nev/ Delhi This includes
Riy. fare etc. We do not know exact VISA fee.
Rs. 3,000.00
3. L
5,
Total
Mr.Mangahhai Patel
\st
xvagixiuxuui xs. xvxz ix x » » i xik
(ASHOKA PflLLUW)
C-6 AKSHARJDHAM SOCIETY
inR.ivIADHAVBAUG, NIRInAYNAGAR,
AHMEDABAD-382481 (GTJJ)
PH-732143U (O) /52VU88(K)
*
Ptnoil
>1/?»hrftliAA
*
nAivAhc
nnm
Pct 53,200.00 apprx.
OH- H
Issues of Concern to Workers in the Readymade Garment Sector and Some
Aspects of Cividep’s Intervention
The Garment Industry at a Glance
‘Globalisation’ is the increasing interaction of domestic economies with the world
economy. We get an idea of the importance of globalisation in the world today from the
rising share of international trade in the world output. World trade in clothing was of the
value of $ 199 billion in the year 2000. Asia as a region dominates world trade in clothing
having the largest share, 44.9% (2000), of world trade. Western Europe, the second
largest region accounted for 28.8%. Within Asia, China is the undisputed leader with
18% share in world exports (2000). India ranks ninth largest exporter in the world (2.8%
in 1999) and third largest exporter in Asia.
India’s readymade garment industry contributes around 16% to total export earnings and
is the largest net foreign exchange earner for the country. It has reached this position in
just over four decades, with most of this growth occurring since the eighties. Garment
exports have been continuously rising, from a mere $2 million in 1960-61 to $696 million
in 1980-81, and then sharply to $2236 million in 1990-91 and to $4765 million in 19992000.
The driving force behind the globalization of the garment industry is the vast disparity in
wage levels. The hourly wage of a British garment worker is over twenty times that of an
Indian or Chinese worker. Clothing production continues to be labor intensive and wage
levels are crucial in determining the cost of the final product. Whereas the average hourly
wage of a British worker is about Rs.420, in our estimate, a garment worker in Bangalore
earns about eight rupees per hour.
Women Garment Workers of Bangalore - Some Statistics
The garment industry is the employer of the largest number of women workers in
Karnataka after, perhaps the beedi industry. The garment industry is considerably well
organized in Bangalore unlike other centres and the large majority of employees here
work in factory settings. Officially, there are 788 garment-manufacturing units in
Karnataka out of which 729 are in Bangalore. The total number of workers statewide is
1,53,978 out of whom 1,46,835 are working in Bangalore units. The number of women
workers statewide in the industry is 1,10,019 out of which 1,03,039 are in Bangalore. The
figures were accessed from the department of labour of the Government of Karnataka.
There could be many more casual and contract workers who have not been accounted for
here. The garment industry is famous for rapidly altering production capacity of different
units, size of the labour force and even location of units to get round quota regulations
and other legal provisions. Hence statistics related to the garment industry must be treated
cautiously.
*
Living and Working Conditions of Women Workers
Exploited as workers and as women: The women garment workers of Karnataka,
especially the large majority of whom are in Bangalore, experience all the vulnerabilities
of women as a gender and workers as a class. Paid very low wages, living often in crime
prone neighborhoods, holding insecure jobs, their life is marked by uncertainties. Many
women garment workers are pushed into sex work.
Effects of low wages: The consequences of unfavourable terms of employment, low
wages and inadequate social security on the lives of women garment workers are
pervasive. Unable to afford decent housing, most of them live in squatter’s colonies or
slums, which have scanty civic amenities like water supply and sanitation. Many of them
live in constant fear of eviction and are at the mercy of ‘slum lords’ and hoodlums in the
neighborhood. Frequent lay off in the factories and sometimes retrenchment compound
the experience of insecurity in their lives. Most of the men in their households are also
workers in the informal sector and hence many families live on the brink of poverty and
deprivation. Domestic violence is prevalent. Desertion of married women is very
common and the number of women-headed households is very high.
Harassment at workplace: Sexual harassment at the work place is reported to be
rampant. Supervisors, many of whom are male, take advantage of the vulnerability of
women workers. Abusive behavior is very common and workers are penalized for even
minor infractions of workplace rules. Anybody who questions such high-handed behavior
is either humiliated or even removed from her job. Lack of effective unionization allows
many of the unfair labour practices and abusive behaviour of supervisors and managers
go unchallenged. Participation in union activities itself often serves as sufficient ground
for dismissal.
