General hygiene and medical ecology

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Ministry of Education & Science of The Russian Federation
Crimean Federal University
named after V.I.Vernadsky
Medical Academy named after S. I. Georgievsky
Department of General Hygiene and Ecology
General Hygiene and Medical Ecology
TEXTBOOK
for Students of Medical Faculties
Simferopol
2018

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Recensents:
Prorector Crimean Federal University named after V.I.Vernadsky, Head of
the Department of pathological physiology Medical Academy named after S. I.
Georgievsky, doctor medical sciences, professor A.V.Kubyshkin
Head of the Department of medical biology Medical Academy named after
S. I. Georgievsky, doctor medical sciences, professor S.A.Kutiya
Textbook is reccomended for issue by Scientific Counsil of Medical
Academy named after S. I. Georgievsky 28.12.2017, protocol N 12
Shibanov S.E. General Hygiene and Medical Ecology. TEXTBOOK for
Students of Medical Faculties. – Simferopol, 2018. - 247 p.
The manual has been elaborated by the Head of the department of general
hygiene with ecology of the Crimean state medical university professor
S.E.Shibanov according to the State Federal Educational Standart and program
on general hygiene and ecology for the students of medical faculties and
elucidates the basic questions of the discipline.
The manual is designed for the students of the 3rd course of medical
faculties and the 2nd course of stomatological faculty.
The authors: professor S.E. Shibanov.
CONTENT
Introduction. Goals and Objectives of Studying General Hygiene and Medical Ecology

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at medical faculties
Theme No 1. Subject and Tasks of Hygiene and Ecology
Theme No 2.Hygiene of the Environment. Hygienic Regulation of Adverse Factors in
Objects of the Environment. Influence of the Environment Quality on Health of Population
Municipal Hygienе
Theme No 3.Hygienic Requirements to Microclimate
Theme No 4.Weather and Health. Prevention of Heliometeotropic Reactions. Climate
and Problems of Acclimatization
Theme No 5.Chemical Composition of Atmospheric Air. Effect of its Components on the
Man. Protection of Atmosphere from Pollution
Theme No 6.Significance of Solar Radiation. Hygienic Requirements to Lighting
Theme No 7.Hygienic Requirements to Drinking Water Quality
Theme No 8.Hygiene of Water Supply. Methods of Improving Water Quality
Theme No 9-10.Hygienic Significance of Soil. Hygiene of Inhabited Locality.
Hygienic Requirements to Cleaning Inhabited Locality from Waste Products
Hospital Hygiene
Theme No 11-12. Hygienic Requirements Hospitals. Prevention in-hospital infections
Hygiene of Nutrition
Theme No 13.Principles of Sanitary Examination of Foodstuff. Sanitary Examination of
Milk
Theme No 14.Principles of Rational Nutrition. Prevention of Alimentary Diseases
Theme No 15.Value of Various Nutrients in Nutrition. Functions of Proteins, Fats and
Carbohydrates in the Body
Theme No 16.The Significance of Vitamins and Minerals in Nutrition
Theme No 17.Food Poisonings. Reasons, Symptomatology, Prevention
Theme No 18.Medical and Prophylactic Nutrition. Prophylactic Nutrition
Hygiene of Work
Theme No 19.Subject and Tasks of Hygiene of Work. Physiology of Work. The
Occupational Harmful Factors and Occupational Diseases. Prevention of Occupational
Pathology. The Occupational Dust Pathology and its Prevention
Theme No 20.Hygiene of Work at Effect of Physical Occupational Harmful Factors
(Noise, Vibration, Electro-Magnetic Fields)
Theme No 21.Radiation Hygiene and Ecology
Theme No 22.IndustrialToxicology.Toxicology of Agrochemicals and Hygiene of Their
Application
Hygiene of Children and Teenagers
Theme No 23.The Physical Development of Children and Teenagers as a Criterion of
Health
Theme No 24.Hygienic Requirements to Children's Preschool Institutions and Schools.
Hygienic Requirements to Training, Physical Training and Hardening of Children and
Teenagers. Hygiene of Children‘s Nutrition
Hygiene of Hot Climate
Theme No 25.Hygienic Characteristics of Hot Climate and Its Effect on a Human
Organism. Hygiene of Nutrition, Hygiene of Work, Personal Hygiene under Conditions of Hot
Climate

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Final Control on Hygiene and Ecology
1. Key questions
2. Samles of Tests
3. Situational tasks
LITERATURE
Attachment 1 Students’ Independent Work. Evaluation of adequacy of an indi-
vidual nutrition
Attachment 2 Symptoms of poisoning by Lead and Mercury
INTRODUCTION
Goals and Objectives of Studying General Hygiene and Medical Ecology at Medical
Faculties
The purpose of studying hygiene and ecology at medical faculties is the formation in a
future doctor of hygienic thinking, i.e. understanding the interrelation between health and
quality (degree of the pollution level) of the environment that is a necessary condition of
scientifically proved systems of health protection, healthy lifestyle, effective public and
individual prevention of various diseases.
While studying hygiene and medical ecology, the students should acquire the
knowledge of:
 methodology, basic laws of a hygienic science and common laws of relation of health
with factors and conditions of the environment.
 origin, characteristics and laws of influence of the basic natural and technogenic
factors of the environment and social conditions on the ecological situation and health
of the population.
 methodology of studying the influence of the environmental factors and conditions on
health of various groups of population; qualitative and quantitative parameters of
hygienic estimation of the environment condition and its influence on health of the
population.
 methodology and principles of hygienic regulation of harmful factors in the
environment, organization and contents of preventive and current sanitary
supervision over medical-preventive establishments, inhabited and other objects of
sanitary-municipal purpose, establishments of nutrition, children's and educational
establishments, enterprises of industrial and agricultural manufacture.
 bases of a healthy lifestyle, personal hygiene and balanced diet, to be able to prove
recommendations for prevention of various diseases.
In the future professional activity the hygienic knowledge and practical skills are
necessary for the doctor in the following situations:
 At differential diagnostics of diseases, administration of treatment, medical-preventive
conditions and medical-labour examination.
 In the work on professional orientation, professional training and employment of
persons with a different level of health.
 At estimation and maintenance of sanitary-hygienic and antiepidemic conditions of
medical-preventive establishments, institutions of preschool, school and professional

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training, establishments of public catering and others.
 For optimization of conditions of life, education, training, work, prevention of
intrahospital and other infections, substantiation of recommendations on personal
hygiene, balanced diet.
 At development and realization of complex programs of prevention of various
diseases.
 In the work on propaganda of medical knowledge and hygienic education of various
groups of population.
Theme No 1.
Subject and Tasks of Hygiene and Ecology
Hygiene as a Medical Science
In medicine it is possible to distinguish 2 areas: medical and preventive. They are
interrelated and supplement each other, but are separate scientific disciplines. The object of
studying clinical medicine is a sick person (patient); its aim is diagnosis and treatment of
diseases.
The preventive medicine or "hygiene" (from Greek — "bringing health") studies a
healthy person (individual health) or health of the population of a region or country (population
health) with the purpose of maintaining or improvement of health. Specialists in this area are
referred to as doctors-hygienists or sanitary inspectors (abroad — doctors of public health).
The task of studying hygiene in medical university is to inculcate hygienic thinking in a
future doctor, which means:
 to be able to connect the occurrence of disease in a separate person or certain
population of people with the influence of factors of the environmental, industrial or
household surroundings, with sanitary conditions of life
 to be able to develop the appropriate measures for prevention of negative influence
of adverse environment factors on human health.
The Concept of Hygiene
Hygiene is a medical science studying the influence of environmental factors on a
human organism and on public health in order to prove hygienic measures, sanitary rules and
measures for maintenance and improvement of a human health and prevention of diseases.
Factors Influencing the Health of Population
According to the data of the World Health Organization (WHO), the health of population
of any country of the world depends on the following factors:
 in 48-53% — on socio-economic conditions in the country or region and a lifestyle
of a person (physical training, smoking, etc.)
 in 18-20 % — on the genetic factor (spread of hereditary illnesses in population)
 in 17-20 % — on quality (degree of pollution) of the environment
 in 8-10 % — on level of development and quality of medical aid.
Thus, the improvement of quality of the environment can theoretically produce a positive
effect two times greater than that of the development of the clinical medicine. It shows the
significance of preventive medicine or hygiene for improvement of health of population.

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The Origin and Development of Hygiene
A centuries-old history of hygiene can be conditionally divided into 2 periods:
Empirical hygiene (experimental hygiene) is a gradual accumulation of hygienic
knowledge by people from the time of primitive society on the basis of own experience or
experience of the previous generations (the use and preservation of various food, water from
different water sources, arrangement of habitation in different districts, etc.). The further
development of empirical hygiene took place in the slave-owning system, to a great extent
under the influence of religious instructions of Ancient East, Babylon, Greece, Rome. In the
Middle Ages the centers of medical science shifted from Europe, suppressed by inquisition, to
the East (the works by Avicenna or Ibn-Sina).
The period of empirical hygiene had been completed by the epoch of Renaissance in
Europe (15th century), by discovery of microscope and nature of infectious diseases (16-17th
centuries).
The period of scientific-experimental hygiene is a period of studying the harmful
factors influencing the health of a person in natural and experimental conditions (on laboratory
anivals) and development of scientifically grounded preventive recommendations.
The first known scientific work on hygiene was "Reflections on Illnesses of
Handicraftsmen" by Italian doctor B. Ramazzini in which the conditions of work of 52 trades
were described (17th century). In Russia the president of Petersburg medicosurgical academy
A. Frank (18th century) issued the multivolume book "A Complete System of Medical Police".
The first department of hygiene in the territory of the Russian empire was opened in
1863 at Kiev University, in 1865 — in St. Petersburg. The prominent hygienists in Russia
before the revolution were N. A. Dobroslavin and F. F. Erisman. In the Soviet period the
outstanding scientists-hygienists were academicians A. N. Sysin, A. N. Marzeev, L. I. Medved.
In USSR such eminent scientists as academician J. I. Kundiev (director of scientific
research institute of occupational hygiene), academician E. I. Goncharuk (rector of Kiev
medical university), academician A. M. Serdyuk (director of Ukrainian scientific hygienic
centre), A.N.Sysin (director of Moscow scientific research institute of general and municipal
hygiene was worked.
Subject of Hygiene
The subject of studying hygiene is health of a person and environment in their complex
interaction.
The environment in a wide sense is everything that surrounds person and influences
him.
In hygiene the environment is considered as 4 objects, which primarily influence the
organism of a person. They are:
 Atmospheric air and air of a working zone;
 Water of reservoirs and drinking water;
 Soil;
 Foodstuffs.
Table 1
Structure of Environment and Biosphere
Environment Biosphere
1. Atmosphere air (Air in premises) 1. A troposphere — a low surface layer of
atmosphere (10-18km)
2. Water of reservoirs and drinking water 2. Hydrosphere — up to 11km
3. Soil 3. A lithosphere — up to 12 km
4. Foodstuffs
Primary Tasks of Hygiene
They include:
 Studying natural and anthropogenic factors of the environment (table 2) influencing a
human being — their sources, reasons of occurrence, ways of influence on a person,

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basic quantitative and qualitative characteristics. In hygiene all the variety of the
environment factors influencing a person are subdivided into:
 Physical factors (noise, vibration, radiation);
 Chemical factors (various chemical substances);
 Biological factors (microbes, viruses, biological agents, etc.);
 Psychogenic factors (informational — a high level of negative information can cause
illness or even death of a person);
 Social factors (level of life, conditions of rest, etc.)
Table 2
Classification of Environmental Factors
Hygienic Ecological
1. Physical (noise, vibration, EMF, radiation, etc.) 1. Abiotic (nonliving nature)
2. Chemical (various materials, steams, gases) 2. Biotic (alive nature)
3. Biological (macro- and microorganisms, bioactive
materials)
3. Anthropogenic (man-caused)
4. Psychogenic (psychophysiological)
 Studying the influence of the environment factors on the organism (in natural or
laboratory experiments).
 Scientific substantiation and elaboration of hygienic standards, rules and
recommendations to decrease or eliminate the influence of harmful factors and
strengthen the effect of positive factors.
 Implementation of hygienic recommendations in practice, check of its efficiency and
further perfection.
 A scientifically grounded prognosis of sanitary situation in certain region or country for
the nearest and remote period on the basis of multifactorial mathematical modelling.
The Basic Sections of Hygiene
The contents of hygiene as a science is determined by the list of its basic sections:
 General hygiene (propaedeutics of hygiene)
 Hygiene of nutrition
 Municipal hygiene
 Hygiene of environment
 Occupational hygiene
 Hygiene of children and teenagers
 Hygiene of medical-prophylactic establishments
 Hygiene of extreme conditions
 Military hygiene
 Hygiene of hot climate
 Radiative hygiene
 Other sections — transport, sports hygiene, etc.
Methods of Hygienic Researches
Alongside with methods used in other medical sciences — physical, biochemical,
physiological, morphological, hygiene has a number of specific methods of research:
 Epidemiological method — studying health of population according to basic quantity
indicators as an integrated criterion of quality of the environment. The basic quantity
indicators of population health are:
 Demographic — death rate, birth rate, natality, average life expectancy, etc.;
 Parameters of morbidity (common sickness rate, morbidity, etc.);
 Physical development — (weight, height) — is especially important in children and
teenagers;
 Disablement (invalidity) of population (amount of invalids in population, reasons

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(diseases) of invalidity, etc).
 Method of sanitary inspection. The very first method in hygiene is a sanitary inspection
of an object (for example, a canteen with drawing up the act of sanitary inspection).
 Method of sanitary examination — examination of civil-engineering designs of objects
from the point of view of hygienic requirements, examination of foodstuffs (comparison of
product parameters to requirements of the state standards and making the decision on
possibility of food product realization).
 Method of hygienic experiment — studying the effect of a harmful factor on the
organism of animals in laboratory experiment with modelling conditions of real influence
on a person with revealing the affected organs and systems, the threshold and
noneffective levels of effect — is the basis of hygienic regulation of harmful factors.
The State Sanitary Inspection and Its Structure
Hygiene is a scientific part of preventive medicine.
Sanitary is a practical part of hygiene; its aim is application of hygienic requirements to
practice and the control of their fulfilment.
To fulfill this task, each country has a special public service supervising the observance
of the sanitary legislation. In Russia and Ukraine such special public service was called a
sanitary-epidemiological service (SES), which is a part of Ministry of Public Health of the
country.
From 2004 in Russia was formed Federal Service for Supervision of Consumer
Rights Protection and Human Welfare (Rospotrebnadzor RF), which includes Territorial
Administrations and Centers of Hygiene and Epideviology.
Types of State Sanitary Inspection
These are the following:
Preventive sanitary inspection — it is carried out at designing, construction and
putting enterprises in operation by means of sanitary examination of projects and sanitary
inspection of enterprise under construction in conformity with hygienic requirements. To this
also hygienic normalization of harmful factors in the environment refers.
Current sanitary inspection — supervision of observance of hygienic requirements on
functioning enterprise, control over the levels of pollution of the surrounding or industrial
environment, application of economic, administrative or criminal sanctions with respect to
those who infringes the sanitary legislation.
Bases of General Ecology
Ecology is a biological science concerned with interrelationships among living
organisms, encompassing the relations of organisms to each other, to the environment, and to
energy balance within a given ecosystem. Ecology(bionomics) issubdividedintothefollowingsections:
Autoecology — a section of bionomics which studies all ecological aspects of separate
species. Autoecology studies the effect of the environmental factors on each living organism.
Thus, an investigated organism is considered outside the link with other living entities of the
given ecological system.
Synecology studies communities of various living organisms, for example, the
community of microorganisms, plants, animals and their interaction with each other, as well as
with inorganic environment.
In ecology the hygienic concept "environment" approximates to the concept of
"biosphere", but ―biosphere‖ is a wider one.
The Concept of Biosphere and Its Structure
The term "biosphere" was introduced in 1875 by the Austrian scientist E. Zyuss. The
doctrine of biosphere as a complex multicomponent planetary system was created by V. I.
Vernadsky.
Biosphere — the sphere of life on Earth — includes:
 Troposphere — a surface layer of atmosphere (its height is up to 25 km)
 Ground — lithosphere (its depth is up to 10 km)
 Hydrosphere (depth of oceans is up to 12 km).

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Ecosystem is a set of organisms interacting with each other, as well as with the
environment, in which they live.
Any ecosystem consists of two parts:
The 1st part is called biocenosis. It includes all living organisms of ecosystem.
The 2nd part is called biotope. It is a part of the earth surface with particular
physicochemical properties, on which biocenosis lives.
Types of Ecosystems
 Microecosystems — a small stream, glade.
 Mesoecosystems — a sea, wood, pond, river.
 Macroecosystems — an ocean, continent.
 Global ecosystems — biosphere as a whole.
Larger ecosystems include smaller ecosystems.
Fig. 3. Types of ecosystems
Environment is a wider concept. The environment consists of biocenosis, biotope and
also physical, chemical, biological, anthropogenic factors (forces) effecting a living organism
(Fig. 4).
Fig. 4. Structure of the environment
Fig. 2. Structure of
ecosystem

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Ecological Factors
 аbiotic (factors of lifeless nature)
 biotic (mutual relations of alive organisms, trophic chains, etc.)
 anthropogenic (connected with a human activity)
At effect on a living organism the ecological factors depending on their intensity can be:
 irritants causing adaptive reactions;
 signals testifying to the change of other factors of the environment;
 modifiers causing morphological changes;
 terminators stopping or suppressing the vital activity of organism.
The rule of limiting ecological factors. The more the value of a separate ecological
factor keeps away from the zone of optimum for the given kind, the more it suppresses the vital
activity and is called limiting.
Ecological niche is a set of ecological factors providing the normal vital activity of the
given kind of organisms.
Ecosystem is a set of in common living species of living organisms and conditions of
their existence.
Biogeocenosis is a set of homogeneous ecological factors and species of living organ-
isms in a certain territory; it consists of 2 parts:
 ecotope — a set of аbiotic factors,
 biocenosis — a complex of living organisms.
The basic parameters of ecosystem are:
 Qualitative — a species variety of ecosystem, amount of species of living organisms
 Quantitative — a number of species of a separate kind.
Every ecosystem is in a condition of mobile-stable balance — homeostasis. A gradual
change of parameters of ecosystem under the influence of any factors is a succession of eco-
system.
The Laws of Existing Ecosystems
The law of ecological optimum (Fig. 5): The vital activity of organisms, their quality and
quantity conditions of life depend on different factors of the Environment. The zone of ecologi-
cal optimum is a range of values of ecological factor, optimal for vital activity of the given spe-
cies of living organisms. Above and below the value of ecological factor in the zone of optimum
there are zones (points) of pessimum (suppression of vital activity).
The range of zone optimum for each ecological factor for the given species of organisms
is called ecological valency of species.
Ecological spectrum of species is a set of ecological valencies on different ecological
factors. By width of ecological spectrum all species are divided into eurybiontic (for example,
eurythermal), having a wide spectrum, and stenobiontic, having a narrow ecological spectrum.
The zone of ecological optimum is a zone of comfort for living organisms, when the
environment factors act favourably on animals and plants. Quantity and quality of organisms in
this zone is greatest.
The zone of pessimum (depression) is behind (lower or higher) the zone of optimum.
The environment factors act unfavourably on animals and plants. The indexes of quantity and
quality of organisms are lower in this zone.
The critical point of life is the value of environment factor. In this point life is impossi-
ble.

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Fig. 5.
The law of trophic chain. The trophic chain is a chain of transmission of substance or
energy from low-organized to high–organized organisms in ecosystems (Fig. 6).
The first level of trophic chain is the level of producents (plants).
The second level is the level of consuments of the1st order (herbivorous animals).
The third level is the level of consuments of the 2nd order (carnivorous).
Fig. 6. A trophic chain
The law of accumulation of polluting substances in trophic chains. Polluting sub-
stances can accumulate in plants, herbivorous and carnivorous. Polluting substances are
transmitted from a lower to a high level of a trophic chain (Fig. 6).
The Significance of Studying Trophic Chains for Hygiene
In these chains due to bioconcentration toxicants may accumulate up to the levels dan-
gerous to a human being. Moreover, the loss of some parts of trophic chains under anthropo-
genic influence results in disappearance of trade species of animals or fish that can worsen the
quality of nutrition of population.
Interrelation and Differences of Hygiene and Ecology
Common features of these sciences are the following: they study factors of environ-
mental effect on organisms, maintain the environment (habitat) from degradation due to pollu-
tion. Changes in ecosystem sooner or later have a negative effect on conditions of life or
health of a person.
Differences are as follows:
 Different objects of research — a person (in hygiene) or living organisms (in ecology)
 Different methods of research in these sciences in connection with different objects of
research
 Differences in principles of normalization of harmful factors (in hygiene — maintaining

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health of each person, in ecology — preservation of basic parameters of ecosystem
with possible partial destruction of organisms).
Recommendations for Practical Classes on the Theme
Key Questions:
1. History of development of hygiene and ecology. Common features and differences of hy-
giene and ecology. Tasks of medical ecology.
2. Basic tasks and sections of hygiene. Basic laws of hygiene.
3. Basic methods of hygienic researches and examples of their realization.
4. Structure of the environment and biosphere, kinds of monitoring of their pollution.
5. Classification of factors of environment in hygiene and ecology.
6. The basic concepts of ecology: ecological factors, ecosystem, biocenosis, trophic chain.
7. Parameters of health of population and factors influencing the health of population.
8. Types of state sanitary supervision, the structure of sanitary-epidemiologic service of
Ukraine, the structure of sanitary-epidemiologic station (SES).
Self-control Test
1. Identify the major factors determining health of the population.
А. Climatic features, geographical position, degree of urbanization of territory
* В. Socio-economic, genetic, ecological, medical
С. Quality of nutrition, lifestyle, conditions of habitation, occupational factors
D. Lifestyle, national features, religious factors, social system
Е. Age, sexual, individual, hereditary factors.
2. Among the majority of factors determining health of the population, the following
group is greatest influence on parameters of population health:
А. Level of development of public health services and quality of medical aid to the popula-
tion
В. Level of a hereditary pathology
С. Educational and cultural level of the population
* D. Lifestyle and socioeconomic conditions
Е. Degree of the environment pollution
3. Identify the proportion of influence of the environment quality on the health of popu-
lation:
А. 45-53 %
* В. 17-20 %
С. 8-10 %
D. 24-25 %
Е. 15-17 %
4. What components are included into the concept "environment"?
А. Air, plants, animals, water, ground
В. Abiotic and biotic factors of the environment
* С. Water, air, ground, foodstuffs
D. Plants, buildings, ground, air
Е. Water of reservoirs, air, ground
5. What components does biosphere consist of?
А. Exosphere, ionosphere, mesosphere, troposphere
* В. Lithosphere, hydrosphere, troposphere
С. Air, water, ground, ecosystems
D. Autotrophic and heterotrophic organisms
Е. Space, globe

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6. What parameters of population health are the most sensitive to pollution of the envi-
ronment?
А. Demographic
* В. Sickness rate
С. Sickness rate with temporary loss of work capacity
D. Disability
* Е. Physical development
7. What diseases refer to ecologically caused (ecopathology)?
А. Diseases which worst yield to treatment in the given district
* В. Most frequently encountered diseases in the given district
С. Diseases, for which the role of the environmental factors is proved
D. Diseases among the most sensitive groups of population (children, elderly people)
Е. Diseases considerably differing in frequency in various regions
8. What parameters are studied at application of epidemiological method of research in
hygiene?
А. Parameters of pollution levels of the environmental objects
В. Frequency and incidence of infectious diseases among the population
* С. Parameters and indexes of population health
D. Incidence of endemic diseases in the given district
Е. Parameters of ecosystems condition on the investigated territory
9. What does the method of sanitary inspection consist in?
* А. The study of object with drawing up the act of hygienic inspection
В. Sanitary inspection of object with the purpose of its closing
С. Selection of tests of the environmental objects and their comparison with standards
D. The study of object quality as to conformity to the requirements
Е. Carrying out experimental researches on animals
10. What does the method of sanitary examination consist in?
А. The study of object with drawing up the act of hygienic inspection
В. Sanitary inspection of object with the purpose of its closing
С. Selection of tests of the environmental objects and their comparison with standards
* D. The study of object quality as to conformity to the requirements
Е. Carrying out experimental researches on animals
11. Identify the classification of the environment factors in hygiene.
А. Biotic, abiotic, anthropogenic
В. Air, water, ground, foodstuff
* С. Chemical, physical, biological, informative
D. Dangerous, harmful, indifferent
Е. Of natural and anthropogenic origin
12. Identify the classification of the environment factors in ecology.
* А. Biotic, abiotic, anthropogenic
В. Air, water, ground, foodstuff
С. Chemical, physical, biological, informative
D. Dangerous, harmful, indifferent
Е. Of natural and anthropogenic origin

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Theme No 2.
Hygiene of the Environment.
Hygiene of the environment is a section of hygiene studying medical aspects of the envi-
ronment protection as a scientific basis of prevention of unfavorable influences of the environ-
ment factors on a person at individual and population levels.
The following concepts of the environment exist:
 The internal environment of the organism is the internal content, the nervous and
humoral mechanisms of regulation and maintenance of homeostasis.
 The external environment is everything that is outside the organism and acts on its
membranes and receptors. From the point of view of physiology, the internal and ex-
ternal environments are very individual and dynamic for each person.
 The environment is everything that surrounds and affects the life and development
of an organism. It is not individual but common for the population. In hygiene the ba-
sic objects of the environment are atmospheric air, water of reservoirs, ground and
foodstuffs.
Depending on degree of influence of anthropogenic factors the following conditions of
the environment are distinguished:
 unchangeable (natural) — part of the environment not subjected to anthropogenic in-
fluence (reservations, etc.)
 changed (polluted) — as a result of human‘s activity, it can render negative influence
on people‘s health.
 artificial — the environment specially created by human (a spaceship, submarine,
etc.)
The Basic Sources of the Environmental Pollution
Natural and anthropogenic sources of the environmental pollution are distinguished.
Natural sources include volcanoes, earthquakes, floods, forest fires, typhoons, and oth-
er natural cataclysms. The dimensions of the environmental pollution in this case may be sig-
nificant, cover great territories, and levels of pollution may exceed anthropogenic pollution.
Anthropogenic sources are caused by human activity: industry, atomic power stations,
transport, agriculture, municipal services, etc.
Major factors of the environmental pollution are:
 chemical (pesticides, oil products, heavy metals, etc.)
 physical (noise, ionizing radiation, electromagnetic fields)
 biological (microorganisms, biological preparations, etc.)
Concept of the Environmental Pollutant
A pollutant is any natural or anthropogenic factor, being in the environment in amounts
exceeding the limits of natural fluctuations or natural background, or exceeding the permissible
standards for the given object of the environment. Not any presence of pollutant in the envi-
ronment is pollution.
Pollution is the presence of pollutant in the environment above the maximal permissible
concentration, which may produce an unfavorable effect on a human health.
Criteria of Danger of the Environment Pollution and Types of Its Monitoring
To estimate the danger of the environmental pollution is possible by the following criteria:
 According to the degree of excess of maximum permissible concentration of pollu-
tants in the environment — analytical monitoring;
 By integrated parameter — the health state of the population — medical-hygienic
monitoring;
 By changes in ecosystems — ecological monitoring (on a regional scale), bios-
pheric monitoring (on a global scale).

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The Basic Directions of the Environment Protection from Pollution
 Administrative-legislative measures of the environment protection on the interna-
tional, national or regional scale. These are priority measures, as they create a legal
basis for all nature-protective activity. Now there is a special direction in jurisprudence
— the nature protection law.
 Hygienic actions — realization of preventive and current sanitary inspection. The
preventive sanitary inspection is examination of projects of enterprises, capable to
pollute the environment, regulation of pollutants in objects of the environment. The
current sanitary inspection is the control of pollution levels of the environment, reveal-
ing sources of pollution and acceptance of measures to decrease pollution.
 Architecture-planning measures — a proper location of pollution sources for de-
crease of influence on especially important objects (for example, zones of sanitary
protection of water sources, functional zoning in cities, sanitary-protective zones near
enterprises, etc.).
 Medico-hygienic measures — studying the parameters of population health, reveal-
ing, treatment and health improvement of persons having disturbances of health due
to the environmental pollution. These measures allow revealing the most dangerous
sources and factors of the environmental pollution and the most sensitive to pollution
parameters of population health.
 Ecological monitoring — studying the condition of ecosystems and separate spe-
cies of living organisms under the influence of the environmental pollution with the
purpose of prevention of irreversible disorders of ecosystems.
 Technological measures: transfer of enterprises into the closed cycle (without emis-
sions into the environment), change of technology for decrease of emissions into the
environment (for example, transfer of motor transport into electricity), development of
sanitary engineering (cleaning constructions for purification of emissions into atmos-
phere, for reservoir burial, construction of areas and storages of waste products, etc.)
Hygienic Regulation of Harmful Factors in the Environment
Regulation of harmful factors in the objects of environment is an important element of
preventive sanitary inspection as it establishes the criteria of the permissible content of pollu-
tants in objects of the environment.
In hygiene there are 2 approaches to regulation of factors of the environment affecting
the man:
 In respect to natural factors (parameters of microclimate, lighting, ventilation of air, re-
quirements to nutrition), regulation is substantiation of optimal levels of factor values for
maintaining and improvement of human health or providing comfortable conditions for his
life and work.
 In respect to harmful factors in the environment there are 2 concepts:
 Concept of exception — absolute prevention of entering harmful factors in the envi-
ronment, but it is unreal because it means stopping industry, transport, power sta-
tions, etc.
 Concept of restriction — when it is impossible to eliminate the presence of a harm-
ful factor in the environment, it is necessary to confine its content up to safe for the
man levels — hygienic regulations.
The Concept of Hygienic Regulation of Harmful Factors in the Environment
It is such concentration, dose or level of the harmful factor in object of the envi-
ronment which neither cause any pathological changes in the organism of man and
subsequent generations (which can be found out on a modern level of development of
science) during the whole time of contact with this factor (during life or work expe-
rience), nor worsen the sanitary conditions of life of population.
Types of Hygienic Regulation of Harmful Factors in the Environment
Each country has its own regulations of harmful factors in the environment approved by
the state; there are also the international standards coordinated by the WHO and UNEP (the
program of the United Nations Organization for the environment protection).

16
In Russia such regulations are called maximal permissible (concentrations, doses, le-
vels):
 maximal permissible concentration (MPC) — for harmful substances in water, air,
ground, foodstuffs;
 maximal permissible dose (MPD) — for radiation;
 maximal permissible level (MPL) — for noise, vibration, electromagnetic fields;
 maximal permissible level (MPL) — for pesticides in foodstuffs;
 permissible residual quantities — for pesticides in ground and foodstuffs.
Apart from these regulations approved by Ministry of Public Health, the temporary regu-
lations for new substances are primarily elaborated:
 a tentative safe level of influence — for air,
 a tentative permissible concentration — in water.
Principles of Hygienic Normalization of Harmful Factors in the Environment
 Priority of medical indications at establishing a standard. At determining the value of
a standard only the levels of its safe effect on organism are taken into account, instead of
technical and economic reasons for observance of this specification.
 Differentiation of degree of biological response of organism to action of a harmful
factor. Depending on level of a harmful factor, which influences organism, and resistibili-
ty of organism to harmful influence we can distinguish the following levels of biological
responses:
 destruction of organism,
 llness,
 prepathology (disturbances of organism‘s functions without clinical signs of disease),
 tension of adaptive-compensatory processes (functional disturbances of unknown ae-
tiology),
 accumulation of substance in organs and tissues without functional and clinical
changes.
Regulations must be established not higher than the 4th level.
 Division of objects of the environment for sanitary protection. As each object of the
environment (air, water, ground, foodstuffs) has the physical and chemical features and
different conditions of contact with a human organism, regulations are established sepa-
rately for each object of the environment.
 Principle of registering all probable adverse effects of the normalized factor on a
certain object of the environment. There are the most important parameters reflecting
the harmful action of the investigated factors on quality of a certain object of the envi-
ronment. Such parameters are called signs or criteria of a harmful action. They include:
organoleptic, common sanitary, phytoaccumulative, water-migratory, air-migratory, reflec-
tory, toxicological, etc. (see table below).
Table5
Signs of Harmful Action at Regulation of Harmful Factors in Objects
of the Environment
Sign of harmful effect Type of unfavorable effect
Organoleptic change of odour, taste, colouring, etc.
Common sanitary influence on a saprophytic microflora, processes of
self-cleaning
Phytoaccumulative accumulation of pollutant in vegetative products
Water-migratory accumulation of pollutant in ground waters
Air-migratory evaporation of pollutant in the air not higher than MPC
Reflective irritating activity on mucous membranes of organism
Toxicological toxical effects on organism of animal
Specific allergenic, gonadotropic, embryotropic effects
The remote effects oncogenic, mutagenic effects

17
At studying each sign of harmful effect in laboratory a threshold concentration (TC) of
pollutant for each sign of harm is determined; the parameter of harmful effect with the least TC
is called a limiting sign of harmful action and according to it MPC is proved.
 Principle of presence of threshold (limiting) harmful effect is the central prin-
ciple of normalization. For each harmful factor there is a threshold of harmful action
— a level at which the harmful effect is registered (LOAEL) and a low level (NOAEL)
— when such effect is absent.
 Principle of dependence of harmful effect on concentration (dose) of the inves-
tigated factor and time of its effect. It is based on mathematical dependences
"concentration (dose) — effect" or "time — effect". The latter dependence is observed
at chronic effect in the presence of cumulation (chronoconcentration poisons).
 Principle of laboratory experiment. The investigations of effect of the normalized
factor on organism and sanitary living conditions are carried out in laboratory condi-
tions at unification and standardization of techniques for comparison of results re-
ceived by different researchers.
 Principle of aggravation. In laboratory researches the most adverse conditions are
modelled promoting the maximal manifestation of harmful effects of the investigated
factor. To the same principle the transfer of toxicological data received on laboratory
animals to the human organism refers.
 Principle of relativity of standards. The established standards are not constant and
final. At occurrence of new experimental data or results of negative effect of the nor-
malized factor on health of population at levels lower than maximal permissible con-
centration, standards are reconsidered towards decreasing.
The Scheme of Research of Toxicological Sign of Harmful Action at Hygienic Normaliza-
tion of Chemical Substances in the Environment
One of the most difficult and expensive for research signs of harmful action at normali-
zation is toxicological. It is investigated according to the following scheme:
1 Stage. Studying physicochemical properties of normalized substance with the purpose
of search of similar substances, for which standards are established, for an approximate eval-
uation of levels of toxicity and mechanisms of activity of a new toxicant.
2 Stage. Studying acute toxicity of substance (at one-time effect — lethal doses and
concentrations, threshold of acute harmful effect, etc.).
3 Stage. Studying subacute toxicity of substance at effect on experimental animals dur-
ing 30-45 days (ability to cumulation, etc.).
4 Stage. Studying chronic toxicity of substance (during some months or years — thre-
shold of chronic harmful effect).
5 Stage. Determination of threshold concentrations or doses by a toxicological sign of
harmful action. The threshold (LOAEL) and subthreshold concentrations (NOAEL) for the per-
son are determined on the basis of the data received on laboratory animals.

18
Features of Hygienic Normalization of Harmful Factors in Various Objects of the
Environment
Hygienic Normalization of Pollutants in Atmospheric Air
Pollution of atmospheric air among other objects of the environment represents the
greatest health hazard for the person for the following reasons:
 The majority of emissions of harmful substances get into the air and spread to big
distances — a lot of people are exposed to its effect;
 On inhalation a large surface of the lungs having many capillaries is exposed to ef-
fect, thus in blood a high concentration of pollutant quickly occurs and blood from the
lungs bypasses liver and spreads in the organism, causing poisonings;
 Except for direct negative effect on a human organism, the atmospheric pollution
renders an indirect negative effect on health and living conditions of the population.
Types of Hygienic Standards in Atmospheric Air
By their effect on organism the atmosphere pollutants are subdivided into 3 groups:
 Substances of the reflex (irritating) action
 Substances of the absorption (toxic) action
 Substances of the reflex-absorption action
There are 2 types of maximal permissible concentration of atmosphere pollutants:
 Maximal–single permissible concentrations (MPC m.s.) are designed for a 20-30-
minute effect of irritation pollutants and directed at prevention of reflex reactions and
poisonings in people at high concentration of pollutants in air (emergencies). They
are established by irritating action on mucous membrane of the eye and by toxic ef-
fect. For toxic substances such researches are carried out on animals with transfer of
the data on a human being.
 Daily average maximal permissible concentrations (MPC d.a.) are designed for
absence of pathological changes in people at a twenty-four-hour effect during the
whole life, and also for absence of remote effects in the subsequent generations.
MPC d.a. is much lower than MPC m.s. in view of greater exposure (time) to effect.
The criteria of harmful effect at normalization of pollutants in atmospheric air are as fol-
lows:
 organoleptic (determining the threshold concentration of pollutant by change of
smell, colour, transparence of air);
 reflectory (establishing the threshold concentration by irritating olfactory effect on a
human or laboratory animal);
 toxicological (threshold concentration is established by common toxic, specific or
remote effects at inhalation on laboratory animals).
Normalization of Pollutants in the Air of a Working Zone
Air of a working zone is the air of industrial and other premises, which pollution affects
the workers. At normalization the term of effect is estimated for 40-50 years (the maximal work
experience), therefore the maximal permissible concentration of pollutants in the air of a work-
ing zone is a bit higher than the maximal permissible concentration in the atmospheric air. At
normalization of substances in the air of a working zone the possibility of the skin-absorptive
effect on organism is also studied in experiments on animals.
Normalization of Harmful Substances in Reservoir Water
Normalization of pollutants in water depends on type of water use, i.e. drinking, house-
hold, recreational, balneological, industrial, fishing, meliorative, transport. Depending on type of
water use, various criteria of harm action are applied, therefore the maximal permissible con-
centration for the same substance can differ considerably. Hygienic standards are established
for first four types of water use.
At hygienic normalization of substances in reservoir water the following 3 signs of harm-
ful effect are studied:
 organoleptic (threshold concentrations changing organoleptic properties of water)
 common sanitary (threshold concentrations affecting the saprophytic microflora,

19
oxygen regulations of reservoir, providing the processes of autopurification of reser-
voir from pollution)
 toxicological (determination of threshold and non-effective concentrations of sub-
stance in experiments on animals as for toxic, specific and remote effects).
Hygienic Normalization of Harmful Substances in Foodstuffs
As standards of pollutants in foodstuffs the MPC and MPL (maximum permissible —
level — for pesticides in foodstuffs) are used. For substantiation of MPC in foodstuffs very diffi-
cult researches are required, that is why maximal permissible concentrations are established
only for few substances for the time being.
The characteristic feature of normalization of pollutants in foodstuffs is that MPCs are
established in view of PDD value (permissible daily dose of harmful substance entering the or-
ganism), thus the entry of pollutant into organism not only with foodstuffs, but also with drinking
water and air are taken into account.
Signs (Criteria) of Harmful Effect at Normalization of Pollutants in Foodstuffs
 Organoleptic — effect on organoleptic properties of foodstuffs;
 Hygienic — maintaining the nutritional value, i.e. major nutrients — proteins, fats, vi-
tamins, etc.;
 Technological — transformations of pollutant at culinary (thermal) processing of
product, the formation of more toxic metabolites;
 Toxicological — studying toxic, specific and remote effects at introduction into labor-
atory animals.
Hygienic Normalization of Exogenous Chemical Substances (ECS) in the Ground
ECS are substances of anthropogenic origin, purposely (pesticides, fertilizers) or acci-
dentally (heavy metals, mineral oil, etc.) brought to the ground by a person.
The ground is a burial place of waste products and at normalization of ECS it is neces-
sary to keep processes of autopurification, and also to prevent pollution of subsoil waters and
atmospheric air.
Maximal permissible concentration of ECS in the ground is such content of pollutant
in the ground, which at direct contact with a human organism (work on the ground) or at migra-
tion on ecological chains guarantees absence of negative effect on a human health, does not
disturb the processes of ground autopurification and does not influence the sanitary living con-
ditions of the population.
The Basic Signs of Harmful Action at Normalization of ECS in the Ground
 Organoleptic — change of organoleptic properties of air, subsoil waters, vegetable
foods contacting with ground, containing various concentrations of normalized sub-
stance.
 Common sanitary — effect on the ground microflora and processes of its autopurifi-
cation.
 Phytoaccumulative (translocative) — accumulation of normalized substance in
vegetable foods (not higher than maximal permissible concentration for foodstuffs).
 Air-migratory — evaporation of substance in atmospheric air above the ground (not
higher than MPC for air)
 Water-migratory — accumulation of substance in subsoil waters (not higher than
MPC for water).
 Toxicological — by toxic, specific and remote effects on laboratory animals at skin or
inhalation action together with a soil dust.

20
Hygienic Estimation of Objects of the Environment at Combined Pollution
In a real life a human organism is affected, as a rule, not by a single but by a number of
harmful factors and their combined effect may considerably differ from a separate effect of
each factor. The following types of combined effect are distinguished:
 A combined effect is a simultaneous action on organism of some factors of identical
nature, for example, only physical (noise and vibration), or only chemical (chemical
substances).
 An associated effect is action on organism of some factors of different nature, for ex-
ample, chemical materials and radiation effect.
 A complex effect — a harmful factor affects the organism in different ways simulta-
neously (for example, with inhaled air, nutrition, water, penetrates through skin).
Types of Combined Effect of Chemical Substances on the Organism
 Antagonism (less than an additive action) — mutual weakening of toxic effects of
poisons at combined action on organism. It has a chemical (mutual destruction of
poisons) or functional nature (different influence on functions of organs and systems).
 Summation (additive action) — an arithmetic addition of separate toxic effects.
 Potentiation (more than an additive action) — a mutual sharp increase of toxicity of
each toxin at combined action.
Rules of Sanitary Estimation of the Environment at Combined Pollution
1. In case of antagonism at combined effect the estimation of environment (water, air,
etc.) is carried out by comparison of concentration of each revealed substance with its MPC
separately. Estimation of the object is given by formula:
C / MPC < 1,
where
C — concentration of revealed substance,
MPC — its maximal permissible concentration in the given object of the environment.
2. At summarizing the combined effect the estimation of the environment is carried out
according to the formula of summational toxicity (Аveryanov‘s formula):
where
C — concentration of the revealed substances,
MPC1 MPC2 MPC3 — their standards
3. In case of potentiation in the above-stated formula 1/К is taken instead of 1 (K —
factor of potentiation, i.e. how many times is toxic effect amplified at combined effect in com-
parison with separate effect of each poison).
where К — an increasing coefficient (factor of potentiation)

21
Hygienic Normalization of Biological Factors in the Environment
To such factors in the environment the following refers:
 Pathogenic organisms of infectious or invasive nature — bacteria, viruses, hel-
minthes, protozoa or their toxins
 Allergens of biological nature
Main Principles of Normalization of Microbe Pollution of the Environment
 Absence of causative agents of infectious diseases in certain volumes or amounts of
the environmental object.
 Substantiation of allowable content of microorganisms in objects of the environment
at which they are considered safe in the epidemiological respect.
 Use at normalization of indicative (sanitary-indicative) microorganisms.
The indicative principle of normalization of microbes in the environment, offered more
than 100 years ago by R. Koch, up to now remains a leading principle of normalization of mi-
crobe environmental pollution.
On choice of sanitary-indicative microorganisms as indicators of pathogenic micro-
bes the following is taken into account:
 Commonplace of dwelling in a human organism
 Identical ways of entering the environment and a human organism (ways of transfer)
 Higher survival rate in the environment in comparison with pathogenic microbes,
higher resistance to disinfection
 Harmlessness for a human being (inability to cause infectious diseases)
Now as an indicator of virus pollution of the environment bacteriophages of colibacillus
(E.coli) are used. By structure, survival rate, resistance they are similar to enteroviruses, caus-
ing intestinal infections.
Various sanitary-indicative microorganisms for estimation of various objects of the envi-
ronment were offered, for example, for reservoir water — bacteria of Escherichia coli group
(BECG), coli-phages.
The quantitative evaluation is made by coli-index — quantity of BECG in a certain vo-
lume of sample and by coli titer — volume of sample in which one BECG is found out.
For example, for drinking water coli-index is up to 3, coli titer is more than 300 ml, in se-
wage coli-index — up to 1,000, coli-phages — up to 1,000, absence of pathogenic microbes in
1 L of water (Table 6).
Table 6
Bacterial Standards in Objects of the Environment for Water Estimation
Kind of water Coli-index Coli-phage Absence of patho-
genic viruses in vo-
lume of water
Drinking < 3 - 10 L
For bathing < 1000 < 1000 in 1 L 1 L
Sewage after cleaning < 1000 < 1000 in 1 L 1 L
Sanitary Estimation of Microbe Air Pollution
The indicative parameter of microbe air pollution of premises is a common microbe
number (CMN) — quantity of microorganisms per m3 of air, a parameter of direct epidemiologi-
cal danger — quantity of haemolytic streptococci per m3 of air. The criteria of estimation of bac-
terial pollution of premise air is given in Table 7.
Special requirements to microbe air pollution are established for operating-rooms, ma-
ternity wards for prevention of intra-hospital infections, postoperative complications (see Table
8).

22
Table 7
Bacterial Standards in Objects of the Environment for Estimation of Premise Air
Quality
of air
Common microbe num-
ber per m3
Amount of haemolytic streptococci
per m3
Clear < 2000 < 10
Satis-
factory
clear
2000 — 4000 11 — 40
Low
polluted
4000 — 7000 40 — 120
Polluted > 7000 > 120
Table 8
Bacterial Standards in Objects of the Environment for Estimation of Operating-Room Air
Time of definition Total microbe number per
m3
Amount of golden staphylococci
per m3
Before operation < 500 0
During operation < 1000 < 4
For estimation of bacterial pollution of ground coli-titer, Cl. Perfringens titer, amount of
helminth eggs per kg are used.

23
Effect of the Environment Quality on the Population Health
Now it is conventional that the integrated criteria of quality of environment (degree of
contamination) is the health of the population. It is used at social-hygienic monitoring environ-
ment of the country.
The Concept of "Health of Population"
Paradoxical though it may seem, but there is no universal definition of concept "health"
up to now.
In medicine and hygiene most frequently the concept of health is used as an average
statistical value characterizing a health state of a certain population, being in identical socio-
economic and ecological conditions.
The border between health and illness is the so-called a 95 % confidence interval — in
a healthy person all the investigated parameters should range within the limits, characteristic of
95 % of people of the given population.

24
Factors Determining Health of Population
If the whole complex of factors influencing health of the population is taken for 100 %,
they are distributed in the following way:
№ Name of the factor Specific Gravity in
%%
1. Lifestyle and social-
economic conditions
49-53 %*
2. Genetic factors 18-22 %
3. Pollution of the environ-
ment
17-20 %
4. Medical factors
(quality of medical aid, devel-
opment of network of public
health services, etc.)
8-10 %
Note: * — oscillations in different countries
According to various data, the occurrence of 70 % of all diseases, 60 % of defects of
physical development and more than 50 % of death cases are caused by environmental pollu-
tion.
Types of Effect of the Environmental Quality on Health of Population
Types of Effect of the Environmental Quality on Health of Population
Direct Negative Effect: Indirect Negative Effect
1. Acute effect: Specific, Nonspecific
2. Chronic effect: Specific, Nonspecific
3. The specific and remote effects
 Direct Negative Effect:
 Acute effect:
 Specific effect — in people sharp specific intoxications occur due to effect of big
concentrations of certain pollutants;
 Nonspecific (provoking) effect (toxic fogs-murderers in London, photochemical
smog of a Los-Angeles type, attacks of bronchial asthma during great air pollu-
tion);
 Chronic effect:
 Specific — accumulation in the environment of small amounts of stable pollu-
tants, causing specific ecologic pathology:
 "Itay-itay" disease (in translation from Japan ―it hurts — it hurts‖) — it was first
described in prefecture of Tokyo. Characterized by myalgia, albuminuria, glau-
coma, dystrophy, spontaneous crises; in 12 years death occurs. Its reason is
accumulation of cadmium compounds in the ground, water, fish and by trophic

25
chains it gets into a human organism;
 Minamata disease — a neurologic disorder caused by methyl mercury intoxi-
cation; first described in the inhabitants of Minamata Bay, Japan, resulting from
their eating fish contaminated with mercury industrial waste. Characterized by
peripheral sensory loss, tremors, dysarthria, ataxia, and both hearing and vis-
ual loss.
 Usho disease (oil illness) — it was also first found in Japan. Characterized by
dimness of the skin, rash, affection of eyes and internal organs; the remote ef-
fects are mutagenic, embryotrophic, cancerogenic. The reason is accumulation
in the environment of polychlorinated compounds containing dioxines — the
extremely toxic and stable substances.
 Endemic diseases (fluorosis, etc).
 Chronic nonspecific effect of biosphere pollution on health — deterioration of all
parameters of health of the population, nonspecific diseases, their aggravation,
etc.
 The specific and remote effects of pollution of biosphere. Allergenic, gonadotrop-
ic (specific), embryotrophic, teratogenic, mutagenic, cancerogenic, immunodepres-
sion effects of environmental contamination which occur in population many years af-
ter pollutant effect or in the subsequent generations.
 Indirect Negative Effect:
The indirect negative effect of pollution is marked by influence on health or living condi-
tions of the population through ecological interrelations in nature (for example, at pollu-
tion of atmosphere the level of ultra-violet irradiation decreases causing growth of rickets
in children; acid rains result in destruction of crop, transition of pollutant from one object
of environment to another, etc.).
Degrees of Biological Response of a Human Organism to the Effect of the Polluted Envi-
ronment
These include:
 death — 1 level of respouse
 disease — 2 level of respouse
 functional signs of illness without symptomatology (prepathology) - 3 level of resp-
ouse
 functional shifts of unknown etiology (tension of adaptive opportunities) - 4 level of
respouse
 asymptomatic accumulation of pollutant in a human organism - 5 level of respouse
Basic Parameters of Population Health and their Use for Studying Influence of the Envi-
ronmental Pollution
 Sanitary-demographic parameters: death rate, birth rate, life expectancy, etc. For
studying the effect of the environment quality they are seldom used because changes
are revealed in a long time, not less than 10 thousand of population and data for not
less than 10 years are necessary for research.
 Parameters of morbidity (sickness rate) are the basic parameters for research of
this problem; it is important to study not the common sickness rate, but that in sepa-
rate groups of diseases.
 Parameters of physical development are especially important in children and tee-
nagers. It is a rather sensitive parameter of the environment pollution that is eluci-
dated in researches of our department carried out in ecologically different regions of
the Crimea.
 Parameters of invalidity: the total amount of invalids per 100 thousand people ac-
cording to groups of physical disability and reasons of physical disability. These are
seldom used for estimation of quality of the environment but more often — for general
characteristics of health state of the population as they largely reflect the effect of
professional harmful factors.

26
Methodical Approaches to Studying the Influence of the Environmental Quality on
Health of the Population
There are a lot of approaches to studying this problem. They include:
 Traditional approach — researches proceed from pollution of the environment to health
of the population. Here 2 main concepts are distinguished:
 A factorial sign X — the factor(s) of the environment which action on health is being
studied;
 An effective sign Y — the parameter (s) of the population health.
There are 4 basic methodical schemes of researches:
Scheme 1: (X > Y) — studying influence of one factor of the environment on one para-
meter of health;
Scheme 2: (X > Sum Y) — effect of one factor of the environment on a complex of para-
meters of health;
Scheme 3: (Sum X > Y) — effect of complex of the environment factors on one parame-
ter of health;
Scheme 4: (Sum X > Sum Y) — effect of complex of factors on a complex of parameters
of health.
 Nontraditional (inversion) approach has been used more often recently, especially
abroad. A way of researches is from a health state of the population to revealing the
most substantial factors of the environment determining the level of health with the pur-
pose of their elimination or minimization.
Concept of Observation (Research) Zones
A very important moment at carrying out researches is a correct choice of such zones; it
is possible to decrease the level of effect of other factors (socioeconomic, demographic, medi-
cal, etc.) on health of the population.
Zone of observation is a certain territory in which the effect of ecological situation on
health of the population is studied.
At carrying out researches it is necessarily to choose 3 zones of observation:
 Experimental zone — territories in which the environmental pollution in accordance
with the investigated factor (complex of factors) essentially exceeds MPC
 Control zone No. 1 — territories where pollution is at a level of MPC
 Control zone No. 2 — territories where pollution is much lower than MPC or absent at
all.
Rules of Choice of Observation Zones
The chosen zones of observation should be identical as for the following parameters: 1)
socioeconomic conditions and lifestyle of population, 2) sex, age, professional structure of
population, 3) number of population.
These zones should differ only in levels of environmental pollution.
Key Questions:
Concepts of ―environment‖ and ―biosphere‖, their basic objects.
 Basic sources and factors of the environment pollution. Classification of adverse fac-
tors in hygiene and ecology.
 Criterion of estimation of the environment quality and types of monitoring of its pollu-
tion (analytical, medical, ecological).
 Concept of hygienic regulations of pollutants in the environment, basic principles of
hygienic standardization.
 Features of hygienic standardization of harmful factors in various objects of the envi-
ronment. Limiting attributes of harmful effect.
 Hygienic standardization of biological pollutants in the environment.
 Hygienic estimation of objects of the environment at simultaneous pollution by vari-
ous substances.
 Basic parameters of population health and their use for monitoring the environment

27
quality.
 Factors of effect on health of the population.
 Types of direct and indirect effect of the environmental pollution on health of the pop-
ulation (acute and chronic effect, remote consequences).
 Methodology and methodical schemes of studying the environmental effect on health
of the population.
 Rules of choice of observation zones for research of effect of the environment quality
on health of the population.
Self-control Test
1. A quantitative parameter of the environmental factor which is safe for maintaining the
ability to life of the man and for population health, and for future generations is
called
* A. Hygienic standard
B. Hygienic factor
C. Sanitary standard
D. Level of safe effect
E. Parameter of the minimal safety
2. A parameter of harmful action, which at establishment of the hygienic standard has
received the minimal concentration (doses) at its action on organism or environ-
ment in comparison with other parameters of harmful action is called:
* A. A limiting parameter
B. A leading parameter
C. A common parameter of sanitary safety
D. A sanitary parameter
E. A hygienic parameter of adverse effect
3. As a level of harmful action of adverse factor on organism, which is determined as
minimally acceptable at establishment of its hygienic standard, is:
A. Accumulation of pollutant in organs and tissues which will not cause any physiological
or biochemical changes in their functional condition (V level)
B. Mortality of organism (І level)
C. Specific disease (ІІ level)
D. Non-specific signs of pathological changes (ІІІ level)
* E. Temporary and partial physiological changes of unknown origin (ІV level)
4. The features of hygienic standardization of the environmental factors based on the
so-called non-line-parabolic dependence of biological effects on dose are:
A. Determination of at least two hygienic standards (level of useful and harmful effect)
B. Determination of at least one hygienic standard (level of harmful effect)
C. Determination of at least one hygienic standard (level of useful effect)
* D. Determination of least two hygienic standards (level of safe and harmful effect)
E. Determination of two and more hygienic standards (useful, minimally safe and harmful
effect)
5. The excess of MPC of toxic substance in the atmospheric air makes up 100. What
changes in the health state of population should be expected?
* A. Severe poisonings
B. Expressed physiological changes in organs and systems
C. Increase of specific and non-specific morbidity
D. Change in health state according to separate functional parameters
E. Fatal poisonings among children
6. The pollutant of atmospheric air refers to the class of extremely dangerous sub-
stances. What is the most probable effect of this pollutant?
* A. Cancerogenic effect
B. Irritating effect

28
C. Neurotropic effect
* D. Embryotropic effect
E. Allergenic effect
7. The hygienic normalization of a harmful factor in the environmental object is:
* А. Such level of the given factor in the environment which does not cause any patholog-
ical changes in organism during the whole period of effect
В. Such level of the given factor in the environment which causes pathological changes in
organism during the whole period of effect
С. Such level of the given factor in the environment which causes prepathological
changes in organism during the whole period of effect
D. Such level of the given factor in the environment which causes functional changes in
organism at the end of effect
Е. Such level of the given factor in the environment which does not cause irreversible
changes in organism during the whole period of effect
8. To hygienic standard of the permissible content of harmful substance in reservoir wa-
ter the following refers:
А. MPL (maximal permissible level)
В. MPD (maximal permissible dose)
* С. MPC (maximal permissible concentration)
D. MAL (maximal allowable level)
Е. MAD (maximal allowable dose)
9. Identify a correct concept of "health" by WHO from the point of view of the individual
theoretical approach.
A. Condition of a human organism, at which it is capable to carry out the biological and
social functions
B. Condition of a human organism, when all its functions are counterbalanced by the en-
vironment
* C. Condition of complete social, biological and psychological well-being of the man (si-
multaneously with absence of illness or physical defects in him)
D. Conditional statistical concept, which is fully characterized by a complex of demo-
graphic parameters, morbidity, physical development, physical disability
Е. Interval, within the framework of which the fluctuation of biological processes keeps
organism at a level of a functional optimum
10. Identify the major factors determining the condition of population health.
* A. Social, economic, genetic, ecological factors
B. Qualitative structure of nutrition, morbidity, mortality, birth rate
C. Geographical position, climatic features, urbanization
D. Ethnical factors
Е. Level of lethality
11. What parameters of population health are primarily worsened under the influence of
the environmental pollution?
A. Demographic
* B. Physical development of children
* C. Morbidity
D. Disability
Е. Quality of emergency care to population
12. To ecopathology of population the following refers:
A. Diseases which most badly yield to treatment
* B. Diseases caused by ecological factors
C. Diseases most frequently encountered in the given district
D. Diseases with a latent course
Е. Diseases affecting the majority of population

29
MUNICIPAL HYGIENE
Theme No 3.
Hygienic Requirements to Microclimate
Concept of Climate and Microclimate
Climate is a complex of average physical parameters of a surface atmosphere in
significant area (region, country, etc.), such as meteorological, synoptic, heliogeophysical.
Microclimate is estimated by physical parameters of air in a small area (a quarter, street)
or in premises.
Major factors of microclimate are temperature, humidity, speed of air movement,
atmospheric pressure (the latter does not vary greatly in premises, therefore it is usually not
taken into account at estimation of microclimate).
Influence of microclimate on a human organism
Microclimate basically affects the thermoregulation system of a human organism.
Thermoregulation system of a human organism may be of 2 types: chemical (heat
production) and physical (heat emission), in a healthy person they are in a dynamic balance.
System of Thermoregulation
It consists of chemical thermoregulation Q1 (thermogenesis) and physical
thermoregulation Q2 (heat emission). Q1 = Q2
System of Thermoregulation
Chemical Thermoregulation
(Thermogenesis)
Physical Thermoregulation (Heat
Emission):
1. Heat conduction (30-40 %)
2. Heat evaporation (10-15 %)
3. Heat radiation (40-45 %).
Chemical Thermoregulation (Thermogenesis)
This is heat formation in the body due to biochemical processes, its level being
determined by the basal metabolism. In a healthy person the level of heat production basically
depends on air temperature (Т)* (through thermoreceptors in the skin and centers of
thermoregulation in CNS). A zone of indifference has the temperature of 15-25º С. If the
temperature is below 15 ºС, the increase of heat production takes place, if above 25 º С — the
decrease of heat production; at over 35 ºС there may be disturbance of thermoregulation
(thermal fatigue, thermal feet edema, thermal emaciation , heat cramps, heat shock, thermal
syncope).
Physical Thermoregulation (Heat Emission)
There are three ways of heat emission:
 Heat conduction (30-40 %)
 Convection — emission of heat to the air (it depends on Т, Е, V)*.
 Conduction — emission of heat to objects (it depends on Т of object, its thermal
conductivity and area of contact with an object).
 Heat evaporation (10-15 %) — it occurs on perspiration and depends on Т, Е, V of the
air.
 Heat radiation (40-45 %). It depends on radiation temperature, i.e. the difference

30
between temperature of environmental objects and a body temperature (36.6 ºC).
_____________________________________________________________________
*Note: Т — temperature, Е — humidity, V — speed of air movement
In normal conditions (in rest) a person loses 30 % of heat due to heat conduction, 15 %
— heat evaporation and 55 % — heat radiation.

31
Types of Thermoregulation Disturbance in Hot Climate
These include thermal emaciation, thermal hypostases of legs, thermal emaciation due to dehydration
and desalination on perspiration, heat spasms, heatstroke, thermal fainting. (See Theme No 25 in the
end of the textbook).
Table 25
Standards of Microclimate for Different Premises and Methods of its Estimation
Factor of microclimate Kind of premise Norms
Temperature of air
Devices: thermometers,
thermograph
Habitable rooms
Sports halls
Operating-rooms
18-22˚С
16-18˚С
22-25˚С
Air humidity
Devices: psychrometer,
hygrometer
Habitable rooms
Operating-rooms
40-60 %
up to 55%
Speed of air movement
Devices: anemometer,
catathermometer
Habitable rooms
Child institutions
0.2-0.4 m/sec
0.07-0.1 m/sec
Air Temperature
The optimal temperature range for any premises (rooms) is 18-22ºС, for sports halls —
16-18˚С, for operating-rooms — 23-25°С (prevention of postoperative complications from cold
are necessary, because in patient under narcosis the centers of thermoregulation do not work).
Fig. 9. Instruments and methods of taking air temperature
The instruments for taking air temperature are called thermometers.
Thermometers may be: household, minimal and maximal.
The household thermometer shows temperature at the given moment, it does not fix
the temperature.
The minimal thermometer fixes the lowest temperature for a certain period. The minimal
thermometers have a capillary with alcohol inside.
The maximal thermometer fixes the highest temperature for a certain period. The
maximal thermometers have a capillary with hydrargyrum inside. The medical thermometers
are maximal thermometers.
Rules for Taking Air Temperature in a Room

32
 Taking air temperature horizontally.
The temperature of air is taken at a height of 1.5 meters above floor level in five
points. The first, second, third, fourth points are the four corners of a room. The fifth
point is in the centre of a room. The odds between measurements of air temperature
in these points should be not more than 2º С.
 Taking air temperature vertically.
The temperature of air is taken in the centre of a room at a height of 0.1 meter above
floor level (at a level of man‘s feet) and 1.5 meters above floor level (at a level of
man‘s respiratory organs). The odds between measurements of air temperature in
these points should be not more than 2.5º С.
 Taking air temperature within a day.
 The temperature is taken in a room in the morning, afternoon, evening and
night. The odds between these measurements should be not more than 5º С at
local heating (fireplaces, furnace). The odds between these measurements
should be not more than 3º С at central heating (radiators of central heating).
Fig. 10. Thermograph
The purpose of this device is determination and recording of fluctuations of air tempera-
ture within time.
Design and principle of its work:
 A perceiving part — a temperature sensor: it presents a bent bimetallic plate
consisting of 2 metals having various temperature coefficients. At fluctuations of
temperature the radius of plate curvature changes, that is transferred to the
pointer with the help of lever system including the driving mechanism — lever,
rod, regulator, axis.
 A recording part: the pointer, which has a writing point on one end, registering
on a tape having an hour and day scale of temperature changes.
 Drum with an hour mechanism. The tape is reeled up on a rotating drum; the
drum can make a complete revolution for one day (daily) or for one week (week-
ly).
Thermograph provides continuous registration of air temperature in a range of +45 - -55º
С with accuracy of ±1º.
Humidity of Air

33
The following types of humidity are distinguished:
 Absolute — the amount of water vapours in the air at a given moment (g/m3 or
mm/Hg);
 Maximal — the greatest possible saturation of air with water vapours at a given
temperature,
 Relative = absolute/maximal in %.
The norm of air humidity is 40-60 % (30-70 %); at a lower humidity dryness of skin and
mucous membranes are observed, at a higher humidity the disturbance of heat emission takes
place. In operating-rooms the humidity should be not more than 55 % in order to prevent the
explosion of ether-air mixture).
Devices for Measurement of Air Humidity
Fig. 11. August’s Psychrometer
Fig. 12. Assman’s Psychrometer
(Aspirational)
Estimation of air humidity. It is necessary to moisten the thermometer with water, to
start the fan with a key, to hang up the device on a support at a distance of 2 m above the floor.
The device can also be used at negative temperatures, but not lower than –10ºС. In 4-5
minutes write down the indications of dry and damp thermometers. As from the surface of a
mercury ball of the damp thermometer the evaporation of moisture and absorption of heat oc-
cur, it will show a lower temperature.
Calculation of absolute humidity is done by the formula:

34
A — absolute humidity;
f — maximal pressure of water vapours at temperature of damp thermometer;
0.5 — constant psychrometric coefficient (amendment to speed of air movement);
t — temperature of the dry thermometer;
t 1 — temperature of the damp thermometer;
Н — barometric pressure;
755 — average barometric pressure.
The maximal pressure of water vapours at t° of damp (f) and dry (F) thermometers is de-
termined by the tables.
Relative humidity (R) is calculated by the formula:
R — relative humidity;
A — absolute humidity;
F — maximal humidity at temperature of the dry thermometer.
Speed and Direction of Air Movement
The normal air speed is 0.2-0.4 m/sec (according to sensations of a person), in a day
nursery — up to 0.1 m/sec (prevention of colds).
Air speed is measured by an anemometer if the speed is more than 1 m/sec, or by a ca-
tathermometer if is less than 1 m/sec according to Hill‘s formula.
For investigation of direction of air movement in open places weather-vanes are used.
The construction of wind rose, i.e. a graphic representation of primary direction of air move-
ment in the given area is very important at location of various objects.
Devices for Estimation of Air Movement Speed
Fig. 13. Anemometer

35
A large pointer goes around a dial having 100 divisions, indicating meters; small pointers
move around a dial having 10 divisions and showing hundreds, thousands, tens of thousands
and more meters. Each small pointer at a complete revolution shows 10 times larger values
than the previous pointer; for example, the transition of the first small pointer to one division
(100 m) is equal to a complete revolution of a large pointer; the transition of the second small
pointer to one division is equal to a complete revolution of the first small pointer, etc.
On observation a person faces a wind and establishes the device in such a way, that the
dial should face the observer. The indications of pointers are written down (a large pointer is
established on zero), then the scales should rotate idle for 1-2 minutes, and after that the coun-
ter of anemometer is switched on, simultaneously with a stop-watch. In 10 minutes the counter
is switched off and new indications of pointers are written down. The difference in indications
between the number of meters passed by air flow for the period of observation is found out.
The obtained number of meters is divided into amount of seconds of the anemometer work.
Fig. 14. Katathermometer
Very weak air flows are determined with the help of katathermometer (cylindrical or
spherical), representing a special spirit thermometer with a scale of 35-38º or 33-40º.
At first the cooling ability of air is determined. For this purpose a katathermometer is put
into hot water (about 80ºC) and heated up until the spirit rises up to half of top expansion of a
capillary. After that the device is wiped and hung up on a support or held on the outstretched
arm in place of investigation, protected at that from effect of sun energy by means of a small
screen (cardboard, plywood). Then, keeping an eye on the stop watch, it should be found out,
how much time it takes the spirit to go down from 38 to 35º; the experiment is repeated twice
and the average value is calculated.
CAA (cooling ability of air) is estimated by the formula:
Н = F/t (mCal per second/cm2),
where F — a katathermometer factor (it is indicated on the back side of each device),
t — time of cooling a katathermometer.
Knowing CAA, the speed of air movement is calculated according to the Hill‘s formula:

36
where Н — the cooling ability of air;
Q — difference between a body temperature of the man (36.5º С) and temperature of a
premise; 0.2 and 0.4 — empiric factors, Х — speed of air movement in m/sec (for small speeds
up to 1 m/sec).

