Health group

First health group includes healthy children and adolescents

with harmonious development and development level of
organism functional systems corresponding to the age. Less
than 3 time per year acute diseases
Second health group includes healthy children and
adolescents who have functional and some morphological
deviations, low resistance to acute and chroonic diseases,
they are ill frequently during long period of time. More than 4
time per year acute diseases
Third health group includes children and adolescents
suffering from chronic diseases in compensation stage, with
normal fucntional resources of organism.
Fourth health group includes children and adolescents
suffering from chronic diseases in subcompensation stage
with lowered funcional resources of organism.
Fifth health group includes children and adolescents
suffering from chronic diseases in decompensation stage
with significantelly lowered funcional resources of organism.
 A 9 y.o. girl has an average height and harmonic growth
development. She was ill with acute respiratory infection for
five times. Define the group of her health.
A. 2nd group
B. 1st group
C. 3rd group
D. 4th group
E. 5th group
ANSWER: A

A 9 y.o. child with diagnosis "chronic tonsillitis"stands

dispanserization control. Within 1 year of observation there was
one exacerbation of disease. Physical condition is satisfactory.
The general state is not infringed. Define group of health:
A. III (a)
B. II-d
C. I-st
D. III (b)
E. III (c)
ANSWER: A
• While asessing the health status of graduates of a secondary school, the
doctor found one of them to have grade 3 tonsillar hypertrophy, chronic
rhinitis and vegetative-vascular dystonia. The organism functionality is
reduced. This student belongs to the following health group:
A. III
B. II
C. I
D. IV
E. V
• ANSWER: A
• A 12-year-old girls has minor functi-onal and morphological abnormalities:
1,0 D myopia, reduced body resistance. The patient has no history of
chronic diseases. Over the last year, there were 4 cases of respiratory
diseases. The girl belongs to the following health group:
• II
• I
• III
• IV
• V
• ANSWER: A
 Method of sigmal deviations
• Deviations from –1s to +1s mean average development of this
index,
• from –1.1s to –2 s – development is below average,
• from –2.1s to - 3 s and below – low,
• from +1.1s to +2s – above average,
• from +2.1s and high – high.
Assessment of physical development using
regression scales
• harmonic, if determined individual indices of body weight and
chest girth circumference have values М±1s ;R

• disharmonic, if determined individual indices of body weight and

chest girth have values from М1.1s to М2s or from М+1.1s to
R R R

М+2s due to increased fat deposity;

R

• sharply disharmonic, if determined individual indices of body

weight and chest girth have values from М2.1s and low or from
R

М+2.1s and high due to increased adipopexis

R
 Assessment of physical development
using complex method

• harmonic, if determined body weight and chest girth

values are М±1sRor from М±1.1sRand functional indices
have deviations from –1s and more;

• disharmonic, if determined body weight and chest girth

values are from М1.1sRto М2sRor from М+1.1sR to М+2sR
due to body weight deficiency or increased adipopexis
and functional indices are from –1.1 to –2;

• sharply disharmonic, if determined body weight and

chest girth values are from М2.1sRand low or from
М+2.1sRand more due to body weight deficiency or
increased fat deposity and functional indices are from
–2.1 and lower.
• A boy, aged 9, is examined: height- cm (-0,36), weight - 28,2
kg (+0,96), chest circumference- 64,9 cm (+0,66), lung vital
capacity - 1520 ml (-0,16).
• What is the integrated assessment of the child’s physical
development?
• What is the complex assessment of the child’s physical
development?
A. Harmonious
B. Disharmonious
C. Markedly disharmonious
D. Excessive
E. Below the average
ANSWER: A
• A 10 y.o. child has average indices of body
length and her chest circumference
exceeds average indices, body weight
index is heightened due to lipopexia.
Functional characteristics of physical
development are below average. Physical
development of this child can be
estimated as:
A. Disharmonic
B. Average
C. Below average
D. Harmonic
E. Deeply disharmonic
• ANSWER: A
• Examination of a 13-year-old boy reveals that his
body length is 147 сm (+2), body weight - 38 kg
(+1,5), circumference of chest - 72 cm (+0,2).
Estimate the harmonicity of the child’s physical
development:
A. Disharmonious
B. Harmonious
C. Above the average
D. Sharply disharmonious
E. Supernormal
• ANSWER: A
• During the medical examination at school the
schoolchildren had to undergo plantography.
After the analysis of footprints platypodia was
found in 30% of pupils. What is the percentage
of the flatfoot isthmus?
A. 65%
B. 30%
C. 50%
D. 55%
E. 45%
• ANSWER: A
 Hospital
• The major repair of a hospital included
renewal of colour design of hospital
premises because it is of great psychological
and aesthetical importance; and so the walls
of patient wards will be painted under
consideration of:
A. Windows orientation
B. Hospital profile
C. Diseases of patients who will be staying in
these wards
D. Wall reflection coefficient
E. Creation of cozy atmosphere
ANSWER: A
Patient with thyrotoxicosis is in the 2-beds hospital ward of
therapeutic department. The area of the ward is 18 m 2 ,
height 3 m, ventilation rate 2,5/hr. Air temperature - 200 ,
relative humidity 45%, air movement velocity 0,3 m/s, light
c o e f fic i e nt 1/ 5, no i se l e v e l 30 d B . M a ke hygi e ni c
evaluation of the conditions.
A. Discomfortable microclimate
B. Non-effective ventilation
C. Poor lighting
D. High level of noise
E. All conditions are OK
ANSWER: A
• The total area of a ward at the therapeutical department is 28 m2
. What is the maximum
number of beds that can be exploited in this ward?
A. 4
B. 1
C. 2
D. 3
E. 5
ANSWER: A
• A city somatic hospital with 300 beds consists of the main building whi-ch houses the
therapeutic and surgical departments. Several separate buildings house the maternity,
pediatric and radi-ologic departments that are connected to the main building by
underground walkways and above-ground covered skybridges. Specify the building system
of the hospital:
A. Central-unit
B. Centralized
C. Decentralized
D. Free
E. Combined
• ANSWER: A
•
• Sanitary examination of the burns unit for adults revealed that 4-bed wards had an area of
28 m2. What is the minimally required ward area for this department?
• A. 40 m2
• B. 24 m2
• C. 28 m2
• D. 30 m2
• E. 52 m2
• ANSWER: A
• During hygienic examination of a hospital it was established that the area for
each bed in a double ward was: in the infectious department for children - 7 ,
2

