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Special Articles

THE SLOUGH EXPERIMENT

A Comprehensive Industrial Health Service on Trial

THOSE not engaged in industrial medicine are apt tothink of industry as conducted in large well-litfactories, equipped with specially designed machineryand echoing to the strains of Music While You Fo.In fact, however, a good deal of industry is done withhome-made equipment in small factories, some of whichare cramped and dirty, having a random, back-kitchensort of air. - Into such unsuitable quarters a new processe 6 A o

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When a request comes from a firm for the investigationof a suspected hazard-say from fumes or dust-Dr. Nashfirst looks over the factory and examines those likelyto have been affected, sending physiological samples forexamination, or arranging radiography or blood-countsas necessary. Mr. Sherwood then visits the factory, takessamples of air at likely danger-points, and examinesexisting protective devices. All the medical and engin-eering findings are combined into a report which notesany damage to health and sets the quantitative resultsof air analyses against the proportion of a particularcontaminant considered dangerous by the MedicalResearch Council and by American authorities. If the

proportion of contaminant has proved to be too high forsafety, the report concludes with some clear proposalsfor improving matters-usually by arranging for betterexhaust ventilation, or other protective devices ; photo-graphs and illustrations are included if necessary. Neatlybound copies of the report are sent to the firm, and as aresult the necessary changes are usually made.The annual report of the Slough Industrial Service for

1951-52 notes that in a study made for one firm, which castsa lead-antimony alloy, no lead hazard was discovered butundesirable concentrations of antimony were present. Recom-mendations were made for preventing this. In another factorya risk from asbestos dust has been removed by local exhaustventilation, installed on the team’s advice ; the workers herewere all examined radiographically. Ten reports were made tofirms using toxic substances, and advice for improving condi-tions given to 6. An outbreak of dermatitis among packersexposed to liquid paraffin has been brought to an end ; andthe medical officer of health of a large London borough hasbeen assured that a chromium-plating factory, about whichlocal residents were complaining, is doing no harm.The work of the team, in their first three years, has

grown so fast that they are unable to cope with allthe requests reaching them. These include invitationsto examine the dust hazards for workers in the whole ofthe diamond cutting and polishing industry, and ina large grinding-wheel and abrasives factory. In factthis pioneer unit, the only one of its kind in the country,has demonstrated conclusively the need for others-

perhaps a dozen scattered up and down the United

Kingdom, like the public-health laboratories.THE ROUTINE SERVICE

The occupational hygiene team, however, is doing onlya relatively small-though highly important-part ofthe work of the service as a whole. Under the medicaldirection of Dr. A. Austin Eagger, the service providescasualty care for workers from all the member firms,industrial nursing, physiotherapy, remedial gymnastics,social services, and recuperative treatment in a residentialcentre at Farnham Park nearby.The central clinic is quartered in a solid square building,

part of the Slough Community Centre. It contains,besides a large casualty department, rooms where cleandressings are done (no-touch technique is used), a roomfor the trained social worker, a chiropodist’s surgery,administrative and record rooms, consulting-roomswhere members of the staff of the Canadian Red CrossMemorial Hospital hold outpatient sessions, and an

X-ray department shared by these hospitals, and ofcourse by the clinic. This liaison with the local hospitalsand their consultants has been of the greatest value. Itmeans that a difficult or serious case can-with theconsent of the general practitioner-be seen on the spotby an appropriate specialist, and if necessary the patientcan be admitted to one of his hospital beds. Continuity oftreatment is thus the rule rather than the exception, andthis appeals to the patient as much as the doctor. More-over the arrangement is doing much to win the confidenceof local general practitioners who at the outset weresomewhat suspicious of the service. Most of them arenow on good terms with Dr. Eagger and his staff, andrefer cases to the centre on their own initiative, well

aware that in this way they can count on getting aconsultant’s opinion at once when necessary. Twoorthopaedic clinics are held weekly, and the consultantorthopaedic surgeon of the area is also a paid member ofthe clinic staff. The X-ray department examines some14 cases a day-mostly bone injuries, but also some casesof suspected tuberculosis or other chest conditions.

MINOR INJURIES

The clinic staff deal with about 3 serious accidents amonth, most of which require hospital care ; but theirmajor concern is with minor accidents, of which some500 daily come their way. Such things as foreign bodiesor splashes in the eye, and damaged fingers or handsrespond quickly to effective treatment at the outset.