37
Atmospheric Pressure. Devices for Estimation of Atmospheric Pressure
Fig. 15. Barometer
A barometer consists of a vacuum metal box with elastic wavy walls. The fluctuations of
atmospheric pressure have an effect on capacity and form of the box, which walls are flexed
inside at increase of pressure, and are straightened at decrease of pressure. With the aid of a
spring and system of small levers these changes are transmitted to a pointer moving around a
dial, on which the divisions corresponding to a scale of a mercury barometer are marked. The
figures of the scale designate hundreds and tens millimeters mercury; units are counted by in-
termediate divisions of the scale. Before readout it is necessary to knock cautiously on the de-
vice glass to prevent friction of the metal transmission parts. On the dial there is also a ther-
mometer, which indications should be written down.
Metal barometers are less precise than mercury ones, but they are portable and conve-
nient in application. Some of them have the second pointer for indicating pressure at a given
moment.
Fig. 16. Barograph
For continuous observation of fluctuations of atmospheric pressure a self-recording de-
vice — barograph is used, which sensor part is composed of a number of aneroid boxes con-
nected with each other. At change of pressure these boxes move, that is transferred by the
system of small levers to the pointer with a writing point rotating with the speed of one com-
plete revolution per week. All components of the device are placed in a case, which opens only
at change of tapes.

38
Methods of Complex Estimation of Microclimate
The main goal is a complex estimation of microclimate according to one parameter.
Several methods of microclimate estimation are distinguished.
Catathermometry
This method was offered by American scientist Hill in 1916. It is based on speed of cool-
ing a heated body depending on 3 factors of microclimate. A catathermometer is a model of a
human body heated up to 36.6°C. The cooling ability of air (H) is determined by the formula:
H = F / t (millicalories/cm2/sec)
(F — factor of catathermometer — a specific heat emission, t — time of cooling a cata-
thermometer from 38°C to 35°C in seconds).
The normal H is 5.5-7 mCal/cm2/sec. If this value is less, it is hot and stuffy, if it is higher,
then it is cold. This method is now applied for measuring small speeds of air movement by
Hill‘s formula.
Method of Effective Temperatures (ET)
It was developed for USA Navy (submarines, etc.). The microclimate was estimated by a
thermal state of a person at mass examination of seamen in a special chamber with the follow-
ing parameters of microclimate: Е (humidity) = 100 %; V (speed of air movement) = 0 m/sec;
only the parameter of air temperature was variable.
A comfort zone of thermal state of people upon these conditions makes up 17.2-21.7°
EТ. A line of comfort is 18.1-18.9° EТ.
The effective temperatures are determined by nomograms or tables with the help of in-
dications of dry and damp thermometers and speed of air movement.
The further modification of this method is the method of equivalent-effective tempera-
tures (EEТ). Additional chambers were created where Е (humidity) or V (speed of air move-
ment) changed in such a way that the thermal state of a person corresponded to EТ in a com-
fort zone. As a result tables were developed for automatic air conditioning via computer.
Application of Methods of Complex Estimation of Microclimate
Methods of complex estimation of microclimate are used in the following situations:
 At conditioning premises while staying indoors for a long time — spacecrafts,
planes, submarines.
 In balneology — for dosing air procedures.
 For improvement of hygienic working conditions in hot workshops of industrial
enterprises.
Apart from this, microclimate can be estimated by thermal state of people staying in a
given premise with the help of:
 a questionnaire technique — interrogation of people in a premise about their
thermal state of health — a 7-point scale of heat sensation exists (but many
people are required for examination),
 method of skin (dermal) temperatures by means of electrothermometer:
Table 26
Temperature Temperature of
the forehead skin
(t1)
Temperature of
dorsum of hand
(t2)
t1 — t2 Thermal sensation
10 31.2 24.2 > 6 cold
20 33.5 29.1 3 — 4 comfort
30 35.3 33.1 2.2 hot
35 35.8 35.6 < 1.5 very hot
 Technique of perspiration measurement — by electroresistibility of skin, by

40
Lesson No. 1.
Hygienic Requirements to Factors of Microclimate
Key Questions
1. Concept of climate and microclimate.
2. Hygienic significance of air temperature and rules of its measurement.
3. Hygienic significance of air humidity and methods of its estimation.
4. Hygienic significance of speed of air movement and methods of its estimation.
5. Characteristics of microclimate of hospital wards and operating rooms, and other pre-
mises.
6. Concept of ―wind rose‖, its hygienic estimation.
Learning Objectives and Their Concrete Definition
1. To know devices for estimation of air temperature and humidity. To get acquainted with a
technique of estimation of air temperature and humidity in premises.
2. To know the design and rules of work with devices for estimation of temperature in de-
grees by Celsius: the minimal thermometer; the maximal thermometer; the household
thermometer; the electronic thermometer; thermograph (see Appendixes).
3. The estimation of air humidity is carried out with the help of Assman‘s and August‘s
psychrometer with application of formulas and psychrometric tables.
4. Devices for estimation of speed of air movement. A technique for estimation of air
movement speed in a lecture-room. Design and rules of work with devices for estimation of
air movement speed. Anemometer.
5. Method of construction of ―wind rose‖ and its hygienic estimation.
Concept of "Wind Rose"
Winds blow permanently in atmosphere. The direction of wind may be: northeast, north,
north–west, west, south–west, south, south–east, east. The direction of wind is indicated by a
point whence the wind blows.
Fig. 17. The construction of "Wind Rose"
Example:
Graphic presentation of the primary direction of air movement in a given area is called a
"wind rose". The direction of wind begins in the center of the picture. Points of the wind direc-

41
tion are connected with a line. In this picture the wind blows from the east more often.
Scientists use the "wind rose" at constructing industrial enterprises, hospitals, houses.
Industrial enterprises must be constructed in a town zone where winds blow least of all.
Example:
Where must the industrial enterprises, hospitals, apartment houses be constructed?
Solution
Industrial enterprises must not be constructed in the east of town. They must be con-
structed in other town zones (north-east, west, south). In this case the town will not be polluted
with industrial wastes. Hospitals must be constructed in the east of the town (the cleanest zone
of the town). Blocks of flats must be constructed in the north, north–west, south–west, south–
east, east of the town.
Self Test
1. Which of the following devices are used for estimation of humidity? (More than one answer
may be correct)
*A. Psychrometer
B. Thermograph
*C. Hygrometer
D. Anemometer
E. Wind vane
2. The optimal norm of relative humidity for premises is:
*A. 40-60%
B. 30-70%
C. 10-30%
3. In the classroom on the 5th lesson the following parameters of microclimate have been
found out: temperature — 25°С, relative humidity — 79 %, speed of air movement —
0.1m/sec. What physiological parameters testify to unfavorable effect of microclimate on
a functional condition of the pupils‘ nervous system?
*A. parameters of capacity for work and chronoreflexometry
B. pulse, respiratory rate, vital capacity of the lungs
C. parameters of capacity for work
D. body temperature, chronoreflexometry
4. In which operating room is microclimate for the operating surgeons more favorable?
*A. temperature — 23°C; relative humidity — 40 %; speed of air movement — 0.03 m/sec
B. temperature — 25°С; relative humidity — 45 %; speed of air movement — 0.09 m/sec
C. temperature — 23°С; relative humidity — 40 %; speed of air movement — 0.1 m/sec
D. temperature — 24°С; relative humidity — 30 %; speed of air movement — 0.05 m/sec
E. temperature — 25°С; relative humidity — 50 %; speed of air movement — 0.08 m/sec
5. The relative humidity of air in a hospital ward meets the requirements of hygienic norm.
Choose the optimal value.
*A. 30 — 60 %
B. 30 — 70 %
C. 30 — 80 %
D. 20 — 40 %
E. 20 — 50 %
Problem Solving
1. On inspection of conditions of patients‘ staying in the hospital the following has been
established: the area of a single-bed ward is 6 m2, an average air temperature — 18° C, hu-
midity — 60 %, speed of air movement — 0.18 m/sec. Give a hygienic estimation of microcli-
mate in the ward.
2. In city N. the engineering plant is being constructed. According to a long-term obser-
vation the recurrence of winds makes up (in percentage): N — 14, NE — 5, E — 2, SE- 6, S-
19, SW — 26, NW — 18. Specify the optimal direction of the engineering plant location in rela-
tion to the built-up area of the city.

42
Standard Answers:
1. The microclimate in the ward is satisfactory; all the parameters correspond to the hy-
gienic norms.
2. East, as the recurrence of winds from the east direction was equal to 2 %, that is the
least value.
Lesson No 2.
Methods of Complex Estimation of Microclimate. Types of Disturbance of Thermoregula-
tion in Conditions of Hot Climate
Key Questions
1. Bases of physiology of a human heat exchange and its connection with a microclimat-
ic condition of the environment.
2. Hygienic significance and technique of estimation of organism physiological reactions,
which manifest the condition of the thermoregulation system.
3. Methods of complex estimation of microclimate:
 katathermometry
 effective temperatures;
 equivalent-effective temperatures
4. Application of methods of complex estimation of microclimate.
5. The disorders in a health condition and diseases which occur due to effect of discom-
fort microclimate on the man. Measures of their prevention.
1. Estimation of cooling ability of air (CAA) by method of katathermometry.
For the purpose a katathermometer (see the description in the previous lesson) is
placed into hot water (about 80°C) and heated up until the spirit rises up to half of top expan-
sion of a capillary. After that the device is wiped and hung up on a support or held on the out-
stretched arm in place of investigation, being protected from effect of sun energy by means of
a small screen (cardboard, plywood). Then, keeping an eye on the stop watch, it should be
found out, how much time it takes the spirit to go down from 38 to 35°; the experiment is re-
peated twice and the average value is calculated.
CAA (cooling ability of air) is estimated by the formula:
Н = F/t (mCal per second/cm2),
where F — a katathermometer factor (it is indicated on the back side of each device),
t — time of cooling a katathermometer.
The normal CAA = 5.5-7.0 mCal per second/cm2; if this parameter is lower than the
norm, there will be overheating, if it is higher — overcooling.
2. A technique of estimation of effective temperatures by nomogram.
A total effect of temperature, humidity and air movement are expressed now in degrees
of effective temperature. The indications of dry and wet thermometers of a psychrometer, as
well as data about speed of air movement are necessary for estimation of effective tempera-
ture by nomogram. Having obtained them, the procedure is as follows: points on the right and
left scales of nomogram corresponding to indications of dry and wet thermometers are con-
nected by a line. The place of intersection of this line and the curve of appropriate speed of air
movement gives the value of effective temperature.
Example: The temperature of the dry thermometer of psychrometer is 24С, the tem-
perature of the wet thermometer of psychrometer is 16С. Air speed is 30 m/min. Determine
the effective temperature under these cinditions.
Solution: On the left-hand side of nomogram we find the temperature of the dry ther-
mometer; on the right-hand side of nomogram — the temperature of the wet thermometer. We
superimpose bar on both retrieved points. We see that the bar intersects a curve of air move-
ment speed corresponding to 30 m/min in a point marked by figure 20. This figure will thus be
considered the effective temperature. On the basis of numerous observations the following

43
norms of effective temperatures are distinguished:
a) The zone of comfort is 17.2–21.7 effective temperatures. At these tem-
peratures 50 % of people feel well and comfortable.
b) The line of comfort is 18.1-18.9 effective temperatures. At these tem-
peratures 100 % of people feel well and comfortable.
3. Definition of equivalent-effective temperatures. There is a special table, according
to which we can find out the optimal microclimate for a person at different values of tempera-
ture, humidity and speed of air movement so, that heat sensation of organism is as if in a zone
of comfort.
Algorithm of Practical Work of Students
The first stage. Testing the initial level of knowledge and skills.
The second stage. Active participation in discussion of key questions on the theme of
the lesson.
The third stage. Independent work on estimation of CAA, speed of air movement in a
premise, determination of effective temperatures.
The fourth stage. Solving situational tasks and final testing on the given theme.
Self-control Test
1. Where are the centers of thermoregulation in a human organism?
A. brain cortex
B. hypothalamus
*C. medulla oblongata
D. cerebellum
E. reticular formation
2. What are the devices for estimation of cooling ability of air?
A. psychrometer
B. thermograph
C. hygrometer
D. anemometer
*E. katathermometer
3. Specify the zone of comfort according to effective temperatures (in ° ET):
*A. 17.2-21.7
B.18.0-22.0
С. 20.1-23.5
D.18.0-20.0
E.16.0-18.0
4. What factors influence the intensity of cooling the heated body?
*A. air temperature, air humidity, speed of air movement
B. air temperature, air humidity
C. air temperature, speed of air movement
D. air temperature
E. air humidity; radiation temperature
5. At harvesting grain in July the air temperature outside was 31°С; in the cabin of com-
bine harvester — 35°С, speed of air movement — 0.2 m/sec, relative air humidity
— 55 %, temperature of sides and roof of the cabin — 45 oС. Normalization of mi-
croclimate in the cabin is possible by means of
A. thermal isolation of sides and roof
B. decrease of air humidity
C. increase of air humidity
*D. cooling of the air
E. increase of speed of air movement
6. In patient with pneumonia the body temperature has increased up to 39°С, the skin
integuments have turned pale and become dry, gooseflesh occurred. What distur-
bances of thermoregulation caused these manifestations of fever?
A. dilatation of vessels, increase of perspiration, prevalence of heat production
*B. vasoconstriction, decrease of perspiration, prevalence of heat production

44
C. decrease of heat production, relaxation of tonic muscles and vessels
D. disintegration of brown fat
E. balance of heat production and heat emission
Problem Solving
1. The dry thermometer shows 20°C, and the wet one — 16°C. The speed of air move-
ment is absent. Determine the effective temperature under the given conditions (according to
nomogram).
2. Determine CAA and speed of air movement in the corridor of a hostel, if F-factor of
katathermometer is 630, time of its cooling — 90 sec. Temperature in the premise is 21.0°С.
3. What can the thermal health state of the man in a habitable room be, if the air tem-
perature ranges within the limits of 18-20°C, difference in horizontal and vertical directions is
2.0-2.5°С respectively?
Standard Answers
1. According to nomogram we find the point of intersection of the line showing the tem-
perature of dry and wet thermometers with the line of speed of air movement = 0. The answer:
ET = 18.5°.
2. The ratio of F:t = CAA = 630/90 = 7.0 mCal/cm 2 /sec, that corresponds to the norm.
According to Hill‘s formula we determine the speed of air movements, which is equal to Н =
7.0; Q = 36.6 — 21 = 15.6°. Hence Х = 0.36 m/sec, that is a norm.
3. It is satisfactory, as all parameters are within the limits of the norm.
Sources of Information
S. Shibanov. Lectures on Common hygiene and Ecology. Simferopol. 2003. 130p.
Park‘s Textbook of Preventive and Social Medicine. India, 2000.— 16th edition.— 660p.
Theme No 4.
Weather and Health. Prevention of Heliometeotropic Reactions. Climate and Problems of
Acclimatization
In spite of the fact that the influence of weather on the man is known for a long time, this
problem is still insufficiently investigated and even now it is little used by doctors in their prac-
tice. It is conditioned by the following:
 The concept of ―weather‖ is very complex; it has many components, which are
not well investigated in meteorology.
 Up to now the mechanisms of development of meteotropic reactions in the or-
ganism are not well investigated.
The Concept of Weather and Climate
Weather is a dynamic set of physical properties of surface air (troposphere) for a short
time interval (hours, day, weeks).
Climate is a long-term mode of weather naturally repeated in the given area; its para-
meters are: an average monthly temperature of air, an average number of rainy days, etc.
Thus, weather is a changeable phenomenon, while climate is a statistically constant
concept.
The basic weather-forming factors are:
 Heliophysical — intensity of a solar radiation and a solar activity
 Geophysical — intensity of a geomagnetic field, geomagnetic storms
 Electric condition of atmosphere — intensity and gradient of electric field, air
ionization, etc.
 Meteorological — temperature, humidity, speed and direction of air movement,
atmospheric pressure
 Synoptic — cloudiness, atmospheric precipitation
 Chemical structure of atmosphere — content of oxygen, СО2, pollutants in
atmospheric air.
All these factors are interrelated and affect a person in a complex way; there is a difficul-

45
ty of their all-round evaluation.
Meteorological factors are sharp fluctuations of temperature and atmospheric pres-
sure: the greater the differences — the more biotropic the weather is. These factors are most
investigated as reasons of development of meteotropic reactions (MR).
A certain role is played by changes of chemical composition of atmosphere — under
some weather conditions there may be the decrease of absolute content of oxygen in the air by
60 g/m3 and over. The annual tendency of oxygen content is increasing in winter and decreas-
ing in summer; the maximal fluctuations are in autumn and spring (the factor of an interdaily
variability is more than 50 %).
An electric condition of atmosphere includes:
 The content of positive or negative aeroions in the air
 The gradient of the electric field of the Earth
Synoptic factors are caused by atmospheric circulation of warm and cold air masses.
There are 3 types of air masses — warm, cold, neutral (local). At their movement the atmos-
pheric fronts are formed — warm, cold, occlusions (mixture of warm and cold masses).
The frequency of changing air masses is on average once per 5-6 days, but it may be
more or less often — it depends on type of atmospheric circulation:
 Cyclone is an atmospheric whirlwind with low pressure in the center and
movement of air masses counter-clockwise. It occurs more often in winter, on
average about 40 cyclones per year occur above Europe. It is characterized by
unstable weather — cloudiness, atmospheric precipitation, hurricanes, ty-
phoons; there is great difference of atmospheric pressure, temperature, content
of О2. The weather is biotropic.
 Anticyclone is an atmospheric phenomenon with a high pressure in the center
and movement of air clockwise. The weather is clear — very hot in summer or
frosty in winter. There are no sharp differences of weather factors, the weather
is more favourable.
Heliophysical factors.Up to now these factors are insufficiently taken into account at
estimation of weather, though the ingenious founder of heliobiology A. L. Chizhevsky in 1920s
determined the influence of solar activity on living organisms, including people. There are data
on coincidence of periods of increased solar activity with revolutions, wars, epidemics, even
with frequency of car accidents. The difficulty of studying this question consists in cyclic
changes of solar activity having different periodicity — 11 years, 22 years, 60 years and over,
which can overlap each other and are poorly studied. The most investigated are 11-12-year
cycles; the beginning of the last 24th cycle known to mankind is 1997, thus the maximal activity
is in the middle of the cycle (2001-2002 years).
Parameters of solar activity include the following:
 Wolf index (W) — amount of spots on the Sun,
 index S — the total area of spots,
 intensity of radioactive radiation of the Sun on the wave of 10.7 cm,
 the solar wind is the corpuscular streams (protons, electrons, etc.) from the Sun
which carry away with themselves the magnetic fields and form the spiral-sector
structure of interplanetary magnetic field (IMF) of + and -- signs.
Every 6-7 days, while moving in orbit, the Earth gets in IMF of other sign that results in
changes of geophysical parameters of electromagnetic field of Earth (EMF), its deviation
from a usual level named "magnetic storms", which may be planetary and local or by intensity
— weak, moderate and strong.
Evaluation of Degree of Weather Changeability
It is determined according to the formula:
K — coefficient of weather changeability in %

46
N — number of days with contrast change of weather
n — total number of days in the observed period
Table 27
Degree of Weather Changeability (V. Rusanova, 1973)
Weather Coefficient of changeability, %
Very stable 25
Stable 25–30
Changeable 30–50
Very changeable more than 50
Reasons, Mechanisms and Manifestations of Heliometeotropic Reactions (HMR)
People as a whole has adapted to rhythmical changes of climate and weather con-
nected with changes of day and night, season of the year. At aperiodic sharp changes of
weather factors HMR occur in people: the sharper changes of weather are, the more ex-
pressed the HMR are.
HMR is neither a disease nor a diagnosis, it is a specific pathological condition having
manifestations of various degree of expressiveness in different people.
According to meteosensitivity all people are divided into 2 categories:
 meteostable, i.e. tolerant: young healthy people
 meteosensitive — according to different data these are 30-70 % of population
of elderly age; up to 90 % of patients with bronchial asthma, hypertension.
The reasons of HMR occurrence are sharp fluctuations of above-stated weather factors.
V. F. Ovcharova (1986) distinguished the following biological effects of weather influ-
ence: tonic, spastic, hypoxic, hypotensive.
Manifestations of HMR
 A mild degree — asthenovegetative syndrome — a mass character and syn-
chronism with changes of weather allow to suspect the presence of HMR.
 A moderate degree — headaches and heartache, marked changes of pulse,
blood pressure.
 A severe degree — aggravation and exacerbation of chronic diseases, e.g.
stroke, heart attacks, aggravation of bronchial asthma resulting in growth of pa-
tients‘ mortality.
Diseases at which MRs are revealed can be subdivided into two groups:
 Diseases at which the presence of HМR is authentically proved, including:
 Cardiovascular diseases — statistically authentic growth of number of strokes,
hypertonic crises, heart attacks and mortality at biotropic weather, including the
emergency data;
 Bronchial asthma — increase and exacerbation of asthma attacks, mortality;
 Rheumatism — activation of the process, exacerbation of polyarthritis, arthralgias in
90 % of patients;
 CNPD (chronic nonspecific pulmonary diseases) are marked in 60-72% of pa-
tients (according to the data of Yalta scientific research institute).
 Diseases for which data on availability of HМR is present: diseases of gastrointestinal
tract (stomach ulcer, gastrites, colites, etc.) — in 40-60 % of patients, diseases of kid-
neys and urinary tracts — in 40-50%, diabetes mellitus (exacerbation of the course) — in
20%, psychiatric disorders — in 50 % of patients, ophthalmologic, surgical pathology,
etc. Among ill children 25-45% are meteosensitive.
Medical Estimation of Weather and Prevention of HМR
The basis of all medical classifications is the concept suggested by N.E.Vvedensky
about the force of external irritation which may be low, moderate and high.
Thus, according to G. P. Fedorov's classification there are 3 types of weather: optimal, ir-
ritating and acute; according to other classifications there are from 4 to 7 types.

47
The main thing in medical estimation of weather is sharpness of fluctuations of
weather factors, their intraday differences.
The scientists of the Yalta climatic scientific research institute named after Sechenov
have suggested the common clinical index of weather pathogenicity — the sum of specific
indexes of weather changes per 24 hours according to the most important weather factors. If
the index is 0-19, the weather is optimal, 20-49 — irritating (it demands intensive medical con-
trol), more than 50 — acute (it demands strict medical control). There are also indexes of
weather changeability (for estimation of climate).
The department of hygiene of Kiev medical university suggested the scheme of medical
estimation of weather according to 15 parameters.
The system of prevention of HMR has 3 basic directions:
 Common hygienic methods: rational nutrition, improvement of life and working condi-
tions, etc.
 Organizational measures: medical weather forecasts, medical estimation of weather.
 Medical prophylactic measures, including:
 Increase of nonspecific resistance of organism.
 Sparing regimen
 Medicinal prevention with specific and nonspecific agents, such as sedatives, spas-
molytics, neuroleptics, etc. Thus seasonal and urgent prevention is distinguished.
The former means a regular intake of small doses of preparations in unfavourable for
the given area months (see Table below). The urgent prevention is carried out for
meteosensitive cardiological and other patients in hospital in the periods and days of
biotropic weather on the basis of urgent medical weather forecasts.
Table 28
Periods for Seasonal Prophylaxis of Cardiovascular Diseases in the Crimea
(V. Bardov, 1985)
Disease The most unfavorable months for authentic
increase of exacerbation rate
hypertonic crises 2, 3, 4, 5 and 12th month
stenocardia attacks 1, 2, 3, 4, 5 and 11th month
myocardial infarction 1, 2, 3, 4, 5, 7, 8th month
disturbance of cerebral circu-
lation (stroke, etc.)
1, 3, 4, 5, 6, 12th month
Hygienic Significance of Climate
Climate is a long-term mode of weather in a given region. The basic climate-forming
factors are:
 the geographical latitude influencing the size of solar radiation,
 height above sea level, relief and type of terrestrial surface (ice, snow, etc.),
 features of circulation of air masses,
 proximity to seas and oceans.
Parameters of climate are average statistical (average monthly, average annual) pa-
rameters of meteorological factors, wind rose, number of clear days, etc.
An important parameter is the index of weather instability:
T = a / b,
where a — the number of days with weather changes, b — number of days of the ob-
servation period (season, year). If index T is over 0.5, the climate is unfavourable (not good for
ill person).
At long living under certain climate a certain dynamic stereotype develops in a person
which provides normal vital activity.
At sharp change of climate (moving to different climatic zone) acclimatization is ob-
served, i.e. a complex set of functional-morphological changes in organism, directed at adapta-
tion to new climatic conditions.

48
Conditionally 2 stages are distinguished in this process:
 partial acclimatization or adaptation — from the first hours up to 14 days (in
sick people — about 30 days and over).
 full acclimatization — in 14 days during some months, to conditions of Far
North — up to 1.5 years.
During acclimatization the resistance of organism to unfavourable factors of the envi-
ronment is reduced that results in increase of disease incidence, asthenovegetative syndrome,
etc.
Acclimatization should be taken into account in balneology: patients should not be sent
to resorts with sharply differing climate (24 days are the basic period of acclimatization). This
presents a great problem for the Army, Navy, people working in the Far North.
Key Questions:
1.The basic weather-forming factors and their characteristics:
-meteorological
-Synoptical
-Heliophysical
-Geophysical
-Electical state and content of the atmosphere
2.Reasons and mechanisms of development of heliometeotropic reactions.
3.Manifestations of heliometeotropic reactions, diseases accompanied by them.
4.Medical classifications of weather and its medical estimation.
5.System of prevention of heliometeotropic reactions.
6.Acclimatization, its types and reasons. Features of acclimatization to a hot and cold climate.
Significance of acclimatization for balneology.
An Example of a Problem Task on Hygienic Estimation of Weather Conditions
According to the data of the city meteorological station the weather condition in town N.
was characterized by the following:
From October 20 till October 24 the anticyclonic weather, partly cloudy, without atmos-
pheric precipitation was observed. The atmospheric pressure was 760 mmHg, the air tempera-
ture — +12º, daily temperature difference — 3 º, daily pressure difference — 3 mmHg, relative
air humidity — 60 %, content of O2 in the air — 325 mg/l, speed of wind — 1.5 m/sec.
According to synoptic forecast such weather will last for 3-4 days, then there will be its
sharp change connected with moving of a cyclone and passage of a warm front. There will be
significant clouding, intensive precipitation. According to forecast the meteorological parame-
ters will be the following: atmospheric pressure — 475 mmHg, air temperature — + 6 º, daily
temperature difference — 7 º, daily pressure difference — 7 mmHg, relative air humidity — 100
%, O2 content in the air — 250 mg/l, speed of wind — 10 m/sec.
The tasks:
1.To determine the type of weather by medical classifications.
2.To determine the degree of weather changeability.
3.To characterize meteorotropism of the revealed types of weather.
Appendix No. 1
Medical Classification of Weather by I. Grigoriev (1974)
Type of weather Characteristics of weather
1. Extremely favourable It is stable, caused by anticyclone, precipitation is ab-
sent. Atmospheric pressure is over 760 mmHg, daily
pressure difference is not more than 5 mmHg, wind
speed is 0-3 m/sec, O2 content is more than 315 mg/l.
2. Favourable Insignificant weather changes of a local character,
there is short-term precipitation, variable cloudiness.

49
Atmospheric pressure — 760-755 mmHg, daily pres-
sure difference — 6-8 mmHg, daily temperature differ-
ence is not more than 5ºC, wind speed — 4-7 m/sec,
O2 content is more than 315 mg/l.
3. Unfavourable (requires a special med-
ical control)
It is cloudy, unstable, there is precipitation caused by a
cyclone, local storms. Atmospheric pressure is 754-745
mmHg, daily pressure difference is 9-14 mmHg, daily
temperature difference is 6-9ºC, wind speed is 8-10
m/sec, O2 content is 289-260 mg/l.
4. Extremely unfavourable (requires a
strict medical control)
The weather is caused by a deep cyclone. There are
thunder-storms, intensive precipitation. Atmospheric
pressure is below 745 mmHg, daily temperature differ-
ence is 10ºC and over, O2 content is below 260 mg/l.
Self-control Test
1. A female patient from Kharkov, aged 62, has the diagnosis of arterial hypertension of III
stage with hypertensic crises. She is administered the necessary permanent chemo-
and physiotherapy. Give recommendations as for the place of health resort treatment in
cardiac sanatorium.
A. Black Sea coast of Caucasus (Batumi)
B. Baltic Sea coast (Yurmala)
*C. Local sanatorium (near Kharkov)
D. Sanatorium near Kiev
E. Southern coast of Crimea (Yalta)
2. A patient from Kiev, aged 70, has the diagnosis of chronic ischemic cardiac disease with
vascular insufficiency of III stage. The necessary permanent chemo- and physiotherapy
is administered to him. He heard the weather forecast on TV: ―A deep cyclone with low
atmospheric pressure is expected tomorrow‖. Give recommendations to the patient.
A. Treatment according to the common scheme or by applying a sparing regimen
*B. Application of spasmolytic and anticoagulant preparations in addition to the usual
scheme of treatment
C. Hospitalization in the ―Biotron‖ ward
D. To include vitaminotherapy
E. To follow the usual home and working regimen
3. The doctor-cardilogist received the urgent warning of the weather bureau. The next day a
large magnetic storm due to flare on the Sun was expected. Give recommendations
concerning changes in the scheme of treatment of the patients with chronic ischemic
cardiac disease in the in-patient department.
*A. To intensify spasmolytic and anticoagulant therapy
B. To administer hypotensive preparations
C. To administer a bed regimen
D. To prolong the administered earlier treatment
E. To cancel the administered earlier medical-diagnostic procedures
4. What group of weather-forming factors do temperature and humidity of air refer to?
A. Synoptical
*B. Meteorological
C. Heliophysical
D. Geophysical
E. Microclimatic

50
Theme No 5.
Chemical Composition of Atmospheric Air. Effect of its Components on the Man. Protec-
tion of Atmosphere from Pollution
Significance of Atmospheric Air
The atmospheric air is a source of breathing for man, animals and vegetation; stuff for
processes of burning and synthesis of chemical substances; material for cooling the industrial
and transport installations; the environment for natural and anthropogenic wastes and pollutant
emissions.
Chemical Composition of Atmospheric Air
Atmosphere is a part of biosphere which is the gaseous environment of the Earth rotat-
ing together with it. This environment has some layers. The upper and lower parts of atmos-
phere are distinguished. The lower part, particularly troposphere, is of special interest.
The air of troposphere (the surface layer of atmosphere up to 10-25 km) represents a
mechanical mixture of various gases:
Table 29
Gas Content volume in %
Nitrogen 78.09
Oxygen 20.95
СО2 0.03 — 0.04
Other gases: argon, neon, helium,
etc.
1.0
Besides in the air different admixtures of natural and anthropogenic origin are practically
constantly present, e.g. ammonia, methane, nitric oxides, hydrogen sulfide, hydrocarbons, etc.
Natural dust pollution of atmosphere is composed of space dust, terrestrial dust (soil,
vegetative, fire, volcanic).
Effect of Components of Atmospheric Air on a Human Organism
Oxygen. Significance of Oxygen in Biosphere
In the nature the processes of oxygen consumption and excretion constantly take place.
The consumption of oxygen occurs at respiration of human and animals, at burning, different
oxidizing processes, etc. However, its content in the atmosphere remains practically constant
due to its excretion by phytoplankton of oceans and green plants.
For a person oxygen is necessary for oxidizing biochemical processes in organism. At
lack of oxygen in organism hypoxia of various degree of severity occurs. It is not the percen-
tage but absolute amount of О2 in the air, depending on its partial pressure (part of the atmos-
pheric pressure for the given gas) is of great importance for a person. Partial pressure of oxy-
gen decreases at cyclones and also at climbing a height.
Pathogenesis, Symptomatology, Prevention of Mountain (High-Altitude) Illness
This disease may be encountered in mountaineers, inhabitants of mountains and pilots.
Pathogenesis: It is a decrease of partial pressure of oxygen in the air at ascending
heights and decrease of partial pressure of oxygen in the alveolar air. Amount of oxygen enter-
ing organism depends on gradient G (difference between the partial pressure of oxygen in the
alveolar air (Pair) and in blood (Pblood):
G = Р in air / Р in blood
On ascending heights Pair decreases. If gradient of pressure decreases, hypoxia of vari-
ous degree of severity occurs.

51
The following zones of oxygen pressure affecting a human organism are distin-
guished:
 Inert — up to 2 km → it is safe for health
 Complete compensation — up to 4 km → increase of lung ventilation, minute volume of
blood
 Incomplete compensation — up to 5.5 km → headache, euphoria, sleepiness, memory
impairment
 Critical — up to 8 km → loss of consciousness
 Threshold of mortality — higher than 8 km → death.
Height of 8 km is a death threshold.
Symptomatology of Mountain Illness
Acute, subacute (in climbers) and chronic (in inhabitants of high-mountainous settle-
ments) forms of mountain illness of a mild, moderate and severe degree are distinguished, e.g.
high-mountainous lung hypostasis.
The symptoms of the disease are dyspnea, palpitation, malaise, fatigability, sleepiness,
nausea, vomiting, nasal bleeding, skin cyanosis.
Prophylaxis of Mountain Illness
 A step-by-step (gradual) climbing mountains with making camps for the devel-
opment of compensatory reactions to hypoxia (development of physiological
erythrocytosis).
 Usage of oxygen apparatuses by pilots of planes
 Cabin pressurization of planes
Ozone is an allotropic form of oxygen having formula О3.
The ozone layer in atmosphere is located at a height of 20-30 km. Ozone absorbs a
space short-wave radiation, including ultraviolet (UV) radiation. The decrease of ozone layer by
20 % due to anthropogenic and natural factors results in "ozone gaps" which in their turn cause
the increase of UVR leading to growth of skin melanoma in people. Ozone has high oxidizing
properties reducing chemical and microbe pollution of atmosphere.
Nitrogen. Significance of Nitrogen in Biosphere
Nitrogen is a part of some proteins and nitrogenous compounds. It is the basis of all liv-
ing beings on our planet. However, living organisms cannot receive nitrogen directly from the
atmosphere, except for some bacteria and blue-green seaweeds. Then nitrogenous com-
pounds through food chains pass into other organisms.
Effect of Nitrogen on Organism
Nitrogen under normal conditions (the normal atmosphere pressure) is an inert gas (no
effect on organism). At the increased pressure nitrogen produces a narcotic effect on the CNS
(it is proved by laboratory tests on animals). In divers on the depth of 100 m in 5 minutes dizzi-
ness, euphoria, spotty memory defect, hallucination occur.
Pathogenesis, Symptoms, Prophylaxis of Decompression (Caisson) Sickness
It is often encountered in divers.
Pathogenesis
 On diving to the depth the pressure of gases as well as solubility of gases in
blood increase.
 On quick rising of a diver from the depth, or decompression of a plane cabin in
the upper layers of atmosphere the pressure of gases sharply falls and solubility
of gases in blood decreases.
 Nitrogen slowly diffuses through a pulmonary-alveolar membrane and is ex-
creted in blood and tissues in a form of bubbles which diameter depends on
depth, i.e. the difference of pressure on depth and on surface.
Thus a gas (nitrogen) vascular embolism occurs.
Other gases, such as oxygen, CO2, helium quickly diffuse through membrane and do

52
not form bubbles.
Symptomatology
The following degrees of severity of the disease are distinguished:
 A mild degree of the disease (the diameter of bubbles is very small) results in
embolism of only capillaries causing numbness and pain of fingers and toes,
headaches.
 A moderate degree of disease is manifested by sharp pains in extremities,
headaches, pains and inflation of intestines.
 A severe degree leads to embolism of large vessels in the CNS (lesion of the vi-
tal centers), coronary vessels, pulmonary artery and cardiac arrest.
Prophylaxis
 A gradual stepped rise to the surface
 Substitution of nitrogen by other inert gas — helium
 Usage of altitude chamber after rising to the surface
Carbon Dioxide СО2
The content of CO2 in atmosphere is 0.03-0.04%. It is excreted in nature at breathing of
biota, processes of burning, etc. Constancy of CO2 in atmosphere is maintained due to its as-
similation by plants, absorption by sea and fresh-water reservoirs.
CO2 acts on the man and animals as a physiological irritator of the respiratory center. At
increased concentrations of CO2 in organism acidosis, disturbances of the CNS occur.
Effect of Various СО2 Concentrations on Organism
Table 30
СО2 concentration, % Biological effect
0.05 — 0.1 The appreciable dilatation of peripheric vessels
0.5 Change of EEG, increase of respiratory depth
1.0 Acidosis starts
1.0 — 2.0 Decrease of work capacity, toxic effect on CNS
2.0 — 3.0 Expressed irritation of respiratory center and CNS
10.0 — 12.0 Loss of consciousness and death
Maximal Permissible Concentration of СО2 in the Air of Closed Premises
In the air of any room the maximal permissible concentration of СО2 is 0.1 % (It was es-
tablished by Pettencofer in the 19th century). Substantiation of MPC: CO2 is a parameter of air
cleanliness and efficiency of ventilation — at growth of СО2 over 0.1 % the increase of concen-
tration of toxic and microbe air pollutants takes place, which can have a harmful effect on a
human organism.
Air Ventilation, Parameters of its Efficiency
The aim of ventilation is to change air in a room. Ventilation is subdivided into the follow-
ing kinds:
 Natural (through windows, doors, window leaves) –due to difference of temper-
atures or speed of air movement;
 Artificial — with the help of ventilators (input ventilation, extract ventilation,
combined extract and input ventilation).
 Mixed — a combined natural and artificial ventilation
Parameters of ventilation efficiency are the following:
 Content of СО2 in the air is up to 0.1 %;
 Air changes per hour (for habitable rooms it should be 0.5-1, in kitchens — 2-3,
in cinema halls — 5-6);

53
 Air exchange capacity for 1 person per hour — 20-30 m3.
Table 31
Standards of Ventilation for Different Premises
Kind of premise Air changes per hour Air change capacity per 1
person
Habitable rooms 0.5 — 1 20 — 30 m3
Kitchens,
laboratories
2 — 3 -―-
Operating room 5 — 6 (with conditioning 8 –
10)
-―-
Cinema hall 5 — 6 -―-
Ecological and Hygienic Estimation of Anthropogenic Atmosphere
Pollution
The modern mankind lives in conditions of constant and growing anthropogenic pollution
of biosphere.
Thus, special danger is presented by pollution of atmosphere:
 It is polluted more than other objects of the environment;
 Pollutants in the air are more dangerous than those in water, foodstuffs and soil be-
cause:
 The area of lungs penetrated with vessels is big (120 m2 in adult), that is why at once
a big concentration of pollutant in blood is formed;
 Blood from the lungs by-passing liver is carried around the whole organism, thus a
neutralizing function of the liver is reduced.
According to prognosis of UNEP (Program of the United Nations on the environment
protection), Washington Science Academy, the pollution of biosphere, including atmosphere,
by stable and toxic substances (heavy metals, pesticides, dioxines, etc.), having a tendency to
increase in the nearest years, constitutes a real threat of global ecological catastrophe for
mankind.
Major Factors and Sources of Anthropogenic Pollution of Atmosphere
 Chemical substances. The sources are industry, especially petrochemical,
transport, processes of fuel burning (thermal power stations, boiler-houses),
rubbish-processing factories, agriculture (pesticides, etc.).
 Dust — soil erosion, cement works, etc.
 Biological pollution — microbes — high density of people in cities, cattle
breeding, factories, biological pesticides.
 Radioisotopes — nuclear power plant, industry, medicine, nuclear tests.
 Thermal pollution of atmosphere — emissions of superheated gases by indus-
trial works and boiler-houses, emission and reflection of heat by the urbanized
territories.
Factors Affecting the Intensity of Atmosphere Pollution
 Amount and intensity of emissions per unit of area, degree of territory urbaniza-
tion
 Height of emissions ( in case of high emissions pollution diffuses on the big terri-
tory)
 Relief of territory — bad air ventilation in low places, e.g. the center of Simfero-
pol.
 Meteorological factors — a temperature inversion (a vertical air exchange is
complicated), humidity, amount of atmospheric precipitation, speed and direc-
tion of winds (a wind rose), etc.
 Features of architecture lay-out — sanitary-protective gaps, etc.

54
 Amount of green plantations.
The Ways of Atmosphere Autopurification
 Dilution of pollutants in air masses, hence decrease of pollutant concentration up to max-
imum permissible concentration and lower;
 Sedimentation:
 Dry — fall-out of large particles,
 Damp — removal of pollutants with atmospheric precipitation, i.e. with snow or steady
rains.
A drawback of sedimentation from air is probable pollution of water and soil.
 Chemical reactions under the influence of О3 and UVR, but sometimes photooxidizers
may form (smog of a Los-Angeles type) — at its action the irritation of the upper respira-
tory tract, mucous membranes of eyes, skin, and cancerogenic effect occur. There may
be the destruction of metal designs, buildings, etc.
 Bactericidal effect of О3 and UVR;
 Neutralization of acid and alkaline pollutants, but there can be more dangerous metabo-
lites;
 Assimilation and processing of pollutants by ground microflora.
The effect of atmosphere pollution on health of people and conditions of their life
It is possible to distinguish two kinds of effect of atmosphere pollution on health of people
and conditions of their life:
 A direct negative effect is an immediate effect of pollution on organism of a
person which results in various biological effects;
 An indirect negative effect occurs when pollution influences health of a person
indirectly by change of ecological conditions.
A Direct Negative Effect
Acute Effect
Nonspecific Specific
Acute provoking action: toxic fogs–
murderers, smog of a Los Angeles type,
attacks of bronchial asthma, etc.
Specific acute poisonings
Chronic Effect
Nonspecific Specific
Deterioration of parameters of population
health: demographic, morbidity, physical
development, physical disability
Chronic specific illnesses:
Itai-itai, Minamata disease, Usho, fluorosis,
etc.
Remote Effect
It may be oncogenic, mutagenic, embryotropic, immunodepressive.
An Indirect Negative Effect
Increase of rachitis or melanomas (UVR)
Deterioration of living conditions of population
Acid rains, pollution of foodstuffs, aesthetic harm
Fig. 18. Effect of Atmosphere Pollution on Health of Population
Basic Directions of Atmosphere Protection from Anthropogenic Pollution
 Administrative-legislative measures: Law of Ukraine on air protection, Constitution,
Law on sanitary and epidemic well-being of population of Ukraine, and other laws. The
administrative measures are taken by local authorities in the given territory.
 Hygienic measures include:
 Preventive sanitary control (see Topic 1)
 Current sanitary control
 Medical-preventive measures — studying the effect of pollution on health of population,
treatment and improvement of victims, revealing the main negative factors, sources, etc.

55
 Ecological monitoring — studying the state of ecosystems and separate kinds of biota
in interrelation with atmospheric pollution.
 Architectural measures — zoning of cities, sanitary-protective gaps between sources of
pollution and residential buildings, etc.
 Technological measures include:
 Application of self-contained technologies — the air is purified and again returns in
operation, thus there are no emissions in free air. It is a very expensive method.
 Change of technology — transfer of motor transport into usage of electricity, gas;
change of chemical technologies with decreased concentration of harmful substances
in emissions.
 Usage of sewage disposal plants in sources of pollution:
 cyclone, multicyclone — a great rotary speed is imparted to emission and the par-
ticles drop out in the bunker;
 scrubber — air passes through water and gases are purified;
 electric filter — the charged particles are deleted.
Checking the work of sewage disposal plants is carried out by observing the specifica-
tions of MPE (maximal permissible emissions of pollutants in free air calculated in con-
sideration of MPC in the air).
Recommendations for Practical Classes on the Topic
Key Questions:
1.Chemical structure of air and physiological significance of its basic components.
2.The reasons, manifestations and prevention of high-altitude (mountain) and caisson (decom-
pression) sickness.
3.Significance of definition of СО2 in the air of premises. MPC of СО2 and its substantiation.
4.Basic sources and factors of atmosphere pollution, criteria and parameters (physical, chemi-
cal, bacteriological) of pollution of atmospheric air. Ways of autopurification of atmosphere.
5.Manifestations of atmosphere pollution effect on a human health and conditions of life.
6.Basic directions of atmosphere protection from pollution.
7.Hygienic significance of ventilation in different premises. Types of ventilation. Classification of
ventilating devices.
8.Hygienic characteristics of ventilation efficiency and calculation of its parameters.
1. To determine efficiency of natural ventilation by CO2 content in the air of pre-
mises.
The method of СO2 estimation is based on comparison of pumped by a rubber syringe
atmospheric air and air of a premise (one and the same volume of passing air is taken). In Pe-
try‘s absorber 10 ml of coloured by phenolphtalein solution of Na2CO3 is poured. While passing
through the solution, the air with СO2 becomes colourless; its reaction with alkaline Na2CO3 to
acidic Na2НCO3 varies. By pressing a rubber syringe, we slowly squeeze out air from it into ab-
sorber through a long tube, thus we fix the number of pumpings until a complete decolouration
of the solution. The same procedure is carried out in the open air, the solution being substi-
tuted for a new one. The calculation is made according to the formula:
Х = A x 0.04 / B,
where: Х — the required content of СО2 in %
A — amount of pumpings in the atmosphere
B — amount of pumpings in a premise
0.04 %- an average concentration of carbon dioxide of the air.
We estimate concentration of carbon dioxide in a premise: the optimum concentration of
CO2 is 0.07-0.08 %, MPC — 0.1 %.
2. Estimation of efficiency of natural ventilation and air changes per hour.
Air changes per hour as a parameter of efficiency of natural ventilation is defined by an
indirect method proceeding from the received results of the СО2 content in a premise according
to the formula:

56
where: N-number of people in a premise
V- cubic capacity of premise
Р- found concentration of СО2
22.6- volume of СО2 exhaled by a man per hour
0.4 (lm3) — an average concentration of СО2 in the air
3. Estimation of parameters of artificial ventilation in situational tasks.
Example: Length of a premise makes up 22.4 m, width — 6m, height — 3.5 m. In the
premise there is one vent 40 cm in diameter; the speed of air movement makes up 5 m/sec.
Identify the air changes per hour and estimate it. Air changes per hour is a ratio of quantity of
entering air per cubic capacity of a premise. The quantity of entering air per hour is identified
by multiplying the vent area by speed of air movement and time of airing.
V- speed of air movement;
S- area of vent in m2,
N- number of vents
T — time of airing (1hour = 3600 sec)
Vp- cubic capacity of a premise (room) in m3
Solution: the area of the vent (since it is of a round form) is determined according to the
formula O = π x R2n, i.e. =3.14х (0.2) 2 = 0.13 m2.
Air changes per hour is equal to 5, that exceeds the established standards.
Self-control Tests
1. In the structure of atmospheric air the maximal percentage makes up:
A. oxygen
*B. nitrogen
C. carbon dioxide
D. argon
E. neon
2. MPC of СО2 for various premises makes up
A. 0.07%
B. 1.1%
*С. 0.1%
D. 0.01%
E. 0.04%
3. What kinds of artificial ventilation do you know?
A. natural, artificial ventilation
*B. input ventilation
*C. extract ventilation
D. combined ventilation
4. At the expense of what factors is the natural ventilation carried out?
A. difference of air in a premise and outside
*B. difference of temperatures in a premise and outside and increased pressure of exter-
nal air at wind
C. presence of sources of radiation temperature in a premise
D. difference of temperatures and humidity in a premise and outside

57
E. difference of speed of air movement in a premise and outside
Problem Solving
1. In a room 400 m3 in size there is a ventilating fan, which is switched on during a break
between lectures for 10 min. Its vent is round with a radius of 0.2 m. Identify the air changes
per hour, if the speed of air movement in the vent makes up 6 m/sec.
2. In a room with a cubic capacity of 60 m3 there are 5 men. Airing occurs at the ex-
pense of a window leaf, which is opened for 10 min per hour; speed of air movement is
1m/sec, area of the window leaf is 0.15 m2. Estimate the ventilation in the room.
3. Microclimate of a premise is characterized by the following parameters: the air tem-
perature — 40oС; relative humidity — 70 %; speed of air movement — 0.1 m/sec; radiation
temperature — 80-90oС. Identify the most probable pathological state of a person, which can
occur under the given microclimatic conditions.
Standard Answers:
1. According to the formula ACh = VxSxNxT/Vp we find out: 6 х [3.14х (0.2)2] х1х600
=1.113 / Vp 400.
ACh = 1, that is not enough for the given room (N=3)
2. Per 1 sec. 1 х 0.15 = 0.15 m3 of air enters the room; for 10 minutes — 90 m3. ACh is
equal to 90 m3: 60 m3 =1.5. The necessary air changes per hour are 22.6 х 5/1-0.4=188 m3.
The necessary air changes per hour are 188 m3: 60 m3 = 3. The necessary air changes per
hour are 3 times/hour.
3. General hyperthermia (heat stroke).
Fig. 19. Aspirator (device for aspiration of air for detecting pollutants in the air)
In aspirator the system of regulation is on a forward panel of the device: 1 — for connec-
tion of a cord to the electricity supply with voltage of 220 V (at 127 V a transformer is applied);
2 — toggle for switching on and switching off the device; 3 — handle of rotameter valves for
regulating speed of taking air samples; 4 — rotameters; 5 — connecting pipes for connection
rubber tubes with filters; 6 — safety valve serving for prevention of the electric motor lugging at
taking samples with small speeds; 7 — socket of a safety-lock; 8 — a bonding point of device.
Starting the work, it is necessary to ground the device, attaching plug 8 to water pipe or
heating system with the help of a flexible wire, and then it is connected to electricity supply.
Then the safety valve 6 is fixed in position 1 and valves of rotameters 3 are opened to the full.
After that the device is switched on by toggle 2 and by rotating handles of rotameter valves the
necessary speed of taking air samples is established. Then the device is switched off, the ne-
cessary absorbers for taking samples are attached to connecting pipes 5 and the device is

58
switched on again, noting the time by a stop watch; by rotameter the necessary speed of air
passage is established and samples are taken. Readout of air speed is carried out from the top
edge of floats of rotameters. Aspirator is designed for continuous work within 3 hours.

59
Theme No 6.
Significance of Solar Radiation. Hygienic Requirements to Lighting
Hygienic Significance of Solar Radiation
All the organic life on Earth owes its existence to the Sun energy — the only external
source of heat and light.
On the border of atmosphere the intensity of solar radiation is on average 2 cal/cm2/min,
it is called a ―solar constant‖ (it depends on activity of the Sun and other astronomical fac-
tors).
Due to absorption, dispersion and reflection of solar beams the quantitative and qualita-
tive changes of solar radiation take place in atmosphere:
 Quantitative changes — only 43 % of solar constant reach the Earth surface (it
depends on geographical position, height of the Sun above the horizon, clear-
ness of atmosphere).
 Qualitative changes in spectrum of solar radiation are as follows:
On the border of atmosphere the ultraviolet beams (UV) make up 5 %, visible beams —
52 %, infrared beams (IR) — 43 %, near the Earth surface UV — 1 %, visible beams — 40 %,
IR — 59 %.
The reason of these changes is 2 screens:
 the electro-magnetic field of the Earth,
 an ozone layer, due to which deviation of short-wave beams and delay of long-
wave part of solar radiation take place.
Reasons, Manifestations and Prevention of Solar Starvation
At lack of solar irradiation a peculiar pathological condition develops in people — solar
starvation, which is characterized by asthenovegetative syndrome, oppression of CNS, de-
crease of adaptable abilities of organism. In children rickets may develop. The main reason of
development of this condition is deficiency of UVR.
The reasons of development of solar starvation are the following:
 Insufficient stay in the open air. There is lack of solar irradiation in rooms, be-
cause window glass reflects 35-90% of solar beams.
 Climatic and geographical conditions of region, e.g. in the Far North where the
polar night lasts 6 months and there is no Sun, and the weather is very cold,
children cannot stay in the open air.
 In Europe the lack of solar irradiation is experienced by the rural population for 2
months a year, and by urban population — 4 months/year (due to high level of
air pollution).
 Pollution of atmosphere which results in reduction of light exposure by 40-50 %,
especially of UVR. Thus in the center of London the level of UVR is 36 times
lower than in its suburbs.
 Occupational hazards, e.g. in miners, submariners, etc.
Prevention of solar starvation includes the following measures:
 The increase of staying in the open air: a correct regimen for children is of great
importance.
 A correct planning of residential areas and buildings (distance from each other),
the observance of norms of natural lighting in premises.
 Struggle against atmosphere pollution.
The most effective way of solar starvation prevention is using preventive UVR in special
photaria with luminescent UV lamps in mines, in the Far North, at home for children in the pe-
riods of possible solar starvation.
Before administering the course of UV radiation it is necessary to determine a biodose
of UVR for each concrete person, because it is different for everybody.

60
Biodose of UVR and Its Definition
It is the minimal time of UVR causing a small erythema on not sunburnt skin (reddening
of skin) in 8-20 hours after UV irradiation. The minimal daily preventive dose of UVR is 1/8 part
of biodose, the optimal dose (treatment of rickets) is 1/2-1/4 of biodose.
Effect of Separate Components of Solar Radiation on Organism
Table 32
SPECTRAL DISTRIBUTION AND BIOLOGICAL ACTIVITY OF SOLAR RADIATION
Kind of
radiation
Wave
length
Mechanism Biological effect
Infrared 20000 –
760
Thermal Heating tissues,
intensifying
metabolism
Visual 760 – 400 Thermal, weak
photochemical
Sensation of light,
irritation of CNS
Ultraviolet: 400 – 180 Photochemical Formation of mela-
nin;
Bactericidal, ery-
themic effect;
Synthesis of vitamin
D in the skin;
Fluorescent effect
Range A 400 – 315
Range B 315-280
Range C 280 – 180
Range D 285 – 265
Ultraviolet (UV) Ray
The most biologically important part of solar spectrum is UV-rays. The length of a wave
is 10-400 nanometers. The mechanism of action is a photochemical effect: on their entry into
the skin the biologically active substances are formed (histamine, choline, acetylcholine, etc.)
causing photochemical erythema of the skin (its signs are precise borders, then melanin forma-
tion).
Types of biological effect of UVR are as follows:
 getting sunburn (melanin formation), fluorescent at UVR effect in area A (the
length of wave is 400-315 nm)
 erythematous, bactericidal — area B (315-280 nm)
 luminescent with increasing the previous effects — area C (280-20 nm)
 antirachitic — area D (285-265 nm).
In optimal doses UV produces a common strengthening effect, stimulates growth and
regeneration of tissues, improves metabolism and functions of endocrine and immune sys-
tems.
Overdosage of UVR (a sharp effect) causes photoerythema, dermatites, burns, increase
of body temperature, photoelectric ophthalmia.
A chronic effect of big UVR doses results in deterioration of health state, decrease of
capacity for work, aggravation of chronic diseases; it is a risk factor of skin cancer — in south-
ern areas skin melanomas in population are 4-5 times more frequent than in the Northern
areas.

61
Visible Light
The length of wave is 400-760 nm; it has a slight photochemical effect — a photosensi-
bilization action on optic nerves in retina. There is also a slight thermal effect — inhibition of
light quanta in tissues.
It stimulates the CNS through excitation of the visual center, has a positive effect on
emotional state of the man, function of cardiovascular system and other systems.
At excessive intensity it may have a blinding effect down to destruction of photosensitive
elements and development of retinitis — inflammation of retina.
Infrared Rays (IR)
The length of wave is more than 760 nm. Their main effect is thermal — increase of os-
cillatory and rotational movements of molecules in tissues. They intensify the biological effects
of UVR. Two parts in infrared rays are distinguished:
 long-wave infrared rays — more than 1500 nm;
 short-wave infrared rays — 760-1500 nm.
Biological effects of infrared rays are the following: hyperemia of skin and internal or-
gans, increase of gas exchange in tissues, strengthening of secretory function of kidneys,
analgesic effect, elimination of inflammatory foci. They are widely applied in physiotherapy.
At excessive intensity of infrared irradiation the following may occur:
 heating of brain membranes causing heatstroke and fainting,
 damage of crystalline lens by short-wave IR-rays leading to cataract
 burns on skin of different degree of severity.
Hygienic Requirements to Natural Lighting (Illumination)
At estimation of natural lighting in premises the following should be taken into account:
 Orientation of windows according to the compass points;
 Distance to the neighbouring buildings, plants (in norm distance between build-
ings should make up 1.5 of their height, trees should be not closer than 10 m to
buildings, schools;
 Size, number, form of windows in a premise; % of window sashes should make
up 25 % of window area;
 Availability of extraneous objects on windows. Curtains, green plants, etc. are
not recommended in schools.
Then the quantitative parameters are estimated including:
 Light coefficient (LC) — the ratio of the total area of windows in a room to the
area of the floor. The LC in habitable rooms should be 1/8-1/10, in hospital
wards and consulting rooms of doctors — 1/5-1/6, in school classrooms — 1/4-
1/5, in operating rooms — 1/2-1/4.
 CNI — coefficient of natural illumination — the ratio of illumination in
workplace in Lux (by luxmeter) to light exposure in the open air in Lux, ex-
pressed in %. The normal CNI for habitable rooms makes up 0.5-0.75 %, for
wards — 1 %, classrooms — 1.5 %, operating rooms — 1.6-2%.
 Light angle — not less than 27 degrees.
 Ventiduct angle — not less than 5 degrees.
Luxmeter (the device for estimation of illumination) (Fig. 20).
A perceiving part of the device is a photocell transforming light energy into electrical
one. A recording part is a sensitive galvanometer graded just in lux. The received results are
compared with the established norms.
If the evaluation is made in the daytime, at first it is necessary to identify the illumination
created by mixed illumination (natural and artificial), and then after switching off the artificial
illumination. The disparity between the received data will make up the value of illumination
created by artificial illumination.

62
Fig. 20. Luxmeter
Hygienic Requirements to Artificial Illumination
The common requirements to artificial illumination are as follows:
 It should be sufficient by level of illumination,
 It should approximate by spectrum to natural light,
 It should be uniform in space not to create sharp contrasts in illumination, oth-
erwise tiredness occurs faster because of light adaptation,
 It should be uniform in time,
 It should not blind organs of vision.
The main parameter of sufficiency of artificial illumination is illuminance of surfaces in
lux. It is measured by luxmeter with the help of photocell.
Systems of artificial illumination are the following:
 Common — in a habitable room — 40-50 lux, classroom — 150 lux, operating
room — 300 lux (this is the norm for incandescent electric lamps, for lumines-
cent lamps it is 2 times more);
 Local — in a habitable room — 100 lux, classroom — absent, operating room
— 3,000-10,000 lux,
 Mixed — local and common illumination together.
The Hygienic Characteristics of Sources of Artificial Illumination
 Candles, oil-stoves, etc. are characterized by nonuniform illumination in time, air
pollution in premises;
 Incandescent electric lamps — their spectrum differs from natural light (there
are a lot of red beams);
 Luminescent lamps are characterized by non-uniformity in time, differences in
spectrum (there are a lot of blue beams).

63
Types of Lighting Fixtures
 Lamps of direct light have high contrasts in illumination resulting in blinding eyes
 Lamps of reflected light requiring a more powerful light source
 Lamps of diffused light (frosted glass spheres) are best of all.
Key Questions
1.Significance of solar radiation, the spectral structure of solar light.
2.Concept of solar starvation, reasons, manifestations and prevention.
3.Physiological effect of various components of a solar spectrum: UV, visible beams, IR–rays.
4.The basic sanitary-hygienic requirements to illumination.
5.Characteristics of light units.
6.Principles of estimation of natural and artificial illumination.
7.Hygienic estimation of natural illumination of premises.
8.Hygienic characteristics of systems and types of artificial illumination.
9.Hygienic requirements to illumination of habitable premises and classrooms.
10.Hygienic requirements to illumination of hospital wards.
11.Hygienic requirements to illumination of operating rooms.
Identifying the Parameters of Natural and Artificial Illumination
The aim of this work is to identify the parameters of natural illumination in a classroom
by students, i.e. to determine CNI (coefficient of natural illumination), light coefficient (LC), light
angle and ventiduct angle.
For estimation of sufficiency of natural illumination some parameters are applied. At hy-
gienic estimation of illumination as geometrical parameters the following are used:
 light angle
 ventiduct angle
 light coefficient
 premise depth
To lighting technology parameters the following refer:
 Coefficient of natural illumination (CNI)
 Illumination in the specified point of a workplace.
The artificial illumination can be estimated in the following way.
At inspection of premises for the purpose of illumination sufficiency it is necessary to fol-
low the scheme of inspection. All students of the group participate in performing the given task.
The course of independent work is drawn up by the proper protocols. In the protocol the follow-
ing should be reflected:
The task, sequence of its performance (scheme of object inspection).
The obtained results.
Conclusion with hygienic estimation of the received data and recommendations.
Estimation of Natural Illumination
Definition of light angle.
Light coefficient (LC) represents the ratio of glassed-in surface of windows (without
frames and window sashes) to the floor area. It is expressed by fraction, which numerator is 1,
and denominator — a quotient of dividing the area of premise by the area of a glass surface.
Task:
 To measure the area of all windows of a premise (room).
 To calculate the glassed-in surface of windows, subtracting 25 % of window
sash area from the found area.
 To measure the area of the floor.
 To divide the area of a glassed-in surface of windows by the floor area.
For example, the glassed-in surface of 3 windows available in the room makes up 3.6
m2; the area of the floor is equal to 30 m2. Hence, light coefficient = 3.6 : 30 = 1: 8.

64
Determination of light angles.
As the light coefficient does not take into account the shading effect of opposite build-
ings, trees and various architectural elements, the light angles should be determined.
Determination of light angle.
The light angle is formed by two beams, one of which (horizontal) is drawn from the
place of estimation (for example, a table surface) to a window frame, and another — from the
same point to the top edge of the window.
Task:
 To measure distance across from the middle of the table surface up to the win-
dow frame (а) and down from the windowsill up to the top edge of the window
(b).
 To find tangent of the light angle, having divided value ―a‖ by value ―b‖.
 According to the table of tangents (see Table below) to determine the value of
the light angle (α˚).
Table 33
Table of Natural Trigonometrical Values of Tangents
α˚ tg α α˚ tg α α˚ tg α α˚ tg α α˚ tg α α˚ tg α
1. 0.017 16 0.287 31 0.601 46 61 76 4.01
2. 0.035 17 0.306 32 0.625 47 62 77
3. 0.052 18 0.325 33 0.629 48 63 78
4. 0.070 19 0.344 34 0.675 49 1.15 64 2.05 79
5. 0.087 20 0.364 35 0.700 50 65 80 5.67
6. 0.105 21 0.384 36 0.727 51 66 81
7. 0.123 22 0.404 37 0.754 52 67 82
8. 0.149 23 0.424 38 0.781 53 1.39 68 2.47 83
9. 0.158 24 0.455 39 0.810 54 69 84
10. 0.175 25 0.466 40 0.839 55 70 85
11. 0.194 26 0.488 41 0.869 56 71 86
12. 0.213 27 0.510 42 0.900 57 72 3.07 87
13. 0.231 28 0.532 43 0.933 58 1.60 73 88
14. 0.249 29 0.554 44 0.966 59 74 89
15. 0.268 30 0.577 45 1.000 60 75 90
For example, the height of the window is 2 m (а), the distance from the window to
workplace (b) is equal to 3.5 m. Identify the value of light angle α˚. Hence we find tgα = 2: 3.5
which according to the table of tangents corresponds to angle of 30˚.
Definition of ventiduct angle.
This angle is formed by two lines, the upper one (the same as with the light angle) goes
from the place of illumination estimation to the top edge of the window, and the lower one is
directed to the highest point of shading object (for example, opposite house). Ventiduct angle is
determined by two students. First the angle adjacent to ventiduct angle (b) is defined. The first
student, having bent his head to the level of the table, imaginary draws a direct line from the

65
middle of the table surface to the highest point of the opposite building. The second student
standing at the window by instructions of the first student fixes by a hand the point of crossing
this line with the window glass and measures its distance from the windowsill (а1). Having di-
vided the received value (а1) by distance from the window up to the middle of the table surface
(b), they receive tangent of angle b.
For definition of ventiduct angle value (g) it is necessary to find the difference between
the light angle (a) and ventiduct angle (b).
For example: a — distance between the windowsill and the point of crossing of imagi-
nary line with a window frame equal to 1.5 m., b — distance from the window to the workplace
equal to 3.5 m. Hence: 1.5: 3.5 = 0.428. According to the table of tangents we find angle β =
23˚. Angle γ = 30˚- 23˚ = 7˚.
Estimation of workplace illumination.
The estimation of workplace illumination is carried out by luxmeter (see above).
Determination of premise depth
To determine this coefficient it is necessary to know the height of window from the upper
edge to the floor and distance between the external and internal walls (depth of a room). Esti-
mating these parameters, we get the required coefficient, which value in a workplace should be
1: 2.
Determination of coefficient of natural illumination (CNI)
CNI is the ratio of illumination at a given point of premise (room) to simultaneous exter-
nal illumination under the conditions of scattered light, expressed in percentage. CNI can be
determined experimentally with the help of luxmeter.
CNI = I in. x 100% / I ex. , where:
I in.— illumination in the given point of premise (room)
Iex.— illumination outside the premise (room).
Estimation of Artificial Illumination
It is necessary to determine type of sources (character of lamps: incandescent, lumines-
cent; type of lighting fixtures — lamps of direct, scattered, reflected light), amount of lamps and
their capacity. The latter should be divided by the area of premise, thus specific capacity of
lamps in watt per m2 is received.
Protocol of Independent Student Work
on the topic “Hygienic Estimation of Natural and Artificial Illumination”
I. Hygienic estimation of natural illumination
1. In classroom No___ there are______ windows, colour of walls is ______________,
colour of the ceiling is_____________, cleanliness of window glasses is______________, size
of piers between windows is _______.
2. Determination of CNI:
External horizontal illumination is _________ lux;
Illumination in a workplace is _________ lux.
CNI is ____________ %.
3. Determination of LC:
The area of glassed-in windows is __________ m2, area of floor is_____ m2. LC =
_______ .
4. Determination of light angle (drawing and calculations) ___________________.
5. Determination of ventiduct angle (drawing and calculations) ___________________.
II. Hygienic estimation of artificial illumination.
1. In classroom № ____ there is a ________________________ system of illumination,
the lamps of a ___________________________type are fixed.
2. Estimation of uniformity of artificial illumination:
Illumination in lux in points cornerwise _______________________.
Ratio of maximal and minimal illumination at a distance of 0.75 m _________, 5
m_______.
3. Estimation of illumination by a calculation method:
Number of lamps is__________, the floor area is_____________ m2.
Specific capacity of lighting fixture is_________ W/m2.

