268 had died, 68 from malignant neoplasms. For 63 employees who had left the plant (2-4%) the vital status remained unknown. The standardised mortality ratio for all causes of death was 0-87 and for all malignancies 0-97 compared with national rates. When local state rates were used the SMRs were slightly lower. Two deaths from leukaemia were observed compared with 2 35 expected (SMR = 0-85). SMRs for carcinoma of the oesophagus (2 0) and carcinoma of the stomach (1-38) were raised but not significantly. In one plant an internal "control group" was selected matched for age, sex, and date of entry into the factory and compared with the exposed group. In both groups a "healthy worker effect" was observed. The total mortality and mortality from malignant neoplasms was higher in the exposed than in the control group; the differences were not statistically significant. There were no deaths from leukaemia in the exposed group and one in the control group. The possibility of raised rates of miscarriages for women engaged in EO sterilisation in hospital has also been discussed.5Two Swedish studies have reported a raised SMR for leukaemia.67 In one of these studies an additional raised rate from stomach carcinoma was also mentioned. A further study reported one case each of myelogenous leukameia and lymphosarcoma.'In a fourth study, however, no case of leukaemia was observed.9 The question ofthe carcinogenicity of EO for man therefore still remains open; this view is confirmed by more recent reviews.'0 1These differing published observations induced the Verband der Chemischen Industrie (VCI) to start its own study of exposure to EO in its member companies. The aim was the investigation of a possible association between exposure to EO and mortality (total mortality and mortality due to leukaemia or other types of neoplasms). The investigation was carried out by means ofhistoric cohort study with the calculation of SMRs. Methods and materials STUDY DESIGNSince only relatively few employees exposed to EO could be included in an epidemiological study from each producer or processor of EO in the Federal Republic of Germany it was decided to conduct a multicentre study in eight plants of the chemical industry.* All members of the cohort formed had to The inquiry into the causes of death had to be carried out within the narrow limits given by the German data protection legislation and also was subject to the relevant laws of the penal code and those paragraphs of the medical code concerning professional secrecy.By following this procedure completeness of the information was obtained to a large extent. For the statistical evaluation the data sheets have been made anonymous. CODING OF CAUSES OF DEATH

No abstract

The article contains sections titled: 1. Introduction 1.1. History 1.2. Differentiation of Tasks 1.3. Hazards in the Chemical Industry 1.4. General Outline of Goals 1.5. Experts and their Training 2. Legal Background 2.1. Laws and Regulations in Germany 2.1.1. State Legislation and Controls 2.1.2. Trade Associations 2.1.3. Company Occupational Safety System 2.1.4. Role of the Social Partner and Associations 2.1.5. Future Developments 2.2. Legal Requirements in Other European Countries 2.3. European Legislation 2.4. Regulations in the United States 3. Industrial Hygiene 3.1. Introduction and History 3.2. Requirements for an Effective Program 3.3. Objectives and Standards 3.4. Organization and Staff Management 3.5. Anticipation of Health Hazards 3.6. Occupational Exposure Assessment 3.6.1. Introduction 3.6.2. Characterization and Identification 3.6.3. Preliminary Evaluation and Prioritization (Qualitative Assessment) 3.6.4. Occupational Exposure Limits 3.6.5. Quantitative Assessment‐Occupational Hygiene Monitoring 3.6.6. Monitoring Planning and Strategy Definition 3.6.7. Sampling and Analysis; Data Quality Assurance 3.6.8. Sampling and Analysis Execution 3.6.9. Data Interpretation and Reporting; Record Keeping 3.7. Exposure Control Methods 3.7.1. General Concepts 3.7.2. Personal Protective Equipment 3.8. Physical Agents 3.9. Communication and Training 3.10. Industrial Hygiene in the United States 4. Occupational Medicine 4.1. Health Surveillance 4.1.1. Monitoring 4.1.2. Periodical Medical Examination 4.1.3. Evaluation and Interpretation of Data 4.1.4. Reporting Health Surveillance Results 4.1.5. Corrective Actions 4.2. Biological Monitoring 4.2.1. Basic Considerations 4.2.2. Prerequisites 4.2.3. Biological Media 4.2.4. Biological Occupational Limits 4.2.5. Interpretation of Biological Monitoring Data 4.3. Occupational Epidemiology 4.3.1. Introduction 4.3.2. Basic Requirements‐Data Collection 4.3.2.1. Data on Exposed Individuals in the Study Group 4.3.2.2. Technical Data on the Occupational Environment 4.3.3. Descriptive and Analytical Study Types 4.3.4. Usefulness of Occupational Epidemiological Studies 4.4. Ergonomics 4.4.1. Introduction; Definitions 4.4.2. Scope of Ergonomics 4.4.3. Stress Factors 4.4.4. Assessment and Testing Criteria 4.4.5. Objectives 4.5. Evaluation of Health Risks 4.5.1. Basic Considerations 4.5.2. Difficulties in Interpretation 4.5.3. Dose/Effect/Polymorphism 4.5.4. Hazard Identification 4.5.5. Risk Estimation 4.5.6. Risk Evaluation 4.5.7. Risk Limitation 4.6. Occupational Diseases and Work‐Related Illnesses 4.6.1. Introduction; Definitions 4.6.2. Occupational Diseases 4.6.3. Prevention 4.6.4. Compensation for Occupational Diseases 4.6.5. Trends 4.6.6. Work‐Related Illnesses 4.7. First Aid 4.8. Occupational Medicine in the United States 5. Acknowledgement