About the working conditions
20th Sept 2018
of the Men of Steel and those who treated them
So as feedback to the museum I suggested more on health or the lack of it.
Occupational Health Services down the ages.
Especially the health service such as it was in the factories.
Steel in the eye ?
So I told them about my experience at the Birmigham Accident Hospital in the 60’s
And the Burns Unit and Outpatients rows of Dentists chairs for removing Steel
from the Steel workers eyes when they lifted the goggles to see what they were doing.
I digress but its of interest to me and for me to remember.
The medicine and the people……
Fluorescein Eye Stain Test
After the Test
What Is a Fluorescein Eye Stain Test?
A fluorescein eye stain test is usually ordered if your doctor suspects you have damage on your cornea or foreign objects in your eye. If you wear contact lenses, your doctor might do this test to see whether the contacts are damaging your cornea.
During the test, a dark orange dye called fluorescein is placed onto the outer surface of your eye. Based on the staining, your doctor can identify any problems with your cornea and diagnose certain conditions.
Why Is the Test Done?
Your doctor may recommend a fluorescein eye stain test if they suspect you have abrasions, or scratches, on your cornea.
The cornea is a clear surface that covers your outer eye. It’s made up of cells and proteins. Unlike most of your body’s other tissues, the cornea contains no blood vessels. It’s protected and nourished by lubrication such as tears.
It has two main functions: to protect your eye from harmful irritants such as dust and germs, and to direct light as it enters your eye.
The cornea is highly sensitive. If it becomes scratched or damaged, new cells quickly cover the injury to prevent infection from occurring. Deeper scratches will take longer to heal and may cause scars. A fluorescein eye stain test can help your doctor detect corneal injuries, small foreign objects or particles in the eye, and abnormal tear production. The test may also help your doctor determine if your contact lenses are irritating your corneas or causing any damage.
Where and How Is the Test Administered?
Your ophthalmologist (eye doctor) will use either a small eyedropper or piece of blotting paper to place the dye into your eye. They’ll ask you to blink several times to allow the dye to spread over the surface of the cornea. Blinking spreads the dye throughout your tear film — the wet surface of your eyeball that lubricates and protects the eye. The tear film is made up of water, oil, and mucus.
You may feel a slight stinging sensation when the dye is first applied. After a few moments, the dye will feel like normal liquid on the eye and will no longer be uncomfortable. Your eye surface may have a light yellow appearance.
Your ophthalmologist will then shine a cobalt-blue light onto your eye through a tool made for examining eyes. This tool is called a slit-lamp or ophthalmoscope. The combination of this light and the dye will highlight any abnormalities or abrasions on the cornea. From this, your ophthalmologist can determine the location of any problems and evaluate the level of damage.
Understanding the Results
If your eye is healthy and your cornea is undamaged, the dye will appear smooth across the entire surface of your eye.
Corneal abrasions or foreign particles will cause abnormal results. These may be a result of:
trauma to your eye, such as from a fingernail, make-up brush, or other object
dust, ash, or dirt that has blown into your eye
a chemical burn
rubbing your eyes too roughly
old or improperly cleaned or fitted contact lenses
any medical condition or situation where your eye is open for a long time, which can dry out the cornea
the presence of foreign bodies, such as an eyelash
In some cases, the damage could be caused by abnormal tear production, or dry eye. With this condition, you have insufficient tears to nourish and protect the eye. This can lead to inflammation of the cornea. Your test may also reveal a blocked tear duct.
What Are the Risks of the Test?
This test is risk-free. The fluorescein dye may stain for a few days if it touches the skin around your eye.
Preparing for the Test
In general, there’s nothing you need to do to prepare for this test. If you wear contact lens, you’ll be asked to take them out beforehand.
What to Expect After the Test
After the test, your doctor will use the results to diagnosis any problems you’re having with your eyes. They’ll meet with you to discuss the damage discovered on your cornea and plan any necessary treatment.
