656

has been confused by the variety of methods used in

collecting the data.The problems presented in one of the recent major

studies are reviewed.

The significance of different types of clinical studieswhich have been published are evaluated and additionalpoints of special importance are stressed. The aim is tosuggest principles which will improve the quality ofstudies of this nature in the future not only for evaluatingthe use of anticoagulants but also for other forms of

therapy.This work was aided by grants from the Lasker, Fullerton, and

Guttman Foundations.

DANGER AT WORK

INDUSTRIAL accidents cause much misery, and wastemen and money besides. Some people, perhaps, believethat every possible preventive measure has already beentaken and that those accidents which still occur are theinevitable results of human fallibility. To them, the chiefinspector of factories’ report 1 for 1961 will come as a shock.For the third successive year the number of accidents has

risen, and the total of 192,517 represents an increase of1% over 1960’s. True, this rate of increase is lower thanthat of 9% between 1959 and 1960; moreover, the numberof accidents per 1000 persons employed has fallen

marginally from 20-7 to 20-4, and the number of fatalaccidents has also fallen, from 675 to 669.

The conclusion of the chief inspector is that all the extra 1 %is accounted for by the increased number of accidents in theconstructional industries; civil engineering was responsible fora third of the increase and building construction for the othertwo-thirds. There were 10% more accidents in these tradesthan in 1960. Accidents on building sites have become steadilymore frequent over the past ten years; although the expansionof the industry and its labour force, the introduction of newand unfamiliar methods, and the statutory obligation to reportaccidents more fully may all contribute to these figures, thereport concludes that safety standards on the sites have indeeddeteriorated. In 1961, for example, 7% more young peoplewere employed on building sites than in the previous year; but27% more were injured. Already the construction regulationshave been extended from building to civil engineering, andmore " safety supervisors " are to be appointed; in addition,a British Standard specification for safety nets is to be intro-duced shortly. What effect these measures will have on nextyear’s figures remains to be seen.

In 1961 25% of all accidents occurred during the handlingof goods. The report exhorts industry to plan the safe move-ment of materials and welcomes the introduction of mechanical

handling. 18% of accidents were due to falls, and 8% to personsbeing struck by falling objects; 7% involved transport, and 7%the use of hand tools. This pattern, says the report, is repeatedyear after year; but the accidents are not inevitable. Manycould be prevented or at least mitigated by the wearing ofprotective clothing, especially boots and helmets. In factoriesthe provision of goggles is still inadequate, and 25% of eyeinjuries were due to particles thrown off from improperlyshielded machines.

New industrial processes introduce new hazards. Increas-

ingly, for example, firms are using radioactive tracers and

ionising radiations. The manufacture of plastics, often carriedon in old and unsuitable premises, may lead to the productionof explosive mixtures of dust and air. A second report,2 on1. Annual Report of the Chief Inspector of Factories, 1961. Cmnd 1816.

H.M. Stationery Office. Pp. 102. 6s. 6d.2. Annual Report of the Chief Inspector of Factories on Industrial Health,

1961. Cmnd 1815. H.M. Stationery Office. Pp. 63. 4s.

industrial health, draws attention to the dangerous potentialitiesof some of the new metals now finding wide application. For

example, the inhalation of cadmium or vanadium oxide as finedust is followed by pneumonitis; and manganese-dioxidepoisoning disturbs the extrapyramidal system. There were morecases of lead poisoning in 1961 than in any other year since thewar; this was attributable to the numbers of lead-painted shipsbeing broken up in the idle yards, although the greatest numberof cases still stemmed from small factories manufacturingelectrical accumulators.

The report concedes that there is growing appreciationthroughout industry of the need for positive action torender work safe and healthy. But organised industrycould still do much more to publicise safety precautionsand to inculcate safe habits of working in young employees.Too often young people are left to pick up their ways ofwork from older men who may themselves be careless of

safety measures. Some safety-training centres have

already been set up, but the effort has yet to become.nation-wide. The Ministry of Labour has approachedseveral industries individually and has obtained their

cooperation in developing safe working conditions.Further, the factory inspectorate has been augmented by30 to a total of 480. But the heart of the problem lies inthe attitude of the men at risk: safety will only be takenseriously on the shop floor if management first showsconcern that it should be.

Conference

SYPHILIS

FROM A CORRESPONDENT

THE World Forum on Syphilis and other Trepone-matoses was held in Washington, D.C., on Sept. 4-8.

Considerable anxiety was expressed concerning the recentrise in incidence of venereal syphilis in the U.S.A. (more thanthreefold in the past three years) which was believed to be duemore than anything to a slackening of effort in earlier yearsfollowing budgetary reductions. Reduced facilities had resultedin even more cases than formerly being treated by privatepractitioners, from whom fewer contacts were generallyobtained for interview than in the case of patients treated in theclinics. Nevertheless American workers were confident that

syphilis could be eradicated from the country by intensifyingthe existing methods of contact tracing and by " cluster

testing " (testing associates of patients with syphilis not

necessarily sexually involved), and by improving the liaisonbetween the health departments and private practitioners.Extended legislation in the various States, to require the

reporting of positive serum findings by serological laboratories,was also urged. The attitude of health departments for thegreat pox, it was felt, should resemble those already adoptedtowards smallpox.

Little new was presented concerning treatment which, withpenicillin, continues to give satisfactory results in all stages ofall of the treponematoses. Treatment reactions, althoughsometimes serious, are not common enough to prejudice a

control programme based on this drug. Simplified methods ofdiagnosis of syphilis are required, and the rapid plasma reaction(R.P.R.) demonstrated at the meeting will produce a result onspecially prepared cards in a few minutes. The fluorescenttreponemal antibody (F.T.A.) test holds promise as a muchsimpler reference test than the cumbersome if specific.treponemal immobilisation (T.P.I.) test.Some overseas participants did not wholly agree with the

declared aim of " eradication ", considering that control" "was still a better word: eradication in one country withouteradication in all did not seem to be feasible.