in the infectious department for adults - 8 , in the burns department - 9 , in

2 2

the radiological department - 10 , in the critical care department - 13 . In

2 2

which wards the area for each bed doesn’t correspond with hygienic
requirements?
A. In burns wards
B. In infectious wards for children
C. In infectious wards for adults
D. In radiological wards
E. In critical care wards
• ANSWER: A
• It is planned to make complete isolation boxes in the infectious
department in order to prevent nosocomial airborne infections. The boxes
consist of a tambour, a ward and a lock chamber. What structure should
be also included in a complete isolation box?
• A. Bathroom unit
• B. Manipulation room
• C. Doctor’s consulting room
• D. Patient’s examination room
• E. Nursing room
• ANSWER: A
• A plot of land with total area of 2,0 hectare was intended for building
of a hospital. The maximal capacity of the hospital will be:
A. 100 beds
B. 200 beds
C. 400 beds
D. 800 beds
E. Over 1000 beds
• ANSWER: A

Bacterial analysis of air in a living space in winter period by means of

Krotov’s apparatus revealed that total number of microorganisms in 1m3 of
air was 7200. What is the allowed number of microorganisms for the air to
be characterized as "pure"?
A. Up to 4500
B. Up to 2500
C. Up to 3500
D. Up to 5500
E. Up to 7500
ANSWER: A
 The site land area depends on the power, specialization
and system of the hospital group of buildings site
development

Number of Area norm Number of Area norm per

beds per 1 bed, m2 beds 1 bed, m2

up to 50 300 > 400 to 800 100-80

> 50 to 100 300-200 > 800 to 1 80-60

000
> 100 to 200 200-140 > 1 000 60

>200 to 400 140-100

The hospital site housing density depending on the
amount of beds should not exceed 10 – 15 %. Up to 60 –
65 % of the area should be occupied by all kinds of green
area; 20 – 25 % - a household zone, passages and
passageways. The size of the landscape zone should be
not less than 25 m2 per one bed.
 Isolator consist of ward, lock, tambours and
restroom. Square of box is 22 m2.
 HYGIENIC REQU IREM ENTS C ONC ERNING HOS PITA L
DEPARTMENTS

Each hospital depar tment is intended for patients with similar

diseases. It should include: ward sections for 25–30 beds, with 6–8
wards for 2–4 beds with the area of 7 m2 per bed, not less than 2 wards
for 1 bed with the area of 9-12 m2 for severe somatic and infectious
patients, with the cubic capacity of 20-25 m3 for each patient and the
ventilation volume – 40-45 m3/hour. Except the wards in the ward,
sector there should be a room for patients’ day-time stay (area of 25 m2),
and medical accessory premises: the doctor’s room (8-9 m2), the
procedure and manipulation room (12-15 m2), the medical nurse’s
station (4 m2), and in the surgical departments sections – dressing
rooms (pure and purulent). Besides, there should be a bar with a canteen
(for two ward sections with the area of 18 m2), a room for clean and dirty
linen (each of 4 m2), a lavatory with a bathroom (10 m2), a lavatory for
patients and for personnel, a sanitary room (6-8 m2), and a corridor.
HYGIENIC REQUIREMENTS CONCERNING HOSPITAL DEPARTMENTS