Treatment options may include:
removal of the foreign object from your eye
using prescription eye drops or ointment, usually an antibiotic to prevent an infection from developing
using over-the-counter lubrication tear drops
wearing a temporary eye patch or bandage contact lens
leaving contact lenses out until the cornea has healed
taking pain medications
If your injury has only affected the surface of your cornea, it should heal in about two to three days. If your injury has penetrated the surface of your eye, healing will take longer, depending on the cause, size, and nature of your injury.
How is scarring treated for very deep corneal abrasions?
Very large or deep corneal abrasions take a longer time to heal. Your ophthalmologist will recommend rest for the eye, protection from additional damage, and antibiotic drops. If there’s a foreign body, it will likely be removed. To reduce discomfort during this long healing period, your doctor may prescribe pain medications by mouth or eye drops. These will temporarily decrease your response to light, relieving any discomfort caused by bright lights. Depending on how the complexity of your abrasion, your doctor may use a pressure patch over your eye until you heal more.
University of Illinois-Chicago, College of Medicine
Ruscoe Clarke and the Treatment of Trauma.
By 1954, before the introduction of crash helmets, UK road injuries were increasing rapidly. Motorcyclists alone accounted for over 1000 UK deaths  compared to the 2008 road user total of just 2645. 
“Research work at the Birmingham Accident Hospital improved the treatment of injury immeasurably.” Alan Ruscoe Clarke studied haemorrhagic shock for different types of injury and showed that the lethal collapse of blood volume was caused by swellings around a fracture or burn and not by blood becoming temporarily static in the capillaries. Immediate transfusion and surgery reversed or delayed the “illness of trauma” and was essential.
In his 1957 lecture to the St. John Ambulance Brigade Surgeons’ Conference in Harrogate, Ruscoe Clarke described the old theory of shock and why it failed. Despite the success of James Blundell with blood transfusions, saline solution was the standard substitute from 1868 to 1916.
Surgeon Ernest Cowell, writing in The British Official History of the Great War described the results of saline solution at the Battle of the Somme as “most disappointing”. Canadian surgeons recommended whole blood transfusions  though volumes used were small: even the largest transfusions used were only about a litre. 
Treatment of shock from 1919 was based on observations of Cowell and Walter Bradford Cannon. However, plasma volume measurements suggested that more blood was disappearing from the circulation than could be accounted for. Since it was in neither the veins nor the arteries, it was assumed to be temporarily immobilised throughout the capillary system. Treatment was therefore aimed at encouraging blood to return to the circulation by heating the patient, rubbing the limbs and providing hot sweet tea intended to increase circulation volume.
The large transfusions made possible by the development of blood banks in the 1930s transformed many patients. In 1940, Alfred Blalock proposed that shock was caused by bleeding, a view accepted by various authorities by 1946. The war injuries study of Grant and Reeve published 1951 recommended early transfusions for large wounds and suggested existing theories were inadequate.
Ruscoe Clarke further described how observations at the Birmingham Accident Hospital on peacetime accident victims confirmed Grant and Reeve’s work and provided evidence to reject the old capillary theory. Their work showed that blood was missing from the circulation just as often in closed fractures as in open wounds, that the blood lost appeared proportional to the severity of the wound and that the swelling of the injury frequently corresponded to the volume of blood lost. Blood loss from open wounds similarly matched blood lost from circulation. Blood losses had been consistently underestimated in the past but the provision of large transfusions during the Korean War had saved people with injuries who would not otherwise have survived.
He recommended that where significant blood loss had occurred, even over an extended period of time, the patient should be transferred to expert medical care and receive an immediate transfusion. There was no place for hot tea, heat treatment or massage, which delayed proper treatment.
Dr Simon Sevitt and Pathology
In 1947, Dr Simon Sevitt set up a pathology department that covered bacteriology, haematology, biochemistry, histology, and morbid anatomy.
Though his best known work was in venous thrombosis and pulmonary embolism, fat embolism, and the healing of fractures, he was to become an “outstanding pathologist, particularly in accident surgery”.
His controversial 1959 paper on thromboembolism after fracture of the hip in old people written in conjunction with Gallagher, which found that fatal pulmonary embolism might occur 30 days or more after surgery for hip fracture triggered work by other researchers and revolutionised the profession’s attitude to preventing, diagnosing, and treating the condition.
Dr Sevitt died in September 1988.