66
4. Conclusion (to give a hygienic estimation and recommendations on natural and artifi-
cial illumination):
Variant 1. The natural illumination of workplace is sufficient (for a classroom the LC is
1:4-1:6, light angle is not less than 27˚, ventiduct angle is not less than 5˚, illumination of
workplace is not lower than 150 lux, CNI is not less than 1.5 %).
The artificial illumination is sufficient (not less than 150 lux at incandescent lamps or 300
lux at luminescent illumination).
Variant 2. Natural and artificial illumination of workplace is insufficient (at lower values
of such parameters).
Self Test
1. Identify the light coefficient which should be in operating room:
A. 1:10
*B. 1:4
C. 1:8
D. 1:6
E. 1: 9
2. Which parameter reflects the value of natural illumination in a workplace?
A. light angle
B. premise depth
C. light coefficient
D. ventiduct angle
*E. CNI
3. How many times is the intensity of artificial illumination higher at application of day-
light (luminescent) lamps than at use of incandescent lamps?
*A. 2 times
B. 1 time
C. 10 times
D. 3 times
E. 5 times
4. The light coefficient is:
A. the ratio of illumination in the open air to illumination indoors
B. the ratio of light angle to ventiduct angle
*C. the ratio of floor area to the area of windows
D. the ratio of window area to tangent of ventiduct angle
5. The total artificial illumination of a school classroom is planned to provide with lamps
of a uniformly dispersing type and incandescent lamps. Identify the least value of
illumination in lux, which meets the hygienic requirements of artificial illumination
for the given type of premises.
A. 200
B. 250
C. 300
*D. 150
E. 350
6. Identify the range of ultraviolet radiation which has a bactericidal effect (in nanome-
ters):
A. 315-265
*B. 280-10
C. 380-300
D. 400-315
E. 320-280
Problem Solving
1. The glassed-in surface of 3 windows available in the room makes up 3.6 m2; the area

67
of the floor is equal to 30 m2. Identify the light coefficient.
2. The light exposure in the open air is 40,000 lux, CNI is 2 %. What is the illumination in
a workplace?
3. The depth of hospital ward is 5 m, its length is 6 m. In the ward there are 2 windows,
which glassed-in area makes up 2.7 m. The height of the top edge of the window is 2.8 m
above floor level. Orientation of windows is SE, the walls are of light warm colours. The light
angle is equal to 35˚, ventiduct angle — 10˚. Give a complex hygienic estimation of natural il-
lumination in the hospital ward.
Standard Answers:
1. Light factor = 3.6: 30 = 1: 8. It corresponds to norm for the given room.
2. The illumination in a workplace is equal to 40,000:2х100=800 lux.
3. LC = 30:2.7 = 1:10. All other parameters correspond to norm.
Theme No 6.
Hygienic Requirements to Drinking Water Quality
Significance of Water for Man
Water is of great physiological, hygienic and economic significance for man.
The following types of water consumption are distinguished:
 drinking — this type of water consumption is the most important for the health
of population; the most rigid requirements to its quality are established. Accord-
ing to the WHO data 80 % of all diseases on Earth are connected with poor-
quality water or with bad sanitary conditions of life caused by deficiency of clear
water.
 household — for providing normal sanitary conditions of life of population and
prevention of infections. The requirements to its quality are the same as to
drinking water.
 recreational — these are reservoirs and water areas used for rest, water
sports, etc. The requirements to its quality are rigid.
 balneologic water use includes baths, showers, inhalations, etc. Very high re-
quirements are set to quality of this water.
 industrial — use of water in technological processes in manufacture. There are
special requirements to its quality.
 meliorative — irrigation of soils in agriculture, etc. There are special require-
ments to quality of this water.
 fish-breeding — for cultivation of fish. The requirements here are sometimes
even higher than to drinking water because some kinds of fish are very sensi-
tive. On pollution of reservoirs toxicants can accumulate in fish and cause dis-
eases in people.
 transport — water transport, ports, etc.
Problems of Fresh Water on Earth
Only 3 % of water-supply on our planet are fresh water (the rest is seawater) intensively
used for the above-stated purposes of water consumption. Thus, resources of fresh waters are
located non-uniformly and are sufficient only for 20 % of densely populated areas, in other
places there is deficiency of water.
In addition to deficiency, fresh-water reservoirs have the greatest anthropogenic pollu-
tion that frequently makes them useless for water consumption.
UNESCO makes prognoses about real threat of water famine for mankind. A cardinal
way of solving water problem is desalination of seawater, but this method is very expensive;
besides seas and oceans are considerably polluted and on desalination toxic and carcinogenic
substances can form.

68
Physiological Significance of Water
A daily need for water in adult person in normal conditions makes up 2.5-3 l, in a hot
climate or on physical exertion — up to 10-12 l/day.
Water performs a structural role — the organism of the adult consists of water for 51-
66%, and organism of a child — for 80-90 %.
Besides, water is a weak electrolyte dissociating into ions of Н+ and OH- which are cata-
lysts of biochemical reactions and water is the medium of these reactions.
Hygienic Requirements to Drinking Water
Documents Regulating Quality of Water
There are two State Standards (SS) of water quality:
 The State Standard "Drinking Water".
 The State Standard "Water of Sources of Centralized Water Supply".
The latter State Standard contains less rigid requirements to quality of water; it is in-
tended for choice of water supply source, then the water passes purification and disinfecting
and after that in a water pipe it should correspond to SS "Drinking Water".
WHO developed the International Standard of Drinking Water (ISDW-73), which prac-
tically coincides with Russian State Standard .
The Criteria of Quality of Drinking Water
The common requirements to quality of drinking water are the following:
 Water should have satisfactory organoleptic properties.
 Water should be harmless according to its chemical composition, both natural
and anthropogenic.
 Water should be safe in epidemiological respect.
These criteria are the basic group of parameters of drinking water in the State Standard.
THE STATE STANDART FOR DRINKING WATER
1. ORGANOLEPTIC INDICATORS
Smell & Taste of water Up to 2 points
Colouring or chromaticity of wa-
ter
Up to 20 degree
Turbidity Up to 1,5 mg/l
Transparency Up to 30 sm
Temperature 7 – 12 degree
2. CHEMICAL COMPOSITION
Dry rest (mineralization) Up to 1000 mg/l (1 g/l)
Chlorides Up to 350 mg/l
Sulphates Up to 500 mg/l
General Rigidity 7 – 10 mg-eq./l
Ammonia 0
Nitrites 0
Nitrates Up to 10 mg/l
Oxide ability 2 – 4 mg O2/l
Iron Up to 0,3 mg/l
Fluorine 0,7 – 1,5 mg/l
3. BACTERIOLOGICAL INDICATORS
Total Microbe Number Up to 100 in 1 ml
Coli-index Up to 3 in 1 l
Coli-titer More 300 ml

69
Organoleptic Properties of Drinking Water
Smell and taste — up to 2 points. These properties are determined in the open and
closed experiments on people with application of 1-5-point scale: point 0 means absence of
smell and taste, point 1 — smell and taste is determined only by an odorator — a person with
the increased sensitivity to smell and taste, 2 — a consumer does not pay attention to smell
and taste, 3 — appreciable — causes a negative attitude to water, 4 — distinct — limits water
consumption, 5 — very strong — water is unsuitable for drinking).
Colouring or chromaticity of water — up to 20 degrees. It is determined by a scale of
ampoules containing a chrome-cobalt solution of different color.
Turbidity — up to 1.5 mg/l or transparency — 30 cm. It is determined with the help of
special flasks — normally there must be the opportunity of reading a text through a 30-cm layer
of water.
Temperature — 10-12ºC. If temperature is below, catarrhal diseases may occur, if it is
higher, then оrganoleptic properties of water change.
Significance of Studying Organoleptic Properties of Water
 It is used for initial examination of water quality;
 Change of organoleptic properties is an indirect sign of organic pollution of wa-
ter.
Chemical Parameters of Water, Their Influence on a Human Organism
These parameters are of great importance because their changes to increase or de-
crease may cause different diseases.
The dry residue or mineralization of water — up to 1000 mg/l (1 g/l). At higher values
of dry residue (1400 mg/l and higher) changes of оrganoleptic properties of water, e.g. taste of
water, take place.
According to degree of mineralization, the following classification of water is suggested:
 water of low mineralization — 1-2 g/l,
 water of high mineralization — 10 g/l and over (seawater contains 35 g/l).
At use of high mineralization drinking water (especially at sharp change of water on
moving to other area) disorders of water-salt balance, retention of water in organism, dysfunc-
tions of digestive and excretory systems, metabolic derangements occur. The increase of dis-
ease incidence of cardiovascular, urinary systems, urolithiases is statistically proved in these
areas. With such water 25-100% of total amount of mineral substances of food ration gets in
organism.
On the other hand, it is experimentally and clinically proved that waters with low mine-
ralization (100 mg/l and less) are biologically deficient that results in increase of secretion
and acidity of gastric juice, disturbance of water absorption in gastrointestinal tract, derange-
ment of water-salt exchange, disorder of tubular reabsorption in kidneys, hypocalcemia, de-
crease of osmotic resistance of erythrocytes, etc.
The content of chlorides is up to 350 mg/l. They impart salt taste to water; in big con-
centrations they change water taste by more than 2 points. At increase of chlorides in water the
derangement of water-electrolyte exchange and dysfunction of kidneys occur. Arterial hyper-
tension, the so-called "salty hypertension" is encountered in the areas with salty water 4 times
more often. At concentration of chlorides over 500 mg/l the inhibition of secretion and acidity of
gastric juice occurs.
It is an indirect parameter of organic pollution of water with household sewage as there
are a lot of chlorides in urine.
The content of sulfates is up to 500 mg/l. They impart bitter taste to water by more
than 2 points. At their increase the inhibition of gastric secretion, disturbance of intestinal ab-
sorption, reflex diarrhea can occur.
It is also an indirect parameter of organic pollution of water as lots of sulfates are found
in faecal masses.
General hardness of water is up to 10 mg–equivalent/l. It depends on content of cal-
cium and magnesium ions. Hardness of water is classified as eliminable (eliminated at boil-

70
ing), non-eliminable (preserved in water after boiling) and common (the last is normalized by
SS).
Classification of water according to general hardness:
 up to 3.5 mg-eq/l — soft water
 3.5 — 7 mg-eq/l — water of average hardness
 7 — 14 mg-eq/l — hard water
 over 14 mg-eq/l — very hard water.
In hard water it is difficult to do washing (expenditure of washing powder on binding
salts), to cook food. Protein absorption is worsened as insoluble complexes with salts form.
Problems of water supply arise as deposits on pipes form (eliminated hardness).
Nitrogenous Substances in Water (Ammonia, Nitrites, Nitrates)
Ammonia and nitrites should practically not be present in water, nitrates — up to 10 mg/l
(converted into nitrogen). As these are the final links of protein disintegration, they give the
possibility to judge about organic pollution: if only ammonia is revealed in water, then it is the
recent pollution, only nitrates — the old one, all nitrogenous substances — the persisting pollu-
tion. It is an indirect parameter of organic pollution of water.
At increased content of nitrates and nitrites (caused by organic pollution of reservoir or
water flushing of nitric fertilizers into it) a specific illness — water-nitrate methemoglobinemia
— may develop which is especially dangerous for children of the first months of life.
Water oxidizability and biochemical consumption of oxygen (BCO). It is an impor-
tant index of amount of organic substances in water as for their oxidation more О2 is required.
Normally water oxidizability is 2-4 mg О2/l. The dynamics of water oxidizability for 5 or 20 days
(BCO) is a criterion of oxygen regimen of reservoir which is studied for normalization of pollu-
tants in reservoir water.
The content of iron is up to 0.3 mg/l. Its source is a natural structure or water pipes. At
high content of iron colouring of water changes.
The content of fluorine is 0.7-1.5 mg/l (in hot climate it may be 0.7 mg/l as more water
is used, in cool climate — 1.5 mg/l). The reason of the abnormal content of fluorine in water is
biogeochemical provinces and anthropogenic sources (superphosphate plants). At small con-
tent of fluorine in water caries may develop in people, at increased content — fluorosis (spotty
damage of dental enamel, derangement of Са-Р exchange, fluoric cachexy, deformation and
fragility of bones).
! Bacteriological Parameters of Water !
All over the world the following parameters of microbe pollution of water are used:
 total number of microorganisms in water
 the content of colibacillus (E.Coli) as a constant inhabitant of sewage and a rela-
tively steadier microbe than others to disinfection of water shows efficiency of
disinfecting water.
Total microbe number (TNM) — up to 100 per 1 ml — amount of microbe colonies at
inoculation of 1 ml water in a Petri dish at 37ºС for 24 hours.
Coli index — up to 3 per liter — quantity of colibacilli per liter of water.
Coli titer — not less than 300 — quantity of water in 1 milliliter per 1 colibacillus.
Epidemiological Significance of Water
It is common knowledge nowadays that water factor plays a leading role in occurrence
of number of infectious diseases, such as:
 enteric infections — typhoid, cholera, paratyphoid, dysentery, etc.
 anthropozoonoses — brucellosis, tularaemia, Siberian plague, leptospirosis,
 viral infections — hepatitis, poliomyelitis, adenoviruses,
 pathogenic protozoa — lamblias, amoebas, balantidia, etc.
 parasitic worms.

71
Signs of Epidemiological Hazard of Water
 direct — deterioration of bacteriological parameters of water, availability of pa-
thogenic microbes;
 indirect — deterioration of organoleptic parameters, increase of amount of chlo-
rides, sulfates, nitrogenous substances, water oxidizability.
Signs of water epidemic (epidemic by a water-way transmission) are
the following:
 Quick mass episode of the same infectious diseases.
 Territorial relation of disease episode to the certain water source.
 After taking antiepidemic measures in the focus of infection (prohibition of using
a water source, disinfection of water) a sharp decrease of disease incidence is
observed, only separate cases are registered ("epidemic tail").
 Hot season presents better conditions for reproduction of causative agents, be-
sides a person consumes a lot of liquid, hence acidity of gastric juice — barrier
to microbes — is reduced.
Key Questions:
1.Physiological and hygienic significance of water.
2.Documents regulating quality of water and requirements to sources of water supply.
3.Rules of taking water tests for chemical and bacteriological researches.
4.Organoleptic parameters of water quality, methods of its research, norms.
5.Chemical parameters of water quality and diseases connected with their deviations.
6.Bacteriological parameters of water quality. Epidemic significance of water. Signs of water
epidemics.
7.Chemical parameters of organic pollution of water.
8.Direct and indirect parameters of organic pollution of water.
9.Water-nitrate methemoglobinemia, its causes and prevention.
1. Determination of organoleptic parameters of investigated water:
temperature of water: 12-14ºС in norm is determined by a thermometer;
c) transparency of water: drinking water should be completely transparent,
allowing through a layer of 30 cm to read a text of Snellen test type;
d) turbidity is determined by amount of suspension particles per 1 litre of
water, they should be not more than 1.5 mg/l;
e) colour: drinking water should be colourless (not higher than 20º) by the
scale of ampoules with chrome-cobalt solution;
f) taste and smell of water: they are determined at a room temperature
(20ºС) and at heating of water up to 60ºС, taste and smell are estimated
by a six-point system (0-5). Water with smell and taste of not more than
2 points is considered acceptable for drinking.
2. Qualitative evaluation of chemical substances in investigated water.
Determination of:
 pH of water is evaluated by litmus paper (in norm 6.5-8.5), that corresponds to
colours from yellow to green.
 ammonia (NН3): to investigated water we add 3-4 drops of Nessler‘s reagent,
the appearance of yellow colouring indicates the presence of ammonia. In nor-
mal water NН3 should be absent.
 salts of nitric acid (nitrates): to 2-5ml of investigated water in a porcelain test
add some crystals of diphenylamine, then some drops of sulfuric acid. The
presence of nitrates is indicated by dark blue colouring. The norm of nitrates in
water is up to 10 mg/l.
 salts of sulfuric acid (sulphates): to the tested water add some drops of hy-
drochloric acid, 2-3 drops of 10 % solution of barium chloride. The presence of
white dreg quickly forming a precipitate indicates the availability of sulphates.

72
Their norm in water is up to 500 mg/l.
 chlorides: the chloride salts form due to the presence of a silver solution (reac-
tion of a silver mirror). To 5 ml of investigated water in a test tube add some
drops of silver nitrate, the presence of chlorides is indicated by white dreg. The
norm of chlorides is up to 350 mg/l.
 iron: to investigated water add 2-3 drops of nitric acid and then 2-3 drops of
ammonium thiocyanate solution. The presence of salts of iron is indicated by the
orange-red colouring, its intensity depending on concentration of salts of iron.
Their norm in water is up to 0.3 mg/l.
Algorithm of Students’ Practical Work
The first stage. Testing the initial level of students‘ knowledge and skills.
The second stage. Active participation in discussion of key questions of the theme.
The third stage. Independent work on determination of some organoleptic and chemical
parameters of water.
The fourth stage. Problem solving and final testing on the theme.
Self Test
1. Name the basic groups of parameters of drinking water quality.
*A. organoleptic
*B. chemical
*C. bacteriological (microbiological)
D. toxicological
E. helminthologic
2. The transparency of drinking water is determined by a text of standard test type
(named after the author)
A. Heiner
B. Giss
C. Herbar
D. Stocks
*E. Snellen
3. The qualitative reaction to chloride content in water is:
*A. reaction with silver nitrate
B. reaction with nitrate solution
C. reaction with sulphuric acid
D. reaction with nitric acid
E. reaction with natrium chloride
Final Testing on the Theme
1. In an hour after feeding a baby with a milk formula, the following symptoms of disease de-
veloped in it: cyanosis of lips, mucous membranes, face, then nausea, increased saliva-
tion, pain in the stomach, vomiting, diarrhea. The called in pediatrician stated the phe-
nomena of cardiopulmonary decompensation in the child. In the course of investigation
it was established that water from a well was taken to prepare milk formula. What diag-
nosis was established by the doctor?
A. nitrate intoxication
B. food toxicoinfection
C. staphylococcus toxicosis
D. food poisoning with heavy metals
E. sulphate intoxication
2. For water supply of the city the water is used containing: fluorine — 2.0 mg/l, nitrates — 43
mg/l, chlorides — 250 mg/l, iron — 0.2 mg/l, residual chlorine — 0.5 mg/l. Identify the
disease which may develop in population at use of water with the given chemical struc-
ture:
A. dental caries
B. thyrotoxicosis

73
C. methemoglobinemia
D. fluorosis
E. endemic goiter
3. The chemical analysis of water from a well has indicated the presence of increased concen-
tration of nitrates, iron and sulphates. What parameter of water quality can testify to re-
cent pollution of water by organic substances of an animal origin?
A. nitrates
B. ammonia
C. nitrites
D. sulphates
E. chlorides
Problem Solving
1. In people of a city district the non-uniform colour of teeth was marked. On incisors the
white spots and cross brown strips were observed. Drinking water from a deep borehole was
suspected in occurrence of these symptoms. What microelement of water components could
have caused the disease?
2. The mountain lake is situated outside the inhabited locality. There is wood around it,
lakeside is sandy, stony. The analysis of water revealed the following: taste, smell — 1 point,
ammonia and nitrites are absent, colour — colourless, nitrates — 40 mg/l, transparency — 40
cm, chlorides — 50 mg/l, coli titer — 300, microbe number — 65. Give a sanitary estimation of
water.
3. Disease incidence of caries among the inhabitants of town N. makes up 89 %. It is
established that water contains 0.1 mg/l of fluorine. What preventive measures should be car-
ried out?
Standard Answers:
1. Fluorine
2. Water is suitable for drinking
3. Fluorination of water.
Theme No 8.
Hygiene of Water Supply. Methods of Improving Water Quality
Hygienic Characteristics of Water Supply Sources
There are 4 types of water supply sources:
 Surface water (open reservoirs) — rivers, lakes, water basins;
 Underground water:
 subsoil water is in the ground above the impervious layer — wells, springs;
 middle water — between the impervious layers — artesian wells;
 Atmospheric water (meteoric water) — accumulation of atmospheric precipitation,
 Desalination of seawater.
Hygienic Characteristics of Open Reservoirs
These are big supplies of water which are easily accessible. Their drawback is that they
are easily exposed to pollution for natural and anthropogenic reasons. Their chemical and mi-
crobe structure is inconstant that requires daily supervision of water quality.
Ways of Autopurification of Open Reservoirs
 Dilution in big water masses
 Sedimentation
 Biochemical oxidation by microflora
 Adsorption by hydrobionts
 Bactericidal effect of UVR in top layers — up to 50 cm

74
 Neutralization.
Estimation of Pollution Degree in Open Reservoirs
Methods of estimation of pollution degree in open reservoirs are as follows:
 Comparison of water parameters with SS or maximal permissible concentration — ana-
lytical monitoring;
 Medical-hygienic monitoring includes observation of changes of health parameters in
people using water from the given reservoir;
 Ecological monitoring is carried out with application of hydrobiological parameters:
 sensitive — indicatory organisms, e.g. trout;
 organisms–filtrators, e.g. mussels — by accumulation of pollutants in them;
 qualitative and quantitative characteristics of hydroecosystems.
Hygienic Characteristics of Underground Water
Subsoil water. It is better protected from pollution than water in open reservoirs, yet
subsoil water in wells is frequently polluted.
Inter layer water is practically sterile, but it also has drawbacks: there are small supplies
of such water, its extraction is expensive and it is frequently highly mineralized and highly
thermal.
Atmospheric Water
This source is rather changeable, besides atmosphere is considerably polluted, so this
water is polluted as well. As this water is low mineralized it causes health disorders.
Desalination of Seawater
It is a very expensive matter requiring a lot of electric power. As seawater is polluted, at
its boiling toxic substances can form.
Hygienic Characteristics of Water Supply Systems
There are 2 systems of water supply:
 Centralized system — a city water pipe. Its structure includes:
 Basic constructions (water supply point, pump stations, sewage disposal plants),
 Distributive network (pipeline, internal water supply system).
 Decentralized system — small rural water pipes, wells. This system is worse in hygienic
respect as it does not have complex sewage disposal plants.
Zones of Sanitary Protection of Water Sources
 Zone of strict regimen. It includes water supply point, basic constructions of
water pipe.
 Zone of restrictions — it is the whole or partial area of water reservoir. There is
a restriction of locating objects of possible pollution of water sources.
 Zone of supervision. Supervision over epidemic conditions (cases of infectious
diseases) in a big territory is carried out with the purpose of improvement of pu-
rification and disinfecting water at unfavourable epidemic conditions.
Methods of Improving Water Quality
They are divided into 3 basic groups:
 Methods of water purification — removal of mechanical impurities and im-
provement of organoleptic parameters of water (turbidity, colouring).
 Methods of water disinfecting — destruction of microflora in water.
 Special methods of improvement of water quality — desalination, dechlorination,
fluorination, defluorination, deodorization, decontamination, deactivation of wa-
ter.
Methods of Water Purification
Water purification is carried out by means of water precipitation and filtration through fil-
ters (slow and fast filters). For acceleration of purification the coagulation of water is applied,
i.e. adding salts of Al or Fe, which results in formation of flakes with calcium or magnesium

75
salts in water. Nowadays flocculants are used, e.g. polyacrylamide, etc.
Control of efficiency of water purification is carried out according to:
 organoleptic parameters — turbidity, colouring, smell, taste;
 oxidability of water.
Methods of Water Disinfection and their Hygienic Estimation
There are 2 groups of disinfection methods:
 physical
 chemical
Physical methods of disinfecting include the following:
 boiling has a favourable bactericidal effect, but it is a very expensive method.
As a great amount of power is consumed, this method is applicable only in do-
mestic conditions.
 UVR has a 100 % effect, but it requires a great amount of power and purifies
small volumes of water, as in clean water UV penetrates through 50 cm only, in
muddy water — even less.
 gamma irradiation is seldom used, as it requires complex equipment, consti-
tutes a threat of irradiation to personnel and induces water radioactivity.
 ultrasonic irradiation is a complex method affecting personnel.
Chemical methods of water disinfection are as follows:
 ozonization — action of atomic oxygen produces a good bactericidal effect.
The method requires great power consumption. It improves organoleptic proper-
ties of water. Full destruction of toxic substances in water takes place.
 oligodynamic effect of silver ions, for example, "sacred water" in churches.
Ions of silver have a bactericidal effect. It is a very expensive method.
 chlorination of water is the most widespread method because of it is cheap.
Chlorination of Water
On entering chlorine into water the hydrolysis of chlorine takes place with formation of
hydrochloric and hypochlorous (HOCl) acids dissociating into Н+ and OCl- ions producing a
bactericidal effect.
The Scheme of Chlorination
90 % of chlorine are bound with various substances in water and inactivated (chlorine
absorptivity), the residual or free chlorine is left. For sufficient bactericidal effect it should be in
amount of 0.3-0.5 mg/l (if it is below, no bactericidal effect is produced, if higher — the change
of water smell by more than 2 points occurs).
Chlorine absorptivity + residual chlorine = chlorine necessity for water. It is determined
at experimental chlorination during practical classes.
Types of Water Chlorination
 According to chlorine necessity or chlorination by normal doses of chlo-
rine under the control of content of residual chlorine amounting to 0.3-0.5 mg/l.
For improvement of bactericidal effect there are other kinds of chlorination:
 Superchlorination — application of big doses of chlorine exceeding the chlo-
rine necessity of water. It is used for extremely polluted water, unknown waters
by bacterial indications (field conditions), by epidemic indications. After that wa-
ter requires dechlorination through activated coal, hyposulfite.
 Double chlorination — introduction of chlorine before and after water purifica-
tion — is the increased time of chlorine action, but the formation of toxic chlo-
rine-organic substances increases.
 Chlorination with pre-ammonation — introduction of chlorine and ammonia
into water, thus chloramines are formed having a greater bactericidal effect,
there is no "chemist's" smell as at usual chlorination when in water chlorphenols
can be formed.
Disadvantages of Water Chlorination:
 Deterioration of organoleptic properties of water (smell),

76
 Disinfection is not always reliable (presence of hepatitis viruses, etc.),
 At water pollution during chlorination toxic chlorine-organic substances are
formed, such as chloroform, tetrachlorethylene, etc, having a mutagenic and
carcinogenic activity.
Problems of Water Pollution
The basic sources of reservoir pollution are:
 Natural — floods, ice drifts, rotting of biota, "flowering of water", seasonal fluc-
tuations of number and dying off hydrobionts, etc.
 Anthropogenic — household sewage, industrial sewage, agricultural drainage,
regulated stream of rivers (dams, water basins), water transport, port works,
dumping waste products in reservoirs, atomic power stations and military nuc-
lear grounds, recreational loading on reservoirs.
Ecological and Hygienic Consequences of Reservoir Pollution
 Hygienic negative consequences:
 restriction or full liquidation of water use for population,
 health disorders of population (water epidemics, acute and chronic poisonings, the
remote effects),
 deterioration of sanitary life conditions of population, restriction of settlement devel-
opment,
 accumulation of dangerous levels of toxicants and microbes in fish products,
 pollution of contact environments — air, ground, underground waters.
 Ecological negative consequences:
 reversible and irreversible changes of hydroecosystems,
 decrease of efficiency and biomass of hydroecosystems,
 loss of rare and valuable species of hydrobionts,
 succession of hydroecosystems.
Basic Directions of Protection of Water Reservoirs from Pollution
These include:
 Administrative-legislative measures (laws, Sanitary Standards, etc.).
 Hygienic measures:
 Preventive sanitary inspection
 project appraisal of industrial and other objects, sewage disposal plants as to ob-
servance of MPD (maximum permissible discharges) into reservoirs;
 Normalization of harmful substances in water.
 Current sanitary inspection — the control over content of harmful substances and mi-
crobes in reservoir water, control of efficiency of purification and disinfecting water,
control of water supply system and observance of norms of water consumption.
 Architectural-planning measures — zones of sanitary protection of water sources.
 Medical monitoring includes studying state of population health depending on quality of
reservoir water.
 Ecological monitoring consists in researching the effect of pollution on hydroecosystems
and separate hydrobionts. Bioindication, biotesting are carried out.
 Technological measures include application of closed technology, decrease of industrial
water consumption, change of technology for decreasing toxicants in effluent, sewage
disposal plants for cleaning and disinfecting sewage, etc.
Key Questions:
1.Hygienic characteristics of water supply sources, zone of their sanitary protection.
2.Parameters of quality and pollution of water.
3.Methods of improvement of water quality. Methods of water purification and control over their
efficiency.
4.Methods of water disinfection, control over their efficiency.
5.Scheme of water chlorination, its types, disadvantages.

77
6.Special methods of improvement of water quality.
7.Basic sources of reservoir pollution and ways of their self-purification.
8.Standardization of harmful substances in reservoir water.
9.Basic directions of protection of reservoirs from pollution.
Self Test
1. The amount of residual chlorine in water in norm makes up:
A. 0.1 mg/l
B. 0.2 mg/l
*C. 0.3 mg/l
D. 0.4 mg/l
E. 0.5 mg/l
2. Identify the chemical element which salts are applied for water coagulation?
*A. Aluminium
B. Fluorine
C. Silver
D. Iron
E. Copper
Final Testing of Students’ Knowledge
1. At substantiation of size of the 2nd sanitary protection zone of water supply sources the du-
ration of water purification from microbes is taken into account. What period of time is
necessary to purify underground water from microbes?
A. 400 days
B. 200 days
C. 50 days
D. 5 days
E. 3 days
2. The military unit after a long march has stopped for 3 seasons to have a rest near the inha-
bited locality. According to the data of sanitary-epidemic investigation some water
sources are revealed. It is necessary to choose a source, which to a great extent meets
the hygienic requirements to drinking water in field conditions.
A. well water
B. artesian well water
C. river water
D. rain water
E. melted snow
Problem Solving
1. What parameters should testify to reliability of carried out disinfection of water in case
of applying a hyperchlorination method?
2. At a distance of 20 m from apartment house there is a mineshaft, which is 10 m from
a toilet and 15 m from the neighbouring house. What distance should be according to sanitary
norms between the well and a source of possible pollution of water?
3. A typhoid epidemic of water origin after the water pipe failure has been registered in
inhabited locality N. What are the main signs characteristic of the water epidemic?
Standard Answers
1. Residual chlorine — 0.5 mg/l, coli titer — 100, coli index — 10
2. 30 m
3. The contingent of ill population lives in the same district and a sharp increase of dis-
ease incidence, decrease of disease incidence after liquidation of water pipe failure, epidemic
tail are characteristic.
Methodical Recommendations for Students’ Independent Work
During the work the students should carry out laboratory researches to determine resi-

78
dual chlorine in water and estimate needs of researched water in chlorine.
Determination of Residual Chlorine in Water
The procedure is started with an experimental chlorination of water, and then the deter-
mination of residual chlorine by titration is carried out by the students.
Experimental Chlorination
The purpose of experimental chlorination is to determine the necessary dose of chlorine
at chlorination by normal doses. The choice of a chlorine dose is made by a three-glassful me-
thod and is usually carried out in field conditions.
Table 34
Method of Carrying out an Experimental Chlorination
Water 200 ml 200 ml 200 ml
1 % chloride lime solution 2 drops 4 drops 6 drops
5 % solution of potassium iodide 5 ml 5 ml 5 ml
Water solution of hydrochloric acid
at a ratio of 1 : 3
1 ml 1 ml 1 ml
1 % amylum solution 1 ml 1 ml 1 ml
Sodium hyposulphite solution 0.01 N by drops up to decolorization of
content in a flask
(20 Drops = 1 ml of Sodium hypo-
sulphite solution 0.01 N)
Fill three conic flasks with 200 ml of investigated water each. To the 1st flask add 2
drops of 1 % solution of lime chloride, to the 2nd — 4 drops and 3rd — 6 drops of this solution.
Intermix the content of the flasks by a rotary movement and leave it for 15 minutes. After that
add to each flask 1 ml of a hydrochloric acid solution at a ratio of 1:3, then 5 ml of 5 % solution
of potassium iodide and 1 ml of 1 % Amylum solution. Shake up the flasks actively. The pres-
ence of free chlorine in water is indicated by dark blue colour; the more chlorine, the more in-
tensive colouring. In the flask, where all chlorine was spent, the colouring will not take place.
Chlorine, as the most active colloid, displaces iodine in potassium iodide, and iodine with amy-
lum causes a dark blue colouring.
Identification of Residual Chlorine
Residual chlorine is determined in painted flasks. Pour the solution of sodium hyposul-
phite from a pipet by drops into a flask up to decolorization of the flask content. At titration after
each added drop shake up the flask with a rotary movement. Then convert the amount of drops
of sodium hyposulphite, used for titration of water in each flask to millilitres (20 drops on aver-
age are contained in 1 ml). Identify the residual quantity of chlorine in each flask according to
the formula:
Х = 0.355  A х 5 , where
Х — residual chlorine in milligrams (mg) per litre;
0.355 — amount of chlorine in milligrams corresponding to 1 ml of sodium hyposulphite;
A — amount of 0.01 N of Sodium hyposulphite solution in ml used for titration of 200 ml
of water;
5 — converting per 1 litre of water.
Determination of Requirement for Lime Chloride Amount at Chlorination of Water
The calculation of the necessary amount of 1 % solution of lime chloride for chlorination
of 1000 litres (1 cubic meter) of water:
Of three flasks of investigated water to select the one in which the content of residual
chlorine is within the limits of 0.3-0.5 mg of chlorine per litre.
To convert the amount of drops of 1 % lime chloride solution added to the given flask at

79
experimental chlorination to milliliters (1 ml contains 20 drops on average). The amount of dry
lime chloride in grams necessary for decontamination of 1 m3 of water is determined according
to the formula:
where:
Х — amount of lime chloride in grams per 1 m3 of water.
В — amount of 1 % solution of lime chloride (in ml) added to flask at experimental chlo-
rination;
1000 — converting per 1 m3 of water;
100 — converting to grams of dry lime chloride.
Conclusion: 1 gram of dry lime chloride per 1 m3 of water is necessary for decontami-
nation of investigated water.
For example: We titrate 200 ml of water in 3 flasks. To the 1st flask we add 2 drops of
0.01 N solution of sodium hyposulphite, to the 2nd — 4 drops and 3 flask — 8 drops of the so-
lution. What is the necessary quantity of dry lime chloride for disinfection of water (in grams per
1 m3 of water)?
Solution
1) 1 ml of 0.01 N solution of sodium hyposulphitum contains 20 drops. To the 1st flask we
add 2 drops
1 ml — 20 drops
Х ml — 2 drops
2) 1 ml of 0.01 N solution of sodium hyposulphite contains 20 drops. To the 2nd flask we
add 4 drops
1 ml — 20 drops
Х ml — 4 drops
3) 1 ml of 0.01 N solution of sodium hyposulphite contains 20 drops. To the 3rd flask we
add 8 drops
1 ml — 20 drops
Х ml — 8 drops
4) Residue of chlorine in each flask is determined according to the formula:
Х = 0.355  A х 5
In the 1st flask: 0.1 х 5 х 0.355 = 0.17 mg of chlorine per 1 litre;
In the 2nd flask: 0.2 х 5 х 0.355 = 0.35 mg of chlorine per 1 litre;
In the 3rd flask: 0.4 х 5 х 0.355 = 0.71 mg of chlorine per 1 litre.
We select flask № 2, where the residual chlorine is within the norm. (N = 0.3 — 0.5 mg of
chlorine per litre).
To the 2nd flask we add 0.2 ml of sodium hyposulphite (4 drops).
5) The amount of dry lime chloride in grams necessary for decontamination of 1 cubic me-
ter of water is determined according to the formula:
Conclusion
The amount of dry lime chloride for decontamination of 1 cubic meter of water is equal

80
to 10 grams.
Theme No 9-10.
Hygienic Significance of Soil. Hygiene of Inhabited Locality.
Hygienic Requirements to Cleaning Inhabited Locality from Waste Products
Soil is one of the important objects of environment where the processes of autopurifica-
tion take place; in the soil many chemical and microbe pollutants can accumulate, getting then
into foodstuffs, atmospheric air, surface and underground waters.
The basic hygienic parameters of soil are:
 Porosity. The more the porosity is, the less the water is filtered, and much of it
remains in the ground forming marshy soil which is unfavourable for the man.
 Air permeability is connected with porosity of soil — the more the air permea-
bility is, the more oxygen enters the soil and more biochemical processes of au-
topurification take place;
 Water penetration, i.e. filtration ability — at sufficient values the ground is dry,
and reserves of subsoil waters form there.
 Capillarity — the more the capillarity of ground is, the higher the subsoil waters
rise.
Structure of the Soil
The soil consists of mineral, organic, mineral-organic complexes, soil solutions, air and
soil microflora. These are important parameters for hygienic estimation of soil, their changes
can testify to pollution of soil.
In the soil 2 processes constantly take place:
 Disintegration of organic substances into inorganic — nitrification
 Synthesis of new organic substances called humus — humification.
Sharp disturbance of correlation of these processes testifies to pollution.
The soil microflora is characteristic of each kind of soil and is the basis of autopurifica-
tion processes of soil. It is estimated by total microbe number (TMN) and amount of the basic
groups of microbes.
Hygienic Significance of Soil
 Endemic significance is the main factor of formation of natural and technogenic bio-
geochemical provinces with abnormal content of mineral substances that may through
foodstuffs and water cause endemic (characteristic for the given district) diseases of the
person. The majority of such diseases refer to microelementhoses (classification and
representatives — see in the theme on mineral substances).
To artificial biogeochemical provinces now the accumulation of pesticides, heavy metals,
etc. in the ground refer. There are data about the interrelation of health state of popula-
tion in these territories with the level of accumulation of these toxicants in the ground.
 Epidemiological significance of soil
The causative agents of different diseases can get into the ground and long be kept
there causing the following:
 Intestinal infections — typhoid, paratyphoid, dysentery, cholera, etc.
 Anthropozoonoses — anthrax, etc.
 Viruses — hepatitis, etc.
 Helminthiases — ascaridiasis, etc.
With soil dust the causative agents of tuberculosis, poliomyelitis, respiratory system dis-
eases, etc. can spread.
 Ecological significance of soil
 It is the environment of accumulation and circulation in the nature of pollutants of

81
physical, chemical and biological origin;
 It is a source of pollution of other environmental objects — foodstuffs, atmosphere,
surface and underground water;
 It is the environment of utilization and sterilization of solid and liquid waste products,
garbage, sewage, animal and human corpses.
At sufficient self-cleaning ability the soil is a primary factor of autopurification of envi-
ronment.
Ways of autopurification of the soil are the following:
 Decomposition of pollutants by means of mineralization and humification which
is due to the soil microflora, О2, enzymatic activity of the soil;
 Adsorption of pollutants by soil particles;
 Washout by subsoil waters;
 Evaporation into air above the soil;
 Oxidation of toxicants by О2 and effect of UVR in higher layers of the soil;
 Neutralization of toxicants in acid or alkaline soil.
Concept of Soil Pollution
By definition of UNEP the ground pollution is chemical substances, biological organisms
and products of their vital functions encountered in the ground not in a proper place, time and
amount.
The Basic Sources of Soil Pollution
They can be divided into natural and anthropogenic.
Natural sources include dying off plants and animals, floods, earthquakes, volcanoes,
fires, etc.
Anthropogenic sources are subdivided into:
 Sources brought into the ground by a person purposefully:
 agrochemicals — pesticides (herbicides are used for struggle against weeds) and
fertilizers promote the formation of artificial biogeochemical provinces affecting the
health of population.
 burial places of people and animals, fields of sewage cleaning are microbe pollution
of ground for many years.
 Sources got into the ground casually — with industrial and household sewage, dump
places, atomic power station, from atmospheric air, surface waters, etc.
Soil Protection Against Pollution
The main directions of soil protection against pollution are the following:
 Administrative–legislative measures: laws and executive decrees of authorities on pro-
tection of soil against pollution.
 Preventive sanitary control includes building project appraisal and normalization of
pollutants in the soil;
 Current sanitary control is monitoring of pollution levels by direct and indirect signs
and its comparison with standards.
 Architectural measures — a correct location of dumps, areas for waste products, etc.
 Medical monitoring — studying endemic and epidemic diseases in the region connected
with soil pollution.
 Ecological monitoring — the control of soil microflora and other biota.
 Technological measures on prevention of soil pollution.
Hygiene of Inhabited Localities
Hygiene of inhabited localities is an important section of municipal hygiene setting hy-
gienic requirements to location, layout and functional zones of inhabited localities, to layout of
residential area, premises. It is of great importance for health of population, for maintenance of
necessary sanitary conditions in cities, etc.
Concept of “Urbanization”
Urbanization is a prompt growth of number and size of cities, increase of urban popula-

82
tion at the expense of rural population decrease.
On average in Western Europe countries the urban population makes up 60% of the
whole population, in England, Belgium, Germany — 80-90 %. According to the United Nations
data, for 200 years (1800-2000) the population of Earth has increased by 7 times, and urban
population — by 125 times.
The principal causes of urbanization are the following:
 The development of industry, science, transport in cities that requires many
workers living near the enterprises;
 In cities the level of cultural, information, public service is higher than in the rural
area that explains aspiration of rural youth to move to cities.
Large cities create nonoptimal conditions for life and health of person, therefore at WHO
a special Committee on problems of urbanization was created.
Consequences of Urbanization
Along with positive sides of urbanization, i.e. high level of cultural, information, public
service, there is a number of negative consequences, such as:
 High density of population in small territory which results in growth of infectious
diseases (flu, tuberculosis, etc.).
 High pollution of city environment by chemical substances, physical and biologi-
cal factors.
 Decrease of solar radiation by 10-20 %, including UVR, causing growth of rick-
ets in children.
 High level of noise — on big highways noise even at night reaches 80 decibel
(dB), (norm for rest — 30 dB). The occurrence of noise illnesses is possible at
50-60 dB.
 Because of building up the air ventilation in cities is worsened, that leads to ac-
cumulation of pollutants (fogs-murderers, smog, etc.)
 Non-optimal microclimate — in summer there is overheating of buildings, roads,
etc.—
 High level of transport traumatism of population.
 Excessive waste of time and energy while getting to work and back.
 Problem of rest out of town — there are not enough parks in cities, and going
out of town for rest is not always possible in large cities.
 High level of negative psychogenic factors — stresses, nervous and mental dis-
orders.
 Growth of cities limits agricultural use of suburban lands.
These negative consequences of urbanization for people health are illustrated by great-
er disease incidence of urban population in comparison with rural one, deterioration of demo-
graphic parameters, decrease of parameters of physical development of children and teenag-
ers in large industrial centers.
Urbanization has resulted in occurrence of megapolises (New York, Tokyo, etc.) with
huge amount of population and sharp deterioration of all negative consequences of urbaniza-
tion.
Factors Causing the Occurrence and Development of Cities
As a rule, cities arise not at any place; their occurrence, development or decline are de-
termined by a number of economic, social and political factors, which are called town-
planning factors.
Earlier such factors included:
 The development of crafts and convenient waterways — at estuary of rivers, on
seashore, e.g. Athens, in the Crimea — Chersonese, Feodosiya (Cafa), Sudak
(Sugdeya).
 Presence of feudal fortress with lock, solid city walls for protection of population
against enemies (medieval cities — center of Moscow, Bonn, Krakow).
 In the 19th century growth of industry and business activity (Manchester).
Modern town-planning factors include the following:

83
 Presence of industrial enterprises and deposits of minerals. Many such cities
are in bad climatic conditions, e.g. Norilsk in Arctic zone.
 Availability of large transport junctions and crossing of large highways. Thus 200
years ago Simferopol (city-gatherer) appeared.
 Presence of administrative establishments of a state level — governmental, re-
publican, regional. It is Washington in the USA, Brazilia — a new capital of Bra-
zil.
 Availability of science, education centers and scientific and technical complexes
— Novosibirsk academic town, Oxford, etc.
 Presence of large Naval bases — Sevastopol, Vladivostok, etc.
 For cities-resorts — the presence of recreational resources (curative mud, min-
eral waters, coastal seawaters), i.e. cities-resorts of the Crimea, Caucasus.
The Basic Groups of Urban Population
All urban population is divided into 3 groups:
 town-forming group — workers of industry, transport, administration, science. It
makes up about 30-35 % of city population.
 serving group — workers of municipal services, education, public health servic-
es, trade, communication, etc. (20-25 % of city population).
 economically unoccupied population –children, students, pensioners, unem-
ployed (40-45 % of city population).
Functional Zoning in Cities
 Inhabited or residential zone where the basic part of population lives. It should
have the best hygienic conditions.
 Industrial zone. There is concentration of industrial enterprises into industrial
units. Between this zone and inhabited zone there should be sanitary-protective
gaps (zones) with green plantations.
 Тransport-warehouse zone. In Simferopol it is clearly expressed in the area of
railway station near our university.
 The green zone is diffusely located on the territory, it is very important for auto-
purification of atmosphere and creation of recreational conditions in the city.
 Residential suburb — parks, woods, recreation areas, agricultural enterprises
supplying city.
Hygienic Characteristics of Types of City Layout
 Radial-circular layout was encountered in medieval cities; in the center there
was the feudal castle and narrow circular streets and streets-radiuses leading to
former city gate, e.g. center of such old cities as Moscow, Bonn, Krakow, etc.
The drawback of such city planning is high density of population, bad airing,
lighting, insufficient number of parks and squares.
 Chess layout — streets and lanes are crossed at right angle. This type of plan-
ning was characteristic of cities of 18-19th centuries, e.g. St. Petersburg, center
of Simferopol, Odessa, etc. The drawback of such city planning is complicated
airing, difficulties for traffic as there are a lot of crossroads, air pollution.
 Linear layout is in cities located along the rivers, highways, e.g. Volgograd,
Dnepropetrovsk, Zaporozhye, etc. Hygienic conditions are better but there are
great losses of time for traveling by transport (a long traveling along river).
 Modern type of layout is a free planning in view of relief, hygienic conditions,
functional zones. Old types of city layout at reconstruction are transformed into
this type of layout.
Types of Layout of Residential Quarters
The initial inhabited city unit is a quarter, i.e. part of residential buildings limited by
streets and lanes. They can have different size depending on type of quarter building up,
namely:
 A continuous building up is encountered in old quarters of city center — all
area of a quarter has buildings. The drawbacks of this type of layout are bad air-

84
ing, lighting, high level of noise, air pollution, high density of occupation.
 A closed building up — it is a continuous building up on periphery a quarter,
while inside there are empty places. Disadvantages of this type are bad airing,
high level of noise and pollution. It is recommended for conditions of Far North.
 A perimeter building up — the buildings are located with intervals on perime-
ter of a quarter, inside which there are green plantations. It is used at recon-
struction of old types of building. Its disadvantage is an increased noise level.
 A line building up — buildings are located in linear fashion along streets. There
are better conditions for airing and light, but there is a high level of transport
noise.
 A stitch building up — a narrow part of buildings faces the roads. There are
better hygienic conditions but disadvantage is an architectural monotony of
quarters.
 A free building up — buildings are located in one quarter in apparent disorder,
but hygienic requirements are taken into consideration.
In modern layout of residential zones as the initial inhabited city unit not a quarter but a
microdistrict is taken. A microdistrict is a large inhabited housing estate for 10-12 thousand
inhabitants with free building up. In the center of microdistrict there are consumer service es-
tablishments — school, polyclinic, post office, etc. Highways are only on periphery of microdi-
strict. At such layout there are only city establishments in the center that reduces time losses at
traveling by transport for microdistrict inhabitants.
Protection of City Environment from Pollution
 Administrative-legislative measures.
 Hygienic measures — revealing and assessment of all sources of city pollu-
tion, control of projected objects, participation of SES in drawing up general
plans of city development, control over realization of these plans. The current
control is sanitary inspection of degree of pollution and taking measures to de-
crease the pollution.
 Architectural measures — functional zones of cities, reconstruction of systems
of building cities and inhabited quarters, location of sanitary-protective zones,
planting trees and gardens in cities.
 Technical and sanitary-engineering measures — the closed technology,
change of technology with the purpose to decrease pollutant emissions, con-
struction of sewage disposal plants on emission points and sewage treatment,
etc.
Hygienic Requirements to Premises
The basic purpose of hygienic requirements to premises is to provide optimal conditions
for rest, work of people.
Microclimate: temperature is 18-22°С, relative humidity is 40-60%, speed of air move-
ment is 0.2-0.4 m/sec.
Ventilation: air changes per hour is 0.5-1 (in kitchens — 2-3), СО2 content — 0.1 %, vo-
lume of air exchange per 1 person is 20-30 m3/h.
Illumination:
 natural — light coefficient is 1/8-1/10, coefficient of natural illumination — 0.5-
0.75 %.
 artificial: general — 40-50 lux, local — 100 lux, combined — 150 lux.
Noise level — up to 30 dB (at night).
Cleaning of Populated Areas from Waste Products
Introduction of hygienically proved methods of removal and neutralization of solid and
liquid waste products in populated areas remains one of the prime problems of public health
care all over the world.
An unsatisfactory state of affairs in this sphere constitutes a real threat of adverse epi-
demiological conditions in the populated areas and is an important reason for growth of infec-
tious and non-infectious pathology.
One of priority problems of environmental quality in Ukraine and Crimea is an unsatis-

85
factory situation with waste products, namely:
 Accumulation of great amount of highly toxic waste products and absence of ef-
fective and ecologically safe methods of their neutralization.
 Unsatisfactory sanitary conditions and overload of dumps with solid household
waste products (dumps), absence of places for new dumps.
 Insufficient degree of cleaning household sewage, thrown in coastal seawater
areas, that results in high microbe pollution of seawater presenting epidemic
danger for bathing and hence closing many sea beaches.
Wastes in populated areas are divided into 2 groups:
 liquid — sewage,
 solid — household wastes, factory wastes, etc.
Systems of Cleaning the Populated Areas
 Cleaning liquid wastes.
For cleaning 2 systems are used — removal and floatable ones (sewage system).
In the first case liquid wastes are taken out from populated areas with the help of
special transport, in the second one — are drained outside the populated areas by
pipes (sewerage system).
 Cleaning solid wastes (garbage).
An average norm of formation of household garbage is 320 kg per person per year, or
0.75 м3. In Ukraine and countries of CIS a regular scheduled system of cleaning gar-
bage is used (from house dustbins).
Methods of Removal and Destruction of Solid Household Wastes
The basic methods of removal and destruction of household wastes are controllable
garbage dumps, biothermal methods, trash burning.
Controllable garbage dumps are areas of solid household wastes. Their location, op-
eration and sanitary condition are supervised by sanitary-epidemiologic service.
Biothermal methods are based on creation of conditions for development of thermo-
phile microbes in garbage, thus the temperature in it increases up to 50-70ºC that promotes
decomposition of organic substances, destruction of pathogenic microflora.
To such methods composting (formation of compost in natural conditions in countryside)
refers, as well as application of artificial biothermal chambers for acceleration of compost for-
mation (fermentative towers, biostabilizers, biotanks).
Trash burning. It is carried out in special furnaces at temperature of 650-1200ºC, how-
ever this method is uneconomical, as lots of emissions are sent out in atmosphere air, that is
why it is applied less often.
The sanitary-dangerous materials, infected waste products of hospitals should be sub-
jected to burning in special destructors (separately in each hospital or in a centralized way).
Methods of Removal of Solid Industrial Wastes
 Non-toxic industrial wastes (debris) are collected in dumps of household wastes
and are used as insulating material.
 Solid toxic organic wastes are burnt in special furnaces at temperature of 1000-
1200ºС with gas-cleaning and dust collecting systems.
 Low-toxic insoluble in water waste products are dug in ground in places with low
filtration ability of soil (clay soil).
 High-toxic waste products are stored in hermetically sealed containers on spe-
cial dumps of industrial wastes, are dug in concrete containers in ground or
dumped in deep-water areas of seas and oceans. But it constitutes a potential
threat of environmental contamination in future.
Methods of Cleaning Household Sewage
They are subdivided into:
 Mechanical or primary — cleaning sewage out of floating impurity and suspen-
sions by means of precipitating and filtration;
 Biological or secondary — cleaning out of dissolved organic substances due to

86
processes of biological autopurification;
 Tertiary — a high degree cleaning out of pathogenic microflora or toxic sub-
stances.
According to ways of carrying out cleaning, all the methods are subdivided into:
 Natural (soil methods, biological ponds);
 Artificial (precipitation tanks, biofilters, disinfecting).
Soil methods of sewage cleaning include the following:
 Fields of irrigation. The sewage moves to fields with agricultural plants along
the grooves between plants. Water passes filtration through ground, where the
processes of autopurification due to soil microflora take place, thus filtrate be-
comes clean enough.
 Fields of filtration. These are ground areas without plants. The separate plots
of such fields limited by soil banks 1 m wide are irrigated by means of sewage
flooding, then they "have a rest" for a year, after that they are used again.
Biological ponds. Special ponds with the development of hydrobionts, plants, sapro-
phyte microbes are used, which provide the processes of biological autopurification of sewage.
In the process of cleaning during 3-7 days sewage passes through cascade of such ponds,
first — anaerobe ponds, then — facultative and oxidizing ponds.
Artificial Methods of Sewage Cleaning
 Mechanical cleaning. It is carried out with the help of lattices, and primary pre-
cipitation tanks. At big sewage disposal plants silt is neutralized in closed tanks
— metatanks.
 Biological cleaning. Biological decomposition of organic substances is carried
out in biooxidizers, where the processes of autopurification are similar to those
in biological ponds, but much faster. For this purpose biological filters (filters
with a thin layer of microorganisms) are used, as well as aerotanks (bring active
silt, aerate and mix water).
 Disinfecting. In case of using sewage after cleaning for watering agricultural
plants, on filling reservoirs for drinking and recreational purposes, the additional
disinfecting is carried out (chlorination in doses of 5-50 mg/l within 1 hour).
 Tertiary processing. In case of repeated use of cleaned sewage in industry, for
cattle drinking, replenishing underground water supply the complex and expen-
sive methods of complete cleaning are used — coagulation, adsorption, foam
removal, ionic exchange, deep disinfecting, etc.

87
Cleaning Sewage of Medical Establishments
Sewage of infectious, tuberculous and some other departments before dumping into the
city sewerage system pass additional disinfecting by chlorination.
Sewage from radiological departments is collected in special precipitation tanks until the
decrease of radioactivity to permissible levels, and then get into the city sewerage system.
Key Questions:
1.What is soil?The hygienic significance of soil.
2.Concept of soil pollution.
3.Protection of soil from pollution.
4.Limiting attributes of harmful action of substances in the soil.
5.Hygiene of populated areas. Urbanization and its main hygienic consequences.
6.The town-forming factors (in the past and nowadays).
7.Urbanization and its consequences.
8.Functional zones in cities.
9.Hygienic characteristics of types of city layout.
10.Hygienic characteristics of types of residential quarter layout.
11.Protection of the city environment from pollution.
12.Hygienic requirements to living premises.
13.Hygienically proved methods of removal and neutralization of solid and liquid wastes in the
populated areas.
14.Methods of removal and destruction of solid household wastes.
15.Methods of removal of solid industrial wastes.
16.Methods of cleaning household sewage.

88
1. To know the scheme of sanitary inspection of living premises.
2. A technique of drawing up the act of sanitary inspection of living premises. To draw up
the act of sanitary inspection of a flat, room, hostel room, etc.
Appendix 1
Scheme of the Act of Sanitary Inspection of Apartment
1. General information: name of building, year of construction, address.
2. Topography of locality: a hill, plain, open or closed for winds.
3. The characteristics of environmental territory: green plantations, location of plants and
factories and pollution of atmospheric air by them, availability of noisy, dusty streets, etc.
4. A territory improvement round the building: the total area, percent of a built-up area,
percent of green area, system and condition of its cleaning.
5. The characteristics of building: its location in a quarter (with a stitch, continuous, pe-
rimeter type of layout), microdistrict. The distance from the neighbouring buildings is ________
meters. The long axis of the building is located (from the south to the north; from west to east,
etc.). Number of floors, number of flats on each floor and in the whole house. Building mate-
rials (ferro-concrete, stone, wood).
6. A sanitary improvement of building: system of removal of liquid and solid wastes. A
sanitary condition of yard, staircases, work of lift.
7. The floor, on which the flat is located, number of rooms ____, including those oriented
to the street _______, to the yard __________. Overshadowing by the neighbouring buildings
(present, absent).
8. Total area of flat ______ m2, height of ceiling ______ m, living space _______ m2, cu-
bic capacity _______ m3.
9. Number of people living in the flat, including children under 14 years _______.
10. The living space per 1 person ______ m2.
11. Walls: brick, wooden, the dampness (present or not). Sound insulation, material and
condition of floors, windows, doors.
12. Heating: central, furnace. Air temperature _____ ºС.
13. Ventilation: central (functioning or not). Window leaves, through airing (possible or
not).
14. Illumination: light coefficient in living premises _______. Artificial illumination with in-
candescent lamps, luminescent lamps, type of light fixture.
15. Area of rooms in m2, whether they are encumbered with things or not.
16. Kitchen: a condition of walls, ceiling, floor. A cooker (gas, electric). A sanitary condi-
tion of kitchen.
17. Water pipe (present or not), bathroom (present or not), where clothes are washed.
18. A lavatory is canalized (or not), its sanitary condition _________.
19. Availability of insects in the flat (present or not).
20. Noise in the flat (present or not), its origin.
21. Dampness in rooms (observed or not). Reasons of its occurrence.
22. Complaints of residents.
23. General conclusion about a sanitary state of object.
24. Measures on sanitary improvement of object state.
Date of inspection ___________ Signature ________________
Appendix 2
Scheme of Sanitary Inspection of Students’ Hostel
1. General information: name of building, whether specially constructed or adapted to
the present purpose, year of construction, address, who resides (students, workers), total
number of single _______, married _______, married are accommodated separately.
2. Topography of area: hills, plain, marshland, open or closed for winds.

89
3. The ground area: total area _____ m2, green plantations (present or not), clean or not.
4. Environmental territory: the inhabited quarter, industrial enterprises, dusty roads and
air polluted by them (present or not).
5. The hostel occupies _________ buildings.
6. Building: stone, ferro-concrete, ____ floors, year of construction _________, dry,
damp, the walls are whitewashed (or not), floors are wooden, painted (yes, no), covered with
linoleum (yes, no), concrete (yes, no), the scheduled repair was last made in ___________
year, complete overhaul in ___________ year.
7. The size of basic premises (bedrooms): width, length, height (in meters). The floor
space and cubic capacity per man.
8. Heating: central, local; sufficient or not; air temperature _______ ºС.
9. Ventilation: window leaves, transoms, conditioners, through airing, possible or not,
applied or not, complaints of residents on temperature-humidity conditions and smells.
10. Illumination, light coefficient _______, light angle, ventiduct angle.
Natural illumination during ____ hours per day. Artificial illumination, type of lamps. Es-
timation of natural and artificial illumination.
11. Water supply: centralized (constant, periodically absent); from well. The hot water
(present or not).
12. Lavatories: canalized (yes or no), located indoors (or in the yard). Regularly cleaned
(yes, no). Quality of its disinfection.
13. Wash-stands, their location, number, sanitary condition.
14. Terms of linen change.
15. Whether washing the linen, cooking food, drying clothes are carried out in bed-
rooms, corridors.
16. Availability of insects in rooms.
17. The list of additional premises serving the hostel as a whole: a canteen, isolator,
reading hall, dryer, etc.
18. System of room cleaning: damp, dry, frequency per week. Containers for garbage
(present or not), distance from the hostel. Frequency of garbage evacuation from containers
per day.
19. The additional data.
20. The general conclusion about a sanitary condition of hostel.
21. Measures on sanitary improvement of hostel.
Date of inspection ______________ Signature ____________ .
The Training Instruction.
Hygienic Significance of Habitation
In each inhabited area the most important element is habitation. In uncomfortable ac-
commodation, at high density of people the particularly favourable conditions for spread of res-
piratory infections, primarily tuberculosis, are created. In dark rooms with insufficient solar and
ultraviolet radiation small children are more often ill with rickets.
At preliminary and current sanitary inspection the following requirements to habitation
are determined:
The ground area for construction of a house should:
a) be located on a well lighted by the sun and accessible to airing area;
b) have good natural or artificial relief for atmospheric water flow;
c) have dry, not polluted soil; the level of subsoil waters should be not closer than 1.5 m
to the ground surface;
d) have the appropriate parameters of a sanitary condition of the ground, namely:
i) the sanitary number should be not less than 0.85.
ii) amount of helminth eggs — up to 10 per 1 kg of ground;
iii) coli titer should be not less than 0.01;
iv) titer of anaerobe microbes (Cl.perfringens). This titer should be not less than
0.001.
6) The hygienic requirements to a building.
Illumination of dwelling depends on orientation of windows to parts of the world. The win-

90
dows of inhabited rooms should be southern and east in hot areas (the western orienta-
tion of a window is not optimal), the windows of additional premises should be oriented to
the north. The axis of the building should approach an equatorial direction.
The inhabited rooms should have insolation not less than 3 hours per day.
At insufficient distance between houses a neighbouring building can throw a shadow,
due to which the solar irradiation is sharply reduced. Therefore the distance between the
neighbouring buildings should be not less than 2 heights of the highest building.
The distance between an inhabited building to a garbage container should be not less
than 30 m and not more than 50 m.
7) Types of inhabited buildings:
a) one-storey apartment house (detached house);
b) multi-storey apartment house (cottage);
c) many-room low houses (for 2-8 apartments);
d) many-room multi-storey houses (3 and more floors). Density of population in such
houses is considerably higher. In houses higher than 5 floors a lift should be neces-
sarily;
e) a hotel type house — hostel.
8) A flat.
The structure of a flat includes habitable and additional rooms. To habitable rooms a bed-
room, a living room, and a study refer.
The additional premises (rooms) are a kitchen, hall, bathroom, lavatory, storeroom, bal-
cony, terrace.
A bedroom should not be with a through-passage, designed for not more than two per-
sons, located far from the kitchen and hall. Its area should be not less than 10 m2.
The room for staying in the daytime (living room, dining room) may be with a through-
passage. Its area should be not less than 14-16 m2. Its depth should be not more than
double width.
A kitchen should be not less than 7 m2 and should be isolated from habitable rooms.
A hall serves for undressing, storage of the outer clothing and footwear, protecting habit-
able rooms from penetration of cold, noise. Its width should be not less than 1.2 m.
Internal corridors — their width should be not less than 1.1 m.
9) Hotel-type houses for small families.
At this type of construction the habitable rooms or flats are located on both sides of the
central corridor. Each flat of this type has 1-2 habitable rooms, a small kitchen, lavatory,
a small hall and a built-in closet. The houses of this type have certain disadvantages:
through airing is impossible, the residents often come into contact. Hostels refer to the
given type of buildings.
10)Hygienic norms for a students‘ hostel are the following:
a) The area of bedrooms should be 6 m2 per one person at a height of bedrooms not
less than 2.7 m.
b) The distance between beds should be not less than 0.5 m, from the outer walls to
beds — not less than 0.3 m.
c) In one bedroom there should be not more than 4 persons.
d) A common corridor is not more than 40 m in length.
e) The additional rooms should be located at the end of the corridor.
f) In a hostel for more than 300 men a canteen should be provided.
g) The building of a hostel should occupy not more than 25 % of the ground area.
h) The distance from a hostel to the container with garbage should be not less than 30
m and not more than 50 m.
Self Test
1. Identify the type of state sanitary supervision over habitation.
*A. current
*B. preliminary
C. precautionary
D. every ten-day
E. single at approval of a building
2. The depth of underground water at construction of buildings should make up not

91
more than
A. 1 m
*B. 1.5 m
C. 2.2 m
D. 2.5 m
E. 3 m
3. Time of insolation of habitable rooms should make up:
A. 60 min/day
*B. 180 min/day
C. 240 min/day
D. 300 min/day
Problem Solving
1. For construction of shielding building (from noise) a shop is chosen 110m in length,
5.5 m in height for protection of neighbouring house № 4. A highway passes nearby. An
equivalent noise level in apartments of the house at present makes up 50.5 dB, on habitable
territory — 65.5 dB. Make the conclusion on expediency of screen construction.
2. In a room of a student's hostel there are 4 persons. Frequency of ventilation is 3
times/hour, СО2concentration — 0.2 %. Light coefficient — 1:5. Temperature is 20º C, air hu-
midity -55 %. General illumination by incandescent lamps -150 lux, local illumination — 50 lux.
What diseases or deviations in a physiological condition of students can occur?
3. A two-room flat is located on the 6th floor, the lift does not work. The windows are
southeast. The kitchen is next to a living room. A bathroom and lavatory are combined. The to-
tal area of the apartment is 45m2, 5 persons live in it. Noise at night is 25 dB. The walls of the
bedroom are of light-green colour. The relative humidity is 66 %. The air temperature is 18º C.
The walls of the sitting room are pink. The temperature is 20ºС. Frequency of ventilation in the
kitchen is 1.5 times/hour. Make a hygienic estimate.

92
Standard Answers
1. The length of a noise-protecting screen is 120 m, its height — 5 m. The height of
house № 4 is not specified. We can assume that at the expense of shielding at a height a
noise level will decrease by 10 dB (ratio of 110 to 50.5 = 2, that reduces a noise level by 10
dB), that will exceed the norm. Hence the shop should be built higher.
2. There may be decrease of capacity for work, headache because of exceeding MPC
of СО2.
3. Hygienic conditions are satisfactory with the exception of the kitchen which should not
be combined with a habitable room. It is necessary to put a partition, to change the door lay-
out.

93
HOSPITAL HYGIENE
Theme No 11.
Hygienic Requirements to Hospitals
The hospitals are built for implementation of medical protective regimen.
The Medical-Protective Regimen and Its Main Components
The medical protective regimen is a complex of medicodiagnostic, hygienic,
administrative and economic measures directed at the fastest restoration of work capacity or
health of a person.
The medical diagnostic measures include:
 Diagnostic and medical procedures. They are considered to be the main factor, but
without carrying out other measures of medical protective regimen their efficiency
decreases.
Hygienic measures include:
 An optimal choice of hospital location, the observance of requirements to hospital site
and its functional zones;
 Providing sanitary-antiepidemic regimen in hospitals, prevention of nosocomial
infections (NI);
 Creation of optimal hygienic conditions of location, lay-out, isolation and functional
connection of premises in hospital;
 Providing hygienic requirements to microclimate, bacterial contamination of the
hospital environment, illumination, ventilation, water supply, hospital heating;
 Providing rational and dietetic nutrition of patients, prevention of food poisonings;
 Observance of personal hygiene by patients and staff;
 Creation of optimal working conditions for medical staff and prevention of
occupational diseases in personnel.
Administrative measures are as follows:
 The establishment of schedule and routine of work of hospital and polyclinic;
 Providing staff of personnel;
 Estimation of work efficiency of personnel, etc.
Economic measures are:
 Supply with medicines, linen and equipment, foodstuffs; transport supply of hospital.
Hygienic Requirements to Hospital Location
While choosing place for location of hospital of general type (central regional hospital,
municipal hospital with polyclinic, etc.), two basic demands should be made:
 Providing optimal hygienic conditions for hospital site - preferably out of town.
 Accessibility to the served population (radius of polyclinic service in town is 3-5 km) –
hospital should be in the town center, where the hygienic conditions are bad.
It is rather difficult to combine both of these requirements, as they are inconsistent.
Nowadays the problem is solved by construction of hospital in the suburbs, and polyclinic - in
the town center.
For specialized hospitals (phthisical, oncological, psychoneurological, infectious,
venereologic) the first requirement is priority, the second one is not essential.
The Area of Hospital Site
The size of ground areas for hospitals of all types is regulated by sanitary norms and
depends on capacity of hospital:
 at hospital capacity up to 50 cots (beds) it is 300 m2 per 1 cot,
 up to 100 cots - 200 m2,
 from 200 up to 400 cots - 140-100 m2,
 from 400 up to 800 cots - 100 - 80 m2,
 from 800 up to 1000 cots - 80 - 60 m2.