Issues of migrant workers: A considerable number of women garment workers are
migrants from the neighboring districts of Bangalore. A good number of workers are also
from the drought prone, arid districts of Northern Karnataka. Hence many of them are
subject to problems typical of migrant workers such as lack of proper housing and the
absence of community support. This makes migrant women workers in garment industry
all the more vulnerable to exploitation. A large number of women workers commute to
work from their villages in the suburbs of Bangalore.
Inadequate medical attention: The garment industry being categorized as nonhazardous, there are no compulsory health checkups in the factory premises. Many
workers avoid going to hospitals designated by the Employees State Insurance (ESI), due
to the cumbersome procedures involved. Most of them, during illness, approach quacks,
who pose as medical practitioners in their neighborhood. The chances of early detection
of reproductive tract infections and sexually transmitted diseases among the workers,
therefore, are very little. We have to remember that a very high percentage of women
garment workers are in the age group of 18-40 years.
Overwork and ill treatment: Hours worked in garment factories also are excessive. Often
workers are required to work for many more hours than the mandatory eight hours when
there is surplus of orders. There are many instances of abusive treatment meted out to
2
women workers by supervisors and others. Women are humiliated if they use the toilets
more often than the number of.times the supervisor believes to be warranted.
Vulnerabilities as women: All other vulnerabilities applicable to women as a gender is
true in the case of women garment workers also. Their occupation has low social status.
Access to social services is minimal. Educational attainment is very low and there are
huge numbers of illiterate workers as well. Awareness of rights has not developed
especially because of the inactivity of trade unions and their limited influence among
garment workers. Most of them have no other marketable skills. Early marriage is the
rule than the exception. Their working and living conditions expose them to various
occupational hazards and gynecological problems.
Expected Impact of Cividep’s Intervention
The crucial test to gauge the impact of the programme is the extent to which it succeeds
in persuading policy-makers in the government, manufacturers’ associations and
workers’ organisations to form a national institution to monitor labour standards in the
garment industry on the model of Ethical Trade Initiative (ETI) of UK and similar models
elsewhere.
Another measurable impact would be the level of acceptance and implementation of
codes of labour practices that ensure minimum standards, by garment manufacturers and
retailers. Women garment workers are expected to gain organizational strength to
exercise their core labour rights such as freedom of association and right to collective
bargaining. The immediate gains would be the curtailment of violations such as
compulsory overtime, denial of leave, verbal and physical abuse and sexual harassment.
One more facet of the impact of the programme would be a favourable disposition among
civil society formations towards the rights of women garment workers. Networking,
lobbying and advocacy efforts would bring together workers, trade unions, NGO groups,
labour researchers and women’s organisations in solidarity with the cause of the women
workers.
The database built by the small research initiative of the programme on the nature of
voluntary codes accepted by manufacturing and retailing companies in India and abroad
and the extent of adherence to the codes would help trade unions to re-formulate their
strategies to claim labour rights of garment workers. It would also help lobbying with
legislators to persuade them to raise questions related to labour practices in the garment
industry in the legislature and other forum. Research results could induce the ministry of
labour and the ministry of textiles to consider policy changes to address issues of garment
workers.
Consultation workshops would hasten alliance building among workers, their
organisations, NGOs and statutory bodies like the women’s commission in the interest of
women workers. Communication of initiatives here to retailing companies abroad doing
business with manufacturers in Bangalore, might encourage the former to intensify
monitoring of labour practices of their suppliers. The workshops would help workers and
trade unions to be conversant with the concept of clothes codes.
3
Mobilisation and organisational efforts of the programme would develop confidence in
women workers enabling them to exercise their rights. It will also result in the greater
capacity of women workers to address individual and family issues as well as those of the
locality where they live. Civic authorities can be expected to respond more favourably to
demands raised by the workers concerning civic amenities and welfare schemes when
their organisation is more visible.
The intervention of the programme would result in greater awareness among the public
and opinion leaders about the labour practices in the garment sector and working
conditions under which this large section of women workers labour. We expect the
women’s commission to play a pro-active role to address gender issues of women
garment workers like sexual harassment at workplace. Greater willingness among civil
society organisations to support women garment workers in their struggle for labour
rights and better working conditions is another spin off expected from the programme. A
concrete gain in this direction would be the inclusion of rights of women workers on the
agenda of the consumer rights groups.
Main Challenges for the Intervention
One of the major objectives of Cividep’s intervention with women garment workers is to
provide legal assistance to them to assert or claim their legal rights.