The optimal ward windows orientation in the Northern

hemisphere is the South-East or South. But there should be 1-2
wards with the orientation towards the Northern points for
severely ill patients or patients with fever. Beds should be
located parallelly to the light conductive wall for a patient to be
able to turn back from the dazzling effect of the direct solar
radiation. The natural lighting indices (near the internal wall)
should be the following: the daylight factor 0,7-1,5 %, the lighting
coef ficient 1:5-1:6, the angle of incidence not less than 27°, the
angle of aperture not less than 5°, the coef fic ient of depth less
than than 2. The artif ic ial lighting should be general, 30-60 lux,
and the night light – 10-15 lux with lamps in the lower part of the
walls
The wards ventilation should be achieved by
means of exhaust ventilation ducts, presence of
window leaves and windows which can be
opened; the modern hospitals should be
equipped with air-conditioners.
The optimal air temperature in the wards in winter and during the
transitional period should range from 19 to 22°C, the relative
humidity should be 40-60 %, the air movement speed within the
limits of 0.05-0.1 m/sec.
In the nursery, post-operative wards, burns units and in case of fever
of the infectious patients the air temperature should be a bit higher
– 22 – 25°C, and for patients with thyrotoxicosis – lower – 18 – 22°C.
CO2 concentration in the hospital is of 0.07 – 0.1 %.
Indices of hospital air pollution, such as air oxygenation (20 – 24 mg
O2/m3) and the microbial figure (500 – 1 000 per m3 in the
operating room, up to 3 500 per m3 in the wards), also have been
calculated and scientifically substantiated.
 Occupation hygiene
• During the medical examination a port crane
operator complained of dizziness, nausea, sense of
pressure against tympanic membranes, tremor,
dyspnoea, cough. He works aloft, the work is
connected with emotional stress. Workers are
affected by vibration (general and local), noise,
ultrasound, microclimate that warms in summer
and cools in winter. What factor are the worker’s
complaints connected with?
A. Infrasound
B. Noise
C. Vibration
D. Intensity of work
E. Altitude work
• ANSWER: A
• An aircraft factory processes materials with
use of lasers. It is determined that the
device radiates in the light spectrum and
that levels of laser radiation at the
workplaces exceed the alarm level. Specify,
what organs will be affected in the first
place?
A. Eyes
B. Skin
C. Liver
D. Spleen
E. Kidneys
• ANSWER: A
• A 56 y.o. patient has worked at the aluminium plant over 20 years.
Within 3 last years he has got loosening of teeth, bone and joint pains,
piercing pains in heart region, vomiting. The provisional diagnosis is:
A. Fluorine intoxication
B. Mercury intoxication
C. Lead intoxication
D. Phosphorus intoxication
E. Manganese intoxication
• ANSWER: A

• A patient complained about problems with pain and tactile sensitivity,

pain in the nail bones at the end of the working day. He works at a
plant with mechanical devices. What pathology can be suspected?
• Vibration disease
• Caisson disease
• Noise disease
• Overwork symptoms
• Hypovitaminosis of B1
• ANSWER: A
 Forms of pneumoconioses are:

— Anthracosis - Coal dust

— Silicosis - Silica
— Asbestosis - Asbestos
— Siderosis – Iron
— Bagassosis - Cane fibre
-- Byssinosis - Cotton dust
— Tobacossis - Tobacco
— Farmer's lung - Hay or grain dust
• A 44-year-old man has been working in coke industry for 16 years.
Dust concentration at his workplace is 5-10 times higher than
maximum permissible concentration. Roentgenography of lungs
revealed changes that are typical for pneumoconiosis. What is the
most probable type of pneumoconiosis in this case?
A. Anthracosis
B. Anthracosilicosis
C. Silicatosis
D. Asbestosis
E. Siderosis
• ANSWER: A
• A survey radiograph of a miner (24 years of service record, the
dust concentration in the workplace is at the rate of 260-280
mg/m3with 15% of free silica) shows lung changes that are typcal
for pneumoconiosis. What type of pneumoconiosis is it?
A. Anthracosilicosis
B. Carboconiosis
C. Silicatosis
D. Anthracosilicatosis
E. Silicosis
• ANSWER: A
• During coke production, the concentration of
dust the air of the working area has been for
many years exceeding the maximum
permissible concentration by 4-8 times. What
disease is mostly likely to develop among the
workers in this industry as a result?
A. Anthracosis
B. Byssinosis
C. Asbestosis
D. Silicosis
E. Siderosis
ANSWER: A
• Survey radiograph of a 52-year-old worker of an agglomeration plant
(28 years of experience, the concentration of metal dust is 22-37
mg/m ) shows mildly pronounced interstitial fibrosis with di-ffused
3

contrast well-defined small nodular shadows. The patient has no

complaints. Pulmonary function is not compromised. What is the
provisional diagnosis?
A. Siderosis
B. Silicosis
C. Anthraco-silicatosis
D. Silicatosis
E. Anthracosis
• ANSWER: A
• The process of opencut mining requires drilling and blasting
operations, rock and ore excavation, transportation of ore to
fragmentation and sorting factories and transportation of barren rock
to slag-heaps, road building and maintenance, repair works. What
factor of production is most important for miner’s health?
A. High content of dust in the air
B. High content of explosion gas
C. Vibration
D. Noise
E. Adverse microclimate
• ANSWER: A
 During coal extraction in a mine the concentration of coal dust in the
working area is 450 mg/m (MPC is 10 mg/m ). What occupational
3 3

respiratory disease may develop in miners?