94
For specialized hospitals in the suburbs the area is increased:
 for infectious and oncological hospitals by 15 %,
 for phthisical and psychiatric - by 25 %,
 for pediatric by 40 %.
The area site of maternity hospital makes up 0.7 of norms for typical hospital.
Hygienic Requirements for Lay-out of Hospital Site
 The hospital site should be of a rectangular form with a ratio of sides as 1:2 or 3:4 for
convenience of functional zones.
 The density of building at hospital site should not exceed 15 %. Green plants should
occupy not less than 60 % of the site area. Along the perimeter a protective green
hedge not less than 15 meters wide is planted.
The functional zones of hospital site are as follows:
 Zone of medical buildings (infectious and non-infectious). The infectious department
is located in depth of the site.
 The gardening zone - includes green plantings along the perimeter of site, among
buildings.
 Zone of pathoanatomical department should be located beyond the sight from
windows of medical buildings.
 Zone of polyclinic. The polyclinic should be located at a distance of 30-50 m from
medical buildings and have a separate entrance, or be as close as possible to the
main entrance to the hospital site (prevention of visitors to polyclinic from intrahospital
infections).
 The economic zone is located at a distance of 30-40 meters from other zones. Here
the central boiler-house, laundry with desinfection chamber, warehouse premises,
garage, kitchen are placed.
Plan of hospital plot
Infection
diseases depart-
ment
Pathoanatomical
zone
Econom-
ic zone
( foods-
tuffs stores
and
preparation )
o
bstetric
–
gynecol
ogic
depart
ment
Main medical buildings
M
ain
medical
build-
ings
Ec
onomic
zone
(
laundry,
steriliza-
tion)
polyclinic
Eco
nomic
zone
(
garage)
Green zone
Gr
een
zone
Green zone
Green
zone
G
reen
zone
Green zone
Green zone

95
Hospital section ( 25 beds)
balco-
ny
b
buff
et
W A R D S ph
ysician
room
3
-4
bed
s
3
-4
beds
3
-4
beds
3
-4
beds
3
-4
beds
3
-4
beds
1
-2
beds
1
-2
beds
corridor
surgical block’s scheme
T
reat-
ment
room
nu
rses
ro
om
Post of
nurse on duty
Bath-
room
Toilet
M
Toilet
W
Sanita
ry room
M
ate
rial
roo
m
H
ostess
nurse
r
oom
iso
lation
wa
rd
choll
Narcosis room
20 м2
Operating room
36м2
sterilizating
room
10 м2
Preoperative
room
15 м2
2, 8 м corridor

96
N
urses’
assis-
tants
R
oom
10
м2
Nurs
es
Roo
m
10
м2
Room
for manager
of surgical
block’s
10 м2
Cloa-
kroom for
patients
10 м2
Cl
oakroom
for doc-
tors
10
м2
M
aterial
room
10
м2
T
oilet
1
0 м2
- exit
Box ( 22 m2) for 1 patient and half-box .
5
1 - bed; 2 - table; 3-chair ; 4- rack for doctor’s overall; 5-wash-hand-stand;
6-bath, 7-toilet
- ventilation
window for food
exit
Hospital ward
corridor
sluice
Sanitary room
tambur
Hospital ward
sluice
Sanitary
room
1
2
3
4
5
5
6
7

97
The Systems of Hospital Construction
Historical types of hospital construction are as follows:
 In the 17-18th centuries a barrack type of hospital construction was applied (one big
room for all patients), then a corridor-barrack type was used when big wards are
connected by corridor – the conditions for patients and personnel were very bad.
 A hutment type was for the first time in the world applied by N. I. Pirogov in the
Crimea in 1855-1856 during the Russia-England-France-Turkey war. After operations
patients stayed in one wooden barrack for a while, then they were moved to another
barrack, and the former one was burnt. It gave the possibility to decrease the number
of postoperative infectious complications.
 A pavilion type was applied at the end of 19th-beginning of 20th century. It consisted
in construction of separate premises in a park with wards having good airing and
illumination.
The modern types of hospital construction have the following features:
 The decentralized system is characterized by presence of several, usually one- or two-
storey buildings, each of them being used for one type of department, e.g. surgical,
therapeutic, etc. In some hospital buildings the general diagnostic, economic and
additional services, hospital authorities, polyclinic are located.
The advantages of this system are: good conditions for prevention of intrahospital
infections (isolation of each department of hospital in separate building), easy access for
patients to hospital garden, where they can be in the open air in good weather and get a
daily dose of UV irradiation.
Disadvantages of this system are as follows: it requires a very big area for hospital site,
the construction of lots of one-floor buildings is very expensive, it is difficult for personnel
to transport patients to different diagnostic departments (especially in bad weather), to
supply departments with medicaments, food, etc.
This system is now applied at construction of sanatoria and while building hospitals in
mountain districts.
 The centralized system is characterized by location of all medical departments,
polyclinic, administrative offices (apart from pathological anatomical and economic
departments) in one multi-storey building. For example, for a 900-cot hospital a 15-storey
building is necessary. The advantages and disadvantages of this system as compared to
decentralized system are: in such hospitals there is a high level of intrahospital infection
and it is very difficult to fight against it at such system of hospital building).
 The mixed system of building is characterized by tendency to decrease the number of
medical buildings up to 2-4, centralization of hospital medical-diagnostic and additional
services. The infectious, children's, radiological departments and polyclinic are placed in
separate buildings. Thus, on hospital site there are some low and multi-storey buildings.
 The centralized-block system in modern conditions is the most appropriate to large
hospitals. The basic feature of centralized-block system is division of all premises of
hospital complex into two groups for the best maintenance of medical-protective regimen
in hospital:
 premises for long-term, stable operation, including medical buildings with ward
sections of any structure.
 premises which functional purpose demands regular updating of equipment,
reconstruction or decoration which realization should not stop the work of hospital
complex as a whole, namely the surgery block, premises for functional diagnostics,
diagnostic laboratories, physiotherapeutic departments, polyclinic, etc.
Hygienic Requirements to the Ward Section
The basic functional unit of any hospital department is a ward section for 25–30 cots, in
some specialized departments (resuscitation unit) it is less. The number of ward sections in the
department is determined by number of cots in it. If a department is planned for 30 cots, it has
one ward section.
The basic premises of ward section are: wards, doctor‘s consulting room, room for
patients‘ examination, buffet, lavatory, dining-hall, material facilities. There should be two 1-
bedded wards (an isolation ward - for infectious patients and a ward for agonizing patients).

98
Hygienic Requirements to a Hospital Ward
The capacity of ward for adults and children elder than one year in hospitals should be
not more than 4 cots. This parameter is optimal both in technological and in hygienic relations.
The area of ward should be 7 m2 per cot, the area in the ward of intensive therapy - 13
m2 per cot.
The microclimate in a ward should correspond to the main standards for living quarters:
temperature is 18-22ºC, relative humidity - 40-60%, speed of air movement – 0.2-0.4 m/sec.
Ventilation: СО2 content – 0.1 %, frequency rate of ventilation - 2-3, volume of
ventilation - 20-80 m3/hour/cot.
Natural illumination: light coefficient (LC) 1:5 – 1:6, coefficient of natural illumination
(CNI) -1%. Artificial illumination: general illumination in a ward is not less than 50 lux, local -100
lux, tell-tale light (at night at exit) - 3 lux.
The distance between beds is not less than 0.8-1m, and between beds and external
walls is not closer than 0.9-1 m.
The maximal permissible level of noise in a ward is 25 decibel.
Hygienic Requirements to a Surgery Unit
At designing large modern multifield hospitals it is expedient to unite several operating
rooms in a uniform complex, which should have two departments: septic and aseptic with
operational, auxiliary and office rooms.
The structure of a surgery unit should include an operational, preoperational,
sterilization, anesthetic room, premises for storing blood and portable equipment, rooms for
surgeons and scrub nurses.
A surgery unit is divided into 4 zones according to degree of sterility:
 sterile (operational) zone;
 zone of strict regimen (sanitary inspection room for personnel, sterilization room);
 zone of limited regimen (washing chamber, rooms for personnel);
 zone of common hospital regimen (office of a surgery unit head, etc.).
Hygienic Requirements to an Operating Room
An operating room is designed for one operating table.
The area of operating room should be not less than 36 m2, for difficult operations with
participation of big surgery team - 45-50 m2. The total number of operating tables is taken on
the basis of one table per each 30 cots of surgical department. The walls of operating room
should be easily washed, preferably of greenish color.
Natural illumination. Light coefficient - 1:2-1:4, coefficient of natural illumination -2.5 %.
General artificial illumination - 300-500 lux, local (on operational field) - 3-10 thousand lux.
Ventilation. Air ventilation in operating room should have a 6-time input ventilation, 5-
time extract ventilation with preliminary purification of air so that microbes in the air from other
premises of surgery unit could not get into the operating room. An input ventilation vent must
be near the ceiling, an extract one - near the floor, as anaesthetic vapour is heavier than air.
The temperature of air in operating room is 22-25ºC, because in patient under
anesthesia the thermoregulation centers don‘t function and overcooling may occur; humidity is
up to 55% (prevention of explosion of narcotic vapour in view of high electric conductivity of
damp air), speed of air movement – 0.1 m/sec.

99
Hygienic Requirements to the Admission Department of Hospital
Table 35
FUNCTIONS AND STRUCTURE OF HOSPITAL ADMISSION DEPARTMENT
FUNCTIONS TYPES of PREMISES
Admission of patients and
reception of visitors
Entrance hall with registry
Physical examination,
establishing or
confirmation of diagnosis
Doctor‘s consulting room, room for patient‘s
examination, express laboratory
Rendering emergency care Room for patient‘s examination
Cleansing patients Cloakroom, bathroom, dressing room
The admission department is intended for registration, physical examination,
establishing or confirmation of diagnosis, cleansing patients and if necessary - rendering
emergency medical aid. Patients with doubtful diagnosis are placed at reception wards.
The structure of admission department includes the following premises: entrance hall
(for waiting), registration and inquiry office, room for patients‘ examination, sanitary inspection
room (a cloakroom, bathroom, room for dressing), room for medical procedures, dressing
room, laboratory for urgent analyses, X-ray room, wards per 1-2 cots, consulting room of
doctor on duty, toilet for personnel.
Hygienic Requirements to the Infectious Department
The infectious patients are admitted to the infectious departments not only for treatment
but also for isolation. Therefore, the interior planning and sanitary regimen of this department
are arranged with the purpose of prevention of intrahospital infections.
The infectious department should have two entrances: one for patients, the second - for
personnel, for delivery medicines, food, etc.
Sewage from infectious department before dumping into city sewerage system is
disinfected (norm of residual chlorine in it is 3 mg/l).
Types of wards. Isolation of patients is realized in boxes, half-boxes and isolation
wards.
A box is a premise with total area of 22 m2 (per cot) or 27 m2 (per 2 cots) in which there
is a ward external, entrance for admission of patients, bathroom, internal entrance which is
connected with a hospital corridor. In boxes patients with doubtful diagnosis and particularly
dangerous infections, such as cholera, etc. are placed.
Half-boxes differ from boxes only in absence of external eutrance. Patients get into a
half-box through a hospital corridor.
Isolation wards are usual wards, cots in which are separated by partitions 2–2.5 m high
to prevent contact of infectious patients. It is impossible to place patients with respiratory
infections there, as there is common air exchange in such wards.
Causes and Prevention of Intrahospital Infections
According to WHO’s definition the intrahospital infection (II) is any clinically expressed
disease of a microbe etiology affecting the patient during hospitalization or visiting medical
establishments, as well as medical staff during its professional work, irrespective of the fact,
whether the symptoms of this disease are manifested or not during presence of the given
persons in medical establishment or up to 3 days after discharging from the hospital.
The spread of intrahospital infection is now registered in all countries of the world, it is a
very topical problem for public health services, therefore there is a special Committee in WHO
for investigation and struggle with intrahospital infection.
Structure of causative agents of intrahospital infection in the 20-21 century:
 Till 1950s a dominant position in the structure of intrahospital infections belonged to

100
acute infectious diseases caused by pathogenic microorganisms (scarlet fever,
diphtheria, chicken pox, whooping cough, gas gangrene, tetanus, etc.).
 A real "plague" of many hospitals in 50-60s of the 20 century became a
staphylococcal infection.
 Beginning with 1970s due to wide use of antibiotic therapy the leading place is
occupied by gram-negative flora – proteus, E.coli, enterobacter, etc. which are very
stable to antibiotics and it is very difficult to eliminate them with the help of antibiotics.
Danger of occurrence of intrahospital infection for the patient consists in the
following:
 the course of the basic disease is exacerbated;
 lethality of patients at generalized form of intrahospital infection is up to 60 %;
 new diseases during treatment in hospital can occur.
Danger of intrahospital infection for public health services is as follows:
 disorganization of hospital work, down to temporary closing of hospital or its
department for disinfection;
 increase of duration of patient‘s stay in hospital (on average one case of intrahospital
infection increases the term of patient‘s stay in hospital up to 13-17 days);
 additional economic expenses for treatment of patients, work of personnel.
Basic sources of intrahospital infection are subdivided into:
 primary, including patients, medical staff, visitors (less often)
 secondary, including objects of the intrahospital environment, i.e instruments; linen,
furniture; air, food.
Categories of intrahospital objects according to the danger of transmission of
intrahospital infection are as follows:
 critical, which are the most dangerous, requiring the most careful disinfection; they
include surgical toolkit, needles, endoscopes, catheters;
 half-critical, including the equipment for inhalation and anesthesia, kitchen utensils;
 non-critical, i.e. linen, furniture.
The basic ways of transmission of intrahospital infection are the following:
 aerosol (a respiratory and air-dust way);
 contact (through tools, linen, furniture);
 parenteral (at injecting medicines);
 fecal-oral (through dirty hands);
 alimentary (through food).
Structure of intrahospital infection according to localization includes:
 infections of the urinary tract - 15-40 %;
 wound (surgical) infection - 10-30 %;
 infections of respiratory ways - 15-20 %;
 intestinal infections - 10-20 %
Causes of intrahospital infection growth nowadays in different countries are the
following:
 a considerable increase of intrahospital infection among hospitalized patients of risk
groups, i.e. patients with various chronic diseases (cardiovascular, oncological, blood
diseases, diabetes mellitus), immunodepressive states; aged patients;
 weakening of natural immunity and allergization of population due to unfavourable
ecological situation;
 "urbanization" of intrahospital environment, concentration of great number of patients
and staff in multi-storey buildings;
 complicating the operative interventions, increase of their duration and traumatism,
wide application of endoscope equipment which badly yields to sterilization;

101
 an excessive, sometimes insufficiently grounded application of antibiotics, the
formation of intrahospital strains of causative agents of intrahospital infection,
polyresistant to antibiotics used in a hospital;
 insufficiently careful disinfecting of injection and other instruments;
 increase of duration of patient‘s stay in hospital due to numerous functional-
diagnostic researches;
 insufficient attention to strict observance of hygienic and sanitary-antiepidemic
regimen in hospitals.
System of prevention of intrahospital infection includes the following:
 Strict observance of sanitary-antiepidemic regimen:
 good ventilation, air sanitation of premises, optimal microclimate;
 realization of medical control of personnel;
 high-quality disinfection and sterilization of equipment, linen etc.;
 regular bacteriological control of instruments, linen, air, food, hands;
 revealing and isolation of infectious patients;
 observance of rules of personal hygiene by personnel and patients.
 Architectural measures:
 rational location and zoning of hospital site;
 rational interposition of departments and subdivisions in buildings and on floors in
order to provide disconnection of ward sections, departments, operating rooms,
offices, wards;
 observance of hygienic norms of area, volume of hospital premises.
 Increase of resistance of patients and personnel:
 optimal regimen of work and rest;
 rational nutrition;
 sufficient staying in the open air;
 scheduled and emergency immunization of patients.
Occupational Hygiene of Medical Personnel
The sickness rate of medical workers as compared to other professions is marked to be
rather high, especially of surgeons, anesthesiologists, infectionists, phthisiatricians,
roentgenologists, radiologists, etc.
Occupational Hygiene of Surgeons and Anesthesiologists
During their professional work surgeons and anesthesiologists come across a number of
harmful factors, such as:
 action of chemical substances (preparations for narcosis) – professional poisonings;
 adverse microclimate (hot temperature) - overheating;
 increase of СО2 concentration and decrease of О2 content (sterile mask on face) –
hypoxia and hypercapnia;
 psychoemotional and physical overloads with long overstrain of visual, acoustical,
tactile analyzers – cardiac diseases;
 effect of X-rays;
 compelled position of body (long stay in vertical position) – radiculitis,
osteochondrosis;
 contact with infectious agents (including AIDS);
 frequent violation of working and rest regimen.
To prevent a professional pathology a number of preventive measures are carried out:
 creation of good artificial microclimate (air-conditioning);
 the centralized supply of О2 to operating room;
 combined extract and input ventilation with prevalence of input ventilation;
 observance of working and rest regimen (working hours in operation day should be
not more than 5 hours, alternation of one operation and two non-operation days,
gymnastic exercises and taking a shower after operation);
 rational nutrition;
 after operation it is not recommended to have reception hours at the out-patient
department.

102
 supplying surgeons and anesthesiologists with white gowns made of materials
providing good ventilation;
 change of white gowns every four hours, mask - 2 hours after the beginning of
operation (because after this period of time the sterility is lost).
Recommendations for Practical Classes on the Topic
Lesson No 1.
Hospital Hygiene
Key Questions
1.The medical protective regimen in hospital and its components.
2.Hygienic requirements to a hospital site and structural divisions of hospital.
3.Hygienic requirements to functional zones of a hospital site.
4.Hygienic requirements to a ward section and a hospital ward.
5.Hygienic requirements to a surgery unit and operating room.
6.Hygienic requirements to the infectious department.
7.Causes of growth, sources, ways of transmission and prevention of intrahospital infections.
8.Occupational hygiene of surgeons and anaesthesiologists and doctors of other specialities.
To do the test on checking the initial level of knowledge.
To master skills of locating a hospital site, systems of hospital construction according to the
suggested tables and instruction.
To draw the general plan of hospital in the notebook.
To draw schematically in the notebook the layout of:
a typical ward section;
an operating room;
a box, half-box, infectious department.
Substantiation of necessary measures for struggle against intrahospital infections. The
decision of situational tasks with estimation of necessary measures to prevent or fight against
intrahospital infections.
To do the test on checking the final level of knowledge on the topic.
Self Test
1. One of the methods of specific prevention of intrahospital infections is
A. isolation of surgery units.
B. rational location of departments on floors.
*C. emergency immunization of patients.
D. zoning of a hospital site.
E. sanitary-antiepidemic measures.
2. On sanitary examination of the project of infectious hospital it was established that
the basic premises are boxes and half-boxes. Identify the element which
distinguishes half-box from box.
*A. Entrance from outside
B. Wards
C. Lavatory
D. Sluice
E. Entrance from the department
3. On sanitary inspection of pulmonary department for adults it was established that
wards per 4 cots had the area of 28 m2. What should be the minimal area of ward
in the department?
A. 40 m2
B. 24 m2
*C. 28 m2
D. 30 m2

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E. 52 m2
Problem Solving
1. The obstetric department is located in a 3-storey building. The second floor is
occupied by admission department, the first one – by the physiologic pregnancy department,
the third one - by the pathologic pregnancy department. All the floors incorporate by channels
of extract ventilation. What does not correspond to hygienic norms in the obstetric division and
needs re-planning?
2. The total area of the ward is 28 m2. What number of patients is the given ward
designed for?
3. In regional hospital the room for reception and discharge of patients of children
department is combined with other departments. Is the similar location of reception rooms
admissible in the children department and in what case?
Standard Answers:
1. The admission department should be located on the first floor, thus it is necessary to
interchange the physiologic pregnancy department and admission department.
2. For 4 patients, the norm is 7 m2 per patient.
3. According to the hygienic standards the admission department in the children
department should always be separate. It is allowed to combine rooms for discharging patients
with other rooms of the department.
Topic of Independent Students’ Work: Sanitary-Hygienic Inspection of Hospitals
The student should be able to:
 carry out sanitary inspection of hospital;
 make the act of sanitary inspection of hospital.
Purpose of independent students‘ work:
 To acquire the skills of estimating the location of a hospital site, system of building a
hospital complex, lay-out and equipment: reception wards, therapeutical, surgical,
obstetrics, infectious, children departments (children's hospitals), ward sections,
polyclinics.
 To master the technique of estimation and realization of sanitary inspection of
projects and construction of hospitals and departments of different type and hygienic
estimation of conditions of medical personnel work, substantiate the necessary
measures for struggle against intrahospital infections.
Algorithm of Practical Independent Work of students
The first stage. Independent sanitary inspection of hospital, department and ward of
Simferopol hospital according to the scheme (see Appendix).
The second stage. Presenting the project of act of sanitary inspection to the teacher.
The third stage. Preparation of act of sanitary inspection.
The fourth stage. Handing in the act of sanitary inspection of Simferopol medical
preventive establishment to the teacher.
Appendix
Scheme of Sanitary Inspection of Hospital
Name, capacity, address, type of medical establishment.
Hygienic estimation of location of a hospital site.
Functional zoning of a hospital site, hygienic estimation.
Area of a hospital site (per 1 cot).
Presence of polyclinic, radius of its service.
Lay-out of hospital building up.
Estimation of measures providing medical protective regimen.
Structure of premises of the reception ward, equipment, sanitary condition.
Description of one of the basic departments:
Name, amount of ward sections;

104
Structure of premises of ward section;
Sanitary condition of department.
Description of ward in the department:
№ of ward;
number of cots, area per 1 cot;
microclimate, ventilation, illumination, colouring of walls;
sanitary condition;
interrogation of patients in the ward about a sanitary condition of hospital, convenience of
its location;
estimation of measures providing medical protective regimen (administrative, hygienic,
economic).
The basic drawbacks revealed at inspection of hospital as a whole, and of department and
ward in particular.
Suggestions to their elimination.
General conclusion on possibility to provide medical protective regimen in the hospital.
Date of inspection _____________________
Signature (group, full name)___________________________________
Note: the inspection and drawing up the act of sanitary inspection is made according to
the scheme: one hospital per 1 group, 3-5 students per one department, one student per one
ward.

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HYGIENE OF NUTRITION
Theme No .
Principles of Sanitary Examination of Foodstuff.
Topicality of the Theme
A doctor of any speciality should know the rules of estimation of foodstuff quality with the
purpose of improvement and maintaining a human health. The biological and nutrient value of
foodstuff is preserved under the condition of their high quality meeting the demand of standard.
During reception, storage, transportation or processing the foodstuff can spoil, become conta-
minated by chemical substances, microorganisms, etc. Therefore it is necessary to carry out a
thorough sanitary inspection of foodstuffs at all stages of their production and realization.
To determine the quality of foodstuff, a sanitary examination is carried out. The doctor of
any speciality should be able to reveal changes of parameters of food quality: organoleptic
properties, presence of harmful impurity and reasons of foodstuff spoiling, and also to establish
the order of its realization.
Methods of Analysis of Food Quality
 Organoleptic — colour, taste, smell and consistence;
 Physical — density, temperature, etc;
 Chemical — content of proteins, fats, carbohydrates and others nutrients;
 Microscopic — finding foreign substances, ova of helminths, etc. in foodstuff under
microscope;
 Bacteriological — finding microorganisms in the food ;
 Biological — biological test of dangerous foodstuff on the laboratory animal;
 Radiometric — the level of radioactivity of the foodstuff.
The obtained data are compared with standards of foodstuffs.
For this purpose the following documents regulating the quality of foodstuffs exist:
 The State Standard of a food product. This is a document defining the necessary val-
ue of main parameters of the given foodstuff and including the unified, standard pro-
cedures of its definition.
 Temporal Technical Conditions of a food product. It is designed for new products and
includes main parameters of the given product.
Classification of Foods by Quality
 A good-quality product:
 Standard — a product, which parameters correspond to the requirements of the State
Standard, e. g. milk with a 3.2 % fat content)
 Non-standard — a product having 1-2 unessential non-standard parameters, e.g. milk
containing fat lower than 2.5 %)
 Conditionally suitable product demands the preliminary processing before usage
(acidic milk is subjected to processing for kefir, curd, cheese and other milk products).
 A bad quality product has parameters making its usage impossible for man‘s nutrition, e.g.
milk with high contamination by pesticides). The further perspective of such products is
destruction or utilization as forage for cattle, etc.
 Falsified products. (Falsificatio from Latin means deception). Properties of such prod-
ucts are changed specially for deceiving the customer (for example, milk diluted with wa-
ter). Falsification of products is prosecuted.
Except for above mentioned categories of foodstuff quality there is another concept — a
product substitute — a substitute of a natural product officially produced by the state at lack of natu-
ral products, e.g. margarine is a substitute for cow butter). It is estimated according to the State
Standard and may belong to one of the categories of foodstuff quality.

106
Sanitary-Hygienic Characteristics of Foods
Fish is rich in proteins of high biological value. The proteins of fish have a satisfactory
amino acid balance. The fish oils are rich in unsaturated fatty acids of the omega–3 family hav-
ing an antisclerotic action and A and D vitamins. Fish liver oils are the richest source of cal-
cium, phosphorus and A, D vitamins. Fish is less rich in iron (Table 3). Sea fish contains iodine,
while fresh water fish does not.
But fish may be a source of some diseases — fish-borne diseases, such as:
 Helminthiasis: Dibothriocephalus latus, opisthorchiasis
 Bacterial infections: salmonellosis, botulism
 Viral infections: Hepatitis A Virus.
Eggs. Egg contains all the nutrients except for carbohydrates and vitamin C (Table 3).
But in eggs cholesterol is contained in a dose of 250 mg per egg. Cholesterol promotes hyper-
cholesterolemia and the risk of atherosclerosis. Elderly people can eat only 2 eggs a week.
Egg-borne diseases include bacterial infections, e.g. salmonellosis.
Meat. Meat contains 15 to 20 % of protein. Meat proteins are a good source of essential
amino acids. The energy provided by meat depends upon its fat content. Iron is contained in
meat in a dose of 2 to 4 mg per 100 g (Table 9). Iron from meat is more easily absorbed than
iron from plants and it is another major quality of meat. Meat contains some vitamins (A, B6, B2,
and PP), minerals, such as phosphorus, iron, zinc. It is poor in calcium and carbohydrates.
Liver is extremely rich in many nutrients.
All meat should be examined by veterinary inspector before sale. It is necessary to exert
a strict sanitary control over places of sale and conditions of keeping fresh meat. Fresh meat
must be wet, of pink colour, elastic and have an agreeable smell. It must be clear from patho-
genic bacteria. If in a slice (40 cm2) of meat not more than 3 cysts are found out, a special
cooking is necessary.
Meat-borne diseases:
 Helminthisms: Taenia saginata, Taenia soliumand, Trichinella spiralis
 Bacterial infections: tuberculosis, anthrax, brucellosis, salmonellosis
 Viral infections: spongy encephalitus
Table 9
Nutritive Value of Meat, Fish, and Eggs (g100 g)
Proteins (g) Fats (g) Carbohydrates (g) Iron
(mg)
Meat 21.4 3.6 - 2-4
Fish 19.5 2.4 - 0.7-3.0
Eggs* 10.0 10.0 - 2.5
* Two large eggs weighing about 100g
Sanitary-Hygienic Characteristics of Milk and Dairy Products
Milk is the most valuable foodstuff with high nutrition value. It is an ideal food for infants
and children. The milk proteins contain casein, lactatalbumin and lactoglobulin; milk fat is easily
digestible. Carbohydrates are present in milk as lactose. Milk contains vitamins, but vitamin С
is present only in very small quantities. Human and animal milk is compared in Table 10.

107
Table 10
Nutritive Value of Milk
(Food Value per 100 ml)
Nutrients Buffalo
milk
Cow milk Goat milk Human
milk
Fat g 6.5 4.1 4.5 3.4
Protein g 4.3 3.2 3.3 1.1
Lactose g 5.1 4.4 4.6 7.4
Calcium mg 210 120 170 28
Iron mg 0.2 0.2 0.3 0.5
Vitamin C mg 1 2 1 3
Minerals g 0.8 0.8 0.8 0.1
Water g 81.0 87 86.8 88
Energy kcal 117 67 72 65
Milk Products
Vegetable milk is produced from certain vegetable foods (soyabean, groundnut). It may
be used as a substitute for animal milk.
Cheese — proteins 12-16%, calcium — 8OO mg, phosphorus — 400 mg, fats — 25%.
Sour cream — fats up to 36%.
Curds (cottage cheese) — fats — 9-20%, proteins -12-16%.
Kefir is slightly alcoholic and acidic, produced by fermentation of milk with yeasts and
lactobacilli.
Curd. Fresh curd must be white or creamy without sour smell. Fats — 9-18%, water —
65-80 %, acidity — 20-27 Тerner.
Milk-Borne Diseases (FAOWHO)
These can be divided into:
 Animal infections that can be transmitted to man including those of:
 primary importance, i.e. tuberculosis, brucellosis, streptococcal infections, staphylo-
coccal poisoning, salmonellosis, Q fever
 lesser importance, i.e. cowpox, foot and mouth diseases, anthrax, leptospirosis, tick-
borne encephalitis.
 Infections primary to man that can be transmitted through milk, such as typhoid and pa-
ratyphoid fevers, shigellosis, cholera, enteropathogenic Escherichia coli (EPEC), non-
diarrheal diseases including streptococcal infections, staphylococcal food poisoning,
diphtheria, tuberculosis, enteroviruses, viral hepatitis.
Sanitary Examination of Milk
Sanitary-Hygienic Expertise of Milk
Evaluation of Organoleptic Properties of Milk
 Colour of milk is evaluated in a cylinder made of colourless glass, which contains 50-
60 ml of milk.
Normal colour of milk is white with a yellowish shade.
Skim milk has a bluish shade.
Diluted with water milk has a bluish shade.
Impurity of blood in milk (cows diseases) is of pinkish shade.
If an animal eats some plants, shade of its milk may be: orange, yellow — at eating
carrots, pinkish — at eating beet, etc.
 Consistence of milk is determined by a trace remained on walls of a flask after its
churning.
Normal consistence has a white trace
Watery consistence of milk (milk diluted with water) has no white trace.

108
Mucous or viscous consistence of milk (in case of development of bacteria in milk)
leaves a dragging trace on walls.
 Smell. For evaluation of smell 100 ml of milk are poured in a conic flask. Milk is sha-
ken and after that smell is evaluated.
Fresh milk has a milk specific smell.
Sour milk has a specific acidic smell.
Putrefactive microorganisms of milk add the smell of ammonia, hydrogen sulfide, etc.,
to it.
If milk is improperly stored or transported, it can acquire different smells, e.g. of petro-
leum, soap, fish, perfume, etc.
 Taste. For evaluation of taste an oral cavity is rinsed by a small amount of milk (5-10
ml).
Good-quality milk has a slightly sweet taste.
Diluted with water milk or skim milk has a watery taste.
Other tastes (bitter, salty, styptic, fishy) are caused by a forage animal, its illness,
extraneous impurities, incorrect taking and storage of milk.
Evaluation of Physical Properties of Milk
 A dry residue is determined as quantity of organic substance and salts which are
found in 1 liter of milk. A dry residue is determined by boiling down of water. A normal
dry residue makes up 11–12.5%.
 Density of milk is evaluated with the help of a device called a lactodensimeter (Fig.
7).
A lactodensimeter is immersed in a cylinder with milk and the density of milk is determined
by level of milk. For example, point 20 designates the density of 1.020, point 30 — 1.030, etc.
The indications of lactodensimeter are added to the number 1.0. For example, the level of milk
indicates point 30 of a lactodensimeter scale; it means that the density of milk is equal to the
following:
1.0 + 0.030 = 1.030.
The density also depends on temperature of milk. For this purpose there is a thermome-
ter in lactodensimeter showing the temperature of milk. If temperature of milk is lower than
20ºС, for each degree below 20ºС it is necessary to subtract 0.0002 from the readings of lacto-
densimeter.
If temperature of milk is higher than 20ºС, for each degree above 20ºС it is necessary to
add 0.0002.
The normal density of milk at 20°C is 1.028 — 1.034.

109
Fig. 7. Lactodensimeter
Evaluation of Chemical Properties of Milk
 Fat content is determined by a butyrometer (Fig. 8). This is a glass vessel of a cylin-
drical form. Into the device 10 ml of milk, sulfuric acid, amyl spirit are poured. Then
butyrometer is placed in a centrifuge. The device is centrifugated for 5 minutes and
after that the fat content of milk is observed. The isoamyl alcohol containing milk fats is
concentrated at the neck of butyrometer with points, each major scale point corresponds to
1% of fat, each small — to 0.1 % of fat. The normal fat content is 2.5 — 3.2 %

110
Fig. 8. Butyrometer
 The acidity is measured by Turner‘s degrees (T). It is the quantity of 1 ml of deci-
normal caustic soda (0.1 N solution of Na2CO3), which is used for titration of lactic acid
in 100 ml of milk at addition of 3-4 drops of 1% phenolphthalein (10 ml of milk + 20 ml of wa-
ter + phenolphthalein + titration by 0.1 N solution of Na2CO3 up to a weak-pink stain-
ing). The obtained result is multiplied by 10 times.
Normal acidity is 16-22°T (16-19°T is fresh milk, 20-22°T — fresh enough, over 23°T
— not fresh milk). Milk diluted with water has acidity below 16°T.
Tests on Falsification of Milk
 Test for definition of starch. It is necessary to pour 10 ml of milk, add 1 ml of iodine solu-
tion. The appearance of a blue colour demonstrates the presence of starch in milk.
 Test for definition of soda (addition of rosolic acid). It is necessary to pour 5 ml of
milk + 4-5 drops of a 0.2 % solution of rosolic acid in 96 % alcohol. If milk contains
soda, its colour becomes crimson (+ Test). The milk which does not contain soda be-
comes yellow-pink (-Test).
The Main Parameters of Milk According to the State Standard
 Organoleptic properties:
 Colour — white with yellowish shade
 Smell and taste — specific lactic,
 Consistence — it should not be watery or dense
 Physical properties:
 Density at 20°C — 1.028-1.034
 Dry residue — 11–12.5%.
 Chemical properties:
 Fat content — 2.5-3.2 %
 Acidity: normal acidity — 16-22° Terner (16-19°T — fresh milk, 20-22°T — fresh
enough, over 23°T — not fresh). Diluted with water milk has acidity below 16°T.
 Bacteriological properties:
 Pasteurized milk in bottles and packages:
 Common microbial number per ml — 75,000

111
 Coli-index per ml — 0.3
 Pasteurized milk in flasks and tanks
 Common microbial number per ml — 300,000
 Coli-index per ml — 0.3
 Tests on Milk Falsification
 Evaluation of starch addition (–)
 Determination of soda (–)
Falsified milk has the following parameters:
The skim milk: colour — of bluish shade, watery consistence, the dry residue is less
than 11%, density of milk at 20°C is over 1.034.
Milk diluted with water: colour — of bluish shade, watery consistence, the dry residue
is less than 11%, milk density at 20°C is less than 1.028, acidity — below 16°T.
Addition of soda. Soda is added to milk if its acidity is over 23°T (not fresh milk). Thus acidity
is lowered. Rosolic acid is added to falsified milk (+ Test for determination of soda).
Addition of starch. Starch is added to milk diluted with water in order to increase the densi-
ty and dry residue of milk. Solution of iodine is added to falsified milk (+ Test for determination of
starch).
Recommendations for Practical Classes
A sample of milk in a cylinder (200 ml) is given to each student for him to investigate and
make the conclusion about its quality.
Protocol
of Independent Work on Hygienic Examination of Milk Sample
1. Organoleptic properties:
Colour ________________________________________________________________
Smell ________________________________________________________________
Taste _________________________________________________________________
Consistence __________________________________________________________
2. Density of milk: ______________________________________ The readings of
lactodensimeter ____________________________________________________________
Temperature __________________________________________________________
3. Fat content of milk — _____________________________________________
4. Dry residue —
_____________________________________________________
5. Acidity —
___________________________________________________________
Thus, the given sample of milk should be estimated as ___________________ accord-
ing to the classification of product quality, because: ____________________________ (to
enumerate parameters which do not correspond to the State Standard and possible causes of devia-
tions).
Example 1
1. Your conclusion about the sample of pasteurized milk in bottles
Results of analysis:
Colour White-yellowish
Odour Standard
Fat content 2.5%
Temperature 24°
24 C
Density of milk 1.030
Acidity 25°T
Number of bacteria 25000 /ml
Coli-index 2
Starches
For definition of soda ( — )

Soda


112
Problem Solving
1. Temperature of milk = 24 C (above 20ºС).
24 C — 20 C = 4 C
4 C  0.0002 = 0.0008
2. The density of milk at 20 C = 1.030 + 0.0008 = 1.0308 (Normal density)
Normal density of milk at 20°C = 1.028 — 1.034
3.Acidity — 25°T (above normal acidity). Normal acidity = 16-22° T
4. The rest of indexes (colour, odour, fat content, number of bacteria, Coli-index) are normal.
Conclusion
Milk may refer to conditionally suitable foods. It may be used for production of curd, cheese, ke-
fir, yoghurt.
Example 2
1. Your conclusion about the sample of pasteurized milk in bottles
Results of analysis:
Colour Bluish shade
Odour Standard
Consistence Watery
Fat content 1.9 %
Temperature 10оС
Density of milk 1.029
Acidity 19°T
Number of bacteria 25000 /ml
Coli-index 2
Starches
Soda
Problem Solving
1. Temperature of milk = 10 C (less than 20ºС).
20 C — 10 C = 10 C
10 C  0.0002 = 0.002
2. Density of milk at 20C = 1.029 — 0.002 = 1.027 (less than normal density)
Normal density of milk at 20°C is 1.028-1.034
3. Fat content — 1.9%(less than normal value of fat). Normal fat content of milk = 2.5–3.2 %
4. Colour — bluish shade. Normal colour of milk — white-yellowish.
5. Consistence — watery. Normal consistence should not be watery or dense
6. The rest of indexes (odour, number of bacteria, Coli-index, acidity) are normal.
Conclusion
Milk may refer to falsified products (milk diluted with water). It cannot be utilized.
Self-control Test
1. As a result of veterinary inspection of animals on a milk farm 20 cows with a positive
reaction to tuberculosis have been revealed. Identify the possibility of using milk
of such animals for nutrition.
* A. It can be used after pasteurization at 85C during 30 minutes
B. It can be used without any preliminary processing and restrictions
C. It can be used for calves
D. It can be used for technical recycling
E. It should be destructed
2. A student has the following devices: Geiger’s counter, Eber’s counter, Krotov’s de-
vice, Mishchuk’s device, Eber’s device. What device should be used for evalua-
tion of meat quality?
* A. Eber‘s counter
B. Geiger‘s counter
C. Mishchuk‘s device

113
D. Krotov‘s device
E. Eber‘s device
3. In the market the milk is sold which is delivered in flasks. Smell and taste of milk are
usual, colour is white with bluish shade, density — 1.015, fat content — 2 %. Aci-
dy is 15 Terner. The extraneous impurity is absent. Estimate the quality of milk.
A. Milk is not fresh
B. Surrogated milk
* C. Falsified milk
D. Milk of good quality
E. Conditionally suitable milk
4. A sample of milk has been taken to laboratory for examination. The following data has
been established: colour, smell — without features, taste — characteristic of milk,
density — 1.038, acidity — 35 Terner, fat content — 3.2 %. Identify the degree of
milk quality.
A. Substandard milk
B. Milk of good quality
* C. Conditionally suitable milk
D. Milk of reduced quality
E. Falsified milk
Problem Solving
1. The analysis findings of a milk sample are as follows: colour, smell, taste are usual.
Density -1.033 at 30˚С, fat content — 2.6 %, acidity — 20˚ Тurner. Give a hygienic estimation
of milk.
2. The analysis findings of a milk sample are: smell, taste — dairy, colour — white with a
bluish shade, consistence — liquid. Density — 1.033 at 8˚С, fat content — 2.3 %, acidity — 20˚
Тurner. Give a hygienic estimation.
3. A milk sample from a tank shows: taste, smell — dairy, consistence — usual. Acidity
— 17˚ Тurner. Density at 22˚С — 1.032. Fat content — 3.2 %. Reaction to starch and soda —
negative. Total number of bacteria in 1 ml — 120,000. Give a hygienic estimation of milk.
Standard Answers:
1. Density at 20˚С is 1.035 (normal). Fat content is increased. As density is normal, dilu-
tion with water is excluded. The milk corresponds to standard. The conclusion: milk is of good
quality.
2. Density at 20˚С is 1.029 (corresponds to standard). Fat content is decreased. As
density is not increased, only depriving of fat is excluded; as density is not reduced, only dilu-
tion with water is excluded. The milk is simultaneously deprived of fat and diluted. The conclu-
sion is: the milk is falsified.
3. Milk is of good quality, standard (bacteriological parameters of milk in flasks and tank
— 300,000 per ml), density at 20˚С — 1.032.
Theme No 4.
Principles of Rational Nutrition. Prevention of Alimentary Diseases
Nutrition hygiene is a section of hygiene studying the influence of factors connected
with nutrition on a human organism and developing recommendations for a balanced diet. A
part of nutrition hygiene is nutriology — a science about nutrients (food substances).
According to WHO‘s data, about 70 % of all diseases are directly or indirectly caused by
a wrong nutrition or deterioration of food quality.
The basic sections of nutrition hygiene are the following:

114
 A rational nutrition is nutrition of a healthy person for maintaining and improving his
health,
 A medical or dietary nutrition is for treatment of patients,
 A medical-prophylactic nutrition includes special diets for those working in harmful
conditions, i.e. with chemical substances, radiation, etc.
 A preventive nutrition is for people with risk factors of development of diseases
(atherosclerosis, diabetes, etc.).
Table 11
Classification of Types of Nutrition According to Purpose and Biological Effect
Type of nutrition Purpose Group Biological ef-
fect
rational prophylaxis of nutritional dis-
eases
healthy people non-specific
preventive prophylaxis of diseases of a
multifactor nature
risk groups of diabetes,
etc.
specific
medical-
prophylactic
prophylaxis of occupational
diseases
people working in
harmful conditions
protective
medical (dieta-
ry)
correction of metaboliс distur-
bances
patients pharmacological
Classification of Alimentary and Alimentary-Conditioned Diseases
 Primary (exogenic) alimentary diseases. They are connected with insufficient or
surplus nutrients or energy in diet. Their main feature is that aetiology, pathogenesis,
symptomatology, prevention and treatment are connected only with nutrition.
 Secondary аlimentary-conditioned diseases. They are caused by diseases of or-
gans and systems resulting in disturbances of food assimilation, increase of disinte-
gration and consumption of nutrients. They may be infectious, surgical, oncologic ill-
nesses. To these also endogenic avitaminoses, cerebral, hypothalamic, endocrinic
adiposity or dystrophy refer.
The differential diagnostics of the 1st and 2nd group is very important for the doctor,
because their therapeutic approach is completely different: in the first group only the
correction of nutrition is necessary, while in the second — the treatment of a primary
disease plus dietetic therapy, application of biologically active additives (BAA) are re-
quired.
 Diseases of multifactorial etiology, including the alimentary factor. They develop
on a background of genetic predisposition, nervous-emotional causes and other fac-
tors, such as atherosclerosis, hypertension, urolithiases and cholelithic diseases,
gout, gastrointestinal tract diseases, oncopathology, diabetes mellitus. In occurrence
of these diseases nutrition is a risk factor, but not the only reason. Prophylaxis is a
preventive nutrition, dietetic therapy at the developed pathology.
 Diseases connected with availability of harmful factors in food. These are food
poisonings, intestinal infections, helminthiases. Their prevention is control of food
quality.
 Food intolerance is a set of clinical reactions to food: a food allergy (immunopathol-
ogy), pseudo-allergy (individual reactions to separate substances), idiosyncrasy of
food owing to enzymopathies.
Classification of Alimentary Diseases (I group)
 Diseases and syndromes of malnutrition:
 Protein-calorie deficiency (PCD) of various degree, alimentary marasmus, physical
development delay owing to PCD.
 Protein deficiency, including kwashiorkor (infantile pellagra)
 Avitaminoses.
 Mineral deficiency: iron-deficiency anemia, endemic goiter (hypothyroidism), caries,

115
hypozincosis, hyposelenosis, etc.
 Diseases and syndromes of excess nutrition:
 Surplus of caloric content — alimentary adiposity of 1-4 degrees.
 Hypervitaminoses A and D.
 Syndrome of excess of proteins, fat acids.
 Excess of mineral substances — fluorosis, selenosis, molybdenum gout.
Principles of Rational Nutrition and Methods of Control of Their Obser-
vance
They were developed by academician A. A. Pokrovsky in the USSR and are now rec-
ommended by WHO for estimation of adequacy of individual nutrition and nutrition of popula-
tion of different countries. It is a scientific basis of hygiene of nutrition.
1. Conformity of caloric content of nutrition to the daily energy consump-
tion.
This is the main principle of rational nutrition with which the analysis of nutrition begins.
Methods of Control
Caloric content of nutrition is estimated by:
 a table-calculation method (taking into account a dietary intake and according to
tables of food value of products) with the help of calorimetric coefficients.
Calorimetric coefficients of nutrients:
1g proteins and carbohydrates = 4 Kcal,
1g fats = 9 Kcal.
Proteins give 14 %, fats — 30 %, carbohydrates — 56 % of daily calories.
 a laboratory method — burning of 100 g of food product in a calorimetric bomb.
Daily Energy Consumption
It is composed of the basic exchange + energy consumption for work + 10 % of the ba-
sic exchange for food digestion.
The basic exchange is calculated by tables in accordance with sex, age, height and
weight.
Ways of estimation of energy consumption for work:
 Table-chronometric method (by time of performing any activity),
 Direct calorimetry (in the calorimetric chamber)
 Indirect calorimetry (by respiratory coefficient = O2/CO2)
2. Balanced nutrition.
The diet should contain all necessary nutrients: proteins, fats, carbohydrates, vitamins,
mineral substances in an optimum ratio. It provides a better absorption and full-value use of
food substances. Examples of balance:
Ratio of proteins, fats, carbohydrates (P:F:C) = 1:1:4 (an adult person), 1:1:5 (hard
physical work), 1:0.8:3 (elderly people), 1:1:3 (children).
Ratio of proteins: of animal origin — 60 %, of vegetative origin — 40 %,
Ratio of fats: of animal origin — 70-80 %, of vegetable origin — 20-30 %
Ratio of carbohydrates: digestible — 10-15 %, indigestible — 85-90 %.
Ratio Са:P = 1:1.5, etc.
Methods of control: а) table-calculation, b) laboratory (proteins in foodstuffs are deter-
mined by Keildal, fats — by Sokslet method).
3. Optimal diet regimen.
The food should be taken every 4-5 hours (time of evacuation function of the stomach),
i.e. 4-5 times a day. Food intake less than in 2 hours is not optimal because gastric secretion is
suppressed. Nutrition less than 3-4 times a day is harmful, because of great appetite a person
eats plenty of food that leads to hypercholesterolemia, hyperlipemia, adiposity, etc.
Taking food at one and the same time (30 minutes) is of great importance as a condi-
tioned reflex of digestion is formed. The recommended distribution of daily caloric content by
meals is as follows:

116
Breakfast — 25-27 %, lunch — 10-15 %, dinner 35-45 %, supper 10-20 %.
Methods of control include filling in a questionnaire about a diet and evaluation of caloric
content of each meal.
4. Good organoleptic properties of food, its high digestibility, favora-
ble conditions of taking food.
This is necessary for maintenance of normal conditioned-reflectory activity of digestion
(Acad. I. P. Pavlov).
5. Safety of food in chemical and epidemiological respect.
It means absence in foodstuffs of chemical substances or microbes in amounts higher
than allowable levels which may cause food poisonings. Now it is a very important principle in
view of global pollution of biosphere by heavy metals, radionuclides, pesticides, etc. Ways of
control are chemical and bacteriological analyses of foods and comparison of the results with
food standards.
Theories and Concepts of Nutrition
In ancient times the hemopoietic antique theory of nutrition by Aristotle-Galen existed,
according to which blood is food transformed in intestines.
Scientific Theories of Nutrition
These include the following:
 Classical theory of balanced nutrition by academician A. A. Pokrovsky (60s of ХХ
century).
 Theory of adequate nutrition by аcademician A. M. Ugolev (1975) — in addition to the
theory of rational nutrition the membraneous and endocellular digestion is taken into
account.
 Functional-homeostatic theory of nutrition by V. V. Vanchanen (1995) also takes into
account functions and biological effects of different nutrients.
Nonconventional (Unscientific) Concepts of Nutrition
These contain both rational moments and antiscientific statements. They include:
 Vegetarianism (veganstvo)
 Nutrition of macrobiotics (Japan)
 The concept of ―yan‖ and ―in‖ (China)
 Nutrition in yogi system
 Separate nutrition by G. Shelton
 Nutrition of the ancestors (raw food, dry food)
 Reduced nutrition (theory of ―alive energy‖ in vegetable food)
 Concept of coefficients of alimentary value by E. Carise (―point diet‖) (Germany)
 Complete long-lived or temporary starvation
 Absolutization of nutrition optimality (Selective diet for each separate person — USA)
Key Questions
 Types of nutrition (rational, preventive, clinical, clinical-preventive), their differentiation
and purposes.
 The basic principles of a balanced diet.
 Theories of nutrition. Functions of food. Concept of dietary and food status of the
man, methods of its study.
 Methods of controlling the observance of balanced diet principles in a separate man
and in collectives of people.
 Methods of assessment of a daily energy consumption of a human organism and food
value of foodstuffs.
 Bases of nutrition at unfavourable ecological conditions.

117
 Norms of nutrition, parameters which are taken into account at their elaboration.
 Classification of alimentary and alimentary-conditioned diseases, examples, causes,
manifestations, treatment and prevention.

118
Self Test
1. What methods are used to determine the caloricity of man’s nutrition?
A. direct and indirect calorimetry
* B. a laboratory and calculation method
C. a tabular-chronometric method
D. a spectrophotometric method
2. The optimal number of meals for an adult man is
A. 2-3 times a day
* B. 4-5 times a day
C. 5-6 times a day
D. when the feeling of hunger occurs
E. every 2-3 hours
3. A clinical nutrition is developed for:
A. diseases caused by ecological conditions
* B. for feeding patients in medical establishments
C. diseases which badly yield to treatment
D. persons contacting with occupational hazards
4. On medical examination of male drivers in 10 % of persons an increased body weight
(65 % higher than normally) was revealed. What is their nutritional state?
A. Normal status (adequate nutrition)
B. Obesity of 1st degree
C. Obesity of 2nd degree
* D. Obesity of 3rd degree
E. Obesity of 4th degree
5. Determine the caloricity of a student’s diet, which basic exchange makes up 900 Kcal,
and energy losses in all kinds of activity during a day make up 2,100 Kcal.
A. Caloricity of a daily diet is 900 Kcal.
B. Caloricity of a daily diet is 2,100 Kcal
* C. Caloricity of a daily diet is 3,090 Kcal
D. Caloricity of a daily diet is 90 Kcal
E. Caloricity of a daily diet is 1,545 Kcal
Problem Solving
1. The diet of a miner includes 90 grams of proteins, 65 grams of fats and 650 grams of
carbohydrates. Dietary habits are chaotic. An interval between meals is very large. What group
of work intensity does the miner refer to? What is the amount of his energy losses? What is the
caloricity of the submitted diet? Will it cover energy losses of the miner? Estimate this diet.
2. A 39-year-old surgeon spends 3,100 Kcal daily. The diet of the surgeon contains 93 g
of proteins (including 40 g of animal origin), 116 g of fats and 300 g of carbohydrates. Caloricity
of the diet is 2,651 Kcal. He usually has three meals every day: breakfast — at 7.30, dinner —
at 15.00, supper — at 20.00. The distribution of caloricity by meals is as follows: breakfast —
20 %, dinner — 50 %, supper — 30 %. Determine the group of work intensity, estimate calorici-
ty of nutrition and diet regimen. Give recommendations for balanced nutrition.
3. Patient Н. aged 63 suffers from excessive body mass, there are expressed signs of
coronary atherosclerosis, hypertension. He has meals 3 times a day, avoiding fatty and spicy
food. Estimate his nutritional state. What recommendations for correction of nutrition of antis-
clerotic orientation should be given in this case?
4. A patient aged 53 has a body weight of 82 kg at a height of 162 cm. She has 3 meals
a day; the diet is usual. On examination an increased sugar level in blood (during last 5 years)
has been revealed. In anamnesis: her mother was ill with diabetes mellitus. Estimate the nutri-
tional state. Give recommendations for preventive nutrition.
5. Estimate the nutrition rationality of citizen N., aged 65, having 3 meals a day (at 8
a.m., at 4 and 8 p.m.), consuming 100 g of proteins, 100 g of fats and 500 g of carbohydrates.
A daily energy allowance is 2,700 Kcal.
Standard Answers
1. The miner belongs to the 4th group of work intensity. Depending on age, the amount

119
of his daily energy losses makes up 3,900-4,300 Kcal. The caloricity of his diet is = 90 х 4.1 +
65 х 9.3 + 650 х 4.1 = 3,638 Kcal. The diet of the miner by caloricity does not correspond to his
energy losses. The regularity of meals is disturbed. The time and frequency of meals should be
regulated.
2. By energy losses the doctor-surgeon relates to the 3rd group of work intensity. Calo-
ricity of his diet does not correspond to energy losses. A qualitative structure of the diet has
deviations. The total amount of proteins (93g) in the diet corresponds to physiological norms,
but the content of animal proteins is below the recommended norms — 43 % (instead of 55-60
%), total amount of fats in the diet is sufficient (116 g). The amount of carbohydrates in the diet
is much lower than the norm. Instead of 426 g it makes up 300 g. The ratio of proteins, fats and
carbohydrates in the diet is not rational: it is 1:1.2:3.2, while normally it is 1: 1:4-5. An interval
between meals is more than 7 hours. The conclusion: the nutrition of the doctor-surgeon is not
rational and imbalanced.
3. The nutritional status is excessive. Alimentary obesity, the development of ischemic
cardiac disease in connection with hypercholesterolemia are probable. A fractional nutrition (6-
8 times a day) with a ratio of P:F:C = 1:0.8:3, limitation of fats and unprotected carbohydrates
to limit the caloricity of food up to 2,000-2,400 Кcal a day are necessary. The inclusion in a diet
of alimentary antisclerotic factors is necessary, e.g. irreplaceable aminoacid methyonin
(cheese, cottage cheese), PNFA (vegetable oil, fat of sea fish), phosphatides (vegetable oil,
etc.), antioxidant vitamins C, A and Е.
4. The nutritional status is excessive. Alimentary obesity is quite probable. The exclusion
of unprotected carbohydrates from a diet, fractional nutrition (6-8 times a day) with a ratio of
P:F:C = 1:0.8:3, limited amount of fats are necessary. Daily caloricity of food should be 2,200
Кcal. It is necessary to include sugar substitutes (sorbite, xylite, fructose, etc.) in meals, to pro-
vide optimal supply of diet with vitamins.
5. We begin solving the problem with estimation of caloric content of nutrition with the
help of calorimetric factors (At burning 1g of proteins and carbohydrates gives 4.1 Kcal, and 1g
of fats –9.3 Kcal of heat):
100 x 4.1 + 100 x 9.3 + 500 x 4.1 = 3,390 Kcal,
This exceeds a daily energy allowance (2,700 Kcal). Besides a nonoptimal balance of proteins,
fats and carbohydrates (1:1:5) is observed, which for elderly people should make up 1:0.8:3.
The regimen of nutrition is also irrational: three meals a day (it should be four meals a day),
there are nonoptimal intervals between taking meals (between breakfast and dinner — 8 hours, between
dinner and supper — 4 hours), These time intervals should make up 4 -5 hours.
The conclusion: the nutrition does not meet the demands of a balanced diet. It is necessary
to decrease the consumption of fats by 20 g, carbohydrates — by 200g, to have 4 meals a day with inter-
vals of 4-5 hours.
Theme No 5.
Value of Various Nutrients in Nutrition.
Functions of Proteins, Fats and Carbohydrates in the Body
A section of hygiene of nutrition devoted to studying the functions of food substances
(nutrients) in organism is called nutriology.
Structure of Foods
 Nutrients — proteins, fats, carbohydrates, vitamins, mineral substances.
 Non-alimentary substances are substances adding organoleptic properties, i.e. color,
smell, etc. to foods.
 Antialimentary substances — antitrypsins (in raw egg protein), antivitamins (ascorbi-
nase, thiaminase), antimineral substances (phytates, oxalates).
 Toxic substances:
 inherent in foods — toxins of poisonous mushrooms, solanine in potato, etc.
 casually obtained pollutants of the environment — pesticides, heavy metals, dio-
xines, etc.

120
Table 17
Functions of Nutrients
Function Nutrients
Energy carbohydrates, fats, proteins, organic acids, etc.
Plastic proteins, minerals, fats, carbohydrates
Bioregulatory proteins, vitamins, mineral substances
Adaptive-regulatory proteins, water
Immunoregulatory proteins, vitamins, etc.
Treatment-and-
rehabilitation
dietary foods with the improved content of nutrients and ade-
quate caloricity
Signal-motivation gustatory and extractives (spice, seasoning)
Role of Proteins in Nutrition
Proteins perform a great number of very important functions in the body: structural (con-
struction of tissues), protective (gamma-globulins, etc.), regulatory (hormones, enzymes),
transport (hemoglobin of blood), energy (14 % of daily calories).
According to their value, proteins are classified into high-grade and less high-grade.
Attributes of High-Grade Proteins
 Presence in proteins of irreplaceable amino acids at an optimal ratio. By this criterion
proteins are placed in the following order: protein of eggs, milk, meat, fish, soya, sun-
flower.
 Good assimilability of protein in organism. There are 3 groups of proteins:
 easily assimilated — milk, fish,
 moderately assimilated — meat, eggs (after thermal processing),
 badly assimilated — leguminous, bread, mushrooms.
 High biological value. After absorption a greater part of irreplaceable amino acids should
be used for the main functions of proteins, except for energy.
Parameters of Protein Value
1. Aminoacidic number (AAN) in %%:
The composition of ideal protein (FАО/WHO) in g per 100 g of protein: valine — 5, leu-
cine — 7, lysine — 5.5, isoleucine — 4, methionine — 3.5, threonine — 4, tryptophan — 1,
phenylalanine — 6.
AAN of key products: an egg — 100 %, cow milk — 95 %, rice — 67 %, wheat — 53 %.
2. The ratio of irreplaceable and replaceable amino acids in protein:

121
3. Protein efficiency ratio (PER) > 2.5
where :
W1 — the initial mass of the body
W2 — mass of an animal body at the end of experiment
В — amount of protein (in g), received by the animal during experiment.
4. Net protein utilization (NPU) > 0.7
A — quantity of nitrogen in meal (in g)
where U — quantity of nitrogen discharged
A with urine (in g)
F — quantity of nitrogen discharged with feces (in g)
Irreplaceable Amino Acids and Their Functions
Irreplaceable amino acids are not synthesized in a human organism and should be sup-
plied from outside with foods. Among the 20 amino acids eight are irreplaceable for an adult
person. They are methionine, lysine, tryptophan, leucine, isoleucine, threonine, valine, pheny-
lalanine.
Methionine. A daily need is 2-3 g. It regulates the exchange of fats, phosphatides and
cholesterol — an antisclerotic factor. It is contained in milk, cottage cheese, eggs, legumes,
meat, fish.
Lysine. A daily need is 3-5 g. It participates in synthesis of hemoglobin, supports a ni-
trogenous balance, regulates content of Са in blood. It is contained in milk, meat, fish, soya. Its
content in cereals is little.
Tryptophan. A daily need is 1.6 g. It stimulates growth of tissues, synthesis of blood
proteins and hemoglobin, maintains a nitrogenous balance. It is contained in little portions in
different food proteins.
For children, in addition to above mentioned, 2 more irreplaceable amino acids are ne-
cessary — аrginine and histidine. They are conditionally irreplaceable, synthesized in the or-
ganism but in insufficient amount for a growing organism, since they stimulate growth, devel-
opment, metabolism, hematosis.
A Protein Norm and Protein Minimum
A protein norm is a necessary daily amount of protein for a person, which allows the
protein to fulfill all its functions. It is a part of the nutrition norms of the population (Table 18). It
depends on age, sex, intensity of work. For adults on average it makes up 70-100 g a day. The
optimal ratio of animal and vegetable proteins for adults is 50 : 50%, for children 60 : 40%.
Table 18

122
A Daily Need of Protein (g/kg of body mass)
Country Men aged 18-59 Women aged 18-59
FAO WHO 0.75 0.75
USA 0.80 0.80
Canada 0.77 0.69
England 1.15 1.0
Russia 0.93 — 1.7* 0.96 — 1.4*
Ukraine 0.83 — 1.53* 0.83 — 1.4*
Note: * — depending on age and work intensity
A protein minimum is the necessary amount of protein for maintenance of nitrogen
balance in organism — at that all protein is spent on decomposition and formation of nitrogen.
Calculation: daily in the organism 6-7g of nitrogen are lost, 1 g of nitrogen is formed at de-
composition of 6.25 g of protein (upon the whole about 40 g that is less than 50 % of protein
norm). At nutrition on this level the basic functions of protein are not fulfilled, that can result in
acquired immunodeficiency.
A Protein Problem and Ways of Its Solving
On a global scale nowadays in the world 50 % of the necessary amount of protein for
nutrition of all population of the planet is produced. Almost in all countries, especially in those
with an insufficient level of economic development and a low living standard, part of the popu-
lation experience either shortage of protein in general, or shortage of high-grade (animal) pro-
teins, that affects the population health.
The traditional ways of solving a protein problem are as follows:
 Increase of agricultural production by extensive and intensive ways (at these agro-
chemicals should be used, that results in contamination of foods and pollution of bi-
osphere)
 Increase of a crop preservation by means of chemicals
 A wide use of protein products of the ocean (but they are very expensive, may cause
allergic reactions and accumulate pollutants from the sea water).
 Isolation of protein concentrates from soya, sunflower and their addition to sausages
up to 20-30%.
Unconventional ways of solving a protein problem include the following:
 Application of microbiological synthesis (growth of some microbes on sugar produc-
tion wastes, on oil, but it is very difficult to refine protein from waste products, and
such protein cannot be used in man‘s nutrition).
 Search of profitable ways of synthesis of irreplaceable amino acids (for the present
such chemical synthesis is very expensive).
Role of Fats in Nutrition
The structure of food fats includes: neutral fats (ethers of glycerin and fat acids), fatty
substances — phosphatides, mineral substances, fat-soluble vitamins (in some fats).
Functions of fats in nutrition: energy (30-32% of daily calories, 1g fat gives 9 Kcal), regu-
latory, plastic, protective (from mechanical and temperature effects), gustatory.
Characteristics of Fat Acids
According to the content of free (double) links in formula, fat acids are subdivided into
saturated, unsaturated and polyunsaturated.
 Saturated fat acids (SFA) are stearin, palmitic acids in animal fats, butyric and caproic
acids — in vegetable oils. They are nonreactive, absorbed worse than others, perform
basically an energy function. They are contained in the beef, mutton fat. At excessive
use they contribute to the development of atherosclerosis due to plenty of cholesterol
and absence of antisclerotic factors.
 Monounsaturated fat acids (MUFA) — oleic acid — contain one free link in the formula;
they are better absorbed, perform basically an energy function. They are found in vege-
table fats.

123
 Polyunsaturated fat acids (PUSA) — linoleic, arachidonic acids (omega-6 family), lino-
lenic acid, etc. (omega-3). They have several free links in the formula. They are the most
biologically active and valuable among fat acids. They fulfill:
 a regulative function, controlling the cholesterol exchange (an antisclerotic factor), re-
ducing coagulability of blood and permeability of vessels.
 a protective function, increasing the resistance of organism to infections, toxicants,
excess ultra-violet rays (antioxidants).
 a plastic function: PUSA are included into vessel walls and myelinic membranes of
the nerves.
Suppliers of PUSA: PUSA of omega-6 family are contained in unrefined vegetable oils,
PUSA omega-3 are contained in sea fish oils (biologically are most active).
Phosphatide Value
Fatty substances are those in which one fatty acid is replaced by a phosphoric acid and
nitrogen base. Their representatives are: lecithin, cephalin. They participate in synthesis of
nucleic acids, in cholesterol exchange (an antisclerotic factor). A plastic role is as follows: they
are included into cell protoplasm, especially of the nervous system and liver. Suppliers are: liv-
er, brain, egg yolk, butter, lard, unrefined vegetable oils.
Sterols. They are divided into phytosterols and zoosterols (Cholesterol). Despite a
widespread opinion about its harm, cholesterol is very important for an organism. Its plastic
function is as follows: it is contained in cell protoplasm, creates elasticity of tissues as hydro-
phylic colloid due to preserving water. A regulative function includes synthesis of vitamin D, bile
acids, sex and steroid hormones. A protective function is inactivation of hemolytic poisons.
According to modern concepts the development of atherosclerosis has a multifactorial
etiology, which basis is the disturbance of a fatty exchange and increased endogenic synthesis
of cholesterol; excess of alimentary cholesterol is of a comparatively small significance — it is
an alimentary risk factor of atherosclerosis.
Value of Carbohydrates in Nutrition
Functions of carbohydrates include the following:
 an energy function (56 % of caloric content of a diet per day), 1 g = 4 Kcal
 a regulatory function (a cellular tissue stimulates the motility and secretion of intes-
tines)
 a plastic function (carbohydrates are included in the structure of protoplasm and cel-
lular membranes)
 a protective function (carbohydrates are bound to heavy metals, cholesterol; glucose
inactivates cyanides),
 a gustatory function — a sweet taste.
Table 19
Classification of Carbohydrates
CHEMICAL HYGIENIC
1. Monosaccharides (Glucose,
fructose)
1. Unprotected (refined) from absorption
2. Disaccharides (Saccharose, lactose) 2. Protected (starch)
3. Polysaccharides (starch, pectins) 3. Overprotected (Cellulose, pectin
substances)
In hygiene carbohydrates are subdivided according to degree of absorption:
 The unprotected (refined) carbohydrates are mono- and disaccharides (glucose, lac-
tose, etc.). They are quickly absorbed in the organism and supply energy. At consump-
tion of plenty of such carbohydrates alimentary adiposity, diabetes mellitus and caries
may develop.
 To protected carbohydrates starch relates. It is slowly absorbed in organism and sup-
plies most of the energy.
 Overprotected carbohydrates are а cellular tissue, pectin substances.

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Key Questions
1.Food structure. The basic groups of nutrients.
2.Significance of proteins in nutrition:
concept of a protein norm and protein minimum, signs of full value of proteins and protein
products;
irreplaceable amino acids for adults and children; representatives, role in organism, a daily
need, foods-suppliers;
3.Significance of fats in nutrition:
- classification of fat acids, representatives, role in organism;
- polyunsaturated fat acids, representatives, their role, foods-suppliers;
- phosphatides, representatives, their role, foods-suppliers;
- cholesterol, functions in organism. Alimentary antisclerotic factors.
4.Significance of carbohydrates in nutrition:
hygienic classification of carbohydrates, representatives;
- hygienic characteristics of various carbohydrates.
Self-control Tests
1. What percentage of total fats should fats of a vegetable origin make up in a balanced
diet of an adult man?
* A. not less than 30 %
B. not more than 30 %
C. not less than 50 %
D. not more than 20 %
E. not less than 70 %
2. The signs of full value of proteins include the following:
* A. an optimal ratio of irreplaceable amino acids
B. convenience of thermal processing without loss of food value
* C. good assimilability
* D. high biological value
E. performance of energy function
3. Identify the alimentary antisclerotic factors.
* A. methionine
B. lactose
* C. PUSFA
D. vitamin C
* E. phospholipids
Problem Solving
1. Suffering from bilateral pneumonia, patient N. received intensive antibacterial therapy,
which resulted in dysbacteriosis of intestines. What changes expedient to the diet of the patient
will you recommend?
2. What foods are the prevailing source of phospholipids?
3. Energy losses of a miner aged 35 make up 4,100 Kcal. The analysis of a daily food
allowance has shown that its caloricity is equal to 3,640 Kcal. It contained proteins — 100 g,
fats — 90 g, carbohydrates — 598 g. Dietary habits provide four meals a day: breakfast — at
6.00, lunch — at 11.00, dinner — at 16.00, supper — at 20.00. Caloricity is distributed by
meals: breakfast — 20 %, lunch — 15%, dinner — 40 %, supper — 25 %. Determine the group
of work intensity, estimate value of nutrition, balance of the diet and dietary habits.
Standard Answers:
1. It is necessary to increase the amount of dairy products (kefir, yoghurt, acidophilin) in
the diet.
2. Cereals, oil, leguminous cultures.3. The 4th group of work intensity. Daily caloricity
should make up 3,900-4,300 Kcal. The diet meets to principles of balanced meals.

