accommodating junior staff

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tions of exemption are set out, and the manufacture oruse of these substances for medical and other research isnot precluded, provided that a number of safety require-ments are met. Similar prohibitions apply to other sub-stances which contain as an impurity more than 1% ofany or all of these substances. These measures are whollywelcome; but it may be found in the future that thetolerance level has been set too high at 1%.The manufacture and use of certain other substances

(fx-naphthylamine, o-tolidine [often used as a test foroccult blood], o-dianisidine, dichlorbenzidine, and theirsalts) is to be rigidly controlled, as is the manufacture (butnot the use) of auramine and magenta. Among the con-trols proposed is a statutory requirement for employersto ensure that men employed in the manufacture or use ofthese substances undergo urine examination by exfoliativecytological techniques. This requirement affects onlypersons employed under conditions to which the FactoriesAct of 1961 20 is applicable, and so it will not apply tolaboratory workers or employees of municipal authorities.Furthermore, the wording does not make it plain whetherthe Regulations are intended to apply only to the manu-facture or use of the named chemical compounds them-selves, or to include substances which may contain themas additives or impurities. A spokesman for the Ministryof Labour was unable to resolve this ambiguity, but it isessential to elucidate it; for if this regulation covers onlythe chemical compounds themselves, then it does not

cover the use of certain dangerous rubber chemicals orthe possibly dangerous rodenticide ’AnTu’ (containingresidual a-naphthylamine), and these could be usedwithout any statutory control.

The wording of the section of the Regulations dealingwith the requirements to provide medical examinationincluding exfoliative cytology is also obscure. It seems to

imply that when the Regulations come into force a factorymaking or using any controlled substances must ensurethat urine screening tests are carried out on all men withpast or present contact with a controlled substance at that

factory-but the employer would be under no obligationto screen men with past exposure to any of the far more

dangerous prohibited substances. Moreover, the Regula-tions will not apply to factories that have made or usedthese substances in the past but are no longer doing so,thus exempting from any screening obligations the wholeof the rubber and cable-making industries, the subject ofmuch concern in this respect.21 22

If this somewhat limited interpretation of the require-ments for medical examination is in fact correct, it seemsat variance with the Ministry of Labour’s statement to thePress, which said, in relation to the controlled substances:"Provision is made for the medical supervision of personswho are, or have at any time been, employed in the makingor use of these substances." Such provision, extended tocover contact with the prohibited substances also, is whatwe had been expecting. Since the Regulations are still indraft form, we hope that before they become law theMinistry will revise them to conform to this expectation-if necessary in the teeth of objections about the un-desirability of retrospective legislation. Legislationwhich may give a lead to the world should be bold andimaginative.

Furthermore, the Ministries of Labour and of Health,20. The Factories Act 1961. H.M. Stationery Office, 1961.21. Wallace, D. M. Proc. R. Soc. Med. 1966, 59, 1251.22. Case, R. A. M. Ann. R. Coll. Surg. 1966, 39, 228.

which are to provide the facilities for exfoliative cytologicalscreening, should seize the opportunity to make a criticalappraisal of the results of the screening programme. Atpresent we are very much in the dark about the actualbenefits of early diagnosis of industrial tumours of theurinary tract.

ACCOMMODATING JUNIOR STAFF

CONDITIONS of work, accommodation, and pay-theseare the three main elements in the discontent of juniorhospital medical staff. Last September the Ministry ofHealth 1 urged hospital authorities to ensure, largely byrationalisation, that junior staff did not work over-longhours and that they had some time and opportunity forleisure and for study. Unfortunately administrativeaction, though it may help, cannot yield a completesolution. All grades of hospital staff are under pressure;and, even with rationalisation, more time-off for the

juniors may spell curtailment of hospital services-acurtailment that is likely to be accentuated by partialdiversion of senior staff from routine work to the expansionin formal postgraduate teaching which both the Ministryand academic bodies recognise as necessary.The deficiencies in hospital accommodation (to which

the Ministry also pointed) are underlined in a reportfrom the Scottish Hospital Centre.2 These deficiencesare not new; but they have been much magnified byan increase of over 60% in hospital staff since 1948,and by a tremendous growth in the proportion of juniorstaff who are married. Before the 1939-45 war this

proportion was negligible. The Centre’s report showsthat nowadays in Scottish hospitals some 34% of house-officers are married, and for all grades up to senior registrarthe figure is about 55%. Married accommodation is leastlikely to be found in teaching hospitals, which have theleast difficulty in recruitment; but this is not to say thatthe position in non-teaching hospitals is satisfactory. Onlytwo years ago, none of the big general hospitals in theWestern region of Scotland had any married accommoda-tion at all.The need for accommodation within the hospital would

be reduced, says the report, by a shift system, underwhich only those on duty would be required to remainovernight. " Even without a shift system it might bemore satisfactory to provide some residential accommoda-tion for both single and married medical staff away fromthe hospital and to provide an overnight stay room orduty room for emergency purposes." Furthermore, withthe emergence of intensive-care and other units in whichthe patients have a high degree of " doctor dependency ",grades of staff to be accommodated will have to bescrutinised: as these units multiply, the argumentbecomes stronger for early care being in the hands of theconsultant, and later care (when doctor dependency is

lower) in the hands of his juniors. An interesting possiblecorollary is that the consultant on call should sleep in,while his houseman might sleep out. Any such changelies in the future. Meanwhile hospital authorities clearlyshould improve both the quality and the quantity ofaccommodation for junior staff; but they are ill placed todischarge this duty without additional funds, which so farare not forthcoming.1. Junior Hospital Medical Staff. Circular dated Sept. 2, 1966.2. Scottish Hospital Centre. Residential Accommodation for Hospital

Medical Staff. December, 1966.