A. Anthracosis
B. Allergic nasopharyngitis
C. Byssinosis
D. Siderosis
E. Talcosis
• ANSWER: A
• 6 people live in a modern flat with the total area of 60 m2. There
are TV-video equipment, radios, microwave ovens, computer. The
residents of the flat complain of bad health, occasional
headaches, arrhythmia, conjunctivitis. What is the most likely
cause of this condition?
A. Electromagnetic fields
B. Anthropotoxins
C. Carbon dioxide
D. Tetrachlor plumbum
E. Formaldehyde
• ANSWER: A
• A driver had been fixing a car in a closed garage and afterwards
complained about headache, dizziness, nausea, muscle
asthenia, sleepiness. Objectively: pulse and respiratory rate
elevation, excitement, hypertension, delirium of persecution.
What is the most likely diagnosis?
• A. Intoxication with carbon oxide
• B. Intoxication with ethyl gasoline
• C. Posttraumatic encephalopathy
• D. Hypertensive crisis
• E. Asthenovegetative syndrome
• ANSWER: A
• An electro-gas welding operator working at a machine workshop
performs welding and cutting of metal, which is accompanied by
intense UV-radiation. His welding station is equipped with
effective mechanical ventilation. What occupational disease is
most likely to develop in an electro-gas welding operator?
A. Photoelectric ophthalmia
B. Heatstroke
C. Vegetative-vascular dystonia
D. Chronic overheating
E. Pneumoconiosis
• ANSWER: A
• After treating a field with pesticides a machine operator presents with great
weakness, headache, nausea, vomiting, diarrhea, visual impairment, watery eyes.
Objectively: the patient is excited, hypersalivation, hyperhidrosis, muscle fibrillation
of tongue and eyelids are oberved. Pupils are narrowed, there is tachycardia, lung
auscultation reveals moist small and medium bubbling rales. In blood: changed
level of cholinesterase activity. What is the most likely diagnosis?
A. Intoxication with organophosphorous pesticides
B. Intoxication with organochlorine pesti-cides
C. Intoxication with organomercurial pesticides
D. Intoxication with arsenic-containing pesticides
E. Intoxication with carbamic acid deri-vatives
ANSWER: A
• The air of a foundry worker’s working zone contains condensation aerosol with
dust particles sized 2 nm (90%), 2-5 nm (2%), over 5 nm(6%), below 2 nm (about
2%). Characterize the dust dispersivity:
A. Fine-dispersed
B. Median-dispersed
C. Coarsely dispersed
D. Ultrafine-dispersed
E. Mist
• ANSWER: A
• A 50-year-old locksmith has a long-term record of work under the effect of mercury
vapors with concentration exceeding MPC by 5-10 times. Clinical examination
revealed the lability of vasomotors of skin, pulse and arterial pressure; total
hyperhydrosis; asymmetric innervation of facial and lingual muscles, positive
subcortical reflexes, intention tremor. Against the background of increased emotional
excitability the patient presents with lack of self-confidence, shyness. A dentist found
him to have parodontosis, chronic stomatitis. What disease can be suspected?
• A. Chronic mercury intoxication
• B. Residual effects of neuroinfection
• C. Parkinson’s syndrome
• D. Acute mercury intoxication
• E. Vascular encephalopathy
• ANSWER: A
•
• Among the inhabitants of a workmen’s settlement located near an industrial plant the
cases of nervous and endocrine system diseases as well as renal diseases became
more frequent. Blood analyses revealed a decrease in sulfhydryl groups. These
pathologies might have been caused by the following substance released into the
environment:
A. Mercury
B. Cadmium
C. Boron
D. Chromium
E. Lead
• ANSWER: A
• A worker at a workshop that produces car batteries
came to a doctor with complaints of nausea, loss of
appetite, sharp pain in the abdominal cavity, and
constipations. Examination reveals elevated blood
pressure, bradycardia, an enlarged liver, pain in the
right subcostal region, a prayish-blue strip on the
gums, and gray skin, Complete blood count indicates
t he p re se nc e o f e r yt hro c yt e s w it h b aso p hilic
st ippling and reduced hemoglobin levels.
Amonolevulinic acid and coproporphyrin can be
detected in the patient’s urine. What is the most likely
provisional diagnosis in this case?
A. Aluminum poisoning
B. Cadmium poisoning
C. Lead poisoning
D. Mercury poisoning
E. Food poisoning
• ANSWER: C
• Among the population living near a pesticide
production factory, the number of congenital
malformations that manifest as central paralysis,
idiocy, and blindness of newborn is dynamically
increasing. Compounds of what chemical
substance can cause the development of these
pathologies.
A. Mercury
B. Strontium
C. Chrome
D. Iron
E. Cadmium
• ANSWER: A
LEAD POISONING
 It is one of the most common industrial
diseases. Lead is a cumulative poison.
When absorbed it is stored in the bones in
th e for m of tr i pl e ph os ph ate. Lead i s
dissolved out of bones by acidosis,
especially if food taken by the workers is
def ic ient in calcium, i.e., if it does not
contain enough milk and milk products,
eggs, green vegetables etc.
 Mode of entry of lead in organism.

1. Ingestion. By swallowing minute particles of lead

through drinking water from lead pipes, which is
converted by the hydrochloric acid of the stomach
into a soluble chloride of lead.
2. Inhalation. By inhaling dust and fumes of molten
lead.
3. By Absorption. Skin absorbs lead particularly when
it is m ixed with oil, as in paint m anufacturing
concerns.
 Occupation involved

The main industrial occupations, in

which lead poisoning is liable to occur are
mining, ref ining and smelting of lead, pottery
manufacture, electric accumulator works,
enameling and paint manufacturing
industries, smelting of metals, glass and f ile
cutting, manufacture of lead pipes, lead
rubber compounds and plumbing supplies
such as solders, gun shots manufacture,
foundries etc.
 The symptoms of lead poisoning :