Neglected, they may mean great discomfort as well asloss of time. The finger which has gone septic can keepa man anchored to the hospital casualty department formany hours a day. At Slough he can be treated first atthe centre, and afterwards by the team of the mobiledressing-station which travels round the member firmsevery morning for this very purpose. The patient leaveshis job when the van arrives, and may be back at workin ten minutes. The mobile dressing-station is staffed

by a State-registered nurse, who does the dressings, anda doctor who pays routine visits, in the afternoons, toexamine personnel at the various factories. There isalso an accident van with an emergency team of doctorand nurse, which goes to_the scene of an accident as soonas a call comes in to the centre. Seriously injured patientsare brought in by ambulance ; and thanks to the closeliaison between the ntre and the Emergency BedService it is always possible to get a bed for anyonewho needs it.

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The records of -minor accidents kept at the centre areof a time-saving pattern, but very full and informative.

- An average of 50 eye injuries-mostly due to foreignbodies or splashes-are seen weekly. More than once ithas been possible to point out to a firm that they aregetting a high incidence of accidents of a certain type,and that these are preventable ; with the result that thefirms have asked the occupational hygiene team foradvice on ways of preventing them.Each firm, of course, has its own first-aid team, manned

by volunteers. At one time volunteers were hard to find,because time spent in learning first-aid reduced the bonusfor the group in which the volunteer worked. The firmswere asked to adjust this difficulty, and did so ; and asa result volunteers have come forward to take the courseof training organised by the service. The standard offirst-aid has risen rapidly, and now these lay helpers areable to deal with 60% of minor casualties. These variousarrangements, it is estimated, save 2000 man-hours amonth.

ANCILLARY SERVICES

It often happens that a patient recovering from aninjury, or suffering from a rheumatic or other affectionof the joints or muscles, needs remedial exercises or

physiotherapy ; but to get this at hospital he may haveto spend hours away from work. The physiotherapydepartment of the centre is housed in an adjoiningbuilding, and is very active. Patients come by appoint-ment, and are away from their work only for as long astheir treatment requires. The community centre swim-ming-bath can be used by those who need to do water-borne exercises. The chiropodist employed by the centreholds two sessions a week.

RECUPERATION AT FARNHAM PARK

A well-run and very agreeable course of reablement isoffered at Farnham Park to those patients who need it.They go either as residents or outpatients to this finehouse with wide gardens, where they work hard at

recovery every day until 4.30 P.M. They may be senteither to the workshops, where there are plenty of ingeni-

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ous devices to keep particular muscle-groups exercised,or to the warm plunge-bath, where physiotherapistsexhort and persuade the gaily clad bathers to achieve thenext stage of activity, or to the gymnasium, where theinstructor notes with pride the gain in power of limbsimpaired by poliomyelitis or other disorder. From 4.30to 9.30 P.M. the patients are off duty. They can havetea in the handsome lounge, rest and read in the quietroom, chat or play games in the common-room, walkin the grounds, go out and visit friends, or join in theprogramme arranged by their own entertainments com-mittee. On three evenings a week the education andrecreation department provides programmes of docu-

mentary and instructional films, or arranges discussions,games, or plays by local amateur dramatic societiesor by the patients themselves. All the patients havephysical disabilities. Treatment for industrial patientswith neuroses is, of course, available at Roffey Park,near Horsham. The average stay at Farnham Park isfour weeks-the longest ten weeks. The food is verygood, and so is the morale of the patients ; perhaps thetwo are linked.The Slough Industrial Health Service is thus a compre-

hensive scheme for the welfare of workers in industry,and has already shown its member firms a good returnin the saving of working-time. The workers themselvesat first regarded it with the customary scepticism ofthe British working man, who is always wary of institu-tions outspokenly designed to do him good. Gradually,however, they have come to recognise the value of theservice, and now make full use of it.

1. Lancet, May 16, 1953, p. 988.

SCURVYThe Edinburgh Meeting

As already recorded in these pages, the Royal Collegeof Physicians of Edinburgh and the Nutrition Societycombined during the weekend of May 22 to celebrate inEdinburgh the bicentenary of the publication of Lind’sTreatise of the Scurvy.’The proceedings opened with a " special graduation

ceremonial " at which the Vice-Chancellor (Sir EdwardAppleton, F.R.S.) conferred the honorary degree of doctorof laws upon Surgeon Vice-Admiral Sir SHELDON DUDLEY,F.R.s. In a fighting speech Sir Sheldon said that themedical officer in the Royal Navy must educate hisexecutive superior in practical hygiene, and that theimportance of this subject was so great that there shouldbe a health officer on the Board of Admiralty. Therewas, he declared, no such entity as subclinical scurvy,and he believed that less than 15 mg. daily of ascorbicacid was a maintenance dose although during the wardietitians had tried to persuade him that the figure was300 mg. At the conclusion of the ceremony a bronzeplaque commemorating Lind was unveiled, the gift of theSunkist Growers of Citrus Fruit in California andArizona. Later in the day another formal speech wasmade-this time by Prof. V. P. SYDENSTRICKER (Augusta,Georgia), who gave the Sydney Watson Smith lecture inthe Royal College of Physicians on the Impact of VitaminResearch on the Practice of Medicine.