We encounter some problems in actually delivering legal services to the workers. Very
few women workers are willing to take recourse to legal action. Some of them know that
their employers are violating labour laws and legal rights as workers. This is primarily
due to the fear of dismissal from work and harassment in case they complain to
authorities. It is obvious that the workers are unable to do anything to safeguard their
rights as there are no unions or other collectives within the factories. The absence of
unions makes it impossible for them to represent their individual or collective grievances
to even higher management, let alone labour authorities. Women workers in the garment
industry are at the mercy of the all powerful production manager. Owners of the
enterprises largely rely on these functionaries to ‘manage’ labour.
When it is obvious that there is rampant violation of workers rights as well as other laws
related to labour, why is it that there is very little litigation? We have come across a few
cases through contacts in the labour courts. We need to have a more accurate assessment
of the extent of litigation between employers and workers in the garment industry.
Issues of Concern in Brief
The main issues that concern workers in the ready-made garment sector are:
-
Payment of wages below statutory minimum wages
Stagnant wages
Disadvantageous terms of employment (Arbitrary dismissal etc.)
Retrenchment when about to qualify for gratuity
4
-
Work hours (compulsory overtime)
Denial of legitimate leave
Verbal and physical abuse by supervisors/managers
Sexual harassment
Excessively high targets of production arbitrarily set by management without
consultation with workers
Corruption and inefficiency of the authorities of Employment State Insurance
Difficulty to claim Provident Fund dues
Some Aspects of Cividep’s Intervention
Faced with the absence of workers’ collectives within the factories and the victimisation
of workers for attempts at organisation or for raising objections to the highhanded
behaviour of supervisors and the management, we as an NGO have to seek other ways of
addressing workers’ issues. We are currently moving in the following directions*
"
•
■
*
Investigating and documenting the violations of labour rights within the factories
with reference to the provisions of the Law along with the possible administrative and
legal remedies
Exploring ways of holding the labour department of the state government accountable
to rights violation and urging it to act according to its mandate.
Advocacy with the political leadership in the government responsible for the ministry
of labour.
Study the nature and extent of voluntary codes of labour standards accepted by
garment manufacturing units and assess the effectiveness of their implementation.
Holding Legal awareness workshops for workers as part of our mobilisation efforts,
so that, worker gain the confidence to assert their rights through legal means.
5
Page 1 of2
OH
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"Cividep India" <cividepindia@rediffmail.com>
<ader@vsnl.com>; <srini_adv@yahoo.co.in>; <alforum@vsnl.net>; <avatsyayan@oxfam.org.uk >;
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Wednesday, April 27, 2005 6:49 PM
ATT00007.txt
'Dharna' to Protest Night Shifts for Women Workers in the Garment Sector
‘Dharna’ to Protest Night Shifts for Women Workers in the
Garment Sector
Thursday the 28th of April 2005, 6.00pm to 7.00pm
Town Hall, Bangalore.
Organised by ‘Garments Mahila Karmikara Munnade’
‘Garments Mahila Karmikara Munnade’ strongly oppose the move to remove legal restrictions on
night work for women workers. The Government has taken this measure without considering the
social and economic reality of women workers in this country. We are in particular concerned
about the impact that such a move will have on women workers in the garment sector.
The garment sector in Bangalore has very low levels of regulation of work. Workers are already
made to work extra hours, often without any compensation. There are many reports of harassment
at the workplace of women workers. If the legal protection is removed, the harassment of women
workers at the workplace will only increase.
We also fear that permission for night shifts for women workers will become a punitive weapon in
the hands of employers. Women workers who protest harassment or become part of trade unions
may be victimized by employers by repeatedly assigning them to night shifts. This will be a huge
step backward in a sector that is just beginning to organise itself for better regulation and more
humane working conditions. This can in fact create hindrance to increasing the participation of
women in economic activities.
We would like to clarify that we are not per se opposed to women working at night, provided
enabling conditions are put in place like housing, transport and adequate child care. However, in
the present social and economic condition it will be disastrous to remove restrictions on night
work for women.
We appeal to all individuals and organisations who believe in a just and equitable society, rights
of workers to safe and healthy working conditions and the need for an enabling environment for
women to play a constructive role in society, to express solidarity by attending the protest
programme.
In solidarity,
4/28/2005
Page 2 of 2
V. P. Rukmini, D. L. Shylaja and N. R. Pushpa
Convenors, ‘Garments Mahila Karmikara Munnade’
No. 8/3, Srimatha Nilaya, New Timber Yard Layout,
Mysore Road, Bangalore - 560 026
Ph:26751320
4/28/2005
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