125
Theme No 6.
The Significance of Vitamins and Minerals in Nutrition
Value of Vitamins in Nutrition
Vitamins are the low-molecular organic substances, biologically active in very small
amounts.
Functions of vitamins:
 regulatory — they form enzymes and regulate metabolism,
 protective — they increase the resistance of organism to the unfavourable climatic
factors, harmful physical and chemical influences, infections, etc. (vitamin C is an an-
tioxidizer).
Classification of Vitamins
Water-Soluble Vitamins
Vitamin C — Ascorbic acid
Vitamin В1 — Thiaminum
Hepatoflavin — Riboflavinum
Vitamin В3 or В5 — pantothenic acid
Vitamin B6 — pyridoxine, pyridoxal, pyridoxamine
Vitamin В12 — cyanocobalamin
Vitamin Н — biotin
Vitamin РР — Niacin, nicotinamidum
Folic acid
Liposoluble Vitamins
Vitamin A — Retinolum, retinolacetat, retynal
Vitamin D — ergocalciferol (D2), cholecalciferol (D3)
Vitamin E — admixture of tocopherols
Vitamin K — admixture of naphthoquinones
Vitamin-like Substances
Choline
Inosite — Vitamin B 8
Lipoic acid — Vitamin U
Orotic acid — Vitamin B 15
Pangamic acid — Vitamin В15
Carnitine
Para-aminobenzoic acid
Biologically fissile materials — Bioflavonoids
Sources of vitamins
Vitamins are formed basically in plants, and also accumulate in animal organisms. A
person receives water-soluble vitamins with vegetable food, fat-soluble ones — with animal
and vegetable food.
Some vitamins can be synthesized in a human organism:
 Vitamins of group B, especially B12, are formed in intestines at microflora activity;
 Calciferoles (vitamin D3 — cholecalciferol) are formed in the skin from provitamin de-
hydrocholesterol at ultra-violet irradiation.
 Vitamin A (retinol) is formed from beta-carotenes of vegetable food in very insignifi-
cant amounts (1/6 of need for vitamin A).

126
Types of Vitamin Status of Organism
By level of vitamin supply of organism the following are distinguished:
 Avitaminosis — a complete absence of vitamin in nutrition for a long time;
 Hypovitaminosis — insufficient supply of organism with vitamins (about 50 % of re-
quirement);
 Subhypovitaminosis — a boundary condition between hypovitaminosis and a nor-
mal vitamin state;
 Normal supply of organism with vitamins;
 Hypervitaminosis — an excess intake of vitamins (vitamins A and D, as a rule).
Avitaminosis and hypovitaminosis can be exogenic and endogenic (the latter is caused
by disturbance of vitamin absorption).
Methods of diagnostics of vitamin status are as follows:
 According to symptomatology of disturbances, characteristic of each avitaminosis
connected with a concrete vitamin (scurvy, beriberi, etc.).
 Biochemical methods (by content of vitamines in blood or urine and comparing the
results with the norm).
 Functional tests (skin haemorrhage at vitamin C hypovitaminosis).
Factors influencing the vitamin requirement of organism are divided into:
 Exogenic:
 a phsychoemotional and physical overstrain
 work at high and low temperature
 work in mines, in the Far North
 contact with industrial poisons, at medicine intake (antibiotics)
 work with radiation, noise, vibration
 smoking
 seasonal fluctuations — insufficient amount of vitamins in a diet in winter and spring.
 Endogenic:
 age
 pregnancy and lactation
 infectious diseases
 endocrine diseases (hyperthyroidism, increase of metabolism in organism)
 intestinal diseases (disturbance of vitamin absorption, resection of intestines).
Significance of Separate Vitamins
Vitamin C — ascorbic acid. For an adult person 75-100 mg of this vitamin per day are
necessary. Its functions are the following:
 participation in oxidation-reduction processes
 strengthening a vascular wall — prevention of haemorrhage (scurvy)
 stimulation of immunity — resistance to infections
 regulation of protein and carbohydrate exchange
 increase of resistance to toxic substances (an antioxidizer)
 influence on Са absorption (at scurvy in children — changes in bones).
It is a very unstable vitamin. An ascorbic acid is easily oxidized.
Factors destroying vitamin C are temperature, access of oxygen, catalysts (salts of
Ferrum and Cuprum — knifes, utensils), the alkaline environment, ascorbinase enzyme (acti-
vated at cutting vegetables and fruit; inactivators of ascorbinaze are salt, sugar, vinegar).
Vitamin D is a complex of calciferols.
They distinguish ergocalciferol (vitamin D2) which is formed in plants and cholecalci-
ferol (vitamin D3) which is formed in skin at action of ultra-violet irradiation from dehydro-
cholesterol. The products of their oxidation are biologically active, formed in the liver and kid-
neys. Lack of vitamin D causes rickets in children, infrequently osteoporosis in adults. Regula-
tion of absorbtion and exchange of Са has an antirachitic effect. It is of particular importance
for children.
The reasons of D-hypovitaminosis are lack of a solar irradiation (Far North, pollution of
the atmosphere, insufficient staying in the fresh air, work in mines, etc.), using only vegetables

127
for food.
Prevention and treatment of rickets in children are introduction of vitamin Dз — 500 In-
ternational Units (IU) per day, preventive artificial UV irradiation (1/6 — 1/8 of biodose, at rickets
— ½ — ¼ of biodose).
At overdosage of vitamin D — D-hypervitaminosis — severe derangements of calcium
metabolism, calcinosis of heart, kidney and other vessels occurs. Calcinosis of coronary ves-
sels in childhood at overdosage of vitamin D results in predisposition to myocardial infarction.
Vitamin A — retinol. It is necessary for vision, growth, stimulation of immune system.
Avitaminosis more often occurs in children of preschool age and results in hemeralopy (night
blindness) and xerophthalmia (degeneration of eye conjunctiva and cornea). "Vitamin of pros-
perity" is basically contained in expensive animal foods — cod-liver oil and liver, as well as in
plants — beta-carotins. A daily norm of the vitamin is 1.5 — 2 mg.
Signs of A-hypervitaminosis are: headache, baldness, disorders in the bone tissue and
liver, in pregnant — spontaneous abortions and deformities of foetus. The reason is overdo-
sage of vitamin-A preparations, less often — consumption of the liver of a polar bear which is a
fatal retinol poisoning.
Significance of Minerals in Nutrition
Of 50 elements, present in a human organism, 26 are vitally important, among which 12
are macroelements and 14 are microelements (Table 20).
Table 20
Classification of Minerals
Macrobioelements
[Content is more than 10 mg/kg (mg %)]
Microbioelements
[Content is less than 10 mg/kg
(1 mg %)]
1. Cations of calcium, potassium, magnesium, sodium 1. Necessary:
Iron, iodine, fluorine, zinc, copper,
cobalt, manganese, nickel, selenium,
chrome, etc.
2. Anions of phosphorum, sulfur, chlorine 2. Necessity is not clarified: strontium,
boron, bromine, cadmium etc.
3. Organic bonds with oxygen, carbon, hydrogen 3. Toxic: lead, cadmium, arsenic,
hydrargyrum
Requirements for Minerals (mg/day)
Calcium — 800-1500 Phosphorum — 1200-3000 Magnesium — 400-500
Iron — 15-18 Zincum — 15 Iodine — 0.15 Copper — 1.5-3 Manganese — 2-5
Fluorine — 1.5-4 Chromium — 50-200
Characteristics of Some Macroelements
Calcium. Its needs are 0.8 g per day, for pregnant at lactation — 2 g. It is especially im-
portant at children's age — 1-1.5 g/day are necessary.
Functions
 plastic — in structure of bones, teeth (makes them harder)
 regulatory — strengthening a vascular wall, participation in blood coagulability, trans-
fer of impulses in the nervous system, maintenance of normal nervous-muscular exci-
tability, is a part of buffer systems,
 protective — increases the resistibility to infections, produces a desensibilization ef-
fect (antibiotics).
Conditions of Ca Absorption
 An optimal ratio with phosphorus — Са : P = 1:1.5 — in milk and dairy products
(cheese, cottage cheese).

128
 Presence of vitamin D — improves Са absorption
 An optimal ratio with magnesium — Са : Mg = 2 : 1 (for children 9:1). Magnesium is
Ca antagonist; it is contained in great amounts in cereals.
 Sufficient content of proteins in meals — a better Ca absorption
 Absence of great amount of fats and oxalic acid — insoluble compounds with Ca are
formed.
Phosphorus. Its requirements are 1.6 g a day, for children — 3 g, for pregnant — 3.8 g.
Functions
 plastic — is a part of a bone tissue (providing elasticity), nerve tissue
 regulatory — the formation of phosphatides and nucleic acids, ATP and buffer sys-
tems of organism.
Conditions of Absorption
 Ratio of Са : P = 1 : 1.5
 Sufficient amount of fats in food
Products-sources: dairy products, yolk, fish, legumes, meat.
Microelements
These are mineral substances contained in tissues of organism in amounts less than 1
mg%, required for organism in minute quantities, but playing a very important regulation role.
The diseases connected with disturbance of microelement structure of nutrition are
called microelementoses (Table 21).
The reason of their occurrence is biogeochemical provinces (according to V. I. Ver-
nadsky) — territories with abnormal contents (increased or lowered) of microelements. These
provinces may be natural caused by features of geological formation of Earth's crust and anth-
ropogenic connected to human activities (heavy metals, fluorine, etc.). People in these areas
get insufficient or superfluous amount of microelements with food and water, so endemic dis-
eases (characteristic of certain districts) occur.
Table 21
Classification of Microelementoses
(based on lack or excess of microelements in ground, water and foodstuffs)
Hypomicroelementoses Hypermicroelementoses
Monohypomicroelementoses
fluorine → caries
iodine →endemic struma
iron → iron-deficiency anemia
Monohypermicroelementoses
1. Natural:
molybdenum → molybden-endemic gout
selenium →selenium toxicosis
strontium → strontium rachitis
fluorine →fluorosis
cadmium → cadmium nephropathy
iodine → Basedow‘s disease
Polyhypomicroelementoses :
iron, copper, manganese, zinc →
anemia
2. Anthropogenic:
hydrargyrum →Minamata disease
cadmium → illness itai-itai
PCD → Usho illness
lead, arsenic, pesticides, dioxines,
nitrates → different disease
Polyhypermicroelementoses:
strontium, manganese, fluorine → river Urova dis-
ease (Kasin-Beck disease)
Significance of Some Microelements
Fluorine. Daily requirement is 2.5-3 mg. It regulates Ca-P exchange. It participates in

129
formation of dentin, dental enamel and bones. Due to lack of fluorine caries occurs, at its
excess (5 % of Ukraine territory) — fluorosis, i. e. damage of teeth, bones, disorders of intellec-
tual development in children.
Iodine. Daily requirement is 0.1-0.2 mg (100-200 µg). It participates in synthesis of the
thyroid gland hormone — thyroxin, regulates function of this gland. Because of lack of iodine
hypothyroidism (endemic goiter or myxedema) occurs, at its excess — hyperthyroidism (Base-
dow‘s disease).
Iron. Its requirement is 15 mg a day, for women — 30 mg a day. It takes part in synthe-
sis of hemoglobin (60% of all iron in organism), is a part of some oxidizing enzymes — perox-
idase, cytochrome. It is an indispensable part of a cell cytoplasm and nucleus.
Conditions of absorption: hydrochloric acid, vitamin C.
Key Questions:
1.Vitamins and minerals. Their classifications.
2.Biological role and conditions of absorption of vitamins and minerals.
3.Physiological, natural and social factors determining the needs and supply of organism with
vitamins and minerals.
4.Concept of hypovitaminoses, subhypovitaminoses, avitaminoses and normal supply of or-
ganism with vitamins. Reasons of occurrence, clinical, physiological and biochemical manife-
stations.
5.Concept of minerals, their classification. Concept of macroelements, their functions. Func-
tions of Ca, P, Na, conditions of their absorption. Microelements (Fe, F, J, Zn, etc.). Microele-
mentoses, their classification, reasons of occurrence, clinical, physiological and biochemical
manifestations.
6.The basic foods-suppliers of vitamins and minerals. Conditions of storage and culinary
processing of foodstuffs ensuring the maximal preservation of vitamins and minerals.
7.Methods of determination of vitamin C in foods and in biological liquids of a human organism.
8.Method of estimation of mineral salt intake in оrganism with a daily diet.
Evaluation of adequacy of individual nutrition as for vitamins and minerals according to
the tables made at home beforehand, taking into account sex, age, kind of activity, body
weight, diet.
Table 22
Physiological Daily Need for Vitamins and Minerals in Adults
Vitamins Minerals
Men
Age C
mg
A
µg
E
mg
D
µg
B1
mg
B2
mg
B6
mg
B12
mg
Ca
mg
P
mg
Mg
mg
Fe
mg
Zn
mg
I
mg
18-
50
70 1000 10 2.5 1.4 1.3 2 3 800 1200 400 10 15 0.1
Women
18-
50
80 1200 400 18 15 1.5 2 2.5 800 1200 400 18 15 0.1

130
Table 23
Estimation of Vitamin and Mineral Value of Food
Food Weight
(g)
С
mg
A (carotin)
mg
E
mg
B 1
mg
B2
mg
Ca
mg
P
mg
Fe
mg
I
µg
Meat 100 0 0 0 0.08 0.14 9 178 2 -
Liver 100 33 3.8 - 0.3 2.2 5 339 9 -
Chicken 100 -- 0.04 - 0.07 0.15 10 210 1.5 -
Fowl 100 - 0.07 - 0.07 0.15 16 228 3.0 -
Sausage
boiled
100 - - - 0.25 0.18 7 146 1.7 -
Sausage
smoked
100 - - - 0.19 0.2 10 226 2.7 -
Eggs 100 - 0.35 - 0.07 0.44 55 185 2.7 -
Fish 100 - - - 0.1 0.1 - 310 - 100
Milk 100 1.0 0.02 - 0.03 0.13 121 91 0.1 -
Kefir
(yoghurt)
100 0.8 0.02 - 0.03 0.01 121 94 0.1 -
Cheese 100 2.4 0.21 - 0.03 0.38 760 424 - -
Butter 100 - 0.5 - - - 22 19 0.2 -
Oil 100 - - 35 - - 45 - - -
Bread white 100 - - 3.2 0.2 0.1 23 131 3.2 -
Bread black 100 - - 2.2 0.2 0.1 21 174 3.6 -
Rice 100 - - 0.4 0.08 0.04 24 97 1.0 -
Buckwheat 100 - 0.01 6.6 0.4 0.2 55 298 6.6 -
Oatmeal 100 - - 3.4 0.5 0.1 64 349 3.9 -
Cabbage 100 50 0.02 - 0.06 0.05 48 31 1.0
Potato 100 20 - - 0.12 0.05 10 58 0.9
Carrot 100 5 9.0 - 0.06 0.07 51 55 1.2
Onion 100 10 - 0.05 0.02 31 58 0.8
Leek 100 30 2.0 0.02 0.1 121 26 1.0
Beetroot 100 10 0.01 0.02 0.04 37 43 1.4
Tomatoes 100 20 0.03 0.1 0.1 14 26 1.4
Paprika 100 250 2.0 0.1 0.08 8 16 -
Orange 100 60 0.05 0.04 0.03 34 23 0.3
Lemon 100 40 0.01 0.01 0.04 40 22 0.6
Apple 100 13 0.03 0.1 0.03 16 11 2.2

131
At the end of the lesson in the protocol notebook the students make up the following ta-
ble:
Estimation of Adequacy of an Individual Nutrition as for Vitamin and Minerals Content
Nutrient Actual intake with a
diet per day
Norm of daily in-
take
Difference
Vitamins:
C
A
В1
Mineral sub-
stances:
Са
Р
Fe
F
Self Tests
1. Name the basic groups of minerals.
* A. microelements
B. water-soluble minerals
C. liposoluble minerals
* D. macroelements
E. phosphatides
2. A daily need for vitamin C makes up:
* A. 75 mg
* B. 100 mg
C. 50 mg
D. 60 mg
E. 10 mg
3. As a result of a thorough medical examination of cadets of a military school the disorders of
colour perception, conjunctivitis, dryness of the skin, skin pigmentation and nail fragility
were revealed in some of them. To control the similar clinical manifestations, it is, pri-
marily, necessary to increase in their diet the content of:
A. carrot
B. meat
C. groats
* D. bran bread
E. fish
Problem Solving
1. A group of students living in a hostel addressed the doctor with the complaints of
general weakness, early fatigue, gingival hemorrhage. On interrogation it was established that
the students had meals irregularly, frequently took canned food, food concentrates for meals.
The examination has shown the presence of gingival edema and hemorrhage. What is your
preliminary diagnosis and its substantiation? What objective adequate methods of research
and examination can you offer? What methods can be used to carry out a mass inspection of
all students living in the hostel? Give your recommendations for prevention of such diseases.
2. What hypovitaminoses should be expected first of all in patients being fed parenterally
for a long time?
3. What foodstuff is the basic source of Ca, its daily norm? What is the ratio of Са: Р:
Mg?
Standard Answers:

132
1. Hypovitaminosis C. For specification of the diagnosis it is necessary to inspect skin
integuments for revealing petechial hemorrhage. It is necessary to determine content of vitamin
C in blood and urine. The inspection of all students living in the hostel should be carried out
with the use of express-methods of research, tongue test and definition of capillary resistance.
It is possible to recommend the enrichment of diet with vitamin C, taking fresh vegetables and
fruit, correct culinary processing of products.
2. Vitamins D, K, group В1, A, Е.
3. Milk, cabbage, spinach. A daily norm is 0.8 g. The ratio of Са:Р = 1:2 (1.5), Mg:Са =
0.5:1.
Theme No 7.
Food Poisonings. Reasons, Symptomatology, Prevention
Food poisonings are non-contagious, more often acute and mass diseases,
caused by the use of substandard food, containing microorganisms or toxins of various
origin.
Their difference from the intestinal infections (dysentery, cholera, etc.) is non-
contagiousness (absence of transfer of the disease from a patient to a healthy person).
Food poisoning may occur only in persons, who eat food containing harmful substances
or microbes.
Classification of Food Poisonings
 Food poisonings of a microbe etiology:
 Toxoinfections are caused by entry of living microbes into organism with nutrition
(E.coli, Proteus, Cl.perfringens, Bac.cereus, etc.).
 Bacterial toxicoses occur at entry of microbial toxins with nutrition into organism:
 staphylococcal toxicosis (Staphylococcus aureus)
 botulism (Clostridium botulinum).
 Food poisonings of a non-microbe etiology:
 with toxic products:
 toxic mushrooms (death-cup, fly-agaric, etc.)
 toxic plants (belladonna, etc.)
 toxic weeds (heliotrope)
 toxic parts of some fish
 with foodstuffs sometimes or partially toxic:
 stone-fruits (amygdalin)
 haricot (phasing)
 potatoes (solanine)
 with chemicals:
 heavy metals — lead, copper, zinc, hydrargyrum, etc.
 pesticides
 nitrates and nitrites
 food additives.

133
 Mycotoxicoses
Table 24
Type of
fungi
Mycotoxins Foodstuffs Pathology
Aspergillus Aflatoxins Nuts, coffee Cirrhosis and primary cancer of the liver
Aspergillus Ochrotoxins Grain, coffee Balkan epidemic nephropathy
Fusarium Trichocetenes Grain 1. Fusariotoxicosis
(poisoning with ―drunk bread‖)
2. Alimentary-toxic aleukia
Claviceps Alkaloids of
ergot
Grain Ergotism
Penicillium Patulin Juices, mashed
potatoes
Malignant tumours
 Food poisonings of non-investigated etiology:
 Alimentary paroxysmal toxic myoglobinuria (Gaffen disease)
 Poisoning with quail meat
 Kashin-Beck disease (now it is referred to as strontium, manganese and fluorine
hyperpolymicroelementosis)
Food Poisonings of a Microbe Etiology
These include the following:
 Toxicoinfections are caused by entry into organism of food containing living micro-
organisms. The specific causative agents are Salmonellas, potentially pathogenic mi-
croflora — E. Coli, Proteus, etc.
 Bacterial toxicoses (former — food intoxications) occur on entry into organism of
foodstuffs containing bacterial toxins formed in them. The examples are staphylococ-
cal toxicosis, botulism.
 Those of mixed etiology — when food contains both living microbes and toxins, for
example, Salmonellas + staphylococcal toxin.
Toxicoinfections
Foods-sources: meat products, especially minced meat (pies with minced meat), eggs
(frequently infected with Salmonellas), fish (stuffed, cooked and hot smoked), sour milk prod-
ucts (sour cream).
Conditions when products become dangerous in respect of toxicoinfection include the
following:
 The reasons of entry of causative agents into foodstuffs:
 slaughter of diseased and tired animals, improper cutting of animal carcass,
 improper storage and transportation of foodstuffs, processing raw and cooked foods-
tuffs on the same cutting board, with one and the same knife, etc.,
 non-observance by the personnel of nutrition units of rules of personal hygiene, ab-
sence of regular medical examinations of personnel, attraction of unknown or ill
people to work in the kitchen.
 The reasons of reproduction and preservation of causative agents in foodstuffs:
 improper storage — non-observance of storage temperature and terms of realization,
 insufficient thermal processing.
Signs and Symptoms of Toxicoinfections
There are 5 clinical forms:
 Gastroenteric form: nausea, vomiting, diarrhea, stomach pains. It may be of a
 mild degree — 80% of all cases;
 moderate degree — 20% of cases (increase of temperature up to 38°C);
 severe degree — 2% (body temperature is 38-40°С, decrease of arterial blood pres-
sure, severe intoxication).
 Typhus-like form — severe intoxication with intermittent fever

134
 Choleroid form — severe intoxication with profuse diarrhea
 Dysentery form — diarrhea with blood in faecal masses
 Grippe-like form — signs and symptoms of grippe, gastroenteritis is slightly expressed.
Prevention of Toxicoinfections
It includes elimination of reasons of entry and reproduction of causative agents of tox-
oinfections in foodstuffs (see above).
Bacterial Toxicoses
This is a group of food poisonings of a microbe etiology caused by the microbe toxins
which have accumulated in foodstuffs.
1. Staphylococcal Toxicosis
Its cause is a golden staphylococcus, capable of producing exotoxin in products. Food-
sources are: dairy products, creams, pies, cakes, fish and meat products.
The conditions of a staphylococcus entry into foodstuffs and producing exotoxin are
the following:
 Staphylococcal diseases of personnel of nutrition units, such as quinsy, pustular dis-
eases of the hand skin,
 Improper storage of foodstuffs — at room temperature, non-observance of expiration
date.
Clinical signs and symptoms: gastroenteritis at a normal temperature, infrequent di-
arrhea, in severe cases — cardiac abnormalities, dehydration of organism.
Prevention: physical examinations and dismissal of personnel from work, proper sto-
rage of products, especially cakes and pies in a hot season.
2. Botulism
The reason of botulism is the formation of exotoxin in food products by botulinic bacillus
Clostridium botulinum. Features of the causative agent are as follows:
 a spore formation — spores withstand boiling for 4-5 hours, (the bacillus itself in a
vegetative form dies in 15 minutes), they survive at temperature of 16ºС for 14
months, resist the action of preservatives, e.g. salt, vinegar, sugar for a long time;
 an obligate anaerobe microbe — it develops without access of oxygen (canned
food);
 Under certain conditions (+10-30ºС without oxygen) it forms the strongest neurotropic
exotoxin, which lethal dose for a person is 35 μg.
Foods-sources: in the 19th century in Germany they included cooked and blood sau-
sages (poisoning with "sausage poison"), dried and cold smoked fish, nowadays these are
most frequently tinned goods (household preserved mushrooms and vegetables — it is difficult
to destroy spores in home conditions), sometimes — dried and smoked meat, canned meat.
Clinical Signs and Symptoms of Botulism
The toxin affects the central nervous system: medulla oblongata, nuclei of the cranial
nerves. The following is affected more often:
 nuclei of oculomotor nerve — ptosis (a sinking down of the upper eyelid), anisocoria
(unequal pupils of the eyes), ill-sustain accommodation;
 nuclei of ophthalmic nerve — blurring of vision, visual impairment;
 nuclei of glossopharyngeal and hypoglossal nerve — speech disturbance up to
aphonia (the person cannot speak), difficulty in swallowing — dysphagia (the person
cannot drink water);
 nuclei of facial nerve — disappearance of mimic and chewing muscle tonus of one
half of the face;
 nuclei of vagus nerve — the increase of pulse rate at a normal or lowered tempera-
ture, defecation is normal or there is a tendency to constipation (as compared to
other microbe food poisonings, it is a very important differential symptom !).
Then there may be spasms, pains in muscles, affection of vasomotor, respiratory cen-
ters of the central nervous system and death. The mortality of non-treated botulism is up to 70
%, at treatment — up to 30 %.

135
Treatment of Botulism
It includes introduction of antibotulinic serum or anatoxin (15,000 IU, recurrent in-
troduction of a 5,000 IU dose in 5 hours). On taking suspicious food prophylaxis is neces-
sary, namely introduction of serum in a dose of 2,000 IU.
Prevention of Botulism
There should be strict observance of temperature technology in cooking tinned goods,
dried fish, meat. At household conservation small jars should be used and long boiling should
be applied, the storage of canned food should be at temperature less than 10°C.
Food Poisonings of a Non-Microbe Etiology
Poisonings with Poisonous Mushrooms (Toadstools)
Poisoning with Death-cup
It is the most poisonous mushroom containing ammonitotoxin and ammonitohemoly-
sin. They block all kinds of metabolism, primarily carbohydrate and water ones. This type of
poisoning results in acute gastroenteritis — a cholera-like diarrhea, dehydration of organism,
disturbance of the central nervous system and cardiovascular system (a sharp fall of the arteri-
al blood pressure). In blood hemolysis (destruction of erythrocytes) occurs manifested in skin
paleness, as well as acute hepatic insufficiency (destroyed parts of erythrocytes go with blood
to liver) manifested in icteritiousness of skin. Death may result from collapse at affection of the
CNS.
Poisoning with Fly-agaric
This mushroom has an atypical appearance, sometimes disguising itself as an edible
mushroom. It contains muscarine and mycoatropine causing changes of m-cholinergic nerv-
ous system. The symptoms include: gastroenteritis, perspiration, lacrimation and salivation,
mydriasis. Affection of the central nervous system is according to the type of alcoholic intoxica-
tion. Death results from paralysis of the respiratory centre of CNS.
Prevention of Poisonings with Poisonous Mushrooms
 The population should get acquainted with poisonous mushrooms in the course of
sanitary-educational work, including lectures, conversations, posters, mass media
(TV, radio).
 Supervision of markets, places of mushroom sale — mushrooms should be sold only
with the sanction of the sanitary physician's assistant. The sale of mushroom salads
and mixtures is forbidden.
Poisonings with Poisonous Wild Plants
These poisonings are most common in a child's age.
Plants containing m-cholinolytics, i.e. atropine, hyosyamine, scopolamine are bella-
donna, henbane, stramonium. The symptoms are gastroenteritis and mydriasis (belladonna
is from Latin ―a beautiful woman‖ — in the Middle centuries women dropped the solution of bel-
ladonna into their eyes which thus became dark and beautiful), spasm of accommodation (vis-
ual impairment for close distance), dryness and reddening of skin and mucous membranes. At
poisoning with stramonium, henbane there are also visual and acoustic hallucinations with cen-
tral nervous system depression. Death occurs from cardiac abnormalities. In case of recovery
the remote effects on CNS, e.g. amnesia (loss of memory), etc., may occur.
Cicuta (cicutoxin). In Ancient Greece it was used for suicide. Children use its stems as
whistles. In case of poisoning excitation is changed by CNS depression. Loss of conscious-
ness, spasms, mydriatic pupils, cold perspiration, breathlessness, cyanosis are characteristic.
Death may occur in 2-3 hours from respiratory paralysis.
Spurge-flax. Myserin produces an irritating action resulting in bloody vomiting, diarr-
hea. Daphin causes CNS and cardiac abnormalities. 10-12 berries cause a lethal outcome.
Wild grapes. They contain brionin causing severe gastroenteritis, excitation, then CNS
depression. Death is due to collapse. A lethal dose for adults is 40 berries, for children — 15
berries.

136
Prevention of Poisonings with Poisonous Plants
 Destruction of these plants on the territory of children's preschool establishments
 Supervision over children in the parks. Carrying out the sanitary-instructive work with
tutors.
Poisonings with Products Sometimes or Partially Poisonous
Solanine in potatoes. It can be found in greensprouted potatoes. It has an irritating and
haemolytic effect. The symptoms are gastroenteritis of a mild and moderate degree of severity.
Prevention includes the elimination of green parts of potatoes.
Phasin in haricot beans. Its toxin has an irritating and hemagglutinating effect. De-
composition of the toxin takes place at a long thermal processing. The use of uncooked haricot
beans or haricot flour in shops is forbidden. In case of food poisoning gastroenteritis of a mild
and moderate degree of severity occurs.
Amygdalin in stone fruits. Most often it is found in bitter almond, in stones of apricots,
peaches, cherries, etc. In organism it is disintegrated with the formation of cyanic acid, causing
blockade of tissue respiration. In severe cases loss of consciousness, abundant vomiting, di-
arrhea, spasms, death in 2-9 hours due to paralysis of the CNS respiratory center occur.
Prophylactic measures include boiling these products for a long time, because the tox-
ins are thermolabile (they are destroyed at a high temperature).
Poisonings with Salts of Heavy Metals
The causes are:
 food stored in containers containing heavy metals (zinc buckets, copper utensils,
glaze on pottery containing lead),
 ground contaminated with heavy metals — lead, cadmium (in ground and plants
along motorways).
Zinc and copper (cuprum). They basically act at storage of acidic products in contain-
ers comprising these metals. At poisoning a mild form of gastroenteritis occurs: in the intes-
tines albuminates of copper and zinc are formed which are not absorbed in organism produc-
ing an ulcerating and irritating effect on intestines.
Lead. Poisoning may follow the consumption of food stored in lead-glazed pottery or
due to contamination of ground. Poisonings are usually chronic. The symptoms include a lead
triad: lead encephalopathy (CNS dysfunction) and polyneurites (peripheral nervous system
dysfunction), lead pains in the stomach, lead border of gums. In the blood basophilic granulari-
ty of erythrocytes, reticulocytosis (an irritating effect on blood-forming organs), increase of lead
content in urine (more than 0.04 mg/l) are marked.
See attachment 2 – Pictures – at the end of textbook
Prevention:
 hygienic regulation of heavy metals in foodstuffs and control over the observance of
maximal permissible concentration,
 prevention of entry of metals from containers, utensils in food.
Food Poisonings Caused by Agrochemicals
Food Poisonings Caused by Pesticides
Pesticides are chemical agents used for protection of plants from pests, diseases and
weeds. Without application of pesticides the loss of crop makes up 50 %. Sometimes their ac-
cumulation in products over the maximal permissible concentration is possible, hence the de-
velopment of poisonings.
The reasons of pesticide accumulation in products:
 application of non-permissible preparations, which are very stable or toxic,
 excess of the established norms of usage or frequency rate of processing,
 non-observance of term of expectation — time between the last processing of plants
and harvesting.
The symptoms of poisonings depend on group of pesticides — chlorine-organic (de-
crease of activity of cytochrome oxidase — enzyme of tissue respiration), phosphorus-organic
(decrease of activity of cholinesterase — accumulation of acetylcholine in organism), carba-

137
mates, etc.
Food Poisonings with Fertilizers
Fertilizers are substances increasing the crop capacity of plants. Nitrogen fertilizers are
most often applied. Thus in plants nitrates can accumulate, which in organism are restored in
nitrites and bind with hemoglobin in erythrocytes causing methemoglobinemia — hemoglobin
cannot transport oxygen and hypoxia occurs. These poisonings are especially dangerous for
children of the first 3 months of age because:
 HСl is not present in the stomach and it stops restoration of nitrites from nitrates.
 children of this age have fetal hemoglobin which is very sensitive to nitrites
 of low activity of enzyme methemoglobin reductase in children which releases he-
moglobin from nitrites
At a high level of nitrates in foodstuffs nitrososubstances (NS) can form which produce
carcinogenic effects.
Food Poisonings with Food Additives
Food Additives and their Classification
Food additives are non-nutritional chemicals, synthetically added to foodstuffs to en-
hance their organoleptic properties, to facilitate foodstuff processing and preservation.
For investigating food additives and putting them on the list of permissible ones there is
the Joint committee of experts of FАО/WHO on food additives.
Classification of Food Additives Allowed for Application in the Countries of European
Union
Е 100 — Е 200 — coloring agents
Е 200 — Е 300 — preservatives
Е 300 — Е 400 — antioxidants, acidity regulators
Е 400 — Е 600 — emulsifying agents, consistence stabilizers, agents preventing con-
glomeration
Е 600 — Е 900 — agents strengthening taste, flavor
Е 900 — Е 1000 — agents enriching quality of grain and bread.
Such food additives are recommended by EU for application, but each country approves
the list of allowed agents itself.
In Ukraine the List of allowed food additives is affirmed by the resolution of Ministry of
Ukraine and the addition of new food additives to it is admitted only according to the resolution
of Ministry of Public Health Service of Ukraine.
More than 5,000 chemicals are now used as food additives — coloring agents, aromat-
ics, emulsifying agents, preservatives, baking powders, etc. Poisonings occur at application of
forbidden additives or at exceeding their permissible amount, e. g. using nitrates as food color-
ing agents for sausages (see above about their action on person).
Mycotoxicoses
These are food poisonings caused by toxins of microscopic mould fungi on bread and
bread products (grain, flour) at their storage in moist conditions. They are characteristic of
countryside — bad conditions of flour storage, using spoilt grain during disasters (famine, wars,
etc.). Nowadays they are encountered in connection with baking bread by private manufactur-
ers from the untested flour.
Ergotism. Ergot poisoning follows eating grain contaminated by ergot fungus. Foods-
tuffs can contain such toxins as ergotoxine, ergotamine, ergometrine. They cause a spasm of
smooth, then transversal striated muscles.
Three forms of ergotism are distinguished:
 Convulsive, manifested by paresthesias, dizziness, spasms, sometimes — ga-
stroenteritis. The duration is 3-6 weeks.
 Gangrenous ("Saint Anthony fire"), characterized by necrosis of skin with rejection of
necrotic sites, severe pains in these sites. In severe cases death occurs in 1-2 days
accompanied by secondary infection (sepsis).
 Mixed — a combination of the 1 and 2 forms.

138
Ergotism is especially dangerous for pregnant women, as it causes a spasm of smooth
muscles of uterus leading to abortion, or premature birth.
Fusariosis. This is poisoning with "drunk bread" caused by mould fungus Fusarium
graminearum. The symptoms are: gastroenteritis, and damage of CNS like alcohol intoxication.
This is an endemic disease in the Far East.
Alimentary-toxic aleukia. As far as 1944 this disease had been called "septic quinsy".
It is caused by fungus of a Fusarium type which develops in grain wintered under snow. The
disease is characterized by serious disturbance of hematosis, leuko- and thrombocytopenia.
The main sign is aleukia (occurs in 1-2 weeks) — a sharp decrease of leukocytes and erythro-
cytes, increase of lymphocytes. A severe necrotic tonsillitis and sepsis are also marked. The
mortality makes up 50-80 %.
Аflatoxicosis. They are caused by fungi of Aspergillis type which are found in peanuts
and peanut flour, grain, corn, rice at storage in moist conditions at increased temperature. Re-
cently it has been found in Spanish red wine. The disease causes a severe liver injury and
produces a cancerogenic effect on liver — a primary cancer of the liver (earlier it was encoun-
tered basically in Africa and Asia). Now it is often found in the Crimea and South Ukraine.
Food Poisonings of Insufficiently Investigated Etiology
River Urova disease (Kashin–Beck disease). Now it is established that it is hyperpo-
lymicroelementosis (strontium rickets). This is an endemic disease for Eastern Siberia (the
Urova river is situated there) and for some other territories on Earth. The disease causes de-
formation of skeleton in the period of growth, severe metabolic disturbances.
Gaffen disease. Gaffen gulf is in Holland. The disease occurs at use of fish from some
reservoirs in certain periods of time. The cause of the disease is not established, but it is sup-
posed that in water toxic seaweeds are formed, toxins being accumulated in fish.
The official diagnosis is alimentary paroxysmal-toxic myoglobinuria (the excretion of
muscular protein myoglobin in blood and urine). The disease causes the attacks of sharp mus-
cular pains and sharp renal insufficiency due to myoglobinaemia. In this case hemodialysis is
necessary.
Poisoning with quail meat. Sometimes it causes gastroenteritis of various degree of
severity. The causes are not established.
Tactics of the Doctor at Suspicion of Food Poisoning
 The establishment of primary diagnosis on the basis of:
 dietary history (what food was eaten by the patient) from the patient or relatives,
 characteristic clinical signs and symptoms
 Rendering urgent medical aid by life-saving indication — cardiacs, respiratory
analeptics, etc.
 Confirmation of the diagnosis:
 gathering and sending to laboratory of Rospotrebnadzor department of nutrition
hygiene of remnants of food, gastric lavage waters, vomiting materials, faeces, blood,
urine.
 writing out the "Accompanying direction to laboratory investigation" with indica-
tion of reason of taking food samples and method of laboratory food investigation.
 Disintoxication therapy: gastric lavage, abundant drinking, antibiotics, droppers. In
case of botulism — antibotulinic serum, anatoxin.
 To prevent mass food poisoning the "Emergency notification about food poisoning"
should be sent to Rospotrebnadzor department of nutrition (especially if poisoning
took place in a public catering establishment). On receiving the emergency notification
the doctors within 24 hours should carry out the investigation of food poisoning — sanita-
ry inspection of public catering establishment, examination of the personnel, etc.
 If necessary the emergency hospitalization at the infectious department of hospital
should be arranged.

139
Key Questions
1.Concept of food poisoning. Characteristic features of these poisonings. Classification.
2.Etiology, pathogenesis, symptoms and prevention of food poisonings of microbe nature:
Toxicoinfections
Bacterial toxicoses
3.Etiology, pathogenesis, symptoms and prevention of food poisonings of non-microbe nature:
Food poisonings with poisonous plants and mushrooms;
Food poisonings with foodstuffs sometimes or partially poisonous;
Food poisonings with salts of heavy metals;
Food poisonings with food additives (nitrates);
Food poisonings with agrochemicals (pesticides and fertilizers)
4.Etiology, pathogenesis, symptoms and prevention of mycotoxicoses:
Fusarioses
Ergotism
Aflatoxicoses
5.Food poisonings of the unknown nature, symptoms, diagnostics, causes of occurrence, pre-
vention.
To establish the diagnosis of food poisoning on the basis of suggested clinical tasks or
cards of investigation of food poisonings, to determine the product caused it, to draw up the
necessary documents (see Problem Solving).
Appendix 1
Clinical Symptoms of Some Food Pisonings of a Microbe Etiology
Symptoms Toxicoinfection Staphylococcus in-
toxication
Botulism
Body temperature elevated or high normal or elevated normal or sub-
normal
Headache + + +
General weakness + ++ +++
Loss of conscious-
ness
- - -
Spasms - + +
Decrease of heart rate + ++ ++
Cyanosis - + -
Cold perspiration + + -
Visual impairment + + +++
Dryness in the mouth - - +++
Nausea, vomiting +++ ++ +++
Pain in epigastrium + +++ +
Constipation - - +++
Diarrhea ++ + -
Blood in faecal
masses
- + -
Mucus in faecal
masses
Duration of disease
at adequate treatment
1-3 days 1-3 days 5-20 days
+++ sharply expressed symptoms

140
++ clearly expressed symptoms
+ infrequently observed symptoms
— symptoms which are not observed
Self Test
1. What is the pathogenesis of botulism?
* A. affection of the medulla
B. involvement of the GIT and CVS
C. involvement of kidneys and liver
D. affection of the brain cortex
E. involvement of the respiratory system
2. What clinical forms are not characteristic of toxicoinfections?
A. gastroenteritis
B. typhoid-like form
C. grippe-like form
D. cholera-like form
E. dysentery-like form
* F. haemolytic form
3. A citizen has picked mushrooms in the wood and has eaten them fried. In 12 hours severe
pains in the stomach, vomiting, diarrhea with blood suddenly occurred. At the end of the
first day of the disease jaundice, enlargement of the liver, oliguria appeared. Spasms
were observed. Death occurred on the third day. What might be the cause of the dis-
ease?
A. death-cup poisoning
B. supercooling
* C. toadstool poisoning
D. poisoning with false honey fungus
E. nitrate poisoning
Problem Solving
1. A case of food microbe poisoning took place on 20 July in the family of a clerk after
eating fried veal cutlets (the calf had been ill for a week and that is why was slaughtered with-
out knowledge of veterinary inspectors). The main symptoms of the disease: a 12-16-hour in-
cubational period, high temperature, severe pains in the abdomen, vomiting, diarrhea, general
weakness, headache. Which is the most probable causative agent of the given poisoning?
2. In the reception ward of the local hospital two children of the same family aged 4 and
6 were admitted in May with complaints of nausea, vomiting, frequent liquid stool. The disease
began soon after eating boiled unpeeled potatoes. On examining the potatoes used in food by
the family, many sprout and green samples were revealed. Which is the most probable causa-
tive agent of the given poisoning?
3. On examination of patient С., aged 26, in order to render him first aid, the following
has been established: he works on the collective farm, takes meals at home. On July 20 pains
in the abdomen, nausea occurred at 11.00. At 13.00 he had vomiting. He feels bad. A daily diet
for the last 3 days consists of the following: July 18 — breakfast: rice, cottage cheese, tea,
bread; dinner: meat soup, bread; supper: sausage, coffee, bread. July 19 — breakfast: pasties,
milk; dinner: soup with fresh fish, meat with macaroni, tea, bread; supper: meat with macaroni
(left from dinner), tea, bread. July 20 — breakfast: coffee, bread.
Objectively: body temperature is 37.8°C, pulse is full, 86 per minute, the abdomen is
tense and tender on palpation; there is diarrhea with mucus discharge. Make the diagnosis of
food poisoning, identify the product which has caused it.
Standard Answers
1. Salmonella
2. Solanine
3. Food poisoning of a microbe etiology, toxicoinfection caused by pasties

141
Methods of Investigation of Food Poisoning Cases
Key Questions
Tactics of the doctor on revealing food poisoning.
1.Rules of taking samples for the laboratory analysis.
2.Rules of drawing up documentation in case of revealing food poisoning (name of documents,
the order and terms of paper work).
3.Measures of prevention of food poisonings.
4.Scheme of investigation of food poisoning.
Self Test
1. Put the following points of the common plan of food poisoning investigation in a cor-
rect sequence:
A. Inspection of conditions and ways of manufacture, storage and processing of the sus-
pected foodstuff
B. Drawing up the act of investigation based on block of data of laboratory analyses
* C. Revealing clinical symptoms characteristic of the given case
D. Revealing the suspected foodstuff and its exclusion from the use
E. Sending samples of patients‘ biosubstances, samples of suspected foodstuffs, lavages
for laboratory research
2. What documents does the doctor send to Rospotrebnadzor department of nutrition on
revealing food poisoning?
A. case history
* B. urgent notification on food poisoning
C. a sick-leave certificate (medical certificate)
D. a statistical coupon
E. an accompanying appointment card for laboratory analysis
3. How long should the investigation of food poisoning be carried out?
A. 7 days
* B. 24 hours
C. 12 hours
D. 10 days
E. 72 hours
Problem Solving
1. Last year on August 30 from 9.00 p.m. the inhabitants of a village with the population
of 91 persons addressed the medical station with complaints of high temperature (38ºC and
higher), headache, pain in the epigastrium, nausea, vomiting, diarrhea. All the patients had
been on the wedding party which began at 11.00 a.m. The meal was prepared overnight. As
there were only two refrigerators, meat, gammon, cutlets and sausages were kept in a kitchen
cellar. It was very hot that day, the air temperature during the day was 25-29ºС. In the food
remnants, vomiting and faecal masses the culture Salmonella enteritidis was found out. Identi-
fy and substantiate the probable reason of food poisoning, reveal the foods, which could have
caused this food poisoning. Enumerate the preventive measures necessary in this case.
2. During investigation of food poisoning, caused by a river fish (it was caught, salted
within 5 days, then dried and used in meal), botulinum toxin Е was revealed. What measures
should the doctor take in this case?
3. Among the pupils of a children's house the case of a mass food poisoning is revealed.
The reason was eating cakes with cream stored in the nutrition unit with abnormal conditions of
temperature. Name the most effective method of prevention of staphylococcus toxicosis?
Standard Answers
1. The reason: non-observance of storage conditions of meat products, in which further
Salmonella enteritidis has developed and caused food poisoning. It is necessary to render

142
medical aid to the patients, to interrogate them with the purpose of revealing persons who have
taken the same food, to forbid the use of meat products stored in a cellar, to observe the pa-
tients during the incubation period.
2. It is necessary to inject antibotulinic serum intravenously in a dose of 15,000 IU to all
patients having symptoms of this disease. All the other persons who have eaten this fish
should be injected the serum in a dose of 1,000-2,000 IU. The intake of the given product, if
remained, should be forbidden.
3. Prevention of opportunity of staphylococcus multiplication in foodstuffs and producing
toxin; with this purpose to supervise the conditions and terms of food storage.
Additional Material for Self-Preparation
All cases of food poisonings should be obligatory taken into account and thoroughly in-
vestigated with the purpose of establishing the reasons of their occurrence and carrying out
preventive measures of eliminating their consequences. For this purpose it is necessary to
know the rules and order of filling in documentation on revealing cases of food poisonings.
Appendix 1
Accompanying Appointment Card for Laboratory Investigations
―___‖ ________ 200 № ______ Simferopol
(Name of Rospotrebnadzor department of nutrition, where the analysis is made)
___________________________________________________________________________
___________________________________________________________________________
(Name of laboratory, its address)
___________________________________________________________________________
___________________________________________________________________________
(Name of establishment, sending sample, its address, phone number)
№ Name of stuff Weight of sam-
ple
Characteristics of con-
tainer (sterility, glass,
polythene, cardboard,
etc.)
Date and time
of sending
sample to la-
boratory
1
2
3
Urgency of investigation, what product is suspected as the cause of food poisoning
___________________________________________________________________________
___________________________________________________________________________
_____________
(Full name, position of a person who sends a sample for investigation
At reception of samples the laboratory should give the receipt with indication of samples and
time of their reception.

143
Appendix 2
Objects Liable to Investigation and Order of their Sending to Laboratory
Name of stuff Amount of stuff Time of taking a food
sample
Foodstuffs 1-st day
A. Remnants of suspected food 200-300 g - //-
B. Samples of liquid or half-liquid
dishes or foodstuffs
200-300 ml after careful
stirring
- //-
C. Second dishes 1-2 portions - //-
D. Meat of various parts of car-
cass
500 g - //-
E. Brine from barrels with pickles 100-200 ml - //-
F. Poultry 1-2 samples - //-
G. Fish: if large — samples from
2-3 places, if small — several
pieces
- //-
H. Tinned goods: open tins, not
open tins
5-10
Examination of personnel 1-st day
A. Bacterial samples from hands
and, if necessary, smears from
the oral and nasal cavity of
personnel engaged in cooking
food
- //-
B Referral of personnel to reveal-
ing intestinal infections
- //-
Objects of investigation from ill per-
sons
during the first hours or
day after the disease
onset
A. vomiting masses 50-100 g
B. first lavage waters 100-200 ml
C. faecal masses 50-100 g
D. urine 200 ml
E. blood culture 8-10 ml from vein
F. blood for serological test 2-3 ml from a finger is
possible
7-10 days after the dis-
ease onset
Section material
A. content of the stomach 50-60 g reaction of agglutina-
tion on the 28-30th day
for revealing the de-
crease of antibody titer
B. a segment of small or large in-
testine
C. liver, spleen during the first hours
after section
D. heart blood

144
Appendix 3
Urgent Notification about Food Poisoning
1.Diagnosis____________________________________________________________
2. Full name of patient__________________________________________________
3. Sex _______________________________
4. Age______________________________________________________________
5. Address: city/village _________________________ district ___________________
street_______________________house_______________apartment ______________
6. Place and address of work (study)________________________________________
7. Dates of:
disease onset________________________________________________________
primary address to the doctor (revealing) ___________________________________
establishment of the diagnosis ___________________________________________
last visit to school, higher school, work _____________________________________
hospitalization________________________________________________________
8. Place of hospitalization_______________________________________________
9. Indicate the place of food poisoning, the cause of poisoning
___________________________________________________________________
10. Primary antiepidemic measures and additional data
__________________________________________________________________
11. Date and time of primary notification of SES about disease
_________________________________________________________________________
Full name of a person who notified SES_____________________________________
Full name, position of a person who received urgent notification
___________________________________________________________________________
12. Date and time of sending urgent notification _____________________________
Signature of the person having sent notification to SES
13. Date and time of reception of notification by SES_________________________
Registration No_________ in register No ______ SES __________________
Signature of person who sent urgent notification _________________________
Note: It is sent to SES not later than 12 hours from the moment of establishing the diag-
nosis.
Appendix 4
Plan of Preventive Measures
(for the Given Case of Food Poisoning)
Carrying out sanitary-educational work (to specify the forms).
 The necessity of sanitary inspection of a nutrition unit.
 The necessity of examination of personnel of a nutrition unit.
 The necessity of withdrawal of foods or closing a nutrition unit.
 Measures on prevention of similar poisonings in home conditions.
 Other measures.
Signature of student ___________________________
Appendix 5
Scheme of Analysis of Disease Symptoms (Food Poisoning)
1. Full name of patient__________________________________________________
2. Date, time of disease onset, date of hospitalization ____________________
3. Main symptoms: nausea (+ -), vomiting, diarrhea, constipation, pains in the stomach,

145
body temperature (°С), fever, headache, general weakness, dizziness, diplopia, blepharopto-
sis, mydriasis of pupils, dryness in the mouth, deglutitive problem, change of voice, spasms,
cyanosis, muscle pains, joint pains, influenzal phenomena, blood in feces, pulse, arterial pres-
sure, changes of CNS. The revealed symptoms are marked by signs "+" or "-", temperature
— in degrees by Celsius, the severity of disease is indicated as mild, moderate or severe.
It is necessary to specify:
4. Name and address of manufacture or establishment, where samples are taken.
5. The main findings of sanitary-epidemic inspection:
 date of food poisoning
 time of occurrence of disease symptoms after taking suspicious meal
 description of clinical signs and symptoms in patient
 number of victims
 number of hospitalized persons
 presence of cases with lethal outcome
 primary diagnosis
6. At presence of samples of several products it is necessary to specify, which of them is
suspected as the cause of food poisoning.
7. Purpose of investigation:
 establishment of diagnosis
 last visit to children's establishment, school; hospitalization
8. Place of hospitalization.
9. If it is poisoning, it is necessary to specify, where poisoning occurred, what caused
poisoning.
10. Primary antiepidemic measures.
11. Date and time of the primary signal about disease to SES (over telephone, tele-
graph). The surname of the person, who has sent the message and who has accepted the
message.
12. Date and time of sending notification. Signature of the person, who has sent notifica-
tion.
13. Date and time of reception of notification by SES, registration number in a register.
Signature of the person, who has received notification.
Appendix 6
Scheme of Drawing up the Act of Investigation of Food Poisoning
Name of doctor, date of drawing up the act of investigation.
1.Description of disease onset.
2.Clinical state of the patient.
3.Establishment of the primary diagnosis.
4.To specify the number of persons having used a suspicious product.
5.To specify the number of fallen ill persons.
6.To list the stuff sent for the laboratory analysis.
7.To specify the place of food intake.
8.To identify the time passed after intake of suspicious food.
9.To identify, what particularly product could have caused food poisoning.
10.To interview the victims in order to reveal the disturbance of оrganoleptic properties of food.
11. To specify the place, where a suspected product is delivered from, or place and date of its
manufacture.
12.To make a brief description of a sanitary state of a manufacturer or public catering unit.
13.To specify the name of withdrawn or utilized product.
14.To specify the results of laboratory investigation of the product.
15.To draw a valid conclusion in case of food poisoning.

146
Theme No 8.
Medical and Prophylactic Nutrition.
Prophylactic Nutrition
Prophylactic nutrition or therapeutic-prophylactic nutrition as a measure of prevention of
occupational diseases is of great importance.
The basis of prophylactic nutrition is a balanced diet composed in view of metabolic
changes of organism occurred under the influence of harmful physical and chemical industrial
factors, using separate components of the food rendering protective effect at influence of toxic
chemical compounds and adverse physical factors of manufacture.
The Purpose of Prophylactic Nutrition
 Increase of general resistibility of organism;
 Compensation of power and plastic stocks of organism under influence harmful chemical
and physical factors on manufacture.
 Increase of specific resistibility of organism to industrial poisons and harmful industrial
physical factors by means of:
 decreasing the entry of harmful substances into organism;
 acceleration of removing toxicants from an organism;
 acceleration of metabolism of toxic substances in order to form less toxic compounds;
 protection of separate organism systems against harmful effect of industrial physical
and chemical factors.
Structure of Prophylactic Nutrition
 High-grade proteins, performing plastic function, stimulating general resistibility of
organism, participating in detoxication of some poisons.
Thus, amino acids cystine, cysteine, methionine, containing SH groups, are capable
of binding heavy metals, phenol, arsenic. Methionine, producing lipophilic effect, pre-
vents fatty infiltration of the liver, improves its antitoxic function.
 Carbohydrates restore the energy losses of organism caused by poisons, participate
in neutralization of some poisons. For example, fructose and saccharose transform
cyanides and phosphorus compounds into low-toxic substances, pectin substances
bind and excrete lead and other heavy metals, stop absorption of strontium and ra-
dium.
 Mineral substances, first of all calcium, increase general resistibility of organism.
Calcium has an antagonistic effect on strontium, weakens the effect of chlorine, nitro-
gen oxides which cause pathological increase of vascular permeability and develop-
ment of lung hypostasis.
Salts of copper accelerate molybdenum excretion. Phytin reduces or prevents clinical
signs of poisoning with lead.
 Vitamins increase the general resistibility of organism to adverse physical and chem-
ical factors. They are of great importance in destruction and removing many toxic
substances from organism.
Thus, vitamin C transforms arsenic poisons into less toxic compounds and promotes
their removing from organism. Vitamin B1 increases resistance of organism to lead,
benzene, fluorine, styrene.
The Basic Therapeutic-Prophylactic Diets
Milk. All mentioned above substances in the optimal ratio are contained in milk. There-
fore milk is applied to prevent many industrial poisonings. However a protective effect of milk is
produced on rather small number of poisons, e.g. arsenic, heavy metals, phosphorus, phenol,
aromatic compounds.
In other cases, milk as high-grade foodstuff, only improves a general condition of organ-

147
ism increasing its nonspecific resistibility.
Depending on mechanism of effect of physical and chemical industrial factors, some
types of therapeutic-prophylactic nutrition diets are distinguished:
Diet No. 1 is used in conditions of lowered atmospheric pressure when hypoxia devel-
ops and non-oxidized products accumulate in organism, the functions of the nervous, cardi-
ovascular, digestive and other systems are disturbed. In these conditions the decrease of fat
amount and increase of easily digestible carbohydrates, reduction of protein quantity are ne-
cessary.
Diet No. 2 is used under conditions of noise; it is prescribed in case of disturbances of
oxidation-reduction processes caused by noise, lack of vitamins C, Р, B1, B2, B6, decrease of
capillary and cellular membrane resistibility. The increase of protein amount in diet is condi-
tioned by reduction of fats and carbohydrates.
Diet No. 3 is used under conditions of radiation effect. This type of diet includes three
groups of substances:
Amino acids: cystine, cysteine, methionine acids having ability of shielding (SH-group in
molecules);
Substances capable of binding and removing from organism free radicals: pectin sub-
stances, cystine, cysteine, methionine, glycine, bilious and nuclein acids, vitamins and mineral
substances, primarily, calcium;
Lipotropic substances improving exchange of fats and increasing antitoxic function of
the liver: cystine, methionine, phosphatides, polyunsaturated fatty acids, vitamins.
Diet No. 4 is desensibilization nutrition administered to workers contacting the chemical
substances producing an allergenic effect. The diet is limited in carbohydrates, especially sug-
ar. A slight increase of fats, basically of vegetative origin is recommended. The acid strengthen-
ing removal from an organism of calcium, chloride sodium, biogenic amines (histamine, sero-
tonin), spicy and extractive dishes should be limited. The products containing active biological
allergens, pesticides, food additives are limited as well.
Diet No. 5 provides special energy supply at contact with various groups of industrial
poisons. It is composed in view of mechanism of effect of poisons and properties of various
components of food to produce detoxical effect on the given chemical compounds by delaying
their entry into organism, acceleration of removing from an organism or transfer into less toxic
compounds.
Organization of Therapeutic-Prophylactic Nutrition at Enterprise
Therapeutic-prophylactic nutrition is administered to those, working in conditions of con-
stant contact with harmful physical or chemical factors not less than half of working hours. It is
given out free-of-charge at the expense of enterprise in a factory dining room as 0.5 litre of milk
or hot breakfast. Vitamins are given out as vitamin preparations or enriched first dishes. Thera-
peutic-prophylactic nutrition is given out before the beginning of work (the optimal variant) or
during a lunch break. The doctor of a health center of enterprise supervises the quality of the-
rapeutic-prophylactic nutrition and if necessary gives recommendations as for replacing the
missing products with foods having the same detoxic effect.
Medical Nutrition (Dietotherapy)
A science about nutrition of patients is called dietology. The basis of dietology is change
of nutrition and metabolism of a sick person.
The main tasks of dietetic therapy are:
 to give to the patient‘s organism all necessary nutrients;
 to change metabolism of a sick person in the necessary direction promoting treat-
ment of illness.
A practical part of dietology is dietetic therapy, which applies the statements of dietolo-
gy to clinical and out-patient conditions with respect to the given patient, taking into account the
features of his disease course and individual properties of organism. The task of dietetic thera-
py also includes the coordination and conformity of applied diet with other medical means (me-
dicinal therapy, physiotherapy, etc).
A practical part of dietology also includes medical cooking, i.e. practical applying of
statements and requirements of dietology to culinary processing of food.
Dietetic therapy is a powerful medical means of strengthening effect of medicaments

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and other kinds of therapy. Dietetic therapy can also be the main kind of therapy. Sometimes
only dietetic therapy may be sufficient to cure a disease.
Nutrition of the patient is making up an optimal proportion of nutrients on the basis of
physiological needs of organism for food substances and energy of a person, proceeding from
features of pathogenesis, clinical course, stage of disease, level and character of metabolic
disturbances.
Classification of Foodstuffs in View of their Medical Effect
1 group includes foods having a sparing effect on intestinal mucous: groats for a child-
ren's and dietary nutrition, homogenized vegetable and fruit canned food, dietary fruit-and-
vegetable, meat and fish canned food, rolls with a lowered acidity, enpits for IV injections.
Indications for administration: gastric and intestinal illnesses, postoperative conditions,
craniofacial traumas. Mechanical care is necessary because of high degree of dispersion.
2 group — foods with low content of sodium chloride (saltless): bread and saltless
crackers, salt substitutes (calcium chloride or ammonium chloride, sanasol). Indications: hyper-
tonic illness of 1-2 degree, acute and chronic forms of urolithiasis, blood circulation insufficien-
cy of 1-2 stages, nephropathy of pregnant, long treatment with corticosteroids.
3 group — foods with low food value: albumin bread (caloric content is reduced by 15-
30%, carbohydrates — by 3 times), products with methylcellulose (for replacement of butter or
sour cream by 40%), aerin (a sour-milk product from skim milk with fruit additives). These
foods are administered for patients with diabetes, adiposity and chronic constipations.
4 group — foods with reduced amount of fats: The skim dairy products (sandwich but-
ter, sour cream with 10% fat content, skim milk and kefir) products with the increased content
of polyunsaturated fat acids ("Dietary" oil containing 25-30% of vegetable oil, dairy dietary
margarine "Health"). Foods of this group are recommended at vascular atherosclerosis, adi-
posity.
5 group — foods with modified carbohydrate component: group of dietary products-
substitutes of sugar (sorbite, xylite, fructose, saccharin, etc), as well as stewed fruit, confectio-
nery and juices on their basis. These foods are applied at diabetes and adiposity.
6 group — foods without protein simulating bakery, groats. As a substitute of protein
corn and amylopectin starch are used. These are applied at chronic kidney insufficiency.
7 group — foods enriched with microelements and vitamins: products enriched with
iodine (sea kale, iodine salt, etc.), fluorine, vitamins (milk with vitamin C, etc).
Principles of Medical Nutrition
The bases of dietetic therapy are principles of a balanced diet: conformity of caloric con-
tent of food with energy losses of organism, balance between nutrients, optimal diet regimen,
good digestion, maintaining the feeling of pleasure and saturation, safety of nutrition. However,
in case of necessity, the essential corrections caused by character of disease, condition of the
patient, his specific features can be brought to these principles.
Thus, in dietetic therapy the principle of qualitative and quantitative restriction of nutrition
down to partial or full starvation is widely used. Full starvation during rather short time intervals
is applied at acute inflammatory processes in the body, at intoxication, uremia, etc. For a long-
er period of time partial starvation or so-called fasting days are used allowing apples, cottage
cheese, salad, potato, water-melon, pumpkin, cucumber and fatty days used at treatment of
obesity and cardiovascular diseases. To diet regimen with quantitative restriction the nutrition
with limited amount of liquid also refers which, as a rule, is combined with limitation of salt — it
is recommended at obesity, atherosclerosis, hypertonic disease, urological diseases, etc.
Diets with increased amount of liquid are widely used: at intoxication, infectious diseas-
es, diathesis, etc.
Diets with increased amount of vegetative raw food are applied. Besides enrichment of
organism with vitamins, this diet is a source of cellulose, pectin substances, tartaric acid pre-
venting adiposity, a complex of optimum balanced mineral substances, etc. The increasing of
raw vegetative food is recommended at gout, obesity, diabetes, diseases of cardiovascular
system, liver, kidneys, chronic constipations, etc.
In some cases (anemia, decrease of reactivity of organism, etc.) raw animal food is ad-
ministered, i.e. blood, raw liver, minced meat seasoned up to a level of pleasant look and taste.
At food processing the content of pathogenic microorganisms in raw food should be excluded.

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Main Principles of Medical Nutrition
 Principle of mechanical safety.
It is used at restriction or exclusion of indigestible foods, rich in cellulose (brown
bread, cabbage, haricot, etc.), using at cooking food methods of mincing, cutting,
chopping, etc., as well as special methods of food processing aimed at reduction of
cellulose content, dissolving pectin and softening foods.
 Principle of chemical safety.
It is based on exclusion of foods rich in extractive substances, and on restriction of
dishes having a stimulating effect on secretory and motor functions of the stomach,
such as thick broth, rich soups, fried dishes, smoked products, etc). A stimulating ef-
fect of dishes on intestines can be lowered at steam cooking.
Principles of safety are usually used at the initial stage of treatment with the purpose of
strict diet, further it is necessary to pass to a principle of "training". Thus step systems with
gradual transition, or systems of "zigzags" with rather sharp, but short-term changes of diets as
loading (plus "zigzags") or unloading (minus "zigzags") are used.
The diet regimen of dietetic therapy provides uniform within a day intake of a small
amount of food with more often intakes (5-6 times a day). A fractional nutrition (a small amount
every 1.5-2 hours) in some cases is applied.
Hygienic Bases of Alimentary Regulation of Metabolic Disorders and Prevention of Adi-
posity
Techniques of Estimation of Normal (Ideal) Body Weight
 Brocka‘s Index.
Ideal body weight = height (cm) -100 (height of 155-165 cm)
— 105 (height of 166-175 cm)
— 110 (height of more than 175 cm)
 Bongard‘s Parameter:
Normal body weight (kg) = Circumference of the chest (cm) 240
(It is designed for men of 25-30 years with normosthenic constitution)
 Кetle‘s Index:
Body weight (kg) / (height, m) 2
The ideal body weight for men — 20-25, women — 19-23, less than 15-20 — lack of
body weight, 26-30 — excessive body weight, 31-40 — moderate adiposity, more
than 40 — pathological adiposity
 Breitman‘s Index:
Technique of Estimation of Adiposity Degree
Four degrees of adiposity are distinguished:
 1 — excessive body weight by 10-29 %,
 4 — excessive body weight by more than 100 %.
Excess of normal body weight by 5-10% testifies to presence of excessive body weight
but not adiposity as illness.
Hygienic Principles of Dietetic Therapy at Adiposity
 Decrease of food value of nutrition (by 30-50 % of normal).
 Limitation of carbohydrates, especially non-protected
 Limitation of fats of animal origin at the expense of vegetable oils (up to 50 %)
 Optimal amount of protein (60 % — animal protein).
 Having meals 5-6 times a day to weaken the feeling of hunger.
 Limitation of water and salt.
 Having special fasting diets and days.
 Estimation of efficiency of dietetic therapy and its correction on the basis of studying
the course of illness and biochemical status of organism.