• obstinate constipation and colic,

• appearance of a blue line on gums,
• anemia,
• stippling of erythrocytes,
• rheumatic pains in muscles and joints,
• paralysis especially of extensors (dropped wrist
and dropped foot are common).
There may be insomnia, headache, interstitial
nephritis, lead insanity.
 Dark deposits of lead sulphate
(known as lead lines) on the gum of a
patient suffering from lead
poisoning.
Prevention. Hands and f ingernails should be thoroughly cleaned and the
mouth rinsed before eating. Workers should not take their food in the work
rooms, particularly where there is suspicion of lead particles in the air.
Workers should use separate clothing while at work. The workshop should
always be kept clean, well ventilated and free from dust by wet cleansing of
f loors and walls. Arrangement should be made for rapid and complete
collection of all fumes and dust which should be conducted to condensing
chambers. Since inhalation of lead dust is more dangerous than swallowing
it, adequate exhaust ventilation should be compulsorily provided in all dust
processes. Sand papering, lead painted surface for obtaining a better f inish
is dangerous on account of evolution of dust. The use of water-proof sand
paper which can be used is therefore recommended for the purpose.
Handling of poisonous materials should be reduced to the minimum by
substitution of mechanical methods. Women and children being particularly
susceptible to lead poisoning should not be employed in lead factories.
Pregnant women are liable to abortion and stillbirths. Workmen should take
drinks containing minute doses of sulphuric acid and they should take
nutritious food with plenty of green leafy vegetables, eggs, milk and milk
products (owing to their high calcium content) and avoid taking alcoholic
liquors. Workers should undergo medical examination after short periods to
detect absorption and appearance of incipient symptoms of lead poisoning.
Factories should be provided with a separate cloakroom and a mess-room
h d h f l
 Maximum admitted
concentration of lead
and its inorganic compounds in
air is 0, 01 mg/m3.
Mercury Poisoning
 Mercury or its compounds are
used in the manufacture of
barometers, thermometers,
vermilion and in trades like bronzing,
guilding, in manufacture of electric
meters and lamps.
 Mode of entry of
mercury in organism:

Respiratory tract
 Mercury is acutely hazardous as a vapor and in the form of its water-
soluble salts, which corrode membranes of the body. Mercury vapor is a
more toxic form than liquid mercury because the fumes easily enter and
poison the body through inhalation. The f in e gray mercury powder, which is
easily produced when liquid mercury is agitated with substances such as
grease and chalk, is potentially more dangerous than the liquid metal
because it is less readily recognized. Short-term, limited contact with
mercury can cause acute symptoms such as bleeding gums, vomiting, and
stomach pain. Mercury poisoning is potentially fatal and can cause
irreversible brain, liver, and kidney damage. Because it is dif ficult for the
body to eliminate, mercury acts as a cumulative poison; it can eventually
accumulate in the body to dangerous levels. Chronic mercury poisoning
occurs when small amounts of the metal or its fat-soluble salts, particularly
methylmercury, are repeatedly ingested, either orally or by absorption
through the skin, over a long period of time. Ingestion can occur through
contamination of the food chain. Because organic mercury compounds
such as dimethylmercury were once widely used, signif icant quantities of
mercury have been found in whales and some species of f is h. Concern
regarding uncontrolled industrial discharge of mercury into the environment
has led to stricter environmental regulations in many countries
 Symptoms of mercury poisoning
are:
• stomatitis,
• salivation,
• foetid breath,
• sponginess of gums,
• falling out teeth,
• anemia,
• muscular tremors and paralysis
 Prevention
Workmen, while working, should wear overalls and
respirators. Carious teeth of workers should be extracted.
The f lo o r sho ul d be mad e o f asphal t and sho ul d be
designed and sloped in such a way that the spilt mercury is
collected easily and effectively. Since metallic mercury
vaporizes even at ordinary temperature and produces toxic
effects, the work should be conducted in rooms at a
temperature below 15.6°C. So far as possible mercury
should be kept covered so that the volatilization of mercury
may be minimum. Rooms, where d ust and fumes are
evolved, should be provided with exhaust ventilation. Any
v a po r s m a y be n e u t ra l i se d by spra yi n g f lo o r s w i t h
ammonium hydrate solution, if required.
Maximum admitted concentration
mercury in air of a working zone is
0,01mg/m3.
Phosphorus poisoning
 Phosphorus is used in the
manufacture of matchsticks and affects
those workers who expose themselves to
its fumes. Yellow phosphorus is more
poisonous and therefore law forbids its
use. The dangers of phosphorus
poisoning now are much more from its
organic compounds, which are used as
insecticides or rodenticides
 Mode of entry of Phosphorus in
organism:

• absorbed through the skin

• inhalation.
 Symptoms of Chronic Poisoning:
•headache,
•loss of appetite,
•anemia,
•dyspepsia,
•hepatitis,
•albuminuria,
•bronchitis
•insomnia.
•The long bones become brittle and get
liable to fracture; a condition known as
fragilitasossium
 Prevention.

Special attention should be paid to

the teeth. Mouth should be washed
frequently with an alkaline solution.
Tu r p e n t i n e i s r e c o m m e n d e d a s a n
antidote for phosphorus, so it should be
inhaled. Work should be done in well
ventilated rooms and if possible in open
air. Work rooms should be provided with
exhaust fans or f lu es to drive away all
fumes of phosphorus.
Arsenic Poisoning
 It occurs in those persons, who either
handle arsenical pigments, lead arsenate,
paris green, inhale arsenical dust from wall
papers or those who mount or cure skins of
animals. Arseniuretted and phosphuretted
hydrogen are given off from damp ferro-silicon;
an impure alloy of iron and silicon, which is
used in cer tain metal lurgical processes.
Arsenic may enter into the system from the
dust of its salts by inhalation, direct contact
and from arseniuretted hydrogen gas.
 Symptoms of Arsenic Poisoning
Painful eruptions on the mucous membranes of
air and eye passages causing conjunctivitis and
edema of eyelids, vomiting, colic with marked diarrhea,
painful neuritis and anemia. There may be severe
irritation accompanied by acne form or eczematous
eruptions on the skin. The salts of metal act as local
irritants, particularly around the mouth, nose and
armpits.
Arsenic Poisoning
Pictures of Arsenic Poisoning
These pictures show the signs of arsenic poisoning.