* * *

The scientific meetings of the Nutrition Society wereopened by Sir EDWARD MELLANBY, F.R.S., who statedthat Lind was the first to introduce the experimentalmethod into medicine. He cruised in safer waters whenhe came to contemporary history and reminded us ofthe service Sir Sheldon Dudley had performed in estab-lishing the Royal Naval Personnel Research Committee,and of the careful researches on nutrition of DameHarriette Chick over many years ; he and she were theonly two surviving members of the original AccessoryFood Factors Committee set up jointly in 1917 by theMedical Research Committee and the Lister Institute.

Dame HABBiETTE CHICK then reviewed the early investi-gations of scurvy and incidentally differed from SirSheldon in affirming the existence of the prescorbuticstate. Later in the symposium a paper on authors onscurvy before Lind was read on behalf of Mr. A. J. LORENZ.Perhaps the most important contribution of the

session was given by Mr. C. G. KING, PH.D. (NutritionFoundation, New York City), who by labelling com-pounds with 14C has indicated how L-ascorbic acid isformed in the body of the rat from D-glucose, D-glucu-ronic acid being an intermediate. He has also made theinteresting observation that with deficiency of ascorbicacid there is an increased formation of cholesterol fromacetate ; but, although he is a champion of high humanallowances of ascorbic acid, he was careful not to claimthat ingestion of the vitamin would decrease athero-sclerosis.

This relation to cholesterol metabolism is possiblyrelated to one of the most interesting aspects of ascorbicacid, its connection with the adrenal cortex. Ascorbicacid may form as much as 4 % of the dry weight of theadrenal cortex, and the vitamin was of course initiallyisolated from adrenals by Szent-Gy6rgyi in 1927. Sayers 2and his colleagues have shown that adrenal ascorbate isreduced by corticotrophin (A.C.T.H.) or by variousstresses. It is possible that an oxidation product ofascorbic acid is required for the synthesis of adrenalcortical hormone from cholesterol, and it may be thatcorticotrophin promotes the oxidation of ascorbic acid ;Cornforth and Long have suggested that cortisonepromotes the peripheral oxidation of ascorbic acid.

Prof. R. M. KARK (Chicago) reviewed the relationof ascorbic acid to scurvy, corticotrophin, and surgery ;.he claimed that there was no evidence that cold or adrenalcortical activity increases the human requirement ofascorbic acid, and he did not believe that ascorbic acidor a derivative of it is used in synthesising adrenal

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hormones.The Lind tradition of experimental work on man was

upheld by papers from Dr. J. H. CRANDON (Boston)and Prof. H. A. KREBS, F.R.S. Dr. Crandon describedthe now classical experiment 4 in which he subsistedfor six months on a diet containing no vitamin C ;subsequently he has investigated the relation ofascorbic acid to surgery. Professor Krebs describedthe similar experiment later conducted in Sheffield onconscientious objectors.5 In the latter experiment a

supplement of 10 mg. of ascorbic acid daily was found tocure clinical scurvy in all six volunteers and protectedthree volunteers from scurvy for 424 days ; this figureof 10 mg. was somewhat arbitrarily trebled to arrive at afigure which would satisfy " ill-defined additional needsand to allow a margin of safety." Even this figure of30 mg. is of course very much lower than that requiredfor saturation : in a delightful paper Prof. GOUNELLE,of Paris, informed the meeting that he had found thattuberculous prisoners-of-war did not become saturateduntil they were given 300 mg. daily. The questionwhether saturation is desirable or necessary was taken

up by Dr. King in the discussion at the end of the sessionswhen he defended the daily allowance of 75 mg. ofascorbic acid recommended by the National ResearchCouncil. Mr. L. J. HARRIS, sc.D., had suggested that thequestion of requirement was one that needed discussion,and, after pronouncing himself in favour of saturation,he called on Dr. King. Dr. KING said that 75 mg. gave onlyhalf-saturation ; the guineapig allowed to choose its dietkept itself saturated, and animals that synthesised theirown ascorbic acid were saturated ; it could be shownthat guineapigs survived diphtheria toxin better on highlevels (5-10 mg. daily) than on lower levels (2-5 mg.),even though these lower levels completely protected2. Sayers, G. Physiol. Rev. 1950, 30, 241.3. Cornforth, J. W., Long, D. A. Lancet, Jan. 24, 1953, p. 160.4. Crandon, J. H., Lund, C. C., Dill, D. B. New Engl. J. Med.

1940, 223, 353.5. Lancet, 1948, i, 853.