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Hygienic Principles of Alimentary Prevention of Atherosclerosis
 General prevention of adiposity (see above).
 Increase of antisclerotic alimentary factors: irreplaceable amino acid methionine, po-
lyunsaturated fatty acids of omega-3 and omega-6 families, phospholipids.
 Increasing the consumption of high-grade protein (especially of vegetative origin),
vegetable oils, pectins, cellulose, vitamins C, B, A, D, РР.
 Increase in a diet of mineral substances, such as Са, Mg, microelements Cr, Cu.
 Decrease of salt, spicy and fried dishes.
Hygienic Bases of Alimentary Prevention of Presenility
 Keeping balance of nutrition caloricity with energy losses so that 60-65% of daily ca-
loric content is provided with carbohydrates, basically polysaccharides (optimal calor-
ic content for persons not engaged in physical work should make up 2600 Kcal/day).
 Antisclerotic orientation of diet.
 Optimal content of substances in a diet stimulating the activity of body enzyme sys-
tems.
 The most varied nutrition with normal content of basic irreplaceable factors in nutri-
tion.
 Decreased consumption of fats up to 20-25% of daily caloric content, at that vegeta-
ble oils should make up 50 % from all amount of fats.
 Decrease of cholesterol content in a diet up to 300 mg/day.
 Decreased consumption of sugar and confectionery, their replacement by dried fruits.
 Limitation of salt (5-7 g/day).
 Taking food not less than 4 times a day.
Types of Diets
16 types of diet have been developed.
They are subdivided into diets with a choice of dishes — realization of custom-made
system (diet 1, 2, 5, 9, 10, 15,). These diets can be used for a long time, completely providing
the needs of organism.
The second type of diet assumes its strict following without any choice of dishes (0, 0a,
1a, 1b. 1c, 4, 5a, 5b, 8). They refer to unbalanced types of nutrition and can be administered
only for a short period of time. Transition (more often gradual) from strict diets to varied is pro-
vided. An excessively long following the same diet is supposed only in unusual cases.
Diet 0 (liquid) — it is administered after operations on the stomach and intestines (after
fasting days; in case of unconsciousness). Its purpose is to provide organism with a minimal
quantity of nutrients, maximal unloading of gastric tract. It has low caloric content (1,000 Kcal),
the amount of salt (5g), proteins (15g), carbohydrates (200g) is limited. It consists of easily di-
gestible liquid dishes. It is applied every 2.5-3 hours 6 times a day. A bit less strict variants of
this diet are diet 0 a and diet 0 b.
Diet 1 is administered at a gastric ulcer in a stage of exacerbation (the first 8-12 days),
acute gastritis, exacerbation of chronic gastritis and enteritis, after operations and at gastroen-
teric hemorrhages (after diet 0). Its purpose is maximal safety to promote the repairing the
stomach mucous membrane, to decrease its reflex excitability.
Diet 2 is prescribed at chronic gastritis with disturbance of secretory activity without any
exacerbation, chronic colitis, disturbance of masticatory apparatus function. The purpose of
this diet is stimulation of secretion and normalization of disturbed function of the stomach and
intestines, reduction of enzyme processes in intestines.
Diet 3 is administered at alimentary chronic constipations without the expressed symp-
toms of intestine irritation. Its purpose is stimulation of disturbed function of intestines by inclu-
sion in a diet of components producing mechanical, thermal and chemical irritation.
Diet 4 is applied at chronic colitis and enterocolitis in a stage of exacerbation, acute ga-
stroenterocolitis and operations on intestines (after fasting days), dysentery, typhoid, tubercu-
losis of intestines (within the first 5-7 days). The purpose of this diet is maximal mechanical,
thermal and chemical safety of intestines, creation of conditions for elimination of inflammatory
process, restoration of dysfunction, reduction of fermentative and putrefactive processes in in-
testines.
Diet 5 is used at acute hepatitis (Botkin‘s disease) in a stage of recovery, chronic hepati-

151
tis, cholecystitis, cholelithiasis with dysfunction of the liver and biliary tracts without any ac-
companying inflammatory processes in the stomach and intestines, moderate atherosclerotic
cardiosclerosis. The purpose of the diet is normalization of the liver and biliary tract function,
regulation of cholesterol and fatty exchange, accumulation of glycogen in the liver, stimulation
of disturbed function of intestines.
Diet 5a is applied at chronic pancreatitis in a stage of aggravation. The purpose is to
prevent the disturbance of the secretory function of the pancreas, to provide synthesis of pro-
tein necessary for construction of pancreatic enzymes, chemical safety of the alimentary tract,
prevention of fatty infiltration and dystrophy of the pancreas and liver, decrease of reflex exci-
tability of the gallbladder.
Diet 6 is administered at a gout and lithic diathesis. Its purpose is to contribute to reduc-
tion of endogenic formation of uric acid, its removing from the organism and normalization of
pyrin exchange.
Diet 7 is used at acute nephrolithiasis in the initial stage and at chronic form of this dis-
ease during its aggravation. The purpose of the diet is maximal safety of kidney function, de-
crease of albumin exchange, increase of diuresis, elimination of hypostasis, sharp limitation of
proteins (25-35g) and moderate decrease of fats (up to 60g) and carbohydrates (350g). The
diet should be enriched with vitamins. Liquid (up to 400-450 ml), salt in foods (1-2 g) should be
sharply limited.
Diet 8 is administered at adiposity but absence of disturbance of digestive organs. The
purpose of the diet is prevention and elimination of fatty cell accumulation.
Diet 9 is applied at diabetes, in a mild form diet 9a is used without insulin therapy. The
main principle is restriction of caloric content (2300-1700 Kcal) due to carbohydrates (300-
200g), basically, unprotected, and partial restriction of fats (70-50g), the normal content of pro-
teins (100-120g). Taking meals is 5-8 times a day with exact distribution of carbohydrates.
Products with high content of carbohydrates are excluded.
Diet 9 b is administered at diabetes of severe and moderate forms with application of
insulin therapy. The caloric content and chemical structure of the diet is normal, similar to diet
15. Only unprotected carbohydrates are limited (sugar — 30 g per day).
Diet 10 combines a number of diets used at disease of cardiovascular system, atheros-
clerosis, hypertonic illnesses of different forms, insufficiency of coronary blood circulation. The
general requirements are restriction of caloric content due to fats and carbohydrates, limitation
of liquid and salt, exclusion of products rich in cholesterol, fat products containing a lot of satu-
rated fatty acids.
Diet 10 a is one of the variants of diet 10 used at cardiovascular diseases with sharply
expressed insufficiency. Its purpose is to relieve cardiac activity, safety of digestive organs and
kidney function, increase of diuresis and unloading of exchange. Sharp restriction of salt (1-2
g) and free liquid (600 ml), vegetative cellulose, the products promoting meteorism and rich in
cholesterol, irritating liver and kidneys.
Diet 11 is used at tuberculosis of lungs and bones during recovery after infectious dis-
eases, traumas, operations, at anemia. The purpose of the diet is to increase general nutrition
and reactivity of organism, resistibility to chronic infections. The increased caloric content
(3500-3900 Kcal), increase of protein content, primarily protein of animal origin.
Diet 12 is applied at diseases of the central nervous system with hypererethism; it is
transitive from diet 10 to a balanced diet. Its purpose is decrease of excitability of the central
nervous system.
Diet 13 is administered at acute infectious diseases, after operation in the lung cavity
(except for operations on the alimentary tract). The purpose of this diet is intensification of toxin
removing, increase of protective forces of organism, safety of digestive organs under the con-
ditions of confinement to bed.
Diet 14 is applied at phosphaturia. Its purpose is to reduce phosphaturia and to interfere
with the loss of phosphorous-calcium salts in the urinary tracts with formation of stones. The
diet implies moderate decrease of salt content (10-12g), restriction of calcium (0.4g), increase
of amount of free liquid (up to 200 ml).
Diet 15 is recommended for recovering patients and for people with various diseases at
absence of indications to administering medical diets. The purpose of this diet is providing
high-grade balanced nutrition in a hospital. It is a physiologically high-quality and balanced diet
which is intended for persons not carrying out physical work.

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Contrast Diets (Days of Limited Food Intake)
These are administered instead of the basic diet once per 7-10 days. Because of low
caloric content of these diets a patient should follow a bed regimen under doctor‘s supervision.
Contrast days provide significant unloading of exchange, rendering thus beneficial effect on the
course of disease.
Apple day is necessary at acute or chronic colites (especially at diarrheas), kidney
stones, hypertonic diseases, atherosclerosis, gout, adiposity. The diet consists in 300 g raw
mature apples 5 times a day every 2.5-3 hours.
Sugar is applied at diseases of the liver, biliary tracts, kidneys. It consists in 1 glass of
tea with 40g of sugar 5 times a day every 2.5-3 hours.
Dairy (Variant 1) is used at diseases of cardiovascular system in the stage of decom-
pensation and subdecompensation. 100 ml of milk every 1.5-2 hours 7 times a day with addi-
tion of 20-25 g of sugar and 30 g of dry white bread.
Variant 2 is used at adiposity and gout. It consists of 1 glass of milk 5-6 times a day
every 2 hours.
Cottage cheese is administered at adiposity, diseases of cardiovascular system in a
stage of subcompensation, diseases of liver, biliary tracts, kidneys. 600 g of cottage cheese
with 50 g of sugar are divided into 5 intakes every 3 hours.
Kefir is necessary at diseases of cardiovascular system, adiposity, gout, diseases of the
liver, chronic colitis with constipations. It includes 200 ml of kefir or curdled milk 5 times a day
every 3 hours.
Rice compote is compote made of 120 g of fresh or 250 g dried fruit, 100g of sugar and
1.5 l of water. One glass of compote is taken every 2.5-3 hours, including 2 times with sweet
boiled rice (20 g of rice cooked in water). Indications: hypertonic illness, kidney diseases, dis-
eases of the liver and biliary tracts.
Salad is used at chronic polyarthritis, atherosclerosis, kidney diseases, diathesis, gout.
200-250 g of salad from vegetables and fruits without salt with a small amount of vegetable oil
4-5 times a day.
Potato is necessary at diseases of cardiovascular system in a decompensation stage. 1
kg of baked potato, 50 g of sour cream and 20 g of butter for 5 meals.
Cucumber is recommended at adiposity, alimentary constipations, lithic diathesis, gout.
1.5 kg of fresh cucumbers for 5 meals and 1 boiled egg for dinner and supper.
Organization of Dietetic Therapy in a Hospital
Medical diets are administered by the attending physician (and included in case history).
Every day the head nurse of hospital department on the basis of case histories makes up the
list where the total amount of patients and amount of patients for each diet are specified. This
list is passed to the nutrition unit. Dietetic nurse of nutrition unit on the basis of lists from each
department writes a summary list on which basis under supervision of doctor-dietician makes
up a menu according to each diet. The menu-allocation is composed only for 1 day (the next
one). On Friday the menu is made up for 3 days: Saturday, Sunday and Monday). Test of the
prepared food is carried out by the certifying commission consisting of the doctor on duty of the
reception ward (in small hospitals — the doctor on duty of the hospital), the doctor-dietician
and chef. Sanitary inspection over hospital nutrition unit does not differ basically from sanitary
inspection of other public catering establishments, but it is more careful.
HYGIENE OF WORK

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Theme No 17.
Subject and Tasks of Hygiene of Work. Physiology of Work. The Occupational Harmful
Factors and Occupational Diseases. Prevention of Occupational Pathology. The
Occupational Dust Pathology and its Prevention
Hygiene of work is a section of hygiene studying the effect of a work process and
harmful occupational factors on organism of a working person and developing preventive
measures to decrease and prevent occupational diseases.
The basic sections of hygiene of work are:
 Physiology of work studying influence on organism of various kinds of work,
estimation of its difficulty and intensity, prevention of exhaustion.
 Hygiene of work with adverse physical occupational factors studying the effect
on organism of noise, vibration, electromagnetic fields, laser irradiation, etc.
 Radiation hygiene studying the effect of radiation on organism, development of
radiation protection.
 Hygiene of work with industrial poisons - industrial toxicology – studying the
parameters of toxicity of industrial poisonings, causes and clinical manifestations of
occupational poisonings, their prevention.
 Hygiene of work in agriculture and at contact with agrochemicals - agricultural
toxicology - studying the parameters of toxicity of agrochemicals, causes and clinical
manifestations of occupational poisonings, their prevention.
 Hygiene of work in conditions of dust pollution of air – studying the effect of
different kinds of dust on person, prevention of occupational dust pathology
(pneumoconiosis).
There is also the division of hygiene of work according to industries (chemical, mining,
metallurgical, building, etc.) and branches of agriculture.
Physiology of Work
Physiology of work is a boundary section of hygiene and physiology studying the
effect of work process on a human organism and developing measures to increase work
capacity and prevent the development of early fatigue.
Classification of Types of Work
Work is subdivided into mainly intellectual and physical one, however the scientific and
technical progress eliminates clear borders between these types of work.
The basic types of work are the following:
 Physical work which demands great physical activity and energy consumption (work of
a loader, etc.)
 Mechanized work requires significant muscular activity, but energy consumption is less
(work of a turner, combine operator, etc.)
 Automated work requires less energy consumption, but is characterized by monotony
(a serviceman, weaver etc.)
 Work on a production line is characterized by monotony, the imposed rhythm of work
 Intellectual types of work are encountered:
 in the sphere of material production - engineers, operators;
 out of material production - doctors, teachers, artists, etc.
By value of energy consumption work is divided into the following groups:
 work with significant muscular activity (energy consumption is 4,000-6,000 kcal);
 work on the production line, mechanized work (3,000-4,000 kcal);
 the automated work, intellectual types of work (2,000-2,400 kcal).
Physical work is subdivided into:
 static work, when only one group of muscles is loaded, that causes early fatigue as
blood supply is worsened;
 dynamic work, when different muscles work, this type of work is more favorable.

154
Classification of Work by Degree of Gravity and Intensity
The gravity of work is connected with physical gravity of work and characterized by:
 amount of work (in kilogram-meters)
 capacity of work (amount of work per time unit)
By physical gravity work is divided into:
 mild
 of medium gravity
 hard
 very hard
The intensity of work (mental, of an operator) is characterized by:
 demands for attention;
 emotional exertion;
 strain of audition and vision;
 monotony.
By intensity work is divided into:
 not intensive
 slightly intensive
 moderately intensive
 very intensive.
Concepts of "Exhaustion" and “Tiredness”
Tiredness is subjective feeling, as a rule, accompanied by the development of
exhaustion. It depends on psychophysiologic condition of a working person, degree of interest
in work.
Exhaustion is a complex of objective changes in organism due to work manifested in
decrease of capacity for work.
If exhaustion does not disappear before the beginning of the following cycle of work, it
gradually accumulates and turns to overexhaustion, i.e. decrease of capacity for work,
pathology of CNS, cardiovascular system, immunosuppressive state, growth of traumatism.
Concept of “Capacity for Work”
Capacity for work is ability of man to long work without decrease of qualitative and
quantitative characteristics (with high efficiency of work).
Capacity for work depends on such reasons as health state, hygienic conditions of work,
organization of work process, psychophysiologic factors.
Early decrease of capacity for work is an indicator of effect of these factors, therefore
studying its dynamics is of great importance for estimation of health and working conditions of
working people.
Dynamics of Capacity for Work during a Working Process
During work three stages of capacity for work are distinguished:
 In-work period - a gradual increase of capacity for work;
 Working excitation – a maximal level of capacity for work;
 Incipient exhaustion - a gradual decrease of capacity for work.
Dynamics of Capacity for Work after Termination of Work
 After-work excitation – some increase of work capacity occurs.
 After-work inhibition - a sharp decrease of work capacity occurs.
 Restoration of work capacity. At a long duration of this stage the level of work
capacity returns to the initial one and there is no overstrain.
Methods of Studying the Capacity for Work
There are a lot of methods of studying the capacity for work or exhaustion, they are
represented as psychophysiologic or only physiological tests. The most important of them are

155
the following:
 Methods of studying the capacity for brain work (mental work):
 A correcting test – crossing out definite letters or figures in special tables per minute.
Estimation of results of the test is made according to Hartridge formula, i.e. according
to amount of the processed information in bit/sec.
 Verbal-associative experiment - estimation of speed and degree of association
between with given words.
 Estimation of attention stability (for schoolboys).
 Estimation of time of hearing-motor and visual-motor reactions (a latent period of
reflex) with the help of chronoreflexometer (for operator‗s work).
 Methods of studying the capacity for any kind of work – chronometric researches:
 A selective timing of work elements;
 Fixing the distraction of attention (at school);
 Phototiming.
 Methods of studying the capacity for physical work:
 Estimation of physical tolerance with the help of a dynamometer;
 Studying tremor (trembling) of hands (with the help of tremometer)
Exhaustion. Theories of Mechanism of Its Development
Among a great variety of theories of exhaustion development (more than 20) there is no
universal one up to now.
At present the most recognized is the central-nervous theory by Sechenov, Uchtomsky,
Vvedensky. The basic role in exhaustion is played by decrease of capacity for work of cortex
cells, thus the processes of excitation and inhibition in the CNS are disturbed. Thus in the CNS
the stable foci of excitation or inhibition occur – this is the theory of disbalance. This theory
has been recently supplemented with the theory of reticular formation elucidating the
disorder of communications between the upper and lower parts of the CNS.
Earlier the humoral-local theories of exhaustion development at physical work were
acknowledged, such as:
 The theory of exhaustion - exhaustion of energy supply in muscles (ATF, glycogen,
etc.);
 The theory of poisoning - accumulation in muscles of non-oxidized products (lactic,
pyruvic acids).
The inaccuracy of these theories is proved experimentally, besides they do not explain
the development of exhaustion at brain work. However, these processes play some role in the
development of exhaustion.
The Main Reasons of Development of Premature Exhaustion at Work
They may be subdivided into the following way:
 Endogenous:
 diseases and prepathological states;
 defects of development of organs and systems;
 poor or non-optimal nutrition (food);
 the negative attitude to work.
 Exogenous:
 violation of hygienic working conditions:
 non-optimal microclimate;
 non-optimal illumination;
 a forced position of body;
 a high level of occupational harmful factors (chemical, physical, biological)
exceeding MPC, MPL.
 non-optimal organization of a working process:
 very long working hours;
 very hard and intensive work;
 monotonous work;
 non-observance of a work and rest regimen.
 non-optimal psychoemotional working conditions:
 a bad moral climate in a collective (conflicts)

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 a negative attitude to work.
The basic directions of exhaustion prevention are the following:
 Scientific substantiation and keeping hygienic requirements to working conditions
(requirement to microclimate, illumination, areas of workplace, avoidance of
exceeding MPC of harmful occupational factors);
 Scientific (rational) organization of a working process (following regimen of work and
rest, restrictions on working hours, labour-intensiveness, transforming static physical
work to dynamic, etc.);
 Technical measures to improve the working conditions of workplace (application of
ergonomics – a science concerned with human factors in the design and operation of
machines and the physical environment).
 Psychologic measures (psychology of work - industrial psychohygiene, psychologic
help in choosing particular occupation, optimization of psychologic climate in a
collective).
Changes in Organism during a Working Process. Changes in the CNS
The first system reacting to any work is the CNS - its stimulation is marked. At adequate
work the favourable changes of the nervous processes are observed, the latent time of
reactions is reduced; at extremely hard work a temporary improvement of CNS parameters is
replaced by their deterioration resulting in weakening of reflexes, premature exhaustion.
Changes of Respiration
At work the respiration of organism tissues increases. An increased delivery of oxygen
to tissues and removal of СО2 is achieved by increase of respiratory rate and depth (at rest the
respiratory rate is 7-22 times per minute, at work - 50 and over, the volume of lung ventilation
increases by 5-10 times).
The maximal entry of О2 with respiration is 3-4 l/min – it is the oxygen limit. The entry
of oxygen into organism increases gradually and at the beginning of work the oxygen deficit
occurs, during which non-oxidized products of metabolism accumulate. At hard inadequate
work the oxygen deficit becomes great and several days are necessary for full oxidation of
metabolites formed in tissues.
Lingard’s phenomenon. The German physiologist Lingard has established that at hard
static physical work a number of people after finishing work require an increased amount of
oxygen again due to passing the non-oxidized products of metabolism from tissues into blood
that causes stimulation of gas exchange.
Changes of Cardiovascular System
The increased metabolism in working tissues requires the increase of blood circulation.
At work the rate of heartbeat, systolic volume of heart increase; therefore the minute volume of
blood increases. Thus, in trained people it increases due to increase of systolic volume, in
untrained ones - due to increase of a pulse rate. The arterial pressure, especially maximal one,
increases that results in growth of pulse pressure. After adequate work the arterial pressure
returns to normal in 5-10 minutes.
The Occupational Harmful Factors and Occupational Diseases. Prevention
of Occupational Pathology
The occupational harmful factors (OHF) are factors affecting the working people and
capable to cause health disorders, i.e. occupational diseases.
The primary tasks of occupational hygiene in relation to OHF are:
 Studying sources, conditions of occurrence and parameters of OHF at work.
 Studying mechanisms of OHF effect on organism and its systems in experiment with
laboratory animals.
 Investigation of cases of occupational diseases at work.
 The development of preventive measures against occupational diseases.
Classification of OHF

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In occupational hygiene the following groups of OHF are distinguished:
 OHF connected with non-observance of hygienic conditions in manufacture (non-
optimal microclimate, action of harmful occupational factors, etc.);
 OHF connected with improper organization of work (excessively intensive, hard,
prolonged work, monotony of work, etc.);
 OHF connected with disadvantages of working conditions (a small area of workplace,
a forced position of a body, etc.).
According to the State Standard "Dangerous and harmful occupational factors.
Classification" all the OHF are subdivided into:
 a dangerous occupational factor which can cause an acute disorder of health or
death of a person;
 a harmful occupational factor which can cause a chronic disorder of health – an
occupational disease.
Classification of OHF in the State Standard is as follows:
 Psychophysiologic and physical factors in the organization of work, arrangement
of a workplace and equipment (psychological and physical overloads, a forced
position of body, overstrain of separate organs and systems);
 Physical occupational factors (nonoptimal microclimate, illumination, an increased
level of noise, vibrations, radiation, electromagnetic fields);
 Chemical occupational factors (industrial poisons) – chemical substances used in
manufacture.
 Biological professional factors (microbes, substances of protein nature, allergens);
 Industrial traumatism (mechanical, thermal, electric traumas).
Diagnostics and Prevention of Professional Pathology
The basis of diagnostics and prevention of occupational pathology is the order of
Ministry of Public Health, including:
 the list of manufactures and occupations which require obligatory preliminary and
periodic physical examinations of workers;
 the order of carrying out such examinations, staff of medical commission for the
examinations;
 the list of medical contraindications for admission to various kinds of manufacture.
 the list of diagnoses of occupational diseases and poisonings.
Purpose, Types and Organization of Physical Examinations of Workers
Preliminary physical examinations are carried out for newly admitted to work with
harmful and dangerous working conditions with the purpose:
 to admit to work only those whose state of health completely meets the requirements
of a given profession;
 not to admit to work the persons having deviations in health which can amplify under
the influence of working conditions, and also those who can be a source of infections
or parasitic diseases.
Periodic physical examinations are regular medical examinations of people working in
harmful or dangerous conditions. Their periodicity is determined by order No 45. The aims of
these physical examinations are the following:
 to reveal early signs of occupational diseases;
 to reveal common diseases interfering with further work;
 to administer individual medical-prophylactic measures.
Concept and Classification of Occupational Diseases
The occupational disease (poisoning) is a disease which connection with effect of
occupational factors is proved.
In order Ministry of Public Health the ―List of Occupational Diseases‖ is stated consisting
of three sections:
 Names of occupational diseases - 27 diagnoses (pneumoconioses, noise disease,
vibrating disease, etc., acute and chronic poisonings).

158
 Dangerous and harmful production factors, which effect can result in occurrence of
occupational diseases.
 The list of kinds of work and professions at which the given occupational disease is
encountered predominantly or as an exception.
The Rules of Diagnostics and Confirmation of Diagnosis of Occupational Diseases
Acute occupational diseases:
 The diagnosis of acute occupational disease must be made by any doctor, who
receives a patient, because it has characteristic clinical symptoms;
 The doctor in case of acute occupational disease must write Emergency Notice about
acute occupational disease and send it to the department of hygiene of work of
Rospotrebnadzor;
 The doctors of Rospotrebnadzor after receiving such Emergency Notice within 24
hours must go to the place of patient‘s work and make sanitary inspection of working
conditions (as for availability of harmful occupational factor at a level higher than
hygienic norms) and write the official Act of sanitary investigation case of acute
occupational disease;
 Official diagnosis of acute occupational disease can be made only after proving
the availability of harmful occupational factor at a level higher than hygienic
norms.
Chronic occupational diseases:
 The diagnosis of chronic occupational disease can be made only by a doctor-
specialist in occupational pathology, working in special department or hospital of
occupational pathology,
 After making diagnosis of chronic occupational disease this special department or
hospital of occupational pathology informs the local Rospotrebnadzor (where the
patient lives or works) about the case of chronic occupational disease;
 The doctors of department of hygiene of work of local Rospotrebnadzor within 7 days
must go to the place of patient‘s work and make sanitary inspection of working
conditions (as for availability of harmful occupational factor at a level higher than
hygienic norms) and write official Act of sanitary investigation case of chronic
occupational disease;
 Official diagnosis of chronic occupational disease can be made only after
proving the availability of harmful occupational factor at a level higher than
hygienic norms.
The basic directions of prevention of occupational diseases include the following:
 Normative-legislative measures. The CLL (the Code of Laws on Labour), State
Standards, Sanitary rules, etc.
 Hygienic measures: preventive and current sanitary inspection.
 Medical-preventive measures: preliminary and periodic physical examinations,
medical prophylactic nutrition.
 Sanitary education of workers about harmful and dangerous occupational factors
and occupational diseases.
 Technological measures on decrease or elimination of OHF.
 Individual means of protection.
Occupational Dust Pathology and its Prevention
Dust as an Occupational Harmful Factor

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Effect of dust on workers is observed in mining and coal industry, in the building industry
(cement, etc.), at metalworking, in agriculture, etc.
Classification of Industrial Dust
 According to origin:
 inorganic (mineral, metal),
 organic (vegetative, animal, polymeric),
 mixed.
 According to formation:
 aerosols of desintegration (at crushing solid bodies),
 aerosols of condensation of vapours on metal particles
 According to dispersion:
 visible (the size of particles > 10 microns)
 microscopic (2.5-10 microns)
 ultramicroscopic (< 0.25 microns)
The size of dust particles determines the depth of their penetration into lungs and area of
damage.
 According to effect on organism:
 toxic (manganese, lead, arsenic, etc.),
 irritating (limy, alkaline, etc.),
 infectious (microbes, spores, etc.),
 allergic (woolen, synthetic, etc.),
 carcinogenic (asbestos, etc.),
 fibrinogenic (pneumoconiotic), containing silicium.
 According to toxicity:
 nontoxic dust (soil, wood) - maximum permissible concentration is 10 mg/m3;
 toxic dust - silicate containing silicon (maximum permissible concentration is 1
mg/m3), lead dust (maximum permissible concentration – 0.01 mg/m3).
At hygienic characteristics of dust the chemical composition, dispersion, solubility in
blood, hardness, absorption properties are taken into account.
Effect of Dust on Organism
There are different ways of getting dust into organism: through inhalation, deglutition
with saliva and mucus, through skin.
Nonspecific effect: the action of dust may cause the diseases of respiratory organs,
mucous membranes of eyes, skin. It contributes to the development of tuberculosis, allergic
diseases.
Specific effect is manifested in the formation of pneumoconiosis, carcinogenic action.
Pneumoconiosis are the most common dust occupational diseases.
There are: Silicosis (effect of silicon dioxide), silicatosis (dust of silicic acid salts),
asbestosis, anthracosis (coal dust) refer to them. The can also develop at effect of metal dust.
Silicosis is the most common type of pneumoconiosis. Pathogenesis: dust particles in
the lung tissue are absorbed by histiocytes, thus fibroblasts are formed leading to the formation
of collagenic fibres (connective tissue) which results in reduction of lung surface.
Symptoms and signs: respiratory insufficiency of different degree of severity, bronchitis,
pneumonia, emphysema.
Classification of Pneumoconiosis
 Pneumoconiosis caused by effect of highly and moderately fibrinogenic dust (the
content of free silicon dioxide SiO2 > 10 %): silicosis, anthracosilicosis,
silicosiderosis, silicosis complicated by tuberculosis – silicotuberculosis.
 Pneumoconiosis caused by effect of low fibrinogenic dust (SiO2 < 10 %): silicatosis
(asbestosis, etc.), carboconiosis (anthracosis, etc.), byssinosis (vegetative dust).
 Pneumoconiosis from aerosols of a toxic-allergenic action: berylliosis, aluminosis,
farmer‘s lung, chronic pneumonia with allergenic component.
Diagnostics of Pneumoconiosis
Morphologic forms are:

160
 nodular
 interstitial
 mixed
According to the course of disease the forms are divided into:
 slowly progressing
 quickly progressing
X-ray Diagnostics of Pneumoconiosis
1st stage - interstitial fibrosis of the lungs, formation of small nodules 1 mm in diameter
along the bronchial tubes, a moderate bilateral intensification of lung pattern.
2nd stage – exacerbation of interstitial and nodular lung fibrosis and formation of
numerous nodules 2-4 mm in diameter on a background of atelectasis areas (symptom of a
"snow storm"), deformation of the lung pattern.
3rd stage – a massive lung fibrosis, big masses of connective tissue, marked
deformation of the bronchial tree, disturbance of bronchial permeability.
In addition to that metalloconioses are characterized by the increased roentgen contrast
of metal dust in the lungs.
Clinical and Functional Diagnostics of Pneumoconiosis
Its symptomatology includes symptoms of bronchitis, lung emphysema, respiratory
insufficiency, disturbances of pulmonary blood circulation – hypertrophy of the left cardiac
ventricle, changes of ECG readings –"lung heart".
At asbestosis there are asbestine corpuscles in sputum, at anthracosis the sputum is of
black color.
Complications of pneumoconiosis: lung cancer, tuberculosis, pneumonia, bronchial
asthma, rheumatoid arthritis, etc.
Prevention of Dust Diseases
 The labour legislation, preliminary and current physical examinations.
 Preventive and current sanitary control of working conditions with dust.
 Struggle against formation and spread of dust.
 Biological methods - increase of body resistance - UVR, alkaline inhalations,
respiratory gymnastics, clinical nutrition (containing proteins and vitamins).

161
Key Questions
1.Basic laws of functioning of various body systems.
2.Physiology of work. Classification of kinds of work.
3.Dynamics of capacity for work during work and after its termination.
3.Methods of studying the capacity for work.
4.Changes in organs and systems during work.
5.Concept of occupational hazards and occupational diseases. Classifications.
6.Order of registration and investigation of occupational diseases.
7.Purpose, types, organization of physical examination of working people.
8.Classification of dust, pathogenesis and types of pneumoconiosis, their diagnostics and
prevention.
1. Giving the corrector test at the beginning and at the end of the lesson using the
suggested by teacher tests to define the speed of processing information in bit/sec according
to Hartridge formula:
where: S - speed of processing information (bit/sec), N - number of symbols looked
through in the table, n - number of overlooks and mistakes, Т - time of viewing the table (60
sec.).
2. The research of muscular capacity for work. To estimate the physical force, the
examinee should twice compress a dynamometer with the maximal effort; the greatest value is
taken for initial. To determine the exercise tolerance, time (in sec) is estimated, during which
the examinee keeps a spring of a dynamometer at a level of 0.5 of his maximal force, up to
complete impossibility to continue the effort of this intensity.
3. The research of capacity for work by method of finding numbers. Time is marked
during which the examinee names and shows all the numbers printed in the table containing
49 numbers (from 1 up to 25 and from 24 to1) represented by different colours.
4. The investigation of hand tremor is carried out by a tremometer. If rate of tremor
movements is 8-12 per second – it is frequent, 5-8 - moderate, 3-5 - slow.
5. Investigation of capacity for work by a chronometric method. The increase of
time spent on operation testifies to exhaustion. In hygiene and physiology of work a
photochronometric investigation of a working day and detailed selective chronometry are used.
Use of chronometry for studying influence of working process on a body state and capacity for
work reveals the following: the duration of separate operations, ratio of time spent on
performance of basic and auxiliary operations, business activity of a working day, productivity
of work and its change within a day. On the basis of analysis of data and their comparison with
the data of physiological methods of research the recommendations for rational arrangement
of a working day, change of a working rhythm are grounded.
6. The verbal (associative) experiment. This method is more often applied at
estimation of mental work (lecturers, announcers, teachers). It allows to estimate a functional
condition of the nervous system analyzers (speech, hearing, movement). The purpose of the
research is to determine the speed of occurrence in the cortex of associative communications
between images of various objects and concepts. The speed of these communications
depends on a functional condition of the CNS and primarily on degree of exhaustion. The
essence of the method consists in the fact that the examinee is offered from 10 up to 30 words
(nouns) with an interval of 10-20 sec. The examinee should name the word matching the given
one in sense. For example, table - high, cap – big, etc. The researcher fixes the time of latent
period in seconds (time from the moment, when the word is given and answer of the examinee
is received) and number of mistakes available in the answer (the word does not match the
given). The researches are carried out several times within a working day, the results are

162
compared.
7. Definition of attention stability. Change of attention during work is also connected
with a number of reasons and, primarily, with exhaustion. The examinee with the help of a
special device is demonstrated consistently a number of figures painted in different colours for
the certain period of time. The examinee is offered to count mentally, how many such figures
there were. On calculation he should not use a pencil. The researches are carried out several
times within a working day, the results are analyzed. The increase of amount of mistakes
testifies to approaching exhaustion.
Self Test
1. Identify the method of research of capacity for work.
*A. a corrector test
B. Eiber‘s test
C. Duglas‘ method
2. Which of the following is most frequently connected with occupational harmful factors?
*A. Production, its technology and equipment
B. Interruption of work (break, dinner, visit to boss, etc.)
*C. Working process, its organization
*D. Intensity and duration of working process
3. In a foundry the manual casting of liquid metal into small forms was carried out. In the
workers, who repeatedly took part in the casting process, the signs of intoxication by
aerosols of heavy metals have occurred. What radical measures of prevention of
occupational poisonings can you suggest in the given situation?
A. Regular medical examinations
B. Control of metal aerosols in the air of a working zone and its comparison with MPC
C. Expansion of ventilation
*D. Installation of the automatic line of metal casting with effective ventilation
Problem Solving
1. It is necessary to determine stages of capacity for work of a schoolboy according to
the parameters of a corrector test: at the beginning of lessons it is 4.2; at the 3d lesson – 5.5;
at the 5th lesson – 5.3. What other methods can be used to investigate the capacity for work of
the schoolboy?
2. After accident in the chemical plant there was the environmental pollution with nitrose
compounds. Headache, dyspnea, dizziness appeared in people living in this district. What is
the reason of hypoxia?
3. Give the hygienic estimation of work in the workshop of a furniture industrial complex,
where the general dust content makes up 20 mg/m3. What occupational diseases are possible
in the workers? What are the principles of their diagnostics and prevention?
Standard Answers:
1. According to the data of a corrector test, at the beginning of the lessons there was an
in-working stage, and then a stage of working excitation was observed. It is also necessary to
carry out the similar researches with other pupils in the class for correct arrangement of the
lesson and prevention of exhaustion in pupils, and if in some pupils the premature exhaustion
develops, it is necessary to investigate the condition of their health. To study the capacity for
work it is possible to apply methods of estimation of attention stability, verbal-associative
experiment, chronometry researches.
2. The formation of methemoglobinemia.
3. MPC of non-toxic (furniture) dust makes up 10 mg/m3, in this case general dust
content exceeds the standard norms by 2 times, in this connection the development of
pneumoconioses in working people is possible. Their diagnostics is carried out
roentgenologically and clinically (according to degree of respiratory insufficiency). Prevention:
change of technology, strengthening artificial general and local ventilation, application of dust-
gathering equipment, current sanitary control of a dust content of air, application of individual
means of protection of respiratory organs (respirators).

163
Appendix 1
Ministry of Health
City Registration form No 163
Medical establishment
Notification
About Acute Occupational Poisoning or Occupational Disease
Enterprise _______________________________________
Workshop (where poisoning occurred)
Full name________________________________________
Date of poisoning _________________________________
Diagnosis._______________________________________
Date of sending notification_____________________________
Signature of the doctor
Appendix 2
Ministry of Health
City Registration form No 165
List of persons, in whom chronic occupational poisoning or occupational disease was
first revealed in __________ month of year 200 __
Enterprise ____________________________________
Ministry ____________________________________
Branch of industry ____________________________________
No Full name Concrete profession Diagnosis
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Appendix 3
Ministry of Health
City Registration form № 163
Registration Card № ___
of Acute Occupational Poisoning or Occupational Disease
Acute poisoning occurred in __________ (month) of 200 __ (year)
Enterprise ______________ Address ________________
Branch of industry
Workshop, department (where poisoning occurred)
Full name ___________
Sex _________ Age _______
Profession ________________
Record of service in the given shop ___________
Record of service in the given occupation ______
Record of service in the previous work _______ what industry_______,
what occupations ____________ (filled in case of chronic disease)
Circumstances, under which poisoning occurred ___________________________
а) What poisonous substances caused occupational poisoning or occupational disease

164
Theme No 18.
Hygiene of Work at Effect of Physical Occupational Harmful Factors (Noise,
Vibration, Electro-Magnetic Fields)
Concept of Harmful Physical Occupational Factors
During work many physical occupational harmful factors can effect a person, including
adverse microclimatic factors, non-optimal illumination or excess of its components, laser
radiation, noise, vibration, electromagnetic fields (EMF), high or low pressure, radioactive
radiation.
Noise as an Occupational Harmful Factor, Its Characteristics
According to WHO‘s data, noise is a universal problem for mankind, one of the main
physical factors of environmental pollution.
Concept of "Noise"
In physics noise is the chaotic sound fluctuations of different frequency rate and
intensity, having no regularity.
In hygiene noise is any sound, preventing recognition of useful sound signals, interfering
with rest, rendering a negative effect on a human organism and decreasing his capacity for
work.
Classification of Noise
According to sources it is classified into:
 household
 transport
 industrial
 building
 agricultural
According to duration it may be:
 stable – a fluctuation level of noise is not more than 5 dB
 unstable - more than 5 dB
 impulsive - intermittent
According to frequency, noise is classified into:
 audible sounds (16 - 20000 Hertz):
 low-frequency - up to 400 Hz
 medium-frequency - 400-1,000 Hz
 high-frequency - over 1,000 Hz
 infrasound - frequency up to 20 Hz – produces marked effect on internal organs since
its frequency can coincide with frequency of fluctuations of internal organs; the most
dangerous frequency is 8 Hz causing the disturbance of alpha-rhythm of the brain; 1-3
Hz results in disorder of respiration, etc.;
 ultrasound - more than 20,000 Hz - produces a mechanical and chemical effect
resulting in cavitation (formation of cavities in interstitial tissues), destruction of
molecules, their ionization; a thermal effect results in tissue heating – this phenomenon
is used in physiotherapy; at high levels the local damage of peripheral nervous and blood
systems, disorders of the CNS, etc. occur).

165
Level of Noise. Units of Its Measurement
Effect of noise on organism depends not only on frequency, but also on its level. In
acoustics loudness of sound is a sound pressure in Newton/m2 (difference between
atmospheric and sound pressure).
Unit of measurement of sound level in hygiene is a logarithmic unit, which expresses the
excess of sound pressure above a sound threshold: 0-14 Bell, or 0-140 dB:
Sound threshold = threshold of perception - 2 х 10-5 Newton/m2 = 0 dB
Painful sound threshold is 14 Bell = 140 dB.
SON – a comparative unit of level of sounds different by frequency
Abroad the unit of sound is FON (sound with frequency of 1000 Hz at a level of 1 dB).
Effect of Noise on Organism
Specific and nonspecific effect of noise is distinguished.
Specific effect is manifested by disturbance of function of acoustic analyzer due to a
long angiospasm resulting in degenerative changes in the nerve endings and neuritis of
acoustical nerve (occupational deafness).
Three stages of noise disease are distinguished at audiometry, i.e. estimation of
hearing level:
 Acoustical adaptation – at action of noise the acoustical threshold increases by 10-
15 dB, but in 1-3 min it returns to normal (a physiologic phenomenon);
 Acoustical exhaustion - decrease of hearing by 15-20 dB within hours or days after
stopping the noise effect;
 Progressing deafness – a gradual complete loss of hearing in connection with
organic changes of the auditory center in the CNS (noise at the level of more than 80
dB quickly causes the decrease of hearing and development of deafness at length of
service up to 5 years).
Nonspecific effect of noise is manifested by excitation of the cortex, hypothalamus and
spinal cord, quick development of CNS inhibition, then exhaustion of the nervous cells and
consequently irritability, emotional instability, deterioration of attention, memory, capacity for
work; via the vegetative nervous system the functional changes of different systems and
organs occur.
As a result of long effect of intensive noise the so-called noise illness develops - a
general disease with affection of organs of hearing, CNS and other systems.
The struggle against noise in industry and inhabited places includes:
 Administrative-legislative measures.
 Architectural-planning measures (functional zones in cities, sanitary-protective intervals,
transport highways).
 Hygienic measures, including:
 preventive sanitary control - normalization of noise - establishment of MPL according
to different criteria:
Table 36
Maximum Permissible Levels of Noise for Various Premises
Kind of premise MPL, dB Criteria of harmful activity
Habitable rooms 30 protection of sleep at the night
Wards in hospitals 25 maintaining a therapeutic-protective
regimen in hospital
Classrooms 50 maintenance of information
perception
Industrial premises 65* - 85 prophylaxis of noise illness

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Note: * - for high-frequency noise
 current sanitary control - the control of noise levels and its limitation.
 Medical-preventive measures - preliminary and current medical examination of workers
at noisy industries.
 Technological measures: sound-suppressing linings, wall coverings, automatization, etc.
 Individual measures: headphones, over 100 dB - flannel helmets.
Hygienic Characteristics of Vibration
Vibration is oscillations of elastic bodies with frequency over 1 Hz.
It is characterized by amplitude, frequency, direction.
Vibration is classified into: general and local.
According to frequency vibration is subdivided into:
 low-frequency vibration
 middle-frequency vibration
 high-frequency vibration
According to direction vibration can be:
 horizontal
 vertical
Local vibration of small intensity gives a positive effect (a vibrating massage); at general
vibration of high intensity there are changes of the CNS; through the vegetative nervous
system the changes of internal organs occur.
Local vibration causes long angiospasms and mechanical trauma of the peripheral
nerve endings in fingers – disturbance of trophism in tissues, polyneurites, arthroses - vibration
illnesses of various degree of severity.
Stages of Vibration Illness at Effect of General Vibration
 Slight pain and paresthesia of extremities;
 Expressed parasthesia, decrease of skin sensitivity;
 Vascular and trophic disorders of fingers, changes of CNS;
 Generalized sharp vascular disorders, vasospasms of heart and CNS.
Degrees of Severity of Vibration Illness at Effect of Local Vibration
 Peripheric angiodystonic syndrome, sensory polyneuropathy of fingers.
 Expressed angiospastic syndrome of fingers.
 Expressed generalized angiospastic syndrome, dystrophic changes of bones,
muscles of arms, deformation of finger joints.
Hygienic Characteristics of Electromagnetic Fields (EMF)
EMF is a special form of substance created by moving or motionless electric charges.
The basic parameters are: length of wave, frequency of fluctuations. EMF consists of electric
(EF) and magnetic fields (MF). Natural and anthropogenic fields are distinguished.
Natural EMF includes:
 MF of Earth (400 А/m) depending on geographical position, season and time of the
day, solar activity ("magnetic storms").
 EF of Earth - 130 V/m at the surface of Earth decreasing with height.
Anthropogenic (technogenic) EMF:
 Electrostatic field (ESF) is created by motionless electric charges of high intensity,
e.g. in industry, near power lines of ultrahigh voltage. It effects the CNS and causes
functional shifts of vegetative nervous system.
 Stationary magnetic field (SMF)
 EMF of industrial frequency - 50 Hz
 Infrared, visual, UV, laser radiation
 EMF of radio frequencies.

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Table 37
Classification of EMF of Radio Frequencies
Type of waves Wavelength Sources, application
Low-frequency 1-10 km broadcasting, radio communication,
industry
Medium-frequency 100м - 1 km - " -
High-frequency 1 - 100 m - " -
Ultra-high frequency 10 cm - 1 m radio, TV, medicine
Microwave frequencies 1 - 10 cm radiolocation, television, industry, for
cooking food (microwave oven)
Hyperhigh frequencies
(HHF)
1 mm - 1 cm industry
Effect of EMF on Organism
The degree of biological effect of EMF depends on:
 frequency (the higher frequency, the stronger effect)
 intensity
 exposure time
 character of irradiation (continuous, modulated)
 regimen of irradiation (constant, intermittent, periodic)
The mechanism of biological effect of EMF is the following:
 Thermal effect (at very high radiation intensity) causes the destruction of organs and
tissues
 Non-thermal effect (at low intensity) exerts influence on substrate of organism with
the formation of bioactive substances. At chronic action a cumulative effect is
observed.
Clinical pathological effect of EMF:
 Asthenic syndrome
 Asthenic-vegetative syndrome
 Diencephalic syndrome
 Damage of systems: cardiac, hemopoietic, immune, endocrine, etc.
Forms of pathological effect of EMF are the following:
 Acute and chronic form
 Mild, moderate and severe degree
Microwave syndrome is characterized by
 disturbance of CNS (asthenic and vegetative syndrome)
 opacity of lens cataract
 damage of hair follicles (baldness)
Besides there are changes of cardiovascular system, disorders of hemopoiesis,
dysfunctions of immune, endocrine systems, remote effects.
Prophylaxis of EMF Harmful Effect on People Working with EMF Sources, especially
with Microwave EMF
There are four principles of protection from electromagnetic radiation (including ionizing
one). They are:
 protection by dose or amount (MPD)
 protection by distance
 protection by time
 protection by screening.

168
Basic Directions of Prophylaxis of EMF Harmful Effect
 Administrative-legislative measures on work protection – reduction of operating time
(protection by time);
 Architectural–planning measures - sanitary-protective zones at a distance from sources
of EMF, correct placement of EMF sources at certain distance from other objects
(protection by distance);
 preventive sanitary control - substantiation of EMF MPL (protection by dose):
 in industry - MPL for a working day - 2 W per hour/m2
 for population - MPL inside the inhabited buildings – 0.5 kW/m,
 on territory of inhabited building - 1 kW/m,
 outside the inhabited building - 5 kW/m,
 near power lines of ultrahigh voltage - 10 kW/m
 current sanitary control - checking the observance of MPL, hygienic prescriptions,
etc.
 Medical-preventive measures - physical examination of workers and population, health-
improving measures.
 Technological measures - change of technology to decrease the level of EMF (protection
by screening).
The Hygienic Characteristics of Laser Irradiation
Lasers are optical quantum generators excreting a focalized fascicle of electromagnetic
radiation with wavelength from IR up to UV.
According to time laser irradiation is divided into:
 continuous
 impulsive
According to direction it may be:
 direct
 reflecting
 diffusely reflex
 dissipated
Effect of Laser Irradiation on Medical Staff
At reflex radiation the organic changes of tissues in the place of irradiation and
nonspecific reflectory changes of organs and systems may occur.
Thermal specific action - prompt heating of tissues and organs.
Common nonspecific effect – changes of CNS, cardiac, endocrine system, suppression
of chromogenesis.
Local effect:
 On organs of vision - temporary loss of sight,
 On skin - hyperemia, combustions, necroses.
Prevention of Harmful Effect of Lasers
 Hygienic measures
 Planning and technical measures
 Medical-preventive measures
Key Questions:
Methods of prevention of harmful effect of noise:
-What is noise, its classification and units of measurement;
-Devices for measurement of level and spectrum of noise;
-Effect of noise on a human organism, MPL of noise for different premises and criteria of

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their development;
Methods of prevention of harmful effect of vibration:
-What is vibration, its classification and units of measurement;
-Devices for vibration measurement;
-Effect of vibration on a human organism, norms of vibration;
-Methods of prevention of harmful effect of vibration.
Methods of prevention of harmful effect of EMF, ultrasound, infrasound, laser irradiation on
the man.
Hygienic characteristics of EMF, ultrasound, infrasound, laser irradiation;
Effect of electromagnetic field, ultrasound, infrasound, laser on organism.
Devices for measurement of EMF, ultrasound, infrasound, laser irradiation.
Methods of prevention of harmful effect of these factors.
Self Test
1. In a workshop of a machine-building factory, where women work, a periodic (up to 2 times
per hour) hand moving of processed details takes place. What limiting norm of elevation
and moving cargoes by women should be recommended to the authorities in
accordance with standards authorized by Ministry of Health of Ukraine?
*A. 10 kg
B. 20 kg
C. 15 kg
D. 7 kg
E. 5 kg
2. What are the basic methods of research of vibration effect on a person?
*A. evaluation of a skin temperature
B. a corrector test
C. capillaroscopy
D. investigation of vibration sensitivity
E. evaluation of pain sensitivity
3. Which of the following is a correct definition of noise?
*A. It is a chaotic combination of sounds of different frequency and intensity.
B. These are mechanical fluctuations of solid bodies.
C. These are sounds irritating CNS of the man.
Problem Solving
1. In the bar department of a foundry shop a high-frequency heating is applied for drying
bars. In the shop 10 drying chambers work simultaneously. A range of working frequencies is
30-48 MHz. What primary pathological changes can occur at work in the given conditions?
2. In one of the premises of the chemical enterprise the constant disturbance of
microclimate (temperature rate, ventilation) takes place. Identify measures which should be
recommended to maintain the industrial microclimate in the given premise in accordance with
hygienic requirements?
3. The noise level on a workplace makes up 121 dB. What psycophysiological effect is
most probable in the workers?
Standard Answers:
1. Asthenovegetative syndrome.
2. To equip the premise with a conditioner.
3. Risk of an acoustic trauma.

170
Theme No 19.
Radiation Hygiene and Ecology
Radiation as an Adverse Physical Occupational Factor
Ionizing radiation is widely applied in the atomic power station, industry, medicine for
medical and diagnostic procedures, so it can have a negative effect on many workers.
Besides, in connection with great radioactive pollution of biosphere, especially after accident
on the atomic power station, an increased level of radioactivity may have a negative effect on
health of population.
A feature of effect of this factor on organism is the presence of pathological changes
even at small levels of action that demands especially strict observance of hygienic
requirements, norms of radiation safety (NRS) and careful medical examination of staff.
Concept of Radioactivity
Radioactivity is the property of some atomic nuclei of spontaneously emitting gamma
rays or subatomic particles (alpha and beta rays).
In hygiene all sources of radiation are subdivided into closed and open.
At closed source only ionizing radiation gets into the environment, e.g. x-ray tube.
At open source both radiation and particles can get into the environment, e.g.
radioactive isotopes.
Characteristics of Types of Ionizing Radiation
The following are distinguished:
 Corpuscular radiation, including:
 Alpha-radiation is a stream of alpha particles (nuclei of helium) basically from
natural isotopes. The ionization ability is the formation of 6,000 ions per 1 mm3 of air,
the penetrating ability is a particle track equal to 11 mm in the air and 1/6 mm in the
body, so it penetrates only into a superficial layer of the skin. Protection by clothes,
aluminum foil is sufficient. The basic danger appears at internal entry into organism
with water and food;
 Beta-radiation is a stream of beta-particles (electrons or positrons). The ionization
ability is 6 pairs per 1 mm3, penetrating ability - up to 1 m in the air, 1cm in the body.
Any materials, except for lead can be used for protection (formation of braking x-ray
radiation).
 Neutron radiation is a stream of neutrons. Ionization is 400 ions per 1 mm3, particle
track in the air - hundreds meters, in the body - up to 10 m. The protection against
fast neutrons is substances with a small serial number (hydrogen), e.g. water,
paraffin, polymer materials; slow neutrons are absorbed by boron, cadmium.
 Electromagnetic radiation including:
 X-ray and gamma-radiation. Ionization is 0.1 ions per 1 mm3, particle track in the
air is hundreds meters, in the body - some meters (depends on intensity of radiation,
length of waves). Gamma–radiation is more severe. Materials with high density, e.g.
lead, concrete may serve as protection.
Basic Units of Radioactivity
 Unit of isotope radioactivity: becquerel - a SI unit of measurement of radioactivity,
equal to 1 disintegration per second; 1 Bq = 0.027 x 10-9 Ci. Curie (Ci) is an old unit
equal to 4 х 1010 disintegrations per sec.
 Unit of exposure dose. It is used for characteristics of ionization dose in the air - for
gamma and x-ray radiation. Coulomb/kg (SI) - a dose producing in 1 kg of air ions
with electrical charge of 1 coulomb. An old unit - Roentgen - a dose producing in
1cm3 of air 3 х 109 pairs of ions.
 Units of intensity of exposure dose. Unit of a dose correlated to a time unit –

171
R/hour, mR/min, µR/sec.
 Unit of absorbed dose. Grey (Gy) – an absorbed dose of 1 Joule energy per 1 kg
substance. An old unit - Rad - the unit for the dose absorbed from ionizing radiation,
equivalent to 100 ergs per gram of tissue; 100 rad = 1 Gy.
 Unit of equivalent dose. In International System of units (SI) as a unit of equivalent
dose sievert (Sv) = 1 Gy . Q is accepted – it is a dose of ionizing radiation of any kind
producing the same biological effect as a dose of x-ray or gamma-radiations of 1 Gy
in view of a quality coefficient (1 Sv = 100 ber).
Effect of Ionizing Radiation on Organism
The basic stages of development of radiation damages are:
 The formation of ionized and excited atoms and molecules which interact with each
other and various molecular systems, forming biologically active substances; the
breaks of intermolecular links are also possible due to radiation effect (the initial or
starting processes);
 The effect of newly formed biologically active substances (free radicals, ions, etc.) on
biological structures of a cell in organism causing the destruction of biosubstances
and formation of new substances unusual for organism;
 Metabolism imbalance in biological systems with changes of appropriate functions on
a background of neurohumoral reactions.
The Major Biological Reactions of Organism to Radiation Effect
All consequences of radiation effect on organism can be conditionally divided into
somatic and inherited.
The somatic effects occur in the irradiated organism, the inherited ones – in posterity.
All radiation effects are subdivided into the following:
Stochastic (probable) effects are nonthreshold ones, which are estimated by probable
risk of occurrence of radiation damage, i.e. cancerogenic, mutagenic, hereditary effects. It is
difficult to investigate them in experimental research, as it is impossible to establish precisely a
threshold of harmful effect. These effects are basically manifested at action of small doses
(when the occupational and natural irradiation for the whole life does not exceed 100 rem).
Nonstochastic (threshold) effects - the severity of damage depends on dose and it is
possible to establish a threshold of damaging effect, i.e. to determine the safe levels of
radiation effect. All norms of radiation are based on prevention of these effects.
To nonstochastic effects the following refer:
 Acute radiation sickness. It occurs at single radiation doses of more than 100 rem
(100-200 rem – a mild degree; 200-300 – a moderate degree; 300-500 – a severe
degree and over 500 rem - the severest). Doses of 500-600 rem at a single irradiation
are absolutely lethal.
 Chronic radiation sickness. It may occur at prolonged irradiation in a dose of less
than 100 rem.
 Radiation burns of skin. The reaction of I degree occurs at a dose up to 500 rem; II
degree - up to 800 rem; III degree - up to 1200 rem; IV degree - over 1200 rem.
 Irradiation cataract occurs at a dose of radiation over 30 rem per year.
The researches proved that the somatic effects do not occur at observance of
established hygienic standards; however the latter cannot guarantee the absence of these
effects as there is no threshold of stochastic and hereditary effects. The main principle of
norms of radiation safety (NRS) is decreasing a dose of radiation as much as possible.
Groups of Critical Organs of Organism. Berganie’s Law
The law of French scientist Berganie runs: radiosensitivity of a cell is directly
proportional to its reproductive ability and inversely proportional to degree of its differentiation.
Thus, the more intensive the processes of cell division in tissues or organs are, and the less
differentiated the tissue is, the more sensitive a cell to radiation is.

172
According to this law all organs are subdivided into 3 groups of critical organs:
 the whole body, gonads, organs of blood formation (red bone marrow);
 all other organs and tissues;
 skin, bones, thyroid gland.
Hygienic Standards of Radiation. Maximum Permissible Dose (MPD) of Ionizing
Radiation
To protect the working people and population against radiation the following norms are
established:
according to effect on 1 group of critical organs the maximaum permissible doses (MPD) of
radiation at external irradiation are established:
 Category A - persons professionally contacting radiation – MPD - 2 ber/year (0.2
Sv/year) or 40 miliber/week.
 Category B - people who are in premises adjacent to sources of radiation – MPD –
0.2 ber (0.02 Sv/year).
 Category C - all the other population - MPD – 0.1 ber (0.01 Sv/year).
Principles of Radiation Safety at Work with Closed Sources of Radiation
A closed source emits into the environment only electromagnetic radiation - x-ray or
gamma radiation. The basis of protective measures is laws of transmission of radiation:
 The dose of external radiation is proportional to intensity and time of action;
 The intensity of radiation is inversely proportional to distance;
 The intensity of radiation decreases depending on thickness of screens.
Hence there are 4 principles of protection from radiation:
 protection by amount of dose (MPD),
 protection by distance,
 protection by time,
 protection by screens.
There are 5 kinds of screens for protection from radiation:
 protective containers for storage of radioisotopes;
 protective screens for equipment;
 mobile protective screens;
 protective screens in building constructions (walls, ceilings, doors, floors);
 screens of individual means of protection - lead gloves, aprons, etc.
Principles of Radiation Safety at Work with Open Sources of Radiation
An open source emits into the environment not only x-ray and gamma radiation, but
also flows of radioactive particles (alpha-, beta-particles and neutrons).
The main principles of protection are the following:
 Use of principles of protection at work with closed sources;
 Hermetic sealing, automatization of equipment, isolating clothing, special boxes and
drafting devices for work with isotopes;
 Special nonabsorbing coverings of surfaces, frequent cleaning of surfaces from
radioactive pollution;
 Special ventilation equipment (exhaust ventilation is equipped with filters), water
drains (in special sediment chambers), sufficient water supply;
 Special lay-out of premises with the protective screens; a lay-out of site of radiological
department – a remote location of radiological laboratories from residential buildings,
other hospital departments depending on their class (there are 4 classes of
radiological laboratories according to annual amount of used radioactive substances);
 Careful radiation and medical control of personnel;
 Observance of personal hygiene and requirements to overalls.

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Problems of Radiation Ecology
Concept of Natural Radiation Background (NRB)
Natural radiating background is a natural level of radioactivity in the given area, basically
dependent on natural factors. On average it makes up about 100 miliber/year, but it can have
significant fluctuations in view of natural and anthropogenic reasons. In the Crimea it makes up
6-30 miliroentgen/hour (it may be higher in the mountainous part of the Crimea due to
radioactivity of granite masses containing uranium).
Structure of NRB
 Space radiation (25-40 %) – (2 protection screens against it – EMF of the Earth and
ozone layer) - it varies in connection with fluctuations of solar activity and
interplanetary EMF; due to it a person on Earth gets 28 mber/year on average;
 Natural radioactivity of ground (granite - uranium), air, water;
 Foodstuffs - about 25 % of NRB.
Thus, in NRB the external radiation makes up 75 %, the internal one (more dangerous) -
25 %.
Additional anthropogenic sources of NRB increase for population include the following:
 Regions of the atomic power stations and effects of their accidents and nuclear
explosions;
 Diagnostic x-ray procedures (on roentgenoscopy the patient gets 1 ber at once); it is
expedient to exclude unnecessary diagnostic x-ray procedures.
 Television – while watching color TV 4 hours a day a person gets 50 mrem per year.
It should be taken into consideration in respect to children.
Dynamics of NRB
It has been investigated since the 50s of the last century. The increase of NRB took
place in the 50s of the last century caused by mass tests of the nuclear weapon, than the
decrease was observed in the 70s connected with convention on interdiction of nuclear tests in
three environments: air, water, underground (now only underground explosions are
permissible); the growth of NRB since 70s is explained by the development of atomic power
stations.
Key Questions
Concept of radioactivity, hygienic characteristics of the basic types of ionizing radiation.
Basic values and units of ionizing radiation.
Effect of ionizing radiation on organism. The threshold and stochastic (nonthreshold) effects.
Estimation of doses of external and internal radiation.
Groups of critical organs. MPD of radiation.
Principles of protection at work with closed and open sources of radiation.
Natural radiation background: components, levels, dynamics.
Sources of radioactive pollution of biosphere.
Ecologic and hygienic effects of Chernobyl accident.
Methods of neutralization of radioactive wastes.
Hygienic requirements to x-ray and radiological departments.
Learning Objectives
Characteristics of types of radiation. Ionizing ability. Particle track in the air and tissues.
Screens.
Biological effect of radiation. The basic kinds of radiation damage. Conditions of their
occurrence.
Concept of closed and open sources of radiation. Principles and ways of protection.
Natural radiation background: levels, sources, dynamics. Its evaluation with the help of Geiger
counter.
Hygienic requirements to hospitals using sources of radioactive radiation. Structure of x-ray

174
and radiological departments.
Self Test
1. To create the radiation safety of the medical personnel of an X-ray room the protective
means like screens are used including lead glass on the screen, large and small mobile
protective screens, curtain and protective mittens made of lead rubber. What other
means of shielding are necessary?
*A. an apron from lead material
B. boots from lead rubber
C. limitation of a working day duration
D. remote control of x-ray device
E. no other measures are necessary
2. In radiological department for intracavitary therapy a gamma-device, source of cobalt
isotope, is used which is in a steel ampoule. Which of the following methods of
personnel protection from radiation effect should be used primarily in view of a source
type?
*A. shielding of the source and workplace
B. hermetic sealing of device
C. measures of a lay-out character (zoning of premise)
D. effective ventilation of premises
E. use of means of individual protection and sanitary processing of personnel
3. At graduation examinations a student said to the examiner that the greatest penetration into
a human organism has alpha-radiation. A correct answer to the question is
*A. gamma-radiation
B. neutron radiation
C. alpha-radiation
D. proton radiation
E. beta-radiation
Problem Solving
1. At work with radioactive isotopes a radiation dose made up 100 mrem/hour at a 30-
hour working week. Give your estimation of working conditions in the laboratory.
2. A radiation dose of the doctor-radiologist made up 110 mrem/week, or 6 rem per year.
What protective measures are necessary in this case?
Standard Answers:
1. The working conditions do not meet the hygienic requirements, as a week dose of
radiation makes up 100 mrem/hour х 30 hours = 3000 mrem, at MPD = 40 mrem/week. It is
necessary to find out the reasons of MPD excess and eliminate them; if impossible - to
strengthen all kinds of radiation protection at work with open sources of radiation.
2. The dose of radiation exceeds MPD at external irradiation (40 mrem per week and 2
rem per year) that can result in chronic radiation illness and occurrence of remote harmful
effects (mutagenic, cancerogenic). The radiologist works with open sources of radiation
(emission of radiation and flows of radioactive particles). The protection by dose, time,
distance, screens and complex of measures on prevention of radionuclide entry into organism
are necessary.

175
Appendix
Devices of Dosimetric Control
Depending on type of detector and methods of radiation registration the dosimetric
devices are subdivided into:
 ionizational (with ionization chamber, Geiger counters)
 scintillational
 luminescent (thermoluminescent)
 photographic
 chemical
 semi-conductor
 calorimetric
Table 38
Characteristics of Dosimetric Devices
Name Type Registered
radiation
Range of measurements Weight,
kg
Dosimeter СРП-68-01 gamma 1-3000 µR/h 3.6
ДРГ-05 М gamma,
roentgen
1-10000 mR/sec 2.0
ДКС-04 gamma, beta,
neutrons
0,1-1000 mR/h 0.25
ДБГ-06 Т gamma 0.01-99,9 mR/h
0.01-1000 µSv/h
0.25
ДРГ-01 Т gamma 0.01-99.9 mR/h 0.25
Radiometer-
dosimeter
МКС-01Р-01 alpha, beta,
gamma,
neutrons
1-30000 particles/min/ сm2
1-100000 particles/min/сm2
0.01-10000 µSv/h
µR/sec
18.0
Individual
dosimeter
КДТ-02ДТУ-
01КИД-08 C
gamma 5-1,000,000 mR 41.4
Individual
dosimeter
КИД-2 gamma,
roentgen
0.005-1.0 R 4.0
0.04
Individual.
dosimeter
ИФК-2,3ИФКУ beta, gamma,
neutron
0.01-3 rad, rem a film
Theme No 20.
Industrial Toxicology.
Toxicology of Agrochemicals and Hygiene of Their Application
Concept of Toxicology and Industrial Toxicology
Toxicology is a science studying mechanism of action of various toxins (poisons) on
organism. Toxicology is divided into military, household and industrial.
Industrial toxicology is a section of toxicology studying mechanism of action on
organism of industrial poisons, i.e. chemical substances which a person come in contact with in
industry and which can cause the development of occupational poisonings.

176
Basic Parameters of Toxicity of Industrial Poisons
For the toxic and hygienic characteristics of industrial poisonings it is necessary to know
the basic parameters of their toxicity, i.e. parameters of dependence "dose - effect"
(toxicodynamics) and parameters of dependence "time - effect" (toxicokinetics).
All these parameters are determined in experiments on laboratory animals and then
approximated to a person taking into account FSS - factor of specific sensitivity - differences in
toxicological parameters for different kinds of warm-blooded animals (white mice, rats, rabbits).
Key Parameters of Level of Poison Toxicity
Parameters of toxicodynamics are the following (See Table 39):
 Acute toxicity (at a single effect):
 Lethal doses (concentrations) – LD0, LD100, LD50 (amount of animals died at effect
of this dose).
 Threshold of acute effect - Lim ac.— a minimum effective dose for common toxic
effects, Lim ac. sp.— for specific effects (for example, irritating effect).
 Zone of acute effect - Z ac. = LD50/Lim ac.— the less the dose is, the more
dangerous the substance is in respect of probable acute poisonings.
 Subacute toxicity is studied in experiments on animals for 30-45 days.
It is determined coefficient of cumulation (C. cum.) = LD50 at a single action/LD50 totally
during 30 days.
 Chronic toxicity (at prolonged effect – within months or years) - is the most important
parameter as it represents the real conditions of effect of industrial poisons on person:
Lim ch (threshold of chronic effect by common toxic and specific and remote effects).
Abroad LOAEL (low observable adverse effect level) and NOAEL (non-observable
adverse effect level) correspond to the concepts of threshold and subthreshold dose.
The zone of chronic action - Z ch = Lim ac/Lim ch - the larger it is, the higher the risk of
occurrence of chronic poisonings.
Safe Levels of Industrial Poisons for Man
Maximal permissible concentration or dose for man with using coefficient of safety
depending on level of poison toxicity, cumulation, etc. is calculated on the basis of Lim ch
(NOAEL) for animals.
Key Parameters of Toxicokynetics
They are as follows:
Т50 - the half-life period of poison in organism (in blood, organs, biological liquids);
Т95 - the period of elimination of 95% of poison from organism.
It is determined in experiments with the help of radioactive labels (isotope C14).
The less these parameters are, the faster poison is eliminated from organism.
Toxicokynetics is closely connected with cumulation of poisons in organism.