Chronic Arsenic Poisoning - Hands

Arsenic Poisoning - Mee's Lines

Oral Mucosa - Arsenic Poisoning

 Precautions.
Dyed wallpaper should not be used. The
use of arsenic based dyes should be
discouraged. The workroom should have
s u itable condens ing ch ambers . Workers
should not take their meals in the workrooms.
Automatic packing machinery should be used
instead of personal handling of arsenical
pigments.
 Brass Founder's Ague
(Metal fume Fever).
It is the term applied to a condition resembling
malarious ague, but usually apyrexial, which affect
persons who are exposed to the fumes from molten
brass or even brass dust. Brass founders suffer from

bronchitis, asthma, and a disease called "Brass
founder's ague" characterized by rigors, fever, and
sweating owing to inhalation of f ine metal particles
of zinc, magnesium or copper oxides.
The work room should be well ventilated and
should be provided with exhaust fans. Females
should not be allowed to work in brass works.
Protective clothing should be provided to workers.
 Chromate Poisoning.
Persons engaged in chromium plating and in the
manufacture of chromate and bichromate of potassium and
sodium suffer from chronic ulcers on knuckles or at the root of
nails. Chromate poisoning particularly affects nasal septum of
the workers suffering from it.
The preventive measures are frequent cleansing of the
premises, provision of local exhaust fans to draw off the mist,
careful dressing of abrasions, use of ointments or rubber gloves
and wearing of masks. Workers should be provided with
facilities for bath and ablution.
 Poisonous Gases and
Fumes.

1. Carbon dioxide, CO2

2. Carbon Monoxide, CO
3. Carbon Bisulphide, CS2
4. Sulphuretted Hydrogen, H2S.
5. Sulphur Dioxide Poisoning, SO2
6. Arseniuretted Hydrogen or Arsine, AsH3
7. Chlorine (Cl) and Hydrochloric Acid Gas (HCL).
8. Ammonia, NH3
9. Benzene.
10. Aniline.
 Carbon dioxide CO2

It is given off in the process of fermentation in

breweries, aerated water works, limekilns, sewers
and. certain chemical plants. It occurs in mines,
lime and brick kilns, in deep wells and cells etc.
Distressing symptoms arise, if the percentage of
carbon dioxide increases more than 7-8%.
Its symptoms are headache, chilliness, and
symptoms of dyspnoea, leading to
unconsciousness and death. Oxygen inhalation
should be resorted to as a remedial measure.
 Carbon Monoxide CO.
It is a colorless, odorless and tasteless gas
p roduc ed by the c om b ustion of c arb onac eous
materials. It causes distressing symptoms if present
to the extent of 0.1%, whereas exposure to the gas if
present in the strength of 0.4% or more may cause
death due to its combination with the hemoglobin of
the red blood cells to form a stable compound
called carboxyhaemoglobin. It is also found in "after
damp" of mines. This gas is usually found in gas
works, blast furnaces, coke ovens, cement and brick
kilns, soda water manufacture, in motor exhausts
and in manufacture of wood charcoal.

This gas is most poisonous and acts on the tissues of

the body by preventing oxygen from reaching up to
 Symptoms.
1. Headache
2.Irritability
3.Fatigue
4.Vomiting.
5 Impaired judgment
6. Unconsciousness .

Prevention
1. Proper ventilation
. 2.Fresh air pipe should open near workers. 3. Intending
r e s c u e r s s h o u l d w e a r

lifebelts with breathing apparatus.
 Carbon Bisulphide,
CS2

It is used in the manufacture of waterproofs,

as a solvent of fats, coutchouc, India-rubber,
phosphorus, sulphur and in the preparation of
cellulose for artif ic ial silks. It is very poisonous
even in minute doses as air containing one part of
g a s i n o n e m i l l i o n p a r t s o f a i r ( 1 P. P. M ) i s
considered to be toxic.
 Symptoms of Poisoning.

These include headache, giddiness, tremors,

hysteria, atrophy and fatty degeneration of
muscles and connective tissues with loss of
fat. It also causes haemolysis. In some
cases neuritis or paralysis of muscles occur.
Th ere may be man ia, or demen tia. Th e
patient becomes irritable and there may be
frequent attacks of colic accompanied by
diarrhoea or acute constipation.
 Precautions.

Workers should be examined medically

once a month. They should not take their
meals in work rooms. Carbon bisulphide
s h ou ld be kept in covered ves s els and
fumes arising from them should be removed
by exhaust fans.
 Sulphuretted Hydrogen,
H 2S .

This gas has a peculiar smell of rotten eggs

and is dangerous to health even if present in the
ratio of 0.2-0.4%. It is found in chemical works, in
c leansing of b oilers, in soap f ac tories and in
treatment of sulphuric acid to remove traces of
arsenic there from. It is sometimes also found in
sewers, privies, f ilth and manure heaps. It is called "
Stink damp" in mines, where it is produced due to
the decomposition of pyrites.
 Symptoms.