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Table 39
Basic Parameters of Toxicometry of Chemical Substances
Primary parameter Derivative parameter
Parameters of Toxicodynamics
1. Acute toxicity
Lethal doses and concentrations
LD0, LD50, LD100 (LC)
Zone of lethal effect
Z = LD84 / LD16
Factor of specific sensitivity
FSS = LD 50 max/LD 50min
Factor of probability of inhalation poisoning
FPIP = C/LC 50
Threshold of acute integrated effect
Lim ac. integr.
Threshold of acute specific effect - Lim ac.
sp.
Zone of acute effect
Z ac. = LD 50/Lim ac. integr.
Zone of acute specific effect
Z ac.sp. = LD 50/Lim ac. sp.
2. Subacute toxicity
Factor of cumulation
F cum. = LD 50 total for 30 days/LD 50
single
Threshold of subacute effect Lim s/a eff.
3. Chronic toxicity
Threshold of chronic integrated effect
Lim ch. Integr.
(LOAEL) *
Threshold of chronic specific effect
Lim ch.sp.
Zone of chronic effect
Z ch. = Lim ac/Lim ch.
Zone of biological effect
Z ch.sp. = Lim ac.sp./Lim ch.sp.
Safe levels for man
Maximal non-effective dose (NOAEL) *, MPC
Parameters of Toxicokinetics
The half-life period of substance in organism - Т50
The period of elimination of substance from organism - Т95
Factor of cumulation - F cum.
*LOAEL - low-observable adverse effect level
*NOAEL - non-observable adverse effect level
Classification of Industrial Poisons
Classification of Chemical Substances according to Toxicity
I class of danger – extremely dangerous substances (extremely toxic)
II class of danger - highly dangerous substances (highly toxic)
III class of danger - moderately dangerous substances (moderately toxic)
IV class of danger - slightly dangerous substances (slightly toxic)

178
Table 40
Parameter I class II class III class IV class
MPC in air, mg/m3 < 0.1 0.1 – 1.0 1.0 - 10 > 10
DL50 orally < 15 15 - 150 150 - 5000 > 5000
DL50 on skin < 100 100 - 500 500 - 2000 > 2000
CL50 inhalation < 500 500 - 5000 5000-50000 > 50000
FOIP > 300 300 - 30 30 - 3 < 3
Zone of acute effect
(Z ac.)
< 6 6 - 18 18 - 54 > 54
Zone of chronic
effect (Z ch.)
> 10 10 - 5 5 – 2.5 < 2.5
Classification of Poisons according to Primary Effect on Organism
They are subdivided into irritating, neurotropic, cardiotropic, hepatotropic, nephrotropic,
gonadotropic, cancerogenic, mutagenic, etc.
Basic Mechanisms of Poison Effect on Organism
Toxic effect of poisons depends on:
 Exogenous factors:
 Chemical structure of poison (for example, increase of toxicity in homological line of
hydrocarbons);
 Dose, concentration of poison (dependence "dose - effect" and "time - effect");
 Volatility, level of dispersion of poison;
 Way of entry into organism (inhalation or others); character and rate of metabolism,
way of eliminating poison from organism;
 Conditions of environment (meteorologic factors);
 Selective sensitivity: age-related, sexual, specific, individual;
 Selective effect on organs and systems:
 Commom toxic poisons
 Hepatotropic
 Nephrotropic
 Cardiotoxic
 Neurotropic
 Character of effect:
 Constant or intermittent
 Isolated
 Combined, complex
 Endogenous factors depending on state of organism:
 Age
 Sex
 Presence of diseases
 Defects of detoxication system (inherited or acquired)
 Pregnancy, lactation
 Physical and mental overstrain.
Types of Organism Adaptation to Action of Poisons
Adaptation is a real accommodation of organism to action of poison without irreversible
biological changes and with preservation of homeostasis (constancy) of biological system.
Compensation (or accustoming) is a temporary latent pathology due to overstrain of
adaptable reserves; at effect of any adverse factors decompensation, i.e. poisoning occurs.
In experiment on animals the difference between adaptation and compensation is
determined by special functional tests.
Stages of Development of Chemical Intoxication
These include:
 primary decompensation

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 physiological adaptation
 latent pathology
 decompensated pathology (poisoning)
Types of Poison Cumulation in Organism
 Material - accumulation of poison or its metabolites in organism;
 Functional - accumulation of only toxic effects of poison in organism;
 Mixed - accumulation of metabolites or poison and pathological effects in organism
Table 41
Classification of Toxic Substances according to Degree of Cumulation
Level of cumulation Coefficient of cumulation
Ccum
Time of response, (in
days)
Supercumulation < 1 < 20
Expressed cumulation 1 - 3 20 - 60
Moderate cumulation 3 - 5 60 - 100
Slight cumulation > 5 > 100
Combined Effect of Poisons
As a rule, in real industrial conditions the isolated effect of poisons on organism is
practically not encountered, more often the combined effect takes place (the effect of many
substances at the same time), which can considerably change toxic effects in comparison with
separate effect.
Types of Combined Effect
They are as follows:
 Antagonism (less than additive action),
 Summation (additive action),
 Potentiation (more than additive action).
Hygienic Estimation of the Industrial Environment Taking into Account Type of
Combined Effect of Poisons
 In case of antagonism the estimation is carried out in respect of separate maximum
permissible concentration for every found poison C < MPC ;
 At summation the estimation is made according to the formula of summary toxicity by
Averianov:
where
C – concentration of the found substance
MPC1 MPC2 MPC i MPC – maximum permissible concentration
 At potentiation the estimation is made according to the formula:
where C – concentration of the found substance
MPC1 MPC2 MPC i MPC – maximum permissible concentration
K - coefficient of potentiation
The Basic Methods of Detoxication of Industrial Poisons in organism
They include the following:
 Change of chemical structure of poison - hydroxylation (formation of OH-groups),
oxidation, restoration, methylation (binding СН3-groups), connection with glucuronic
acid and amino acids resulting in formation of less toxic metabolites.
 Depositing in organs and tissues (material cumulation) – a temporary decrease of
concentration of poison in blood (for example, heavy metals are deposited in bones,

180
liver and kidneys). It is a defective way of neutralization as under unfavorable condi-
tions the exit of poisons from depot may take place resulting in aggravation of chronic
poisonings.
 Elimination from organism - through lungs, kidneys, intestines, skin.
Detoxication System of Organism and Parameters of Its Functioning
This complex system can be presented as a 5-component protection:
 Microsome oxidation by microsome monooxygenases (MOGS). Indicators are cy-
tochromes R-450, b 5, etc. The accumulation of oxide radicals, etc. is possible.
 Reaction of conjugation (connection) with proteins. Indicators - restored glutathione,
etc.
 Bioenergy processes for detoxication - oxidizing phosphorylation, etc.
 Processes of peroxidation of lipides. Indicatiors – level of malonic dialdehyde, diene
conjugates.
 Antiradical and antiperoxidation protection (activity of enzymes: catalase, peroxidase,
superoxide dismutase, vitamin C, etc.)
According to the state and interrelation of these 5 components it is possible to differen-
tiate adaptation and compensation: at activation of the 1st and 4th links the others links should
be activated (it is adaptation): if at activation of the 1st and 4th links the others links are not ac-
tivated, it is toxicogenic dishomeostasis, i.e. latent decompensation.
Ways of Entry of Industrial Poisons into Organism
 Inhalation is the most frequent and dangerous way (the area of the lungs with blood
capillaries is 100–120 m2; there is no barrier function of the liver). This way is charac-
teristic of volatile poisons – the higher their solubility in blood, the more dangerous
they are.
 Through skin and mucous membranes - lipotropic poisons (soluble in fats) get into
organism through injured skin, hair follicles, sudoriferous and sebaceous glands.
 Per os - through mouth and mucous membranes of stomach and intestines – this
way in professional conditions is very rare; it is encountered at non-observance of
rules of personal hygiene, casually with foods.
Adsorption of Poisons in Organism
After absorption poisons can accumulate in the liver, blood, bones, lymph, hair, nails.
Ways of Elimination of Industrial Poisons from Organism
We can distinguish the following ways of eliminating industrial poisons from organism:
 Through kidneys - it is the most frequent way for many substances.
 Through intestines – it is for badly soluble poisons, such as lead, mercury.
 Through lungs – it is for volatile substances, e.g. sebaceous aromatic hydrocarbons.
 Through skin and endocrine glands (fat-soluble substances - through sebaceous,
mammary glands, heavy metals - through sudoriferous, salivary glands).
Biosubstances, in which the content of poisons or their metabolites is determined to
confirm the diagnosis of poisoning are as follows: blood, urine, faeces, exhaled air, secretion of
glands.
Manifestations of Toxic Effect of Industrial Poisons
These include:
 Sharp intoxications
 Chronic intoxications,
 Specific action (allergenic, gonadotropic)
 Remote effects (mutagenic, oncogenic)
Regulation of Industrial Poisons
There are 3 limiting signs of harmful action at normalization of industrial poisons in the
air of a working zone:
 organoleptic
 irritating action on person or experimental animals;

181
 specific and nonspecific toxic action in experiment with laboratory animals.
Scheme of Investigation of Poison Toxicity in Experiment
The scheme includes the following:
 Research of physical and chemical structure of poison, its chemical properties, tox-
icological parameters of chemical analogs for approximate estimation of a toxicity
level.
 Studying acute toxicity of poison in acute experiments at oral, inhalation action, at
skin effect (LD50, Lim ac.)
 Studying subacute toxicity in experiments for 30-45 days – estimation of C. cum., fea-
tures of toxic action.
 Research of chronic toxicity in 4-6-month experiments - estimation of Lim ch.
 Substantiation of threshold concentration (LOAEL), MPC for a person.
Prevention of Occupational Poisonings
This includes the following:
 Administrative-legislative measures (the list of harmful industries - medical contra-
indications, privileges, age restrictions, etc.);
 Hygienic measures – a preventive and current sanitary control;
 Medical-preventive measures - preliminary and current medical examinations, inves-
tigation and treatment of occupational poisonings; medical-preventive nutrition in
harmful industries;
 Technological measures - change of chemical technologies in industry, ventilation,
hermetic sealing, automation, sewage disposal plants, etc.;
 Individual measures - overalls, gas masks, respirators, dietetic therapy.
Table 42
Remote and Specific Effects of Industrial Poisons and Pollutants of
the Environment
Remote effects Specific effects
Oncogenous (cancerogenic) Gonadotropic
Mutagenic Allergenic
Teratogenic Embryotropic
Decrease of life expectancy Immunodepressive
Acceleration of organism ageing
Oncogenous (Cancerogenic) Effect
Chemical cancerogen is:
 substance or its admixture which can cause in man or animal the formation of tumors
that are not encountered without its action (true cancerogens - the initiators);
 substance which can cause acceleration of formation or earlier occurrence of usual
tumors (promoters – pre-cancerogens).
Classification of Cancerogens
(By International Agency of Cancerogenic Investigation)
 Cancerogenic for the man (there are 23 substances - arsenic, asbestos, chrome, beryl-
lium, nickel, carbon black, petroleum, benzene, etc.— their cancerogenic effect on
people is proved by the epidemiological data);
 Probably cancerogenic for the man:
 Probable cancerogens causing tumours in 80-100% of experimental animals during
4-6 month; they include 14 substances, such as benzpyrene, chlorine – organic com-
binations, etc.
 Possible cancerogens causing tumors in 20-30% of experimental animals during life;
there are 47 substances, e.g. cadmium, nitrosocombinations, some pesticides.

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 Not categorized by cancerogenic ability (data about cencerogenic activity are discordant)
- 64 substances are included, for example, lead and its salts;
 Probably not cancerogenic for man – this group includes all other substances for which
no data about cancerogenic effect have been obtained up to now.
Mutagenicity of Chemical Substances
Nowadays more than 600 substances are found out which have a mutagenic effect on
the man or laboratory animals.
Classification of Chemical Mutagens
 Natural - inorganic and organic substances encountered in the nature (mycotoxins,
nitrogen oxide, nitrites, etc.);
 Anthropogenic - medicines, pesticides, food additives, etc.
 Investigation of mutagenic action of substances is carried out in the following way:
 In experiments on cell systems - microbes, plants, hexapods, cells of the man and
animal in experiments in vitro, in vivo;
 Cytogenetic monitoring of the population and people working in contact with muta-
genic factors
 Biological indication of mutagens in biosphere (ecumene)
To prove mutagenicity of chemical substances for man 4 systems are used:
 Dotted mutations in microorganisms with a metabolic activation
 Dominant lethal mutations for mice
 Chromosome changes in bone marrow of mammalia
 Chromosome disturbances in human leucocytes
Embryotropic Action
Types of fetation disorders under the influence of chemical substances include the fol-
lowing:
 Embryotoxic action - destruction of fetus, decrease of mass and dimensions of emb-
ryo, disturbance of normal differentiation of tissues;
 Teratogenic action - anomalies and defects of a new-born development.
Now there is a new science in toxicology – chemical teratology studying teratogenicity of
chemical substances for the man and animals, in biosphere.
The list of chemical teratogens includes more than 600 materials, such as hydrargyrum
and its compunds, dioxines, pesticides, benzol, benzine, etc.
The evaluation of embryotoxicity is carried out in experiments on laboratory animals.
Parameters of Embryotoxic Action
 Common embryonal mortality
 Pre-implantation and post-implantation mortality
 Number of newborn laboratory animals
 Average mass and dimensions of embryos
Parameters of Teratogenic Action
 External and internal anomalies of development
 State of places of ossification
 Subdivision of newborn laboratory animals by sex.—
Lim sp. and Z sp. = Lim integr / Lim sp.
If Z sp. > 1, the material has a selective embryotropic action and this is taken into ac-
count at establishment of MPC.
Other Remote Effects of Chemical Substances
 Neuropsychic disorders at effect of phosphorus-organic combinations.
 Disturbance of hemopoiesis (anemia), cardiac dysfunctions (acceleration of infarc-
tions, development of atherosclerosis) occur at effect of chlorine-organic combina-

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tions.
Toxicologic and Hygienic Characteristics of Basic Industrial Poisons
Irritating Substances (Chemical Substances of Primary Irritating Action)
To such poisons ammonia, oxides of nitrogen, sulfur, vapours of chloric, hydrochloric, ni-
tric acid, CO2, CO, chlorine and its compounds refer.
These substances are widely used in industry and can frequently affect the working
people.
The common features of their effect are: irritation of respiratory tract and eye mucous
membranes. The effect depends on solubility in water; hence they are divided into highly so-
luble, e.g. chlorine, sulfurous gas, ammonia which are basically retained in the upper parts of
the respiratory tract and cause chemical irritation or burns here, and less soluble, e.g. oxides of
nitrogen which reach deep parts and can cause pulmonary edema.
Effect of chlorine. Chlorine is a yellow gas with a specific smell, 2.5 times heavier than
air. Getting on mucous membranes, chlorine dissolves with the formation of hydrochloric acid
and atomic oxygen producing an irritating effect on the lung tissue causing inflammation and
sometimes addition of secondary infection.
Chlorine poisonings are more often of an acute form and have two stages:
 initial - irritation of the upper respiratory tract and mucous membranes;
 lung hypostasis – respiratory failure, increase of temperature, leucocytosis.
At chronic poisoning bronchitis, emphysema, pneumosclerosis, dermatitis and eczema
on the skin occur.
Effect of ammonia. Its effect is similar to that of poisoning with chlorine; there are se-
vere damages at its entry into eyes and on skin.
Effect of nitrogen oxides and vapours of nitric acid. It is more often results in acute
poisoning of 3 stages:
 initial - irritations,
 latent period – any symptoms are absent,
 increasing lung hypostasis.
In blood there may be the formation of methemoglobin resulting in hypoxia, disorders of
CNS and vegetative NS.
Effect of CO2. It affects the respiratory center, causes hypoxia.
Effect of CO (carbonic oxide). CO is a gas without color and smell formed at incom-
plete combustion of fuel in insufficiently ventilated premises. In blood it forms carboxyhemog-
lobin having scarlet color. Affinity of Hb to CO is 300 times higher than to O2. It causes scarlet
spots on skin. It cannot transport oxygen in blood that leads to occurrence of hemic hypoxia.
The direct effect of CO on tissue breathing in the CNS and internal organs is blockade of cy-
tochrome oxidase.
Stages of acute poisoning are:
 initial - headache, disorders of the CNS;
 euphoria - aggravation of CNS damage;
 coma - loss of consciousness, suppression of reflexes, paralysis of the respiratory
center.
In the remote period after poisoning with CO loss of memory, disorder of consciousness,
affection of the CNS, etc., occur.
Poisonings by Heavy Metals
To this group such metals as lead, tetraethyl lead, mercury, etc., belong.
Poisonings by lead. More than 100 occupations have contact with lead or its com-
pounds. Poisonings are chronic, more often through inhalation. Pathogenesis - blockade of
carbothiolic enzymes (containing SH-groups) and others. Mutagenic, gonado- and hepatotropic
effect is produced. (See attachement 2 – pictures an the end of textbook)
The main symptoms of lead poisoning are the following:
 Lead border – a grey border at the edge of tooth gum due to sulphurous lead (lead is
excreted with saliva and lead sulphide is formed in the mouth).
 Lead colour – a pale colouring of skin - angiospasm and increased content of por-
phyrin in blood.

184
Characteristic changes of lead poisoning in blood are:
 Reticulocytosis – increase of reticulocytes (over 15 per 10 thousand) in blood (irrita-
tion of hemopoietic organs).
 Basophilic erythrocytes in blood - irritation of hemopoietic organs.
Characteristic changes of lead poisoning in urine are:
 Porphyrinuria - more than 50-60 µg/l.
 The increased content of lead in urine - more than 0.04 mg/l.
Besides in symptomatology the following is marked:
 Affection of the nervous system - at the beginning the asthenic syndrome, then lead
encephalopathy and polyneuritis.
 Changes in blood: at the beginning reticulocytosis and basophilic granularity of eryt-
hrocytes, then - anemia and decrease of Hb.
 Involvement of the gastrointestinal tract - dyspepsia, in severe cases – lead colic ac-
companied by severe pains in the stomach which are not controlled by spasmolytics.
 Liver injury - toxic hepatitis with disturbance of all its functions, bilirubinemia.
Poisonings by Tetraethyl Lead (TEL)
Organic compounds of heavy metals are more toxic than elementary metals. TEL is
used as an additive to gasoline to decrease detonation. Poisonings with TEL occur through in-
halation and are very severe (TEL presents the 1 class of danger). They cause disturbances of
the CNS - headache, asthenyc syndrome, euphoria, disorders of sleep, memory, suppression
of CNS. Suppression of the vegetative NS results in vegetative triad: hypotonia, bradycar-
dia (rare cardiac contractions), hypothermia. In severe cases there may be mental disord-
ers and organic lesions of CNS. In years after poisoning the remote effects occur, such as as-
tenization, emotional imbalance, decrease of intelligence.
Poisonings by Mercury
More often they occur through inhalation (mercury vapours). Rather often asymptomatic
course (the content in urine is 0.05 mg/l and over) and chronic poisonings by mercury are
possible.
Symptoms of poisonings. First of all there is effect on the CNS. In Europe in the past
there was a saying ―as fool as a hat maker‖ because in the past at making hats mercury was
widely used. It is marked by
 mercurial ―border―on gingivas of black colour;
 mercurial neuroticism;
 mercurial erethism (psychological disorders in emotional sphere - whining, anxiety);
 mercurial encephalopathy;
 mercurial gingivitis (inflammation of the tongue), and stomatitis, gastritis, colitis;
 disturbances of the cardiac system (changes of electrocardiogram), kidneys (neph-
roses);
 in blood - lymphocytosis, monocytosis, leukopenia, anemia;
 content of hydrargyrum in urine is over 0.01-0.02 mg/l.
The organic compounds of mercury are more toxic, e.g. Minamata disease (poisoning
with methyl mercury).

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Poisonings by Aromatic Hydrocarbons
Aromatic hydrocarbons (dissolvents) are a group including hydrocarbons with aromatic
structure, such as benzene, toluene, ksylol. They affect through inhalation causing:
 disorder of the CNS (narcotic effect), polyneurites;
 disorder of hemopoiesis - leukopenia, thrombocytopenia, aplastic anemia;
 hepatotropic effect - toxic hepatitis;
 allergenic action;
 gonadotropic effect;
 mutagenic and cancerogenic effect.
Synthetic Polymeric and Plastic Substances
At their heating different substances can be formed which produce the following action:
 narcotic action
 irritant action
 effect on blood genesis, internal organs
 disturbance of pregnancy
 allergenic action
 teratogenic and embryotropic action
 cancerogenic effect.
Hygiene of Work in Agriculture.
Hygiene of Application and Toxicology of Agrochemicals
Modern Ecologic and Hygienic Problems of Agriculture
Agriculture is a large sphere of human activity in which a lot of people are engaged. In
many regions, including Crimea, this branch takes a leading position in the structure of national
economy.
The modern way of agriculture development is its intensification, i.e. increase of agricul-
ture production in the available agricultural areas. But this way requires application of many
agrochemicals, e.g. pesticides, fertilizers, growth stimulators, etc. These substances can affect
the working people, pollute the biosphere and accumulate in foodstuffs.
Features of Hygiene of Work in Agriculture
As a whole the work in agriculture has a number of features as compared to work in
other spheres of industry which can negatively affect the health of working people. They
include the following:
 Seasonal irregularity and urgency of work - nonuniform load during a year; in some
periods there is very hard work with no fixed hours (for example, sowing, harvesting
seasons,). It can cause early fatiguability, overstrain and possible disorders of health.
 Work in the open air in different seasons at influence of adverse meteorological fac-
tors - overheating, overcooling, excess UVR + chemicals – melanomas on the skin
are more often encountered in agricultural workers in South regions.
 Hard physical work may cause early overfatigue.
 Contact with traumatically dangerous mechanisms. The level of traumatism in agricul-
ture is higher than in industry.
 Remoteness of work places from residence. Absence of transport causes big energy
losses, hence early fatiguability.
 A wide chemization of agriculture - contact with a big amount of different toxicants at
combined and complex action on organism. It is the most unfavourable feature of
agricultural work and we‘ll stop on it in detail.

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Hygiene of Application and Toxicology of Agrochemicals
Agrochemicals are a big group of chemical substances of natural and anthropogenic
origin applied in agriculture. There are more than 5,000 chemical substances used as agro-
chemicals. The basic groups of agrochemicals are pesticides, fertilizers, growth stimulators,
etc.
Hygiene and Toxicology of Pesticides
Pesticides (in translation ―eliminating harm‖) are chemical and biological means of pro-
tecting plants from pests, weeds and illnesses. It is the most dangerous group of agrochemi-
cals due to a high level of toxicity for person.
Despite the great toxicological and ecological damage from application of pesticides, it
is impossible to refuse their usage, as it leads to destruction of about 50 % of crop that in con-
ditions of world deficiency of foodstuffs, especially proteins, is inadmissible.
To decrease danger of pesticides for the man and environment their assortment is con-
stantly changed and updated by prohibition of especially stable and toxic preparations, a con-
stant toxicological and hygienic selection of newly synthesized preparations with high selective
toxicity for vermins and low toxicity for man and biota. The leading world chemical concerns
(―Bayer‖, etc.) constantly synthesize new pesticides, though only 1 of one million suggested
preparations is allowed for application.
The Development of Hygiene and Toxicology of Pesticides
The USSR was a leading country in studying this problem. The researches began in the
30s of the XX century. The founder of the doctrine about hygiene of work with pesticides aca-
demician L. I. Medved worked in Kiev scientific research institute of hygiene of work and occu-
pational diseases. In 1965 he organized an All-Union research institute of hygiene and toxicol-
ogy of pesticides; academician J. I. Kundiev developed the doctrine of percutaneous effect of
pesticides. Academician J. S. Kagan is a leading scientist in toxicology of pesticides, academi-
cian E. I. Goncharuk created the theory of regulation of pesticides in soil.
Classifications of Pesticides
 Hygienic classification of pesticides (Table 42)
 by general toxicity for animals
Table 43
Degree of toxicity LD 50 mg/kg per os
Extremely poisonous substances < 50
Highly toxic 50-200
Moderately toxic 200-1000
Low toxic > 1000
 by percutaneous toxicity for animals
Degree of toxicity LD 50 on the skin, mg/kg
Sharply expressed toxicity < 300
Expressed toxicity 300-1000
Poorly expressed toxicity > 1000
 by ability to cumulation
Ability to cumulation Factor of cumulation
Supercumulation < 1
Expressed cumulation 1-3
Moderate cumulation 3-5
Slight cumulation > 5

187
 by degree of volatility
Danger of inhalation poisoning Parameters
Very dangerous substances The saturating concentration at 20ºС is
higher or equal to toxic one
Dangerous substances The saturating concentration is higher than
the threshold concentration
Low-dangerous substances The saturating concentration is lower than
the threshold concentration
 by stability in the environment
Degree of stability Time of decomposition up to non-toxic
components
Very stable > 2 years
Stable 0.5-2 years
Moderately stable 1-6 month
Not stable < 1 month
Classification by application:
 Insecticides - for struggle against insects
 Acaricides - for destruction of ticks
 Algicides – for destruction of seaweeds
 Arboricides - for destruction of trees and bushes
 Bactericides – for struggle against bacterial illnesses of plants
 Larvicides - for destruction of larvae and caterpillars of insects
 Ovicides - for destruction of insect eggs
 Zoocides - for struggle against rodents
 Limacides - for destruction of molluscs
 Fungicides – for destruction of fungi
 Herbicides - for struggle against weeds:
 Defoliants - for removal of plant foliage.
 Classification by way of entry into organism of insects:
 Contact - at contact with any part of an insect body;
 Intestinal – getting into insect organism per os;
 Fumigants - through the respiratory organs of insect;
 Systemic – getting to all parts of plants.
 Classification of pesticides according to chemical structure:
 Chlorine-organic pesticides (CHOP) - DDT, aldrin, dildrin, hexachloran, etc.
 Organophosphorus pesticides (OPHP) – carbophos, chlorophos, phosphamide, etc.
 Carbamates - derivatives of aminoformic acids – sevin, zineb, maneb, ziram, etc.
 Mercury and arsenic-containing pesticides – mercuran, granozan, arsenit calcium,
etc.
 Copper preparations – compounds of copper - copper sulfate, Bordo liquid.
 Derivatives of symmetric triazines – atrazin, propazin, simazin.
 Synthetic pyretroids – ambush, zimbush, decis, etc.
Toxicological Characteristics of the Main Groups of Pesticides
 CHOP (Chlorine organic pesticides). The mechanism of insecticide and toxic action
consists in blockade of respiratory enzymes in tissues, especially cytochrome oxi-
dase (an indicator enzyme for diagnostics of poisoning). The symptoms of poisoning
are: affection of the CNS, liver, kidneys, endocrine system, a mutagenic, gonadotrop-
ic, cancerogenic action.
 The ecological danger consists in the fact that they are very stable in biosphere,
therefore practically all of them are forbidden for application. According to data of

188
Washington Academy of Sciences the half-life period of DDT in biosphere is some
centuries.
 PHOP (Phosphorus organic pesticides). The mechanism of their action consists in
blockade of enzyme cholinesterase in blood. Cholinesterase is necessary for de-
struction of acetylcholine, when it is inactivated, the accumulation of acetylcholine in
synapses takes place. Two stages of poisoning are distinguished - excitation, then
suppression and destruction of vital centers of CNS. The symptoms are overexcita-
tion of choline-reactive systems. Poisonings due to small stability of PHOP in the en-
vironment (1-3 months) are more often acute. Last years the remote neurotoxicity is
found out for PHOP, i.e. damage of the peripheral nervous system and CNS in years
after poisoning (functional cumulation). Prospects for further application are insignifi-
cant because of high toxicity and adaptation of pests (the oldest group of pesticides).
 Carbamates (salts of carbaminic acids). Now this group is frequently suggested by
chemical firms. The mechanism of their action is similar to that of OPHP, but block-
ade of cholinesterase is reversible and in some time its activity is restored, therefore
poisonings are less severe than at action of OPHP. They are rather stable in bios-
phere (about a year and more); for some preparations the remote effects are estab-
lished (in experiment).
 Mercury and arsenic-containing pesticides. The mechanism of their action is
blockade of carbothiolic enzymes (containing SH-group). They are extremely toxic
and are applied as fungicides for grain.
 Preparations of copper. It is an old group of preparations applied on vineyards, in-
cluding in Crimea. They are low-toxic - in intestines copper albuminates are formed –
there is no absorption in blood, they have an irritating action in intestines. Poisonings
are usually of mild or moderate degree. The treatment is gastric lavage, application of
antidotes against heavy metals - pectins, unitiol.
 Symmetric triazines. They are widely applied as herbicides in rice fields in the Cri-
mea and with waste waters they pollute the coastal sea water areas. Basically they
are low-toxic. They have high stability in biosphere. They produce a cytotoxic action,
i.e. affect the structure of nucleic acids.
 Synthetic pyretroids – a rather new group with high selectivity for insects. They are
synthesized on the basis of natural pyrethrins (flowers of Dalmatia camomile at the
beginning of 20th century were applied as insecticides). They are low-toxic for man
and are also unstable in the environment, the mechanism of their action is poorly in-
vestigated; there is certain evidence about the remote effects. This is a promising
group of preparations but they are rather expensive.
Hygiene of Work with Pesticides
As it is a very toxic group of agrochemicals, the demands to conditions of work and con-
tact with these substances are very strict.
Hygiene of Work at Pesticide Storage
The territory of pesticide warehouse should be protected from access of other people, it
must be removed from dwelling houses and other objects at a distance of 200-1000 m depend-
ing on toxicity of stored preparations; if there is an extremely toxic group of pesticides the dis-
tance should be 1 km. On the territory, apart from warehouse building, there should be plat-
forms for washing off motor transport and mechanisms from remnants of pesticides, facilities
for prevention of sewage into the surroundings. The internal covering of warehouse should be
made of non-adsorbing materials, preparations should be stored in a hermetic container, there
should be good ventilation, premises for staying the personnel, storage of clothes, and shower.
There should be constant current sanitary control over levels of pesticide pollution of air,
hands, overalls of personnel, containment of preparation packing, rules of work with toxic sub-
stances.
Hygiene of Work at Pesticide Transportation
The common rules of transportation of chemically dangerous cargoes include the follow-
ing: special transport, routes specially chosen by sanitary service – far off towns, hospitals, sa-
natoria, etc. In the car there should be means of individual defence and disintoxication of pesti-

189
cides in case of accident.
Hygiene of Work at Pesticide Application
As many pesticides are highly toxic substances, strict security measures are required at
work with them, including:
 Restriction of working time - 4 hours (pesticides of 2-3 class of danger) or 2 hours (1
class of danger);
 Observance of terms of work resumption (after processing plants), in greenhouses it
is very small - 1-3 days;
 Observance of expectation term - the period between processing and harvesting (it
depends on toxicity, stability of preparation, culture of plants), for example, for OPHP
on apple trees - 20 days;
 Preliminary and current physical examinations, early revealing and treatment of pes-
ticide poisonings (in special clinics);
 Preventive and current sanitary control at application of pesticides;
 Use of individual means of protection of respiratory organs and skin;
 Observance of rules of personal hygiene – taking shower after work, meals in special
places.
Ecologic and Hygienic Estimation of Ways of Pesticide Application
Pesticides in agriculture are applied by 3 ways: aircraft sprayers, tractor sprayers and
individual sprayers. Each way has its advantages and disadvantages concerning health of
working people and protection of biosphere.
The Hygienic Characteristics of Biological Pesticides
The biological means of plant protection has been intensively introduced recently in
connection with toxicity of chemical pesticides. They are based on prevention of destruction
and illnesses of plants due to biological means.
The basic groups of biological means are:
 Bacterial, fungoid, virus preparations causing illnesses of pests;
 Biological preparations for struggle against illnesses of plants (antibiotics);
 Ferromones (sexual hormones) of insects - for attraction in chemical traps or scaring
away.
Disadvantages of biological way of plant protection are as follows:
 Low efficiency in comparison with chemical pesticides (30 %);
 High cost;
 Allergenic action on workers.
Toxicology and Hygiene of Work at Application of Fertilizers
Apart from pesticides many other chemicals are used in agriculture, among them ferti-
lizers are of primary importance by frequency of application. Fertilizers are substances used to
increase productivity of plants.
Classification of Fertilizers
 Organic (peat, manure);
 Mineral fertilizers - macrofertilizers (nitrogen, phosphorus, potassium – simple and
complex fertilizers by form) and microfertilizers (microelements for plants).
By application nitric fertilizers make up 90 % of all fertilizers - they promote fast growth
of plant mass, but thus in ground and plants nitrates and nitrites accumulate – in big amounts
they can cause methemoglobinemia in man. The control over content of nitrates in products is
necessary.
Phosphoric fertilizers frequently contain fluorine as impurity, and fluorosis may occur
among population near such working manufactures and at application of these firtilizers, as
well as the formation of anthropogenic biogeochemical provinces by fluorine.
Hygiene of Work with Fertilizers
As fertilizers refer to low-toxic substances, they do not require such strict measures as

190
at work with pesticides – here the protection of respiratory organs against dust of fertilizers and
protection of skin (individual means of protection) are necessary.
Key Questions
Subject and tasks of industrial and agricultural toxicology.
Parameters of toxicity of substances at acute, subacute and chronic action.
Basic laws of action of toxic substances on organism.
Classification of industrial poisons and pesticides.
Way of entry and elimination of poisons from organism. Ways of neutralization of poisons in
organism. Detoxication system and its parameters.
Manifestation of toxic action of these substances on organism of working people.
Toxicologic characteristics of the basic groups of industrial poisons.
Prevention of occupational poisonings.
Classification and purpose of basic groups of agrochemicals.
Toxicologic and hygienic characteristics of the basic groups of pesticides.
Hygiene of work at storage, transportation and application of pesticides and fertilizers.
Self Test
1. If the factor of cumulation is less than 1 it means
*A. overcumulation.
B. slight cumulation.
2. Into the atmospheric air of the industrial centre the emissions of metallurgical plants enter,
such as oxides of sulfur, nitrogen, metals which negatively affect a health condition of
population. The action of these harmful factors is characterized as
*A. combined.
B. complex.
C. integral.
D. isolated.
E. mixed.
3. The excess of MPC of toxic substance in atmospheric air makes up 100. What changes in a
health condition of population should be expected?
A. fatal poisonings of children and elderly people
*B. acute poisonings
C. changes in a health condition by separate parameters
D. chronic poisonings
4. Which of the following does not refer to parameters of acute toxicity of industrial poisons?
A. DL 16
B. DL 50
C. C cum.
D. Lim ac.
*E. Lim ch.
Problem Solving
1. What kind of work does a hygienist do at making periodic medical examinations at in-
dustrial enterprises?
2. Introduction of toxic substance into animals was carried out daily in doses equal to
1/20 of DL50. Thus at a 5-time-a week introduction during 4 months each animal received to-
tally 10.5 doses of toxic substance equal to DL 50. Determine the factor of cumulation and give
its estimation.
3. At doing electrical welding works the aerosols containing oxides of iron, manganese,
carbon, chrome and silicon are emitted into the shop atmosphere. In welders the lesion of the
nervous system (chronic intoxication) is diagnosed. What can cause chronic intoxication?

191
Standard Answers
1. He determines the list of persons for physical examination.
2. Factor of cumulation is a ratio of total LD 50 to a dose at a single introduction (LD50).
So,
C cum = 10.5/5 since in the task 1/20 of DL50 is taken; C cum = 2.1, that is expressed
cumulation.
3. Manganese oxides.

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HYGIENE OF CHILDREN AND TEENAGERS
Theme No 21.
Subject and Tasks of Hygiene of Children and Teenagers (HCT)
The Physical Development of Children and Teenagers as a Criterion of Health
Subject and Tasks of Hygiene of Children and Teenagers (HCT)
HCT is a section of hygiene studying the action of environmental factors on a growing
organism and developing preventive measures to maintain and strengthen the health of child-
ren and teenagers.
The primary goals of HCT are: studying the physical development, elaboration of hygie-
nic requirements to children‘s preschool and school institutions, to training, physical training of
children, to children's toys, hygiene of work of schoolchildren and teenagers, hygiene of child-
ren‘s nutrition, medical-professional consulting at school.
Basic Methods of Research in HCT
 Epidemiological method (studying the health state of children's contingents depend-
ing on environmental factors);
 Method of sanitary description (sanitary inspection of children's preschool institutions,
schools, etc.);
 Method of sanitary examination (examination of children's toys, etc.);
 Methods of laboratory experiments (for example, studying the effect of harmful fac-
tors on a growing organism in experiments on laboratory animals).
Laws of Growth and Development of Children
 Irregularity of growth and development of organism depending on age – the younger
the organism is, the more intensive these processes are;
 Irregularity of growth and development of different organs and systems at different
age;
 Connection of growth and development with sex - unequal rates of growth and devel-
opment in boys and girls;
 Influence of genetic factors, environmental factors and social conditions, disease in-
cidence on growth and development;
 Influence of acceleration.
Acceleration as an Actual Problem of HCT
Acceleration is a speeded up physical development of children and teenagers as com-
pared with anthropometric parameters of children many years ago. For the recent 10-15 years
rates of acceleration have noticeably decreased and even deceleration is observed, i.e. de-
creasing of physical development of children and teenagers in comparison with anthropometric
parameters of children 10-15 years ago.
Theories (Reasons) of Acceleration
Up to now the universal reason of acceleration is not established in view of great
amount of factors influencing physical development.
The basic theories of acceleration are:
 Alimentary theory – improvement of qualitative and quantitative parameters of nutri-
tion of the population;
 Medical theory – decrease of disease incidence, gynecologic pathology due to de-
velopment of medicine;
 Heliogenic theory - influence of cyclic changes of solar activity and levels of UVR;
 Ecological theory - growth of СО2 content in atmosphere, increase of intensity of
electromagnetic fields, elevation of level of natural radioactive background;

193
 Theory of heteresis – increase of mixed marriages of different races and nationali-
ties.
Medical and Social Consequences of Acceleration
Medical unfavourable effects:
 rejuvenation of many diseases (oncological, cardiovascular, etc.);
 functional disorders of organ and system development;
 the problem of a large fetus in obstetrics due to intrauterine acceleration;
 the necessity of revision of hygienic norms (norms of nutrition, size of school furni-
ture, standards of physical development);
 gynecologic pathology due to early pregnancy and abortions.
Social consequences are caused by delay of mental development as compared with
physical one: increase in teenage crime, growth of divorce number and number of children
without care of parents, etc.
Schemes of Age Periodization
The biological periodization accepted in HCT includes:
 the period of new-born (1-10 days);
 infancy - till 1 year;
 early childhood - 1-3 years;
 the first childhood - 4-7 years;
 the second childhood - boys of 8-12; girls - 8-11 years;
 teenage age - boys of 13-16; girls - 12-15 years;
 youthful age - young men of 17-21; girls - 16-20 years.
The social age periodization includes:
 day nursery age - till 3 years;
 preschool age - 3-7 years;
 junior school age - 7-10 years;
 middle school age - 11-14 years;
 senior school age - 15-18 years.
Physical Development of Children and Teenagers
Physical development is a complex of morphological and functional signs determining
growth, formation of child‘s organism, resources of its vital energy, tolerance and activity.
Physical development is one of the major parameters characterizing the health state of
population and influence of various factors on it.
For estimation of health of children's contingents this parameter is most frequently used
in connection with disease incidence.
The purposes of research of physical development are the following:
 revealing the laws of growth and development;
 estimation of individual and population level of health;
 studying the effect of environmental, social, genetic factors;
 estimation of efficiency of medical-prophylactic measures.
Methods of Research of Physical Development
The requirements to research methods are the following:
 application of simple and accessible techniques,
 carrying out researches at one and the same time (better in the morning after sleep),
 sufficient accuracy of measurements.
The research methods are subdivided into:
 Somatometric (anthropometric) - measuring height, body mass and circumference of
the chest.
 Somatoscopic - the description of the form of skeleton, spinal cord, chest, legs, de-
velopment of muscles, state of skin, sexual development by criteria of Tanner.
 Physiometric - measuring vital capacity of the lungs, chest excursion, muscle
strength, arterial blood pressure, pulse rate.

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Methods of Estimation of Physical Development
 Method of indexes, for example, Brock‘s index:
height in cm - 100 cm = ideal weight in kg (with age correction).
For children this method is rarely used.
 Method of sigma deviations
Sigma in statistics means a standard deviation. There are standard tables of physical
development of children and teenagers according to age and sex on the basis of statistical re-
searches of big contingents in which average indices of height, body mass and chest circumfe-
rence with their sigma are included.
After determination of somatometric parameters of a concrete child, the average values from
the table are subtracted from them, and difference is divided into the given sigma.
For example, a boy aged 10 has body mass of 45 kg, in the table for boys of this age the
average body mass equals to 40 kg, sigma +- 2.5. Estimation: 45 – 40 kg = 5 kg/2.5 = + 2.
If quotient of division is from +1 up to –1, the development is average (it corresponds to
the age norm); if it is +1 - + 2 - the development is above average; -1 - 2 - below average;
more than +2 or below -2 - high or low.
The disadvantage of this method consists in the fact that each parameter is estimated
separately, without interrelation with other parameters, and it is impossible to estimate harmo-
nicity of physical development.
To eliminate this disadvantage the further development of method of sigma deviations
has been suggested, i.e. drawing a diagram (profile) of physical development.
Fig 21. The Diagram (Profile) of Physical Development
The diagram graphically represents the data received according to each parameter, if all
quotients by 3 parameters are within the limits of 1σ the development is proportional (harmo-
nious), up to 2 σ - disharmonious, more than 2 σ - sharply disharmonious.
Method of regression scales (regression sigma) shows on the basis of sta-
tistical researches what body mass and chest circumference should correspond to the given
height. From the received parameters of body mass and chest circumference of the given child
we deduct the average indices corresponding to the given height (from tables with estimated
figures) and difference is divided into regression sigma, showing within what limits the range of
mass and chest circumference in relation to height is possible at harmonious development.
Variants of estimation: development is harmonious within the limits of +1 up to -1 sigma; dis-
harmonious - from +2 up to -2 σ and sharply disharmonious - more than +2 or less than -2 σ.
Method of centile lines (centiles). It is an American method mostly used in pe-
diatrics.
For research not less than 100 children are necessary ranged according to increase of
each parameter (height, weight, chest circumference), thus the first child is 1 centile, the last
one - 100 centiles. The development is considered average between 16 and 84 centiles (+ - 2
σ for 100 observations). More often in pediatrics the range of 25-75 centiles is used.
The drawbacks of this method are: the interrelation of parameters and harmonicity of
development are not estimated, and besides a great number of children are necessary for re-
searches.

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Key Questions
1.Anthropometric, anthroposcopic, physiometric methods of studying physical development of
children and teenagers.
2.Methods of estimation of physical development of children and teenagers:
Method of indexes
Method of sigma deviations and profile of physical development
Method of regression scales
Method of centile lines
A complex method of estimation of physical development.
3.Determination of children‘s health groups.
4.Determination of groups for physical training classes.
5.Method of comparison of physical development in various children collectives.
6.Laws of growth and development of a child‘s organism.
7.Biological and social schemes of age periodization.
8.Acceleration. Theories, essence, consequences of deceleration phenomenon.
Self Test
1. Identify a centile range which testifies to a child’s height appropriate to his age?
*A. 25-75 B. 5-95 C. 16-84 D. 20-80 E. 3-97
2. How many health groups of children are known?
A. 2 B. 3 *C. 5 D. 4 E. 6
Problem Solving
1. On medical examination of a schoolboy aged 14 chronic tonsillitis and caries are re-
vealed. On inspection – his height is average, physical development is harmonious. Determine
the group of health.
2. Evaluate the physical development of Tanya L., aged 14 by method of scales of re-
gress. Height of the child is 120 cm (+0.5 sigma regression), body weight - 20 kg (+0. 8 σR),
chest circumference - 90 cm (+0.4σR).
Standards Answers:
1. The 3rd group of health, as the child has chronic tonsillitis.
2. Differences between all regression sigmas are not more than 1; therefore the physical
development is harmonious.
Theme No 22.
Hygienic Requirements to Children's Preschool Institutions and Schools
Hygienic Requirements to Children's Preschool Institutions (CPI)
Types of CPI are: kindergarten (for children of 3-7 years), day nursery (till 3 years),
children's center (day nursery + kindergarten), children's home, preschool children's home,
specialized CPI for children with disorders of development, preschool health-improving institu-
tions for summer vacation.
Requirements to Choice of Site for CPI
 Accessibility for population - radius of service in microdistrict is 300 m;
 Optimal hygienic conditions on the site (optimal microclimate, absence of air pollution
by chemical and physical factors, presence of green plantations).

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Requirements to Site of CPI
 The site area is 30-40 m2 per child;
 There should be 2 entrances – the main and economic; the form of the site should be
rectangular;
 There should be special functional zones on the site based on principle of group and
age isolation: zone of building; zone of group playgrounds; zone of sports grounds;
economic zone; zone of green plantations.
Requirements to Functional Zones on CPI Site
Zone of Building up
Systems of CPI building up may be:
 Centralized (it is not optimal from the hygienic point of view as all groups and eco-
nomic premises are in one building);
 A pavilion type of building up (it requires a lot of place, the construction is expensive);
 Block building up (modern projects include blocks of, for example, day nursery, kin-
dergarten, gymnasium, economic block).
The building should be located not closer than 25 m from the site border, be surrounded
with green plantations (trees - not closer than 10 m, bushes – 5 m from the building to preserve
the normal natural light exposure).
Zone of Group Playgrounds
The area of group playgrounds should be 7.2 m2 per child, a shadow canopy - 40 m2,
game and sports equipment should correspond to age. Calculation of the necessary number of
playgrounds should be made proceeding from one playground per two day nursery groups or
four kindergarten groups. The playgrounds are separated by a zone of green plantations.
Zone of Sports Grounds
There should be 2 sports grounds with area of 150-250 m2 - separately for junior and
senior age groups, equipped with racetracks, other sports facilities.
Economic Zone
It should be located in a distant part of the site, closer to economic entrance; it should
be separated by green plantations.
Zone of Green Plantations
It should occupy not less than 50 % of the site area. Plants with prickles producing irri-
tating and allergenic action, poisonous wild-growing plants should be excluded.
Requirements to Layout of CPI
The major principle of layout is the principle of group isolation which provides:
 prevention of infectious diseases;
 possibility to carry out quarantine measures;
 different day regimen in different age groups;
 prevention of traumatism at getting children of different age together.
There should be not more than 2 floors in the building, including the basic groups of
premises, such are: group sections, premises for general use, medical and administrative pre-
mises.
Hygienic Requirements to a Group Section
A group section is the basic functional unit of CPI; it is a set of premises intended for
staying of one group of children. A group section includes: a reception-locker room, a group
room (or separately a room for playing, bedroom, dining room), buffet, lavatory, verandah (for
day nursery groups).
The reception-locker room has the area of 18 m2, cupboards for outer clothing, benches,
racks for toys used during walks. In day nursery groups there should also be tables for swad-
dling and feeding children by their mothers.
A group room is a common room which can be divided into a room for playing and a

197
bedroom. The total area is 4 m2 per child. The hygienic requirements are as follows:
Microclimate: the air temperature is 21-22ºC (in a day nursery) or 18-20ºC (in a kinder-
garten), air humidity - 40-60 %, speed of air movement – 0.1-0.3 m/sec.
Ventilation: frequency rate is 3, volume of ventilation per child is 20 m3/h, CO2 content -
up to 0.1 %.
Illumination: natural - LC 1/4-1/5, CNI – 1.5 %, light angle on desks - 27º, corner of
aperture – 5º. Artificial common illumination - 150 lux.
Premises for general use: gymnasium and music hall (75 m2 each), methodical room;
additional premises: a swimming pool, hall, study for hand work and drawing.
Medical premises: a medical room, medical treatment room, isolator.
Administrative premises: manager‘ office with a hall for holding meetings with parents,
cloakroom and shower room for personnel, laundry and ironing room, nutrition unit.
Hygienic Requirements to CPI Equipment
Hygienic Requirements to Children's Furniture
The following should be observed:
 conformity to the anthropometric sizes of children,
 trauma safety,
 it should be made of non-toxic materials (better from wood),
 it should be covered with non-toxic paint, smell of paint is not more than 1 point.
Hygienic Requirements to Toys in CPI
The following requirements are set to toys in children‘s preschool institutions:
 Weight of toys for children till 3 years - up to 100 g, 3-7 years – 400 g, over 7-10
years – 800 g.
 The size of small details of toys for children till 3 years - not less than 3 cm (to avoid
inspiration of small details).
 Material for toys is food types of rubber and plastic. Paints should be non-toxic,
steady to disinfection, smell of paints for children before till 3 years - 1 point, from 3 to
7 years - 2 points.
 Application of toys which are badly subjected to disinfection (soft toys) is not recom-
mended.
 Electric voltage in electric toys is up to 12 V.
Hygienic Requirements to Schools
Requirements to School Location
 Accessibility (radius of service is 1.5 km in a city and 3 km in the country);
 Optimal hygienic conditions in the place of future school site.
Requirements to a School Site
The area is 20-50 m2 per pupil, the site should be of a rectangular form.
Functional zones of school site include: zone of building up (of school building); zone
of rest; training-experiential zone; sports zone; economic zone; zone of green plantations.
Zone of building up – a building should be not closer than 25 m from borders of the
site surrounded with a green plantation shelter belt (not closer than 5-10 m from the building to
preserve natural illumination on the ground floor).
Zone of rest - two grounds for outdoor games for junior and senior classes, a ground
for a quiet rest, benches.
Training-experiential zone – a garden, vegetable garden, greenhouses, educational
workshops, etc.
Sports zone – a stadium with racetracks and pits for jumps, grounds for volleyball,
sports apparatuses, etc.
Economic zone should be located at the end of a school site, closer to economic en-
trance and separated by green plantations.
Zone of green plantations should occupy not less than 40-50 % of the site area.

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Requirements to School Building
The systems of school construction may be:
 centralized (all premises are in one building; it is an old project which causes high
level of infections, noise, air pollution),
 a pavilion type (there are many small buildings, it is accepted now for schools of a
sanatorium type),
 a block type (blocks for junior, middle, senior classes, for gymnasium, kitchen).
The basic groups of premises at school include:
Educational sections, general-purpose premises (vestibule, cloakroom, dining room,
sports hall, assembly hall, library, etc.), offices (director‘s office, teachers‘ room, a first-aid post,
nutrition unit).
The basic functional unit at school is an educational section including some classrooms
or studies, a recreation zone (hall, corridor), lavatory. A one-sided design of a school corridor
with windows and halls is the most optimal.
Hygienic Requirements to a School Classroom
The area should be 1.25 m2 per pupil, on the whole not less than 50 m2.
Microclimate should be the same as for usual premises, air changes per hour - 4, venti-
lation volume - 20-30 m3/h/pupil, CO2 concentration in the air is not more than 0.1 %.
Requirements to illumination are very important. It should be:
 natural: LC 1/4-1/5, CNI – 1.5 %, light angle - 27º, ventiduct angle– 5º;
 artificial: common illumination - 150 lux (luminescent lamps - 300 lux).
Requirements to school desks (school tables): In a classroom the desks should be of
not less than 3 sizes, placed in 3 rows, with distance of 0.7 m between rows, 2.5m to the
blackboard, and 0.5m to the walls.
Hygienic Requirements to Educational Laboratories
Chemistry, physics, biology laboratories. Their area should be 70-100 m2, they should
have an additional room of 6 m2; it is better to locate them on the top floors of a school building
where airing is better; they should be equipped with artificial ventilation, water-pipe for washing
utensils and equipment.
Advantages and Disadvantages of Laboratory System of School Education
The advantages are the following: it is easier to concentrate the equipment and didactic
material in 1-2 studies and not move them to different classes.
The disadvantages include the following: big counter-current flows of pupils during
breaks (infections), reduction of recreation time, non-correspondence of furniture to anthropo-
metrical parameters of pupils of different age.
Requirements to School Sports Hall
It is better to have it on the ground floor, at block system of construction - in a separate
block as noise interferes with classes in other classrooms. Its area is 4 m2 per 1 pupil, height –
4.5-6 m; there should be a locker room and a room for keeping sports stock. The feature of mi-
croclimate is the air temperature of 16ºC not to cause overheating of children at intensive phys-
ical activity; air changes per hour are 4-5.
Common Hygienic Requirements to School Furniture
They include the following:
 correspondence to the anthropometrical sizes of children (prevention of disorders of
the musculoskeletal system and organs of vision);
 prevention of traumatism;
 non-toxicity of materials and dyes, their stability to disinfection;
 light or green colouring of tables.
Size of School Desks (Tables)
In each classroom there should be desks of not less than 3 sizes, at schools the desks
of 6-12 sizes are used having multi-coloured marking for a teacher. At the beginning of classes

199
the teacher should distribute the pupils according to their size (by Flerov‘s ruler or by Listov‘s
formula: № of school desk = 2 first figures of height - 5).
Hygienic Standards of School Furniture
These include:
 Differention – a vertical distance from a table to chair – it should be equal to 1/7-1/8
of height or to the distance from the lowered elbow to sitting.
 Distance of sitting – a horizontal distance between the edge of the table and edge
of sitting – it should be 4–5 cm.
 Distance of chair back – a horizontal distance from the edge of table up to back of
sitting = the anterior-posterior section of body + 3-5 cm.
 Height of sitting - length of leg + 2 cm.
A B C
Fig. 22. Distance of sitting: A - negative, B - zero; C - positive.
Medical-professional consultation and orientation at school are carried out by doc-
tors, teachers and experts of youth employment centers with the purpose of choosing the fu-
ture professions and recommendation to schoolboys in respect to professions suitable for their
health state.
Professional orientation includes: information service about availability of vacant occu-
pations, psychological consultations in view of type of the nervous system activity.
Medical-professional consultation is carried out twice:
 in the 5th form for children with abnormalities of physical development, for the rest -
in the 7th form;
 in the 10-11th form.
For the first time it is carried out for early revealing and treatment of diseases limiting
capacity for work, for the second time – for the final determination of range of professions.
While medical professional consultations the medical documentation for a schoolboy is
used, evaluation of physical development and physical examination are carried out, if neces-
sary – a thorough medical examination in hospital is done.
From the medical point of view all professions are divided into 4 groups:
 professions not connected with difficult working conditions;
 professions connected with action of harmful factors;
 professions connected with constant effect of harmful factor complex;
 professions connected with difficult and harmful working conditions.
Hygienic Requirements to Vocational Schools
They should be located close to the basic industrial enterprises or in the suburbs of in-
habited locality. The size of a site should be 20 m2 per pupil. Functional zoning: industrial prac-
tical training zone (a building for theoretical course and training workshops), sports zone (it is
increased in comparison with school), economic, residential area (hostel), green plantations. At
block system of building up the corresponding blocks should be present. The requirements to a
hostel are the following: the area is 6 m2 per person, availability of the first-aid station.

200
Key Questions
1.The hygienic requirements to the site of CPI. Functional zoning of the site.
2.The hygienic requirements to a group section in CPI (lay-out, illumination, microclimate).
3.The hygienic requirements to children's toys, clothes and footwear.
4.The hygienic requirements to a day regimen of children of different age.
5.Organization of physical training and its control.
6.Adaptation of children to training at school.
7.Estimation of children‘s readiness to school training.
8.Estimation of "school maturity" according to Kern-Ierasik test.
9Medical indications to postponing admission to school of six-year-old children.
10.The hygienic requirements to location and area of a school site.
11.The hygienic requirements to layout and building up of school site; functional zoning of site.
12.Systems of school construction. The hygienic requirements to a school building.
13.The hygienic requirements to the basic functional groups of school premises.
14.The hygienic requirements to a classroom.
15.The hygienic requirements to a sports hall, rational arrangement of a physical training les-
son.
16.The hygienic requirements to school furniture.
17.The hygienic requirements to the equipment of school workshops.
18.The hygienic requirements to school time-table.
19.Organization of health services at school.
20.Organization of medical-professional consultations at school.
Self Test
1. How many 5-year-old children is one group section in CPI designed for?
*A. 20 children B. 10 children C. 5 children D. 30 children E. 25 children
2. What is a group section in CPI?
A. a room for games
B. a room for walks
*C. a set of rooms for staying one group of children
D. a set of rooms for all children in CPI
E. a set of rooms for children‘s medical care
3. Identify the amount of air per one pupil in a classroom.
*A. 3.75 m3 B. 4.75 m3 C. 1.25 m3 D. 1.0 m3 E. 5.0 m3
4. A training section at school is:
A. a set of rooms for staying pupils of one form
B. a classroom
*C. a set of rooms for staying children of the same age of three forms or children of 2
forms of adjacent age groups (2 and 3 forms) with a common recreation room
D. a block at school with a block layout
E. a set of rooms for children of the 1st–10th forms
Problem Solving
1. On the ground of CPI there are the following zones: green plantations, playgrounds
for groups, economic area, a building site. The area of the ground per one child is 10 m2. Ra-
dius of service of CPI is 500 m. What hygienic standard is broken in this case?
2. Before going to school Tanya‘s readiness for training at school was checked by Kern-
Ierasik‘s test. Thus, the total number of received points was 5. Is she ready to start training at
school?
3. In the city on the ground plot of a rectangular configuration having area of 4.4 hec-

201
tares (44,000 m2) the construction of a comprehensive school for 40 classes is planned. The
borders of the site are at a distance of 55 meters from blocks of flats and municipal buildings.
On the ground area there are green plantations, such as white acacia, oak, pine, wild grapes.
Give the sanitary-hygienic estimation of the ground area. Solve the problem on the opportunity
of using the available green plantations on the school site.
4. Give the sanitary-hygienic estimation to location of various premises of comprehen-
sive school. The building of the school is of a block type, has three floors. On the ground floor
of the building there is: a tambour, vestibule–cloakroom, corridor, teachers‘ room, 5 classrooms
for fifth forms, 2 chemistry laboratories, library, lavatory for pupils and personnel of the school.
On the first floor there are 3 English language studies, 2 drawing and fine art studies, 3 ma-
thematics studies, 3 physics studies, the Russian language and literature study, 2 chemistry
studies, the director‘s office, recreation hall, lavatory rooms. On the second floor there are 3
biology studies, doctor‘s consulting room, teachers' room.
Standard Answers:
1. The area of the ground of CPI per one child is reduced (normally it should be 40 m2).
2. She is not ready to study at school (normally the minimal result of the test should be 9).
3. The area of the ground is sufficient. The cultivation of wild grapes on a school site is forbid-
den.
4. The chemistry study should be located on the top (here 2nd) floor, the doctor‘s consulting
room - on the ground or first floor.
Independent Work of Students-Pediatricians:
Sanitary Inspection of Comprehensive Schools and Children's Preschool Institutions
Learning Objectives
1) The hygienic requirements to location of CPI and schools.
2) The rules of drawing up the act of sanitary inspection of schools and CPI.
Plan of the Lesson
The lesson is arranged as an independent work on sanitary inspection of CPI or schools
of Simferopol under supervision of the teacher or doctor of SES according to the given
schemes (see Appendix No. 1 and Appendix No. 2).
Then each student makes up the act of sanitary inspection of the object and hands it in
to the teacher during the next lesson.
Appendix No. 1
The Scheme of Sanitary Inspection of Children’s Preschool Institutions (CPI)
1. Surnames of supervisory members and those present at inspection.
2. Name of CPI, its address, date of inspection.
3. Area of the ground plot in square meters per one child. Availability of all functional
zones on the site.
4. Zone of green plantations: percent of total area of site, distance of trees and bushes
location from borders of the site.
5. Zone of group playgrounds: number of groups per one group playground, availability
of any equipment, awning.
6. Zone of sports grounds: their number, equipment.
7. Economic zone: its location, what is included into it, whether it is separated from other
zones by green plantations.
8. Zone of building up: location of building (in meters) from borders of the site, system of
building up, number of floors. Scheduled number of places in CPE. Location of day nursery
and preschool group sections in the building.
9. Structure and equipment of premises (rooms) of a group section: reception room-

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checkroom, group room, buffet, lavatory, verandah.
10. The observance of hygienic requirements to children's furniture: correspondence to
age and growth, safety, colouring, smell, material of production.
11. Toys available in a group room (their weight, material, smell, colouring).
12. Number of children in one group section.
12. Microclimate and illumination (artificial and natural) in a group room.
13. Availability of premises (room) for general use: a gymnasium, music hall, methodical
study, their equipment and location.
14. Location and equipment of medical premises (medical room, procedure unit, isola-
tor)
15. Location of administrative premises (rooms) (manager‘s office, laundry, nutrition
unit)
16. Catering services for children:
 Presence of cold and hot running water;
 Supply with refrigerating equipment, kitchen utensils, their marking;
 Sanitary state of nutrition unit premises, availability of detergents and disinfectants;
 Availability of complete staff, sanitary cards, timely physical examinations.
17. The conclusion about sanitary state of PCI
18. Specify all revealed drawbacks.
19. Recommendations and terms of their liquidation.
Date:________________________________Signature:______________
Appendix No 2
The Scheme of Sanitary Inspection of School
1. Surnames of supervisory members and those present at inspection.
2. Name of school, address, telephone, date of inspection.
3. Area of the ground plot, its green plantations, availability of game and sports grounds,
their equipment.
4. Type of building: typical, specially constructed or adapted.
5. Planned number of places at school.
6. Number of pupils in classes.
7. Number of shifts at school, amount of pupils studying in the first and second shifts.
8. Amount of classrooms, studies, their area.
9. Average number of pupils in the 1-3, 5-8 and 9-11 forms, area in classrooms per one
pupil.
10. Supply of school with desks, their marking, number of non-standard desks by the
example of one-two classes.
11. Seating pupils at desks according to their height and health condition.
12. Presence of a sports gymnasium, its area, equipment, availability of cloakrooms,
shower rooms, lavatory at a sports gymnasium. Subdivision of pupils into sports groups.
13. Availability of industrial workshops, their area, equipment, location of machine tools,
size of passages, presence of supports to machine tools, used in workshops tools, conformity
of their size to age of pupils.
14. Illumination at school (classooms, studies, workshops, sports gymnasium). Natural,
artificial illumination (luminescent or incandescent lamps). Artificial illumination, amount of elec-
tric points, name of electric armature, capacity of lamps (W/m2).
15. Heating of school (central, furnace). An air-thermal regimen in premises, air temper-
ature in classrooms, workshops, gymnasium. Regimen of premise airing. Presence of mechan-
ical ventilation.
16. A drinking regimen, availability of drinking fountains.
17. Sewerage system of school, sanitary-technical condition of lavatories.
18. A study system of training, presence of studies for two age groups.
19. A hygienic estimation of time-table of lessons in junior, middle and senior classes (by

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the example of one class in these age groups).
20. Presence of breaks between lessons and shifts.
21. A sanitary-hygienic condition of school, quality of the current tidying up.
22. Organization and control of self-service.
23. Catering services for children:
 Availability of a canteen, buffet, amount of seats in them;
 Availability of cold and hot running water;
 Supply with refrigerating equipment, kitchen utensils, their marking;
 A sanitary state of canteen premises, presence of detergents and disinfectants;
 Availability of complete staff, sanitary cards, timely physical examinations.
24. Number of groups for prolonged staying at school. Availability of premises for such
groups.
25. Personal hygiene of pupils.
26. Health services:
 Full name of a doctor, nurse, medical establishment, which serves school;
 Availability of a medical room and its equipment; presence of a separate room for a
dentist;
 Medical control over a sanitary state of school, canteen, hygienic conditions of train-
ing, health state of pupils.
27. Availability of popular medical literature in school library.
27. Hygienic training of school staff.
28. The conclusion about sanitary state of school.
29. Specify all revealed drawbacks.
30. Recommendations and terms of their liquidation coordinated with school authorities.
Date:________________________________________Signature_________________
Appendix No 3
Estimation of a Difficulty Scale of School Subjects
Range scale of difficulty of school subjects (in points)
Mathematics, Russian 11
Foreign languages 10
Physics, chemistry 9
History 8
Literature, native language 7
Biology, geography 6
Physical training 5
Labour training 4
Drawing 3
Painting 2
Singing 1
Theme No 23.
Hygienic Requirements to Training, Physical Training and Hardening of Children and
Teenagers. Hygiene of Children’s Nutrition
Hygienic Requirements to Training of Children and Teenagers
The basic problem of training is the necessity to perceive a lot of information, which is
doubled every 10 years.
Therefore at development of hygienic requirements to training it is necessary to solve
two problems:
 To provide a child with knowledge and skills necessary for professional work;
 To maintain thus children‘s health, not allowing overfatigue.
The basic ways of solving this problem (at any educational establishment, including

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higher school) are:
 To increase the duration of training – but it is already impossible by physiological op-
portunities of organism;
 Optimization of training – the use of new intensive forms of training, rational elabora-
tion and revision of educational programs, optimization of training and rest-time regi-
men.
In a complex process of children‘s training 2 main stages may be distinguished:
 Development of skills of long sitting, writing, reading, concentration of attention – a
preschool stage (in preschool institutions, at home etc.);
 Stage of knowledge accumulation, development of logic and abstract thinking –at
school, vocational school, higher school. It is the most difficult stage.
Ways of Adaptation to Training at School
A gradual change of dynamic stereotype, i.e. child‘s day regimen takes place:
 In 3-5 years - 2 lessons for 15-20 min each as a game;
 In preschool group - 4 days per week with 4 lessons every day by total duration of 1
hour 50 min per day;
 In the 1st form - up to 20 lessons per week 35 min each (not more than 4 lessons a
day).
Age of Starting Training at School
It is determined not by calendar age, but by psychophysiological features of a child, his
physical development, health state. This problem is of great importance for pediatricians.
There are some psychophysiological tests for definition of readiness for training at
school (for example, Kern-Ierasik test).
Exhaustion and Overfatigue of Pupils and Its Prevention
At improper organization of educational process the signs of exhaustion and overfatigue
among schoolboys are rather often observed resulting in subsequent disturbances of health.
Signs of exhaustion of pupils include the following:
 Decrease in work efficiency (increase in number of mistakes and decrease of volume
of the processed information at correcting work);
 Weakening of internal inhibition (diminished attention, distractable attention, excita-
tion);
 Deterioration of regulation of physiological functions (disturbance of cardiac rate and
coordination of movements);
 Occurrence of fatigue.
Usually these signs quickly disappear during breaks and after school, but their long pre-
servation testifies to development of overfatigue which is manifested by:
 Sharp and long decrease of capacity for work;
 Neuropsychic disorders (disturbance of sleep, feeling of fear, hysterics);
 Stable disturbance of regulation of vegetative functions (arrhythmias, vegetovascular
dystonia, disturbance of inner organ function);
 Decrease of resistibility to infections and othe adverse factors.
Prevention of Exhaustion in Pupils
This includes:
 Providing with optimal hygienic conditions for training, i.e. normal illumination, ventila-
tion, microclimate, observance of MPL of noise and other harmful factors.
 Optimization of training regimen, i.e. a correctly planned schedule of lessons, a cor-
rect organization of a lesson, effective use of breaks, optimal day regimen;
 Optimization and revision of educational programs.
Hygienic Requirements to School Schedule
 Restriction of number of lessons per week: in the 1st form - up to 20 lessons by 35
min, 2nd form - up to 22 by 45 min, 3-4 form - 24, 5-8 form - 30, 9-11 form - 31 les-
sons per week;
 Arrangement of lessons by complexity within a day and week using a scale of difficul-

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ty of school subjects: the exact sciences - 11 points, singing - 1 point. Requirements:
it is impossible to put 2 difficult lessons together, at the beginning and at the end of
the day and week. The maximally difficult lessons must be on Tuesday and Wednes-
day, i.e. in the middle of the week. It corresponds to dynamics of capacity for work.
Hygienic Requirements to Structure of the Lesson
Researches of pupils‘ capacity for work have revealed that the in-working stage lasts
first 5 min of the lesson, phase of working excitation - 5-25 min, then goes the phase of inci-
pient exhaustion. Hence recommendations for arrangement of the lesson: the introduction be-
fore the lesson (interrogation) must be 10 mines, the basic part (explanation of new material) -
up to 25 min, then - revision. Application of sports intervals, game elements etc. should be pro-
vided.
Rational Use of School Breaks
A break after each lesson must be 10 min, after the second lesson – a big break for 30
min or two breaks for 20 min after the 2nd and 3d lesson. The use of breaks for other purposes
is forbidden. During breaks the maximal stay of children in the open air should be provided.
Hygienic Requirements to a Day Regimen of Children and Teenagers
The main principles of hygienic requirements are:
 correspondence to daily biorhythms of a child;
 the maximal maintenance of a dynamic stereotype, if necessary - its gradual change
(a new regimen should be introduced gradually);
 a rational arrangement of the basic components of a day regimen (sleep, training,
games, staying in the open air, meals, personal hygiene) within a day and their alter-
nation;
 correspondence to capacity for work limits and to psychophysiological opportunities
of a child.
The Basic Components of a Day Regimen of Children and Teenagers
1. Sleep.
In a newborn age sleep is excessive – 16. 5 h.
Day sleep: at the age of 1.5-2 years – 2.5-3 h.
At the age from 3 to 6-7 years - 2-1.5 h.
Night sleep: at the age from 1 to 7 years – 10 h 40 min-10 h 15 min.
From 8 years sleep is only at night:
at the age of 8-10 years - 10 h, 11-14 years – 9.5-9 h, 15-17 years - 9-8 h.
2. Staying in the open air
Till 1.5 years staying in the open air is at day sleep.
At the age of 2-3 years - not less than 4.5-5h per day (2 walks before going to sleep in
PCI and at home)
At the age of 4-6 years – 4.5-3.5 h
At the age of 7-10 years – 3.5 h
At the age of 11-14 years - 3 h
At the age of 15-17 years – 2.5 h
3. Educational activities
At the age of 1.5-2 years - some activities per week for 8-10 min.
At the age of 3-4 years -10 kinds of activities for 10-15 min
At the age of 4-5 years - 10 kinds of activities for 20 min
At the age of 5-6 years - 15 kinds of activities for 20-25 min
At the age of 6-7 years - 19 kinds of activities for 25-30 min
At school: 1st form - 20 kinds of activities for 35 min, 2nd form - 22 kinds of activities for
45 min, 3-4 form - 24 kinds of activities, 5-8 form - 30 kinds of activities, 9-11 form - 31 kinds of
activities per week.
4. Game activity or rest
At a preschool age – 4.0-5 h, for pupils – 1.5-4.0 h.
5. Meals and personal hygiene.
2.5-4 hours a day (taking a shower and a bath, morning exercises, getting dressed,

206
meals).
Hygienic Requirements to Motion Activity and Physical Training of Children
Motion activity is a necessary condition of normal development of a child‘s organism. It
is measured by locomotions.
At disturbance of physiologically caused necessity of a child‘s organism in movement 2
states may occur:
 hypodynamia (low motion activity) - asthenovegetative syndrome, syndrome of de-
training, excessive weight. The reasons are improper day regimen, diseases, climatic
conditions, social factors;
 b) hyperkinesia (high motion activity, which does not correspond to organism abilities)
- myocardiodysthrophy, stable arterial hypertension. The reasons are intensive physi-
cal training, a strong desire of fatty children to lose weight.
Hygienic Requirements to Physical Training of Children
They include:
 individuality;
 adequacy to a health state and abilities of organism;
 systematic character;
 gradual increase of physical activity under medical care;
 favourable psychoemotional and environmental conditions.
Estimation of Adequacy of Physical Activity
It is made:
 by external signs: reddening of face, respiration rate, perspiration rate, etc.;
 by methods of studying the physical capacity for work: by time of development of
physical exhaustion;
 by pulse rate: it is measured before the lesson (the initial level) and every 5 min dur-
ing the lesson of physical training. Criteria: the increase of pulse rate at a single mea-
surement - up to 90 % from the initial one, on the average within a lesson - up to 50
%.
Requirements to Duration of Motion Activity in a Day Regimen
The motion component of a day regimen should make up 50 % of day time, including 70
% of regular forms of physical training and 30 % of independent motion activity.
Units of Motion Activity
1. As a unit of motion activity the number of movements (number of steps) per day is
taken.
H = 1.3 n, where:
H – a necessary number of steps per day (in thousand steps)
n - age in years
2. Duration of motion activity.
T = 6.5 – 0.2 n, where: T - duration of motion activity per day (in hours)
n - age in years
Note: At usage of these formulas a standard deviation from a daily norm may be not
more than 10 %.
For the girls-teenagers (13-15 years) the estimated values of daily amount of steps and
time of locomotion should be diminished by 15 % in connection with physiological decrease of
dynamic activity at this age.
Hygienic Requirements to Hardening of Children
The purposes of hardening are:
 Development and perfection of organism thermoregulation (basically due to training a
tone of peripheral vessels). Features of thermoregulation in children include: the in-
creased heat production because of high basal metabolism; high heat emission due
to big body surface, lability of vessels;

207
 Adaptation to change of climatic conditions;
 Decrease of sensitivity to catarrhal diseases.
Principles of hardening are the same as for physical training (see above).
Features of Hygiene of Children’s Nutrition
The main feature is high intensity of metabolism in a child‘s organism, thus nutrition
should not only compensate losses of energy, but also provide synthetic processes of growth
and development of organism. Therefore the caloric content of nutrition per kg of body mass in
children should be 1.5-2 times higher than in adults and it should exceed energy losses.
Differences in the 2 principle of balanced diet is the ratio of proteins, fats and carbohy-
drates: it is not 1: 1: 4 as for adult, but 1 : 1 : 3, i.e. a relative increase of protein and fat content
in a diet is marked.
Features of Protein Nutrition in Children
 A greater amount of proteins per kg of body mass as compared to adults;
 Animal proteins, especially dairy proteins, prevail, making up 60-75 %;
 The compulsory availability of conditionally irreplaceable amino acids arginine and
histidine, as well as irreplaceable amino acids lysine and tryptophan (factors of
growth).
Features of Fatty Nutrition
 A greater amount of fats per kg of body mass;
 A lot of animal fats, not more than 10 % of vegetative fats, otherwise inhibition of
growth, lack of vitamins A and D occur.
Features of Carbohydrate Nutrition
 A relatively great necessity per kg of body mass (energy);
 As compared with adults‘ nutrition, children‘s food should contain more unprotected
carbohydrates (up to 20 %) and pectins, less superprotected carbohydrates (vegeta-
tive cellulose).
Features of Mineral Substances and Vitamins in Children’s Nutrition
Because of intensive growth of bones an increased consumption of Са and Р takes
place, because they participate in bone formation. A sufficient amount of magnesium - 12-13
mg/day is necessary. The basic foods of children's nutrition - dairy foods - do not meet the re-
quirements of organism in Fe, therefore additional sources of its supply are necessary.
Vitamins. In view of intensive growth a great amount of vitamins is necessary, especial-
ly vitamins A, D and group B. Artificial vitaminization in winter-spring period is necessary.
Diet Regimen. The smaller the child, the more frequent meals are necessary: for pre-
school children 5 times a day with a 3-hour interval, for pupils - 4 times a day every 4-5 hours.
A more equal distribution of food caloricity by meals is recommended in comparison with
adults.
Key Questions
1.Concept of a day regimen, distribution of its components within day at various age and its
physiological bases (sleep, staying in the open air, studies, game activity and rest for choice,
nutrition and personal hygiene)
2.Concept of motion activity. Units of measurement of motion activity.
3.Hypodynamia. The reasons, signs, prevention.
4.Basic reasons, manifestation and prevention of hyperkinesia.
5.Basic methods of physical training of pupils. Hygienic requirements to arrangement of physi-
cal training lessons. The hygienic requirements to physical training lessons at schools.
6.Basic principles of hardening children and teenagers. The basic kinds of hardening.
7.Organization of hardening children and pupils.
8.Estimation of children‘s readiness to training at school.