These are headache, gastric

disturbances and nausea. When inhaled
for longer periods it causes convulsions,
paralysis, coma and death. In case of
high concentrations, death is sudden
and instantaneous. For remediable
c a re s , t h e m e a s u re s a re a r t i f ic i a l
respiration and the administration of
oxygen.
 Sulphur Dioxide Poisoning, SO2.
It may occur in those workers, who are
engaged in the manufacture of sulphuric acid,
process of ore burning and bleaching of
cotton.

Symptoms. Suffocation, dyspnoea, coryza,

cough, opacity of cornea, cynosis, opacity and
convulsions.
 Arseniuretted Hydrogen or Arsine, AsH3.
This gas is found in chemical and galvansing works. Cases of
p o i s o n i n g h a v e o c c u r r e d f r o m t h e a c t i o n o f c o m

mercial acids containing arsenic on metals and also during
roasting of various metallic ores.

Symptoms. Toxic jaundice or haemolysis may occur. There

may be vomiting, haemoglobinuria, haematuria and supression
of urine.
Remedial measures are the administration of oxygen and
transfusion of blood, together with glucosaline solution and
d iuretic s. Free ventilation should be the rule, in stores
containing arseniferous materials. patients with mesothelioma
die within a year after diagnosis.
 Chlorine (Cl) and Hydrochloric Acid Gas
(HCL).
These evolve in alkali works, bleaching works, paper
mills etc.
Symptoms.
These are spasm of the glottis, cough, dyspnoea, bronchial
catarrh, respiratory distress, pneumonia and immediate
d eath d ue to pulmo nary ed ema. The prec autio nary
measures to be adopted are the maintenance of gas-tight
pl a n t , t h e w e a r i n g o f m a sk s a n d ro u t i n e m e d i c a l
inspection of workers.
 Chlorine (Cl) and Hydrochloric Acid
Gas (HCL).
These evolve in alkali works, bleaching works,
paper mills etc.
Symptoms. These are spasm of the glottis, cough,
dyspnoea, bronchial catarrh, respiratory distress,
pneumonia and immediate death due to pulmonary
edema. The precautionary measures to be adopted
are the maintenance of gas-tight plant, the wearing
of m asks and routine m ed ic al insp ec tion of
workers.
 Ammonia, NH3.
It is evolved in ammonia works, in the
s ilvering o f m irro rs , tin-pla ting, in
manufacture of ice, refrigeration plants,
etc.
Symptoms. Prolonged inhalation of
a m m o n i a c a u s es c h ro n i c bro n c h i a l
ca ta rrh, co nj unctivitis , s a liva tio n,
paroxysmal cough but rarely suffocation
and death.
 Benzene.

It is a coal tar derivative and used in

rubber works, dry-cleaning works,
manufacture of aniline, etc., and explosive
industries. The vapors of the gas may be
inhaled and substances like nitrobenzol or
trinitrol (T.N.T.) may be absorbed through the
skin. Since women are more susceptible to
the effects of benzene than men, they should
not be employed in these trades
 Symptoms.
Flushed face, nausea, vomiting, pain in
abdomen, giddiness, headache, cyanosis,
stupor, coma and death. In chronic cases,
fatty degeneration of heart, liver and kidneys
is common.
Prevention consists in provision of exhaust
ventilation and use of overalls, protective
gloves, aprons etc. Since the fumes of
benzene are heavier than air, exhaust ducts
s hould be laid below the work level,
p r e f e r a b l y n e a r t h e f lo o r. M o r e o v e r,
scrupulous personal cleanliness should be
observed.
 Aniline.
It is used in the manufacture of dyes.

Symptoms. They are due to cumulative
action of the aniline on human system.
They are eczematous ulcerations, cough,
tachycardia, nervous symptoms, insomnia,
blindness and malignant disease, drop of
bladder. The preventive measures are local
exhaust ventilation, mechanical
manipulation, periodical medical
examination and alteration of
employment. Washing facilities should be
made use of and protective clothing worn.
 For prevention of occupational
diseases,
measures-on three points are needed
• medical,
•engineering
• legislature
 Medical measures are:
a) preplacement examinations i.e., placing the right
man for the right job through job analysis and
other ergonomics techniques,
b) p e ri od i c al e x am i nati ons f or asse ssm e nts
especially for hazardous jobs,
c) medical care through employee's state insurance,
welfare and safety aspects through Factories Act
provisions, which include first aid etc.
d) notif ic ation of notif ia ble and compensable
diseases, e.g., aniline poisoning, anthrax, arsenic
and lead poisoning etc.
e) other measures like records maintenance and
health education etc.
 Engineering measures include:
(a) good designing of buildings,
(b) good house keeping, ventilation, safety and welfare
provisions as per Factories Act,
(c) mechanization of hazardous processes,
(d) substitution for hazardous processes,
(e) enclosures or wet processing for dusty processes and
(f) protective devices etc
Occupational Health in
Agriculture
 While a lot of emphasis is given on occupational health
aspe c t s i n i nd ust ri e s, o c c upat i o nal he al t h aspe c t s o f
agriculture and associated agro-industries, village, cottage and
household industries are often neglected. These aspects are to
be covered through Public Health Care (PHC) and its set up.
But within the set-ups, some orientation (at least inservice
orientation) is needed. In a nutshell the occupational health
hazards in agriculture may be stated as
(a) agric ultural ac c id e nts whic h may o c c ur in (i) farm
operations with simple and/or sophisticated tools, (ii) village
home accidents like snake, scorpion and other insects bites or
accidents owing to close maintenance of animals etc., and (iii)
village terrain accidents owing to underdeveloped roads and
rickety means of transport,
(b) he av y e xpo sure risks fo r pro ble ms asso c iate d with
environmental insanitation, zoonosis and cultural lag, poverty,
illiteracy and taboos,
(c) hazards of harsh climate and dependence on nature (e.g.
floods and draughts) and
(d) hazards of toxic chemicals e.g. (i) acute poisoning from
toxic organophosphorus compound (Parathion), nitrated and
chlorinated phenols or chlorinated hydrocarbons like dieldrin,
endrin etc., (ii) delayed or prolonged effects of alkyl-mercury
compounds used for speed dressing organophosphorus
insecticides like malathion etc. and (iii) hazards of other
pesticides, antibiotics and h6rmonal preparations used for
insects and animals.

.
GENEAL PRINCIPLES OF OCCUPATION DISEASE PREVENTION
Substitution:
Replacement of a harmful agent with a relatively safe substance.
Examples:
(a) Benzene can be substituted with toluene.
(b) Yellow phosphorus of match factories is replaced by safe sesqui-sulphide of
phosphorus.
Automation:
Isolation of certain dangerous operations in an enclosure with a view to limit the
exposure and then working the apparatus by mechanical or electrical devices to
protect the workers from noxious agents.
Suppression at the source:
The dust of silica in foundaries and of lead in storage battery plants can be prevented
from pounting the air by wetting the floors.
Artificial and natural ventilation:
Vapours, dusts, fumes and gases can be removed by exhaust pipes or the air of work
place may be diluted by improving the general population.
Personal protection:
Protective equipment such as masks, respirators, gloves, overalls goggles, shoes, head
and car protective devices should be used.
Workers participation:
Reminding the defaulters by other collegues will be helpful in reducing the case incidence.
General cleanliness: It should be applied to the workers before and after their works.
 ”Harmful substances. Classif ication and the
general requirements of safety “ in a basis of
classif ic ations should lay such criteria as
maximal admitted concentration (MAC), DL50
at introduction of substance in a stomach and
drawing on a skin, CL50 for inhalatory receipt,
fac tor of an op p or tu n i ty of a i n h al ator y
poisoning (FOIP), zone of acute and chronic
action:
 Classification of the chemical hazards

Parametr norm on a class of danger

1 2 3 4
MAC < 0.1 0.1-1.0 1.1-10 > 10
mg/m3

DL50 inh mg/kg < 15 15-150 151-5000 > 5000

DL50cut < 100 100-500 501 > 50000

mg/kg -50000

Z o n e o f < 6,0 6,1-18,0 18,1-54 > 54

a c u t e
action
 Pesticides are used not only in an agriculture and industry (for
prevention of damage and destruction of not metal materials (wooden
cross ties etc.) harmful an organism). In system of public health services a
lot of pesticides is used for struggle with malaria mosquitoes (insecticides,
in particular DDT), for struggle with synantropic organisms (insecticides
(ce-ce fly), rodenticides).
By t he che m ical nat ure all pe st icide s are div ide d on
carbohydrogenes, galogenic compounds of aliphatic, alicyclic and aromatic
carbohydrogenes, nitrose compounds, amines and salt of quadritic
ammonia alcales, spirits, phenols, simple ethers, aldegides, ketones,
chi nons; a l i pha t i c, a l i cycl i c a nd a rom a t i c ca r boni c a ci ds,
ariloxyacrilcarbonic acid and their derivative, derivative of coal acids
derivative of carbamate, thyo- and dithyocarbamate acids derivative of
carbamide and thyocarbamide; thyols, sulphides and sulfons, thyocianates
and isothyocianates; derivative by the chamois and sulfuric acid, sulfonic
acid and their derivative, derivative of hidrasine and nitrocompounds,
organic compounds of mercury, tin, silicon, lead. germanium, organic
compounds of phosphorus, compounds of arsenic, antimony, bismuth, iron,
borum, heterocyclic compounds. In separated classes it's allocated
inorganic pesticides (sulfur and its compounds, compound of copper,
galogenes, inorganic phosphorus and others (barium carbonate and
barium chloride tallium sulphate boric acid preparations nickel and cobalt
 The organic com pounds of m e rcur y (die t hylm e rcur y,
e t h yl m e r cu r y ( p r e p a r a t i on s t h e g r a n oz a n , m e r cu r a n a n d
m e rcurhe xan), e t hylm e rcurphosphat e (ce re zan- М) e t c.) are
compounds with high toxity. The cases of mass poisonings with a
grain, dressed with mercury-contained fungicides (1971-1972 ., Iraq -
about 6500 diseases and 459 fatal cases), the pollution of objects of
external environment can be accompanied by cases of illness
Minamata (poisoning with cumulated in biological objects, in
particular in a f ish, organic compounds of mercury). The symptoms
of intoxication is occured usually in 3-5 months after beginning of
work with preparations of mercury, the basic clinical displays remind
clinic of a poisoning wit h inorganic m e rcur y. As t he organic
compounds of mercury will penetrate through a hematoencephalic
barrier encephalopathy and dementic changes develop at earlier
stages of disease.

MAC for mercury-contained pesticides is 0,005 мг/м3.

MAC for chlorophos is 0,5 mg/m3.