208
9.Estimation of "school maturity" of children by Kern-Ierasik test
10.Medical indications to delay of admission of 6-year-old children to school.
Self Test
1. To irreplaceable amino acids for only children the following refer
*A. arginine.
*B. histidine.
C. methionine.
D. cystine.
E. valine.
2. An average level of pulse rate at physical training lessons should exceed the initial
one by
A. 30 %
B. 40 %
*C. 50 %
D. 80 %
E. 90 %
Problem Solving
1. Natasha С., aged 16, is of middle height, her body weight is higher than average due
to fat deposits, the functional parameters are decreased, 7 times a year she was ill with acute
respiratory diseases. Every day she has classes at school for 7 hours, does her homework for
3 hours, attends extra classes in physics and chemistry for 2 hours, watches TV for 3 hours.
She does not attend physical training. She has 5 meals a day; the ratio of proteins, fats and
carbohydrates is 1 : 1: 4, a daily caloricity of food is 2,600 Kcal. What is the basic reason of the
given symptoms?
2. Schoolboy C., aged 16, has morphologic and functional parameters higher than aver-
age. He goes in for athletics. During sports competitions he takes first places. On medical ex-
amination myocardiodystrophy and arterial hypertension were revealed. 10 days before the
examination he had been ill with acute respiratory disease. Identify the probable reason of the
given changes.
Standard Answers:
1. Hypodynamia
2. Hyperkinesia

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HYGIENE OF HOT CLIMATE
Theme No 25.
Hygienic Characteristics of Hot Climate and Its Effect on a Human Organ-
ism.
Hygiene of Nutrition, Hygiene of Work, Personal Hygiene under Conditions
of Hot Climate
Characteristics of Hot Climate
The climate of south countries can be conditionally divided into 2 types: tropical climate
and climate of deserts.
Tropical Climate
Its feature is constant high air temperature with insignificant daily and annual fluctua-
tions (1-6ºC). The level of solar radiation is rather high (100 Kcalcm2 and over). The next fea-
ture is high humidity of air - 80-90%, sometimes 100 % (at night). The level of annual atmos-
pheric precipitation is usually high; there are 2 periods of rains per year (totally about 7
months). The combination of high temperature and humidity of air at its insufficient circulation
leads to formation of fogs, activation of putrefactive processes in fallen foliage that results in
increase of СО2 content in the air up to 0.3-0.4 %.
Climate of Deserts
It is characterized by a small amount of atmospheric precipitation and low humidity of air
- up to 5 %. As against tropical climate, the air temperature in deserts may be much higher,
with significant fluctuations within a day (in Northern Sahara in December the temperature at
night is –14ºC, in the daytime +25-30ºC). Strong winds and high dustiness of air (sandy storms)
are characteristic.
The above-listed features of 2 types of climate considerably affect a human organism
and processes of thermoregulation; when a person moves into such climatic conditions from
other climatic zone, the processes of acclimatization become sharply expressed. At acclimati-
zation the complex processes of reorganization of organ and system functioning takes place in
a human organism, breaking of established "dynamic stereotype", i.e, a mobile balance of or-
ganism with the environment is marked and the establishment of new balance in accordance
with changed climatic conditions occurs. This process takes different time in different people
depending on health state, adaptable abilities, age, etc.
The first phase of acclimatization is adaptation (partial acclimatization) which lasts from
several hours till 14 days; the 2 phase is full acclimatization which takes some months or a
year, sometimes even more. In the course of acclimatization, especially in the 1 phase, the as-
tenovegetative syndrome, increase of morbidity, decrease of capacity for work are observed.
Influence of Hot Climate on Thermoregulation System of Organism
The major factors influencing thermoregulation in hot climate are high temperature and
humidity of air. The system of human thermoregulation provides maintenance of temperature
of man‘s internal environment in the narrow constant range. The increase of body temperature
by 2-3º C essentially influences the function of CNS, cardiovascular and urinary systems, but
its increase for a long term by 4-5ºC and over is incompatible with life.
Thermoregulation is a complex process, consisting of heat production (chemical thermo-
regulation) and heat emission (physical thermoregulation). Heat production is provided due to
biochemical exchange processes (thus at easy work in a human organism about 3000 Kcal of
heat per day are formed). In hot climate organism receives additional amount of heat (up to
200-400 Kcal/h) from the environment. The level of heat production in organism basically de-

210
pends on air temperature; the zone of indifference is 15-25ºC, at higher temperature heat pro-
duction is decreased. Heat emission consists in conducting heat to the air (convection), ther-
mal radiation of IR-beams and perspiration. In conditions of hot climate at high temperature
and humidity of air these processes are decreased that may cause overheating of organism
and disturbance of thermoregulation: heatstroke, thermal spasms, thermal fainting, thermal ex-
haustion by water and salt losses, thermal hypostasis of feet.
Factors Causing Organism Overheating
 High temperature and humidity of air, small speed of air movement;
 Hard muscular work increases heat production;
 Multilayer clothes;
 Insufficient water consumption by organism – deterioration of sweat secretion.
A heatstroke more often occurs in people with cardiovascular diseases (atherosclerosis,
hypertension, heart valvular diseases), endocrine diseases (adiposity, hyperthyrosis). Over-
heating easily occurs in children before a year. Depending on prevalence of these or those
symptoms some forms of heatstroke are distinguished:
 cardiovascular
 pulmonary (atelectatic)
 brain
 shock
 delirious
According to degree of severity a mild, moderate and severe form is distinguished.
Influence of Hot Climate on Water and Mineral Metabolism
Under conditions of hot climate water-salt metabolism has a number of features con-
nected with participation of water in thermoregulation and its secretion through the skin in the
form of sweat. The investigations have revealed that at usual temperature of 20ºC water is se-
creted through kidneys, skin, lungs and gastrointestinal tract in the ratio of 6 : 2 : 2 : 1. At a
high air temperature water is basically (up to 70-80 %) secreted through skin as sweat. Water
losses with sweat at temperature of 37.8ºC make up 0.3 l/h and at temperature rise by every
0.5ºC they are increased by 20 ml. Under conditions of hot climate in weakened people at hard
physical work the daily water losses can reach 12 l - hence dehydration of organism of different
degree of severity may occur. Thus blood plasma suffers primarily, as at dehydration of organ-
ism by 11 % of body mass plasma loses water 2.7 times more than organism as a whole).
Consequently blood viscosity, hemoglobin content sharply increase, volume of circulating
blood decreases causing reduction of blood circulation speed, reduction of stroke volume, in-
crease of heartbeat rate.
A considerable loss of water from organism is called dehydration exhaustion, which
symptoms depend on volume of water loss. Thus, at water loss of about 5 % of body mass the
feeling of malaise, sleepiness, irritability occurs; at water loss of 6-10 % - dizziness, headache,
dyspnea, tingling in extremities, termination of salivation, dysarthria; over 10 % - visual and
hearing impairment, speech disturbance, unconsciousness, delirium. Then all phenomena
progress and a person dies of irreversible disorders of CNS, blood circulation and cardiac ac-
tivity. Death can occur at water loss of 15 % of body weight and temperature above 30ºC, or at
lower temperature and water loss of 25 % of body weight.
Water deficit in organism is accompanied by a subjective feeling of thirst. True thirst (at
dehydration of organism) and conditioned-reflex thirst (at absence of water deficiency in organ-
ism) are distinguished. The feeling of thirst has some inertness and is eliminated not imme-
diately after drink but some time later - in 10-12 minutes. Under conditions of hot climate in
weakened people at hard physical work a peculiar condition of thirst can occur: the more the
person drinks, the more water he would like. If such condition is not eliminated, a severe stage
– drinking illness or water intoxication - can occur which is manifested by salivation, nau-
sea, vomiting, increased diuresis, disorder of movement coordination.
Changes of Salt Metabolism under Conditions of Hot Climate
The disturbance of sodium chloride (NaCL) metabolism is of particular importance. At
slight perspiration of total NaCL lost by organism daily (15-20g) 2-6 g/day is lost with sweat. At
significant perspiration NaCL losses reach great values (sweat contains 0.3-0.6 % NaCL) and

211
cause serious disturbances of salt metabolism, not compensated even at full replacement of
water loss. The compensation reactions of organism to prevent salt deficiency are: decrease of
chloride content in sweat up to 0.1 %, decrease of diuresis up to minimum (360-400 ml/day).
Oliguria (decrease of diuresis) is a characteristic reflex directed not so much at maintenance of
water in tissues, but at maintenance of Na in organism. The addition of NaCL to food is not re-
quired, as food completely covers the needs for salt, and excessive NaCL causes potassium
elimination with urine and occurrence of its deficiency in organism.
In some cases at large losses of salt with sweat a serious condition - salt exhaustion -
can occur with the following symptoms: severe gastric spasms, vomiting, apathy, fainting,
cramps (increase of muscle excitability at decrease of chlorides in plasma). For treatment addi-
tional introduction of NaCL is required.
In conditions of hot climate some restrictions of water consumption are necessary. For
example, while working at +39-40ºC a person needs 6 l/day of water in divided portions 100-
150 ml each.
Hygiene of Nutrition in Conditions of Hot Climate.
Features of Nutrition in Hot Climate
At long action of high temperature and humidity of air the decrease of basic metabolism
up to 10 % is marked due to effect of heat on vegetative nervous system. There can be de-
crease of appetite (especially to meat food), salivation, gastric secretion and motility.
In a diet of population of some regions with hot climate (Africa, Southeast Asia, South
America) significant deficiency of proteins of animal origin with prevalence of vegetable carbo-
hydrates (carbohydrate monophagia) is marked. It is connected to a low standard of life of the
population, religious and traditional factors. A large content of cellulose in food causes constant
mechanical irritation of intestines, especially large intestine, and development of colitis. High
temperature and carbohydrate nutrition results in activation of fermentative processes in intes-
tines, especially in children, causing toxic dyspepsia.
Only carbohydrate nutrition with deficiency of irreplaceable amino acids, animal fats and
some vitamins results in occurrence of specific diseases, such as:
 Kvashiorcor (in translation - "the red boy") – a severe children‘s disease after wean-
ing, i.e. deprivation of breast milk and commencement of nourishment with carbohy-
drate food (deficit of animal protein, methionine, fat-soluble vitamins) that causes
growth inhibition, delay in weight, edemas, dermatoses and skin depigmentation,
mental retardation, fatty liver infiltration, atrophy of pancreas, hypochromic anemia.
 Spru – a severe chronic disease characterized by persistent diarrhea, gastritis, ane-
mia, atrophy of mucous membrane of stomach and intestines, disturbances in bone
marrow and liver; gradually general cachexia develops (big loss of body masses).
 A specific food poisoning of tropic climate is heliotropic toxicosis (heliotropic hepati-
tis) which occurs at use of cereals with admixture of heliotrope weed. The disease
starts with gastroenteritis and in 1-2 weeks proceeds to ascites, atrophy of liver, de-
crease of proteins in blood, anemia, leukopenia. The disease may quickly lead to
death at hepatic insufficiency or in 1-2 years to development of liver cirrhosis.
In tropic climate there are good conditions for development of microbes in food, there-
fore food poisonings of microbe etiology (toxicoinfections, bacterial toxicoses) are rather com-
mon there (see theme ―Food poisonings‖).
Prevention of Alimentary Diseases in Hot Climate
It is based on principles of a rational diet, especially balanced in proteins, fats, carbohy-
drates, minerals and vitamins. It is of particular importance to provide nutrition with proteins
which are responsible for processes of biosynthesis in organism. It is necessary to use animal
fats – up to 60-70 % of total amount. Carbohydrate monophagia should be eliminated, and
amount of vitamins C, В1, В2, В6, РР, etc should be increased.
Feature of this diet is taking meals (up to 40-50 % of a daily diet) in cooler time of the
day, i.e. in the morning or in the evening.
Hygiene of Work in Conditions of Hot Climate
The primary goal is the prevention of overheating and disturbances of water-salt meta-

212
bolism. For this purpose work should be carried out in cooler periods of the day – to begin work
earlier, having a break from 12 a.m. till 6 p.m. During work a 10-15-minute break every hour is
necessary for rest in a cool place and for taking shower. For prevention of toxic effect of occu-
pational harmful factors in conditions of hot climate such processes as automatization, hermet-
ic capsulation, ventilation at manufacture, as well as mechanization of hard physical work are
of great significance.
Requirements to work wear: not multilayered, of light natural fibers, light colouring, free
style. At work in the open uninhabited area the clothes should maximally protect all parts of the
body from action of direct solar beams and dust; for protection of eyes obscure glasses should
be used.
Personal Hygiene in Conditions of Hot Climate
It is recommended to get up early in the morning, often to take a shower (for 15 min not
more to prevent overcooling) and to do the washing of clothes (dirty clothes worsen heat ex-
change), to keep the body clean (high temperature and humidity of air may cause intertrigo,
dermatites, fissures of the skin), to go in for sports at cool period of the day, to have sufficient
sleep at night and in the daytime.
Hygiene of Living Quarters in Hot Climate
The basic purpose is protection of rooms from overheating. The optimal parameters of
microclimate in premises under the conditions of hot climate (at air temperature outside the
premise 30ºC and over) should be the following: temperature is 24-25ºC, humidity - 45-55 %,
speed of air movement – 0.1-0.2 m/sec. At environmental temperature over 35ºC it is impossi-
ble to achieve such parameters only by aeration (airing), that is why the application of air con-
ditioning of premises is necessary. The complex building and sun-protection measures are ne-
cessary, i.e. apartment houses should be built near green plantations and reservoirs, orienta-
tion of windows - to the north, building materials should be heatproof made of wood, brick,
foam concrete, pise materials. Building with an attic having good isolation and aeration is ne-
cessary. It is expedient to increase the size of rooms and their height. Colouring of external
walls is recommended to be light for reflection of solar radiation; special sheds, Venetian blind
above windows are also recommended.
Key Questions:
1.Concept of ―tropical illnesses‖.
2.Concept of climate. The climate-forming factors.
3.The basic parameters of climate.
4.The basic classifications of climate.
5.The climate characteristic of tropical zone.
6.Influence of tropic climate on working conditions and life of population, its health.
7.Influence of hot climate on thermoregulation of human organism. Types of thermoregulation
disturbances in person under such conditions, their pathogenesis, manifestations and preven-
tion.
8.Influence of hot climate on water-salt metabolism of human organism. Pathogenesis, manife-
stations and prevention of disturbances.
9.Alimentary disease and food poisonings characteristic of hot climate, their reasons, manife-
stations and prevention.
10.Features of nutrition hygiene in hot climate.
11.Features of occupational hygiene, personal hygiene, hygiene of inhabited buildings in condi-
tions of hot climate.
Self Test
1. Identify mechanisms which prevent overheating of human organism under the following
conditions of environment: air temperature - 45º С, relative humidity - 40 %.
*A. convection and perspiration
B. heat radiation and perspiration
C. heat conduction and convection

213
D. heat radiation and convection
E. heat radiation and conduction
2. Identify the symptoms which are observed at sunstroke.
A. dryness of integuments
B. stomachaches
*C. general weakness, dizziness
*D. vomiting
*E. epileptiod attacks
Problem Solving
1. In conditions of hot climate the population spends the greater part of the day in the
street, among the green plantations, therefore the construction of their houses is to a great ex-
tent aimed at a wide use of open space in front of the houses. What is constructed with this
purpose?
2. Explain the difference: city Bordeaux (France) and Vladivostok (Russia) are on the
same latitude, both are located on the sea coast, the average January temperature in Bor-
deaux is + 5ºC, and in Vladivostok - -13.5 º C, i.e. 18.5º lower. Why is it so?
3. When does an expressed adaptation of human organism occur under the conditions
of hot climate at action of high temperature? at moderately hard work?
Standard Answers:
1. Half-opened space is widely used, namely internal gardens, verandas, balconies; be-
sides fountains and swimming-pools are built.
2. The difference is explained by the fact that in Bordeaux in winter the south-east winds
prevail, which bring warm air from the Atlantic Ocean and in Vladivostok the north-east winds
prevail at this time of the year, which bring cold air from Siberia.
3. The adaptation is formed during the 1 month. For stable adaptation more time is ne-
cessary.

214
FINAL CONTROL ON GENERAL HYGIENE AND MEDICAL ECOLOGY
Key Questions:
1.Subject and basic sections of hygiene. History of hygiene development.
2.Basic laws of hygiene and their significance for maintaining health of population and
protection of the environment.
3.Basic methods of hygienic researches, examples.
4.Interrelation and difference of hygiene and ecology and other medical sciences.
5.Concept of environment and biosphere, their components.
6.Classification of the environmental factors in hygiene and ecology.
7.The basic criteria of quality (level of pollution) of the environment.
8.Concept of hygienic specification of harmful factors in the environment, its variants,
examples.
9.Basic principles of hygienic regulation of harmful factors in the environment.
10.Features of hygienic regulation of pollutants in the air and water, limiting attributes of
harmful action.
11.Features hygienic regulation of pollutants in food products and soil, limiting attributes of
harmful action.
12.Principles of hygienic regulation of bacterial pollution in objects of the environment,
examples of such specifications.
13.Principles of hygienic estimation of the environmental objects at combined pollution in view
of type of combined action.
14.Structure of sanitary-epidemiologic services of Ukraine, of sanitary-epidemiologic station.
Types of state sanitary supervision and forms of its realization.
15.Subject and tasks of ecology, interrelation and difference of ecology and hygiene.
16.Classification of ecological factors, types of their influence on organisms.
17.Laws of action of ecological factors on organism (law of ecological optimum, zones of
pessimum). Concepts of ecological valency and spectrum of species.
18.Concept of trophic chain in ecology, importance of its investigation for hygiene.
19.Ecosystems and biocenosis, their basic characteristics and features.
20.Concept of "health of population", major factors influencing health of population.
Significance of hygiene in improvement of health of population.
21.Basic parameters of health of population, their use for investigation of effect of the
environmental quality.
22.Concept of environmental diseases, their main groups.
23.Direct and indirect negative effect of the environmental pollution on health of population and
conditions of its life, examples.
24.Methods of study of influence of environmental quality on health of population. Rules of
choice of supervision zones.
25.Basic sources and factors of environmental pollution, protection of biosphere from
anthropogenous pollution. Hygienic measures in this area.
26.State sanitary supervision in the field of hygiene of nutrition, its kinds and examples of
realization.
27.Sanitary examination of foodstuff. Cases when it is necessary. Methods of sanitary
examination of foodstuffs and examples of its realization.
28.Rules of food sampling for laboratory research. Classification of foodstuff quality, examples.
29.Hygienic characteristics of milk and dairy products. Methods of sanitary examination of milk:
main parameters, devices and standards.
30.Basic sections of nutrition hygiene. The purpose and tasks of rational, preventive, clinical-
prophylactic and clinical (dietary) nutrition.
31.Standards of population nutrition, parameters which are taken into account at their drawing
up. Modern nutrition problems of population in Ukraine.
32.Classification of alimentary and alimentary-conditioned diseases, their diagnostics and

215
treatment.
33.Classification of primary alimentary diseases: examples, treatment and prevention.
34.Basic principles of rational nutrition (balanced diet) of a healthy man.
35.Methods of control of observing the principles of a balanced diet by a person.
36.Functions of proteins in nutrition. Signs of high-grade proteins and examples of proteins
different in value.
37.Irreplaceable amino acids for the adult and for children: representatives, importance in
nutrition, products–suppliers.
38.Concept of protein norm and protein minimum, estimation of protein minimum. Protein
problem and ways of its solving.
39.Importance of fats in nutrition. Classification and hygienic characteristics of fatty acids.
40.Polyunsaturated fatty acids of оmega-3 and оmega-6 families: representatives, products-
suppliers, role in a human organism.
41.Phospholipids: representatives, products-suppliers, role in оrganism.
42.Cholesterol: products-suppliers, significance for human оrganism.
43.Alimentary antisclerotic factors: representatives, products-suppliers, application in
preventive and clinical nutrition.
44.Importance of carbohydrates in nutrition. Chemical and hygienic classification of
carbohydrates. Significance of unprotected (rafined) carbohydrates.
45.Importance of superprotected carbohydrates and pectin substances in nutrition; their
application in clinical nutrition.
46.Importance of vitamins in nutrition. Classification of vitamins. Significance of vitamin C, daily
need, products–suppliers. Measures on preserving vitamin C in cooked food.
47.Role of vitamin D, ways of its getting into оrganism, manifestations of D-avitaminosis, its
prevention. Manifestations and reasons of D-hypervitaminosis.
48.Role of vitamin A, products-suppliers. Manifestations of A-avitaminosis and A-
hypervitaminosis.
49.Exogenic and endogenic factors increasing the need of оrganism for vitamins and their
estimation in nutrition.
50.Artificial vitaminization of cooked food and rules of its realization. The control of vitamin
value of a diet.
51.Importance of mineral substances in nutrition. Classification of the basic groups of mineral
substances and its criteria.
52.Importance of Са and P in оrganism, daily need, products-suppliers, condition of their
absorption.
53.Significance of microelements in nutrition, for example fluorine, iodine, iron. The reasons
and manifestations of diseases caused by changes of their content in nutrition.
54.Microelementoses: the reasons, classification, manifestations and prevention.
55.The main principles of preventive nutrition of working people. Usage of different nutrients in
it.
56.Main principles of medical nutrition (dietetic therapy). Kinds of diet at different diseases.
57.Dietetic therapy at overweight and adiposity.
58.Dietetic therapy at atherosclerosis and cardiac diseases.
59.Concept of food poisoning, basic reasons of its occurrence and classification.
60.Food poisoning of a microbe etiology: versions, causative agents, pathogenesis, reason of
occurrence and prevention.
61.Toxicoinfections: causative agents, products-sources, conditions of occurrence, clinical
forms, prevention.
62.Bacterial toxicosis, its versions. Staphylococcal toxicosis: products-sources, condition of
occurrence, symptoms and prevention.
63.Botulism. Features of causative agent, products-sources, pathogenesis, symptoms,
treatment and prevention.
64.Food poisonings with poisonous mushrooms: representatives, toxins, symptoms and
prevention.
65.Food poisonings with poisonous plants: representatives, toxins, symptoms and prevention.
66.Food poisonings with products sometimes or partially poisonous: representatives, toxins,
symptoms and prevention.
67.Food poisonings with zinc and copper: reasons, pathogenesis, symptoms and prevention.

216
68.Food poisonings with lead, mercury: reasons, pathogenesis, symptoms and prevention.
69.Food poisonings with pesticides: reasons, pathogenesis, prevention.
70.Food poisonings with nitrates: reasons, pathogenesis, symptoms, prevention.
71.Micotoxicoses: versions, reason of occurrence, prevention. Ergotism: reasons of
occurrence, toxins, clinical forms, prevention.
72.Fusariose and alimentary-toxic aleukia: reasons of occurrence, symptoms, prevention.
73.Aflatoxicoses: reasons of occurrence, symptoms, prevention. A problem of aflatoxicoses in
the southern countries.
74.Food poisonings of insufficiently investigated etiology: versions, clinical manifestations.
75.Tactics of the doctor at suspicion of food poisoning in patient.
76.Rules of documents registration in case of food poisoning: names, contents and purpose of
the basic documents.
MUNICIPAL HYGIENE
Key Questions:
1. Concept of municipal hygiene, its main divisions and tasks.
2.Concept of climate and microclimate. Climate-forming factors. Factors of microclimate.
3.Influence of microclimate factors on the human thermoregulation system.
4.Influence of climatic factors on a human organism. Problems of acclimatization.
5.Methods of measurement of microclimate factors. Devices, specifications for various
premises and their substantiation.
6.Types of thermoregulation disturbances of man in conditions of hot climate, their
mechanisms and prevention.
7.Methods of complex estimation of microclimate and their application. Norms of parameters
and ways of their estimation.
8.The basic weather-forming factors and their influence on man. Medical estimation and
classifications of weather.
9.Heliometeotropic reactions of man, their manifestations. Diseases accompanied by such
reactions. Prevention of such reactions.
10.Structure of atmospheric air; effect of its components on the man.
11.Pathogenesis, symptoms and prevention of mountain (high-altitude) and decompression
(Caisson) illnesses.
12.Content of CO2 in atmosphere, its dynamics and reasons. Effect of various CO2
concentrations on the man. MPC of CO2 in the air of premises and its substantiation.
13.Basic sources and factors of atmosphere pollution, ways of its autopurification.
14.Factors affecting the level of pollution in certain region. Types of air-cleaning structures.
15.Direct and indirect negative effect of atmospheric pollution on health of people and
conditions of their life, its versions and examples.
16.Protection of atmosphere from anthropogenic pollution: the basic directions and examples.
Standartization of harmful substances in atmospheric air.
17.Significance of solar radiation. The reasons, manifestations and prevention of solar
starvation.
 Biological effect of ultraviolet irradiation, its mechanism. Concept of a biodose of
ultraviolet irradiation, method of its estimationtion.
 Structure of solar light on the Earth surface. Effect of components of solar light on a
human organism.
 The hygienic requirements to natural illumination in inhabited, educational and
hospital premises, its indicators, methods of estimation and specifications.
 The hygienic requirements to artificial illumination, types and systems of such
illumination, methods of estimation and specifications in various premises (rooms).
 The hygienic characteristics of sources of water supply. Zones of sanitary protection
of water sources and their purpose.
 The main types of water consumption, hygienic requirements to quality of water,

217
structure of water pipe.
 The hygienic requirements to quality of drinking water. Organoleptic parameters of
drinking water, their significance, methods of definition and norms.
 The hygienic requirements to chemical structure of water, diseases caused by its
change, their reasons, manifestations and prevention.
 Epidemic significance of water, signs of water epidemics, parameters of epidemic
safety of water.
 Methods of improvement of water quality. Methods of water purification, control of its
efficiency.
 Methods of water disinfection, its hygienic estimation and control of its efficiency.
 Chemical methods of water disinfection, their hygienic estimation and control of their
efficiency.
 Chlorination of water, its types, scheme, parameters of efficiency. Drawbacks of this
method of water disinfection.
 The basic sources and factors of reservoir pollution, ways of reservoirs
autopurification.
 Protection of reservoirs from anthropogenic pollution. Hygienic standartization of
pollutants in water.
 Hygienic significance of soil, its basic parameters. The basic pollutants and ways of
soil autopurification.
 Endemical significance of soil: endemic diseases, their reasons, manifestations,
prevention.
 The signs of harm at standartization of harmful substances in the soil. Protection of
soil from anthropogenic pollution.
 Urbanization and its hygienic estimation. The modern town-planning factors and their
significance for development of cities.
 Hygienic estimation of systems of city and residential quarters building. Functional
zones in cities.
 The hygienic requirements to premises (microclimate, ventilation, illumination).
 Methods of cleaning of populated places from solid wastes. Methods of destruction of
solid household and industrial wastes.
 Methods of sewage clearing. Natural and artificial methods of sewage clearing.

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Hygiene of Work and Hospital Hygiene
Key Questions
Key Questions:
Hygiene of Work
1)Concept of capacity for work, its dynamics during and after work, reasons of changes.
2)Methods of studying man‘s capacity for work.
3) Changes in organism during work. Exhaustion, reasons of its development (theories of
exhaustion). Overfatigue. Prevention of exhaustion in manufacture.
4) Occupational harmful factors and occupational diseases. Classification. Physical
examinations of working people: types, purposes and arrangement.
5) Registration and investigation of acute and chronic occupational diseases and
intoxications. Prevention of such diseases.
6) Noise, its classifications, action on organism. Noise illness, its diagnostics and
prevention. Maximum permissible level of noise and it substantiation for various
premises.
7) Electromagnetic fields, their basic types and sources, effect on organism. Microwave
syndrome: manifestations and prevention.
8) Vibration, effect on organism. Symptomatology and prevention of vibration illness.
9) Industrial poisons, their classification by level of toxicity, specific effect and ability to
cumulation. Factors influencing toxic effect of industrial poisons.
10)Basic parameters of acute, subacute and chronic toxicity of industrial poisons and
methods of their study in experiment.
11)Specific and remote effects of industrial poisons and methods of their study.
12)Ways of entry and removal of industrial poisons. Ways of detoxication of poisons in
organism. Detoxication system of organism and its parameters.
13)Combined effect of industrial poisons, its types, methods of study and significance for
sanitary estimation of industrial environment.
14)Types of harmful effect of industrial poisons on working people, prevention of
occupational poisonings.
15)Causes and manifestations of poisonings with industrial poisons of irritating action (CO,
ammonia, chlorine, nitric oxides).
16)Causes and symptoms of occupational poisonings with heavy metals (lead and
mercury); clinical and hygienic confirmation of diagnosis.
17)Industrial dust, classification, action on organism, maximum permissible concentration
of dust of different structure. Diagnostics and prevention of pneumoconioses.
18)Features of work in agriculture and their effect on organism of working people. Basic
occupational diseases, their causes and prevention.
19)Pesticides, their purpose and classifications by toxicity, function and chemical structure.
Ecological estimation of pesticides by stability and toxicity.
20)Toxicological characteristics of basic groups of pesticides (phosphorus-organic,
chlorine-organic, carbamates, mercury-organic). Indicator enzymes.
21)Hygiene of work at storage, transportation and application of pesticides. Preventive
measures against poisonings of working people and population with pesticides.
22)Toxicological characteristics of mineral fertilizers (nitric and phosphoric). Hygiene of
work at their application.
Radiation Hygiene
23)Concept of radioactivity, hygienic characteristics of types of radiation, screening
materials. Natural and artificial sources of radiation.
24)Mechanisms of radiation effect on organism, types of biological effect of radiation.
25)Radiosensitivity of organs and tissues (Bergonie‘s law). Groups of critical organs.
Limiting doses of external and internal radiation.
26)Hygiene of work with closed sources of radiation. Ways of protection of medical
personnel from radiation damage.

219
27)Hygiene of work with open sources of radiation. Hygienic requirements to radiologic
laboratories.
28)Natural radiation background, its structure, levels, sources and dynamics. Influence of
anthropogenic sources on its increase.
29)Effect of Chernobyl accident on health of population living in polluted territories, early
and remote effects. Features of population nutrition in radioactive-polluted territories.
Hospital Hygiene
30)Concept of medical-protective regimen in hospital and its basic components. The
hygienic requirements to location of hospitals of different type.
31)Hygienic requirements to a hospital site. Functional zones of hospital site. Historical
types of hospital construction.
32)Hygienic estimation of different systems of hospital construction. The basic directions of
prevention of intrahospital infections.
33)Hygienic requirements to internal layout of hospital. A typical ward section and its layout.
34)Hygienic requirements to hospital ward (layout, microclimate, ventilation, illumination).
35)Hygienic requirements to a reception ward of hospital. Its functions and structure.
36)Hygienic requirements to infectious department. Features of ward layout and their
reasons.
37)Hygienic requirements to a surgery unit and operating room (layout, microclimate,
illumination, ventilation).
38)Concept of intrahospital infections, reasons of their growth, structure, basic sources and
ways of transmission. Prevention of such infections.
39)Hygiene of work of surgeons and anaesthesiologists. Basic occupational harmful factors
and prevention of occupational diseases.
40)Subject and tasks of hygiene of children and teenagers. Laws of growth and
development of children. Schemes of age periodization. Problems of acceleration.
41)Physical development of children and teenagers as a criterion of individual health and
health of children's contingent as a whole. Methods of research of physical
development.
42)Methods of estimation of physical development of children and teenagers. Methods of
estimation of harmonicity of physical development.
43)Hygienic requirements to location, layout of site and building of children's preschool
institutions. Functional zones of site. A principle of group isolation.
44)Hygienic requirements to a group section in children's preschool institutions. Standards
of layout, microclimate, illumination in a game room.
45)Hygienic requirements to toys in children's preschool institutions.
46)Principles of hardening and physical training of children. The control of adequacy of
physical load. The basic reasons, manifestations and prevention of hypodynamia and
hyperkinesias.
47)Hygienic requirements to a daily regimen of preschool age children and pupils. Ways of
adaptation to training at school. Requirements to school time-table.
48)Medical-professional consultation at school, its tasks and organization at school and
polyclinic. Health groups of children and basic groups of occupations.
49)Hygienic requirements to location of schools and school site. Zones of site.
Characteristics of school construction systems. Layout of school building.
50)Hygienic requirements to layout, microclimate, illumination of classrooms and studies at
school. Advantages and disadvantages of study system of education.
51)Hygienic requirements to school furniture, basic parameters and norms. Methods of
selection and marking of school furniture, requirement to placement of desks in
classrooms.
52)Features of nutrition hygiene of children and teenagers. The reasons of difference from
nutrition of adult people.
Hygiene of Hot Climate

220
53)Types of climate in hot countries and its influence on person. Features of tropical
climate. Features of desert climate.
54)Influence of climate of hot countries on organism thermoregulation (on processes of
heat production).
55)Influence of climate of hot countries on organism thermoregulation (on processes of
heat emission).
56)Acclimatization of organism to conditions of hot climate. Prevention of adverse
manifestations of acclimatization to conditions of hot climate.
57)Types of disturbances of organism thermoregulation in conditions of hot climate, their
reasons and pathogenesis.
58)Influence of hot climate on water metabolism. Drinking illness, symptoms, prevention.
Dehydration of organism in conditions of hot climate, its reasons and prevention.
59)Alimentary diseases in conditions of hot climate (kvashiorcor, spru), their reasons,
symptoms and prevention.
60)Food poisonings of a microbe etiology in hot climate. Influence of hot climate on
occurrence of food poisonings of a microbe etiology. Prevention.
61)Food poisonings of non-microbe etiology, characteristic of conditions of hot climate
(heliotropic toxicosis, aflotoxicosis).
62)Hygiene of work in conditions of hot climate. Influence of hot climate on occurrence of
occupational poisonings and their prevention.
63)Methods of improvement of microclimatic factors in manufacture under conditions of hot
climate and control of their efficiency.
64)Epidemic significance of water in conditions of hot climate, signs of water epidemics.
65)Control of epidemic safety of water in conditions of hot climate.
66)Hygienic requirements to inhabited premises in conditions of hot climate.
An Example of Test
1. A patient with a body overweight visited the doctor. The patient's diet contained a lot of bread
products, cream products, pork, cheese, cottage cheese, carrot, cabbage, fruit. The
endocrine disorders in the patient are absent. Give recommendations as to correction of
his diet.
А. To restrict protein products (cheese, cottage cheese) in the diet
*В. To restrict carbohydrates and fat products (bread, cream, pork)
С. To restrict the use of vegetables
D. To restrict the use of fruit
Е. To include macaroni products in a ration
2. In a 55-year-old patient the expressed atherosclerosis is revealed. From his words, he
prefers fatty and sweet food: fatty meat, sugar, candies. What is the role of meal in this
disease?
А. Etiological
*В. A risk factor
С. Pathogenesis
D. Factor of transmission
Е. Secondary
3. A patient came to the doctor with complaints of stomatorrhagia, nasal bleedings, swelling of
lower extremities. Objectively: the reduced resistance of capillaries, hypochromic
anemia in the blood. The diet of this patient includes bread, meat canned food,
concentrates from various cereals. What are your recommendations on prophylaxis of
similar diseases?
*А. Satisfaction of physiological requirements in vitamin C
В. Inclusion of products, rich in vitamin В1 in a diet
С. Enrichment of ration with vitamin РР
D. Usage of fish fat
Е. UV irradiation
4. The patient complains of increased fatigability and worsening of vision. On examination the
signs of vitamin insufficiency are detected: adipose seborrhea near nostrils, in
nasolabial folds, in the area of forehead and ears; anguiitis and pericorneal dilation of

221
vessels. These manifestations are most probably associated with
А. polyhypovitaminosis.
В. В6–hypovitaminosis.
С. РР–hypovitaminosis.
D. В1–hypovitaminosis.
*Е. В2-hypovitaminosis.
5. A 25-year-old suckling woman‘s diet contains 1,000 mg of calcium, 1,300 mg of phosphorus
and 20 mg of iron lactate per day. How should the content of mineral substances in her
diet be modified?
*А. To increase the content of phosphorus
B. To reduce the content of calcium
С. To increase the content of calcium
D. To decrease the content of phosphorus
Е. To increase the content of iron lactate
6. A high level of cardiovascular pathology is registered in children and women of fertile age in
the region during many years. There are the following clinical signs: asthenovegetative
syndrome, extrasystole, disorder of atrioventricular conductivity, diffuse-sclerotic,
metabolic disorders and hypertrophy of myocardium, increasing activity of blood
glutationperoxidase and gastric acidity. What microelement deficiency in foodstuff
caused this disease?
*А. Selenium
В. Manganese
С. Copper
D. Zinc
Е. Cobalt
7. A 35-year-old patient has acute hepatitis in the phase of recovery with disorder of hepatic
function and bile ducts without accompanying diseases of stomach and intestine. To
normalize the functions of the liver and bile ducts, cholesterol and fat metabolism the
diet should be enriched with
А. protein.
B. extractives.
C. fat.
*D. lipotropic substances.
Е. carbohydrates.
8. An 8-month child has mental and physical developmental retardation. What amino acid is
necessary to eliminate from the child‘s diet?
А. Tyrosine
B. Leucine
C. Tryptophan
*D. Phenylalanine
Е. Histidine
9. A 32-year-old woman with the complaints of menstrual cycle disorders, frequent diarrhea,
edema around the eyes visited the doctor. OD: pale skin, hypochromic anemia,
reticulocytosis. The woman said that she followed the vegetarian diet. These clinical
manifestations are associated with deficiency of
*A. copper.
B. iron.
C. manganese.
D. magnesium.
E. iodine.
10. A daily ration of a 29-year-old doctor-surgeon contains 90 g of proteins (including 39 g of
animal origin), 101 g of fats, 412 g of carbohydrates. The daily caloricity is 3,000 kcаl.
Give recommendation as for modifying the diet?
*A. To increase the content of animal proteins
B. To increase a calory content of the ration
C. To increase the content of carbohydrates
D. To increase the content of proteins
E. To decrease the content of fats

222
11. In autumn 20 schoolchildren of a village school were poisoned with food. The poisoning
was characterized by subfebrile temperature, nausea, vomiting, colic pains (spasms) in
the abdomen. These manifestations occurred in 1-3 hours after breakfast (pancakes
with sour cream). The cause of the disease became home-made sour cream bought at
a rural inhabitant. What microorganism could have become the reason of the disease?
*А. Staphylococcus
В. Streptococcus
С. Bacterium of a Proteus type
D. Pathogenic strains of E. Coli
Е. Cl. perfringens
12. On investigation of alimentary poisoning the diagnosis of poisoning with amanita palloides
(toadstools) was established. What toxicant contained in mushroom could have become
the reason of poisoning?
А. Gelvelic acid
*В. Amanitotoxin
С. Girometrin
D. Solanine
Е. Fasin
13. Among the pupils of a boarding-school the case of common alimentary poisoning was
detected. According to epidemiological anamnesis, the reason was the use of cakes
with cream. These cakes were stored at the nutrition unit with the disturbed temperature
regimen. Which of the enumerated methods is the most effective in prophylaxis of
staphylococcal toxicosis?
А. Elimination of staphylococcal carrier among the workers of the nutrition unit
В. Elimination of staphylococcal carrier among animals
*С. Prevention of staphylococcal reproduction in foodstuffs and production of toxin
D. Exclusion of foodstuff contamination by staphylococci
Е. Following the methods of thermal processing of foods
14. The onset of disease in the kindergarten was sudden, 2-3 hours after the consumption of
curds, not subjected to heat processing. All had abundant multiple vomiting, abdominal
pain, liquid stool, paleness of skin, some of them had a slight fever (up to 37˚C). The
clinical manifestations were controlled within a day. What is the most probable
diagnosis?
А. Poisoning with salts of heavy metals
В. Bacterial toxicosis
С. Acute intestinal infection
D. Mycotoxicosis
*Е. Alimentary toxinfection
Municipal Hygiene
1. The research of water taken from the mine well is carried out. The following is found out:
transparence–18 cm, color–15°, smell –3 points, hardness–12 mg/equivalent, oxidability
– 4 mg/l, the content of nitrogen – 0.2 mg/l, nitrogen oxide – 0.05 mg/l, sodium chloride
– 80 mg/l, coli titer – 80, coli index – 12. Give hygienic estimate of drinking water quality.
A. Water does not meet hygienic requirements
B. Water meets hygienic requirements
C. Water does not meet hygienic requirements, it needs purification
*D. Water does not meet hygienic requirements, it needs disinfection
E. Water does not meet hygienic requirements, it needs deactivation
2. Before removing sewage of infectious hospital into a city sewer net, it is cleaned and
disinfected on local construction including a lattice, airtank, sand collector, contact tank,
dehelmintizator. Which of the following is used for biological purification of sewage?
A. Dehelmintizator
B. Sand collector
C. Contact tank
D. Lattice
*E. Airtank
3. In the inhabitants of settlement A., situated in 3 climatic zones, there is a mass affection of
teeth with fluorosis. At what concentration of F-ion in drinking water can fluorosis occur?

223
*B. 1.5
С. 1.0
D. 0.3
E. 0.1
4. Diseases of children with methemoglobinemia are registered in the baby's house. On
examination it has been revealed that those children‘s alimentary admixtures are diluted
with drinking water. Identify chemical substance which excess in drinking water can
cause this disease?
A. Chloride
B. Sulfate
*C. Nitrate
D. Lead
E. Mercury
5. On hygienic estimation of conditions of garbage dump in a reservoir of 1st category of water
use it has been determined that conditions of dump do not correspond to hygienic
requirements for biological consumption of oxygen (BCO). What standard of BCO of
reservoir water quality was used in that case?
*A. No more than 3 mg of О2/dm3
B. No more than 2 mg of О2/dm3
C. No more than 4 mg of О2/dm3
D. No more than 5 mg of О2/dm3
E. No more than 6 mg of О2/dm3
6. The typhoid epidemic of water origin is registered in settlement NN. Which of the following is
not characteristic of the given epidemic?
A. An epidemic tail (loop)
B. A sharp rise of disease curve
*C. A three-phase character of disease curve
D. A falling level of disease after liquidation of waterpipe failure
E. The contingent of fallen ill population lives in one microdistrict
7. A man, aged 28, a citizen of Kiev, has the diagnosis of "chronic gastritis with reduced
secretory and acidogenetic function of the stomach with frequent aggravations, the
phase of remission‖. He receives the necessary therapy at aggravations, follows a diet.
Suggest the most expedient gastroenterological sanatorium with mineral waters.
A. Sanatorium in Mirgorod
*B. Sanatorium in Essentuky
C. Sanatorium in Druskeeninkai (Baltic)
D. Sanatorium in Staraya Russa
E. All above mentioned
8. On laboratory analysis of potable water from an artesian borehole it is established that the
transparency makes up 50 cm; chromaticity –200; turbidity–0.5 mg/l; smell and smack–1
point; general water hardness–12.5 mg/l; fluorine–1.5 mg/l; oxidability–0.7 mg/l; coli titer
–500 mg/l; coli index –2; microbic number–10. Which method of purification is
necessary for improvement of potable water quality?
A. Disinfection
B. Deodorization
C. Defluorization
*D. Softening
E. Purification
9. The settlement receives potable water from an artesian borehole. The water has passed a
full work cycle of water preparation. Results of potable water analysis are: transparency
– 30 cm, chromaticity – 20, smell – 1 point, dry residue – 1,000 mg/dm3, dry residue –
5.5 mg/dm3, nitrates – 20 mg/dm3, fluorine – 4.0 mg/dm3, coli titer – 300 ml, microbic
number – 100. Identify the disease which incidence will be influenced by the use of this
water?
A. Urolithic illness
*B. Fluorosis
C. Chronic gastritis
D. Water-nitrogen mеthemoglobinemia

224
E. Iron-deficiency anemia
10. The investigation of potable water quality in city A. is carried out. It has been determined
that organoleptic parameters are lower than properties of water, hardness does not
exceed the norm, and nitrates and coli titer are higher than the norms specified in State
Standard "Drinking Water". What can the use of this water cause?
A. Urolithiasis
B. Infectious disease of intestinal group
C. Cholelithiasis
*D. Меthemoglobinemia
E. It is unpleasant to drink
11. In a hospital ward sized 5 х 3.5 m2 there are two windows. The aeration of the ward is
carried out by repeated opening of window leaves within a day. The estimation of carbon
dioxide content is carried out by the passing of air through Petry's absorber with an
alkaline solution. Identify the allowable content of carbon dioxide in the ward air (in %).
A. 0.04
*B. 0.1
C. 0.01
D. 0.15
E. 0.20
12. At estimation of effect of atmospheric air quality on health of population a degree of danger
of atmospheric air impurity is taken into account. At what degree of atmospheric air
pollution is it possible to expect the increase of incidence of specific and nonspecific
deseases, acute poisoning, death rate?
A. Slightly dangerous
B. Moderately dangerous
C. Dangerous
*D. Very dangerous
E. Rather dangerous
13. For disinfection of air in operating room a source of ultraviolet radiation is planned to be
used. To establish the necessary regimen of irradiation, 5 regimens have been tested.
The estimation of efficiency of air disinfection has been carried out with the help of
Krotov's device. The efficiency of sanitation (in %) has been designed. Identify the
optimal dose.
A. 55 %
B. 85 %
C. 75 %
D. 65 %
*E. 95 %
14. At laboratory research of air in settlement M. it has been found out that concentration of
some chemical substances exceeds the maximum permissible concentration by 5 times.
What changes are expected in a health state of population?
A. Changes of some functional parameters
B. Specific and nonspecific mobidity
*C. Expressed physiological disturbances
D. Acute poisonings
E. Lethal poisonings
15. At laboratory research of the air environment quality of a ward it has been established in
summer that bacterial contamination makes up 4 cells/m3, hemolytic streptococcus – 25
colonies per 1 m3, content of carbon dioxide – 0.1 %. Estimate the degree of air
clearness.
A. Very clear
B. Clear
C. Polluted
*D. Satisfactorily clear
E. Very polluted
16. Patient with thyrotoxicosis is in a 2-bed hospital ward of therapeutic department. The area
of the ward is 18 m2, its height – 3 m, ventilation rate – 2.5/h. Air temperature is 20˚С,
relative humidity – 45%, air movement speed – 0.3 m/sec, light coefficient – 1/5, noise

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level – 30 dB. Make hygienic assessment of the conditions.
*A. discomfortable microclimate
B. non-effective ventilation
C. poor lighting
D. a high level of noise
E. all conditions are comfortable
17. By order of the doctor the nurse has taken measurements necessary for estimation of
microclimatic conditions of the ward of therapeutic department. The results of
measurements are the following: the average temperature of air makes up 20°С, air
movement speed – 0.02 m/sec, relative humidity of air – 58 %. Make hygienic
assessment of the ward microclimate.
A. Discomfortable microclimate of a heating type
B. Discomfortable microclimate of a cooling type
*C. Microclimate is comfortable
D. Microclimate is discomfortable due to increased humidity of air
E. Microclimate is discomfortable due to increased air movement
18. In the departments of infectious hospital the instrumental control over the general work of
ventilation system and keeping the optimal parameters of microclimate is planned. The
following devices are prepared for this purpose: Krotov's device, anemometer,
thermograph, catathermometer, Assman's aspirational psychrometer. Which of the listed
devices are intended for measuring air movement speed in hospital premises?
A. Assman's aspirational psychrometer
B. Anemometer
*C. Catathermometer
D. Krotov's device
E. Thermograph
19. The doctor-cardiologist in Chernigov has received the urgent report of weather forecast:
"Due to chromospheric flash on the Sun a great magnetic storm is expected". Give
recommendation as for changes in treatment of patients with chronic ischemic heart
disease in the hospital.
A. To continue the treatment administered before
B. To administer hypotensive preparations
C. To administer bed regimen
*D. To strengthen spasmolytic and anticoagulant therapy
E. To cancel serious medical-diagnostic procedures administered the day before
20. In a classroom sized 6 х 10 m2 six light points are fixed, equipped with filament lamps
having capacity 150 W each. The illumination intensity on workplaces ranges within the
limits of 70 – 80 lux. Make the hygienic estimate of artificial illumination in the
classroom.
A. Artificial illumination of the classroom is uniform and sufficient: illumination intensity on
workplaces is low.
B. Artificial illumination of the classroom is uniform: illumination intensity on workplaces is
low.
C. Artificial illumination of the classroom is non-uniform, but sufficient: illumination
intensity on workplaces is sufficient.
D. Artificial illumination of the classroom is uniform and sufficient: illumination intensity on
workplaces is sufficient.
*E. Artificial illumination of the classroom is non-uniform and insufficient: illumination
intensity on workplaces is low.
Hygiene of Work
1. In a thermal shop of a machine-building factory the excess of obvious heat makes up 81
kkal/m3 per year. The air temperature changes from 25C up to 30 C (normal–18–20
C), heat emission — up to 1800 kkal/m2 a year, relative humidity –40–60 % (normal –
40–60 %), speed of air movement–0.5–0.7 m/sec (normal–0.2 m/sec). Which of the
above factors can cause an eye disease such as cataract?
А. Speed of air movement
В. Convection warmth

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С. Air temperature
D. Relative humidity of air
*Е. Heat emission
2. An electric welder of a mechanical workshop performs operations on welding and kerf of
metal accompanied by intensive UV-radiation on a welding post supplied with effective
mechanical cooling. What occupational disease is most probable to develop in him?
*А. Electrophthalmia
B. A dust disease
C. Chronic overheating
D. A vegetovascular dystonia
Е. Thermal shock
3. On a workplace of a worker the power of electrical and magnetic fields form electromagnetic
field, created by high-frequency generator located at a distance of 3 m from the
workplace. What zone of exposure is the workplace located in?
*A. Induction
B. Undulatory
C. Interference
D. Alienation
E. Reverberation
4. Student B. and student M. of the medical faculty were given the task to make a hygienic
estimation of noise at a plant shop, namely: to research a noise level /for student B./ and
its effect on organism /for student M/. What instrument should student М. use to make
the research?
*A. Audiometer
B. Actinometer
C. Radiometer
D. Noise-vibration-meter
E. Noise spectrum analyzer
5. A constant noise from the external sources penetrates into the hospital wards and doctors'
consulting rooms in the daytime. Identify the permissible level of noise in the daytime for
the hospital wards.
*A. 35 dB
B. 45 dB
C. 85 dB
D. 60 dB
E. 75 dB
6. In a tool shop the currents of high frequency are used. The working conditions are
characterized by exceeding the limited noise levels, EMF, content of dust (iron,
molybdenum, silicon dioxide), eyestrain. On examination of a worker neurasthenia,
disorders of endocrine regulation are diagnosed. The etiological factor is:
*A. EMF
B. Noise
C. Iron dust
D. Molybdenum dust
E. Silicon dioxide
7. In a mechanical shop a turner at a lathe is exposed to a high level of noise. In 6–8 years of
work by speciality the decrease of hearing can develop in him. Identify the most
significant preventive measures.
*A. Measures of technological character
B. Layout measures
C. Measures of technical character
D. Measures of individual protection
E. Measures of medical prophylaxis
8. The drivers of heavy haulers are subjected to effect of low-frequency transport vibration. In
5–8 years of work by speciality such illnesses can occur in them as radiculitis and
ishialgia, dysfunction of a vestibular analyzer, and early fatigue. Identify the most
significant preventive measures.
*A. the decrease of vibration intensity of the source (at the expense of design

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improvement)
B. means of external protection from vibration
C. decrease of working hours
D. a rational regimen of work and rest
E. elimination of immediate contact with vibrant equipment
9. On receiving an appointment of announcer in the regional broadcasting company citizen Н.
was directed to medical-prophylactic establishment to undergo the initial medical
examination. The medical brigade should include the following doctors-specialists:
*A. Therapeutist, neuropathologist
B. Therapeutist, otolaryngologist
C. Therapeutist, ophthalmologist, neuropathologist
D. Therapeutist, otolaryngologist, ophthalmologist
E. Therapeutist, urologist, neuropathologist
10. On initial medical examination of a person, who arrived to work with the source of noise
and vibration, otosclerosis with unfavorable prognosis was detected. The working
conditions are connected with effect of numerous harmful production factors of a
physical nature. Contraindication to work by the given speciality is
A. local industrial vibration.
B. ultrasound.
*C. industrial noise.
D. infrasound.
E. electromagnetic fields.
11. In a city some unfavorable factors simultaneously act: atmospheric contamination, noise,
electromagnetic radiation and some others. The effect of these harmful factors is
characterized as
A. complex.
*B. associated.
C. combined.
D. mixed.
E. additive.
Radiation Hygiene
1. After an accident on atomic power station people take iodine drugs. What is the purpose of
this measure?
А. To maintain regular processes
В. To strengthen a bactericidal action of tissues
*С. To prevent hypoplasia of the thyroid gland
D. To increase the resistance of organism
Е. To strengthen a protective effect
2. At the enterprise demanding a particular observance of measures of ecological safety, there
was a serious accident accompanied with ignition, explosion, considerable
contamination of the environment with products dangerous to life. In casualties the
following signs were observed: excitement, headache, instability of vegetative functions,
erythropenia, leukopenia, thrombocytopenia, decrease of cytophagous activity and
formation of antibodies, bleeding, vomiting, diarrhea, inflammation of the tongue and
gums, necrotic angina, pneumonia and other disturbances. What is the main etiological
factor of the described syndrome?
А. Damage caused by blast wave
В. Damage caused by high temperature
С. Toxic and chemical substances in the air and nutrition
D. Mental stress
* Е. Radiation damage
3. Mr. S, 45 years old, living on radioactively-contaminated territory, addressed the doctor after
the advice to use vegetables removing radionuclides from organism. Give
recommendations as for chemical composition of vegetables and their content in a diet.
А. Sweet pepper
*В. Carrots

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C. Potatoes
D. Tomatoes
Е. Watermelon
4. The gamma-radiography with the help of a cobalt defectoscope is used for a qualitative
control of details. Identify the type and danger of the used source for workers.
A. Open
B. Non-radioactive
С. Alpha radiation
D. Dangerous at internal exposure
*Е. Closed, causing the external exposure
5. In the radiological department for intracavitary therapy the gamma-ray irradiation device
"Agat" is used with the source of cobalt isotope, which is in a steel ampoule. Which of
the following ways of staff protection from effect of ionizing radiation should be used
primarily in view of type of source?
*А. Screening of the source and workplace
В. Capsulation of installation
С. Layout measures (zones of location)
D. Equipment of department with effective ventilation
Е. Use of means of individual protection and cleansing staff
6. Specify a maximum permissible dose per year for a category A (person, permanently or
temporarily working with immediate sources of ionizing radiation) according to norms of
radiation safety (NRS–97).
*А. 2 rem/year
B. 4 rem/year
С. 0.2 rem/year
D. 1 rem/year
Е. 0.5 rem/year
7. Citizen A. (aged 28 years, body height–175 cm, body mass –74 kg), working at the
establishment with radiation, received 2 maximum permissible doses of radiation during
a local radiation accident. He was referred to a medical commission to solve the
problem on possibility of further work with industrial sources of ionizing radiation. On
medical examination citizen A. did not have any complaints concerning his health. The
experts, who carried out the examination, considered him to be practically healthy.
Evaluate the possibility of further work of citizen A. with sources of ionizing radiation.
*А. The exposure is admitted without any limitations
В. The exposure is admitted conditionally with limitation of a dose
С. The exposure is admitted conditionally with limitation of time
D. The exposure is admitted conditionally with limitation of work with open sources
Е. The exposure is admitted only to closed sources
8. Farmer А. addressed the radiological department with the request to make the analysis of
potatoes as for the content of radionuclides and to draw the hygienic conclusion on
possible use of complete product. The results of the analysis showed that the content of
radioactive substance cesium–137 in the potatoes were equal to 40 Bq /kg, and
strontium–90 – 8 Bq/kg. Identify the most probable variant of the conclusion.
А. The potatoes can be used only as forage to cattle
*В. The potatoes can be used without limitations
С. The potatoes can be utilized for production of ethanol
D. The potatoes can be utilized for production of amylum
Е. The potatoes can be utilized for production of chips
1. The girl, aged 14 years, has deviations in physical development. Her body height is below
average, excess of body mass is of II degree. In the anamnesis: adenoid disease,
rheumatic disease with infrequent exacerbations. Recently she has had complaints of
colicy pains in the epigastric area, feeling of gravity, dryness in the mouth, nausea,
vomiting, sometimes repeated. The diagnosis of gastritis has been established. What
health group does this child refer to?
*А. 3rd

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B. 1st
C. 2nd
D. 4th
Е. 5th
2. The estimation of degree and harmonicity of physical development of children and
teenagers is carried out by anthropometric, physiometric and somatoscopic researches.
What parameters refer to physiometric indexes of physical development?
*А. Vital capacity of the lungs
B. Body weight
С. Form of legs and thoracic cavity
D. Body length
Е. Secondary sexual signs
3. To common measures of hardening the following refers:
А. Physical training, walk, rubdown
В. Gargle of the throat, physical training, proper clothes
С. Rational nutrition for energy supply, physical training
*D. Creation of the optimal thermal regimen, proper clothes, walk, physical training
Е. Creation of the optimal thermal regimen in groups, physical training
4. In a classroom sized 6 х 10 m2 six light sources are placed equipped with filament lamps
150 W each. The illumination on the workplaces changes within the limits of 70–80 lux.
Make the hygienic estimation of artificial lighting.
*А. Artificial lighting of the classroom is irregular and poor: illumination on the workplaces
is low
В. Artificial lighting of the classroom is uniform: illumination on the workplaces is low
С. Artificial lighting of the classroom is irregular, but sufficient: illumination on the
workplaces is sufficient
D. Artificial lighting of the classroom is uniform and sufficient: illumination on the
workplaces is sufficient
Е. Artificial lighting of the classroom is uniform and sufficient: illumination on the
workplaces is low
5. The girl, aged 8 years, has a body height of 135 cm (+1.5), body mass –38.5 kg (+2), size of
the thoracal cavity –67 cm (+1.2). Make the estimation of body height and harmonicity of
the child's development.
А. The child is high and harmonic
В. The child is of average body height, and harmonic
*С. The child is low and harmonic
D. The child is of average body height and disharmonic
Е. The child is high and disharmonic
6. A school classroom is equipped with desks of "E" group. The schoolboys of the class have a
body height of 148–160 cm. Estimate and justify the appropriateness of school desks for
this class.
А. They fit perfectly
В. The group desks "E" correspond to body height of 146–160 cm
С. The group desks correspond to body height of 161–174 cm
*D. The class is equipped with inappropriate desks, since desks of group "E"
correspond to body height of children up to 130 cm,
Е. Desks of group "E" are necessary for body height of 131–145 cm
7. The regimen of children in a middle group was characterized by the following: 1) alternation
of activities — sleep, meals, wake, 2) a 2-hour day sleep, 3) two walks. Does this
regimen correspond to the age possibilities of children?
*А. Yes, it does
В. No, it doesn't due to alternation of activities
С. No, it doesn't due to duration of day sleep
D. No, it doesn't due to number of walks
Е. No, it doesn't due to duration of walks
8. By results of medical-pedagogical control of the physical training lesson in the 9th form a
physiological curve was drawn describing a step-by-step increase of pulse rate at the
beginning of the lesson, increase of pulse rate by 80 % during the main part of the

230
lesson. Make estimatation of organization of a physical training lesson.
А. The lesson is arranged correctly
B. Physical load is poor
С. Physical load is excessive
D. Physical load is sufficient
*Е. There are long intervals between exercises
9. For estimation of school maturity of 6–7-year-old children the assessment of level of mental
development is carried out on the basis of morphologic and functional
psychophysiological criteria. What parameters determine the level of mental
development of children?
А. Biological age
В. State of the central nervous system
С. State of health
*D. Kern-Iracek test
Е. Interrelation of exitation and inhibition processes in the brain
10. In the spontaneous market the desks of handicraft production are suggested. The desks
are made of mild types of wood, the cover has a regulated declination (from 1 up to 45˚),
height of desktop is 0.8 m, height of seat – 0.5 m, distance of seat is positive. What
pathology can occur in children who will use this desk for home studies?
*А. Left-side scoliosis
В. Right-side scoliosis
С. Platypodia
D. Anemia
Е. Hypermetropia
Examples of Situational Tasks
TASK 1
On interrogation of patient A., aged 26 years, a plasterer, it has been revealed that he
has breakfast and supper at home, but dinner — in the dining-room of the building company.
The patient stated that on 11 June, two hours after dinner he felt bad and went home. At home
pains occurred in the stomach area, he had vomiting, weakness. The patient paid attention to
the fact that taste of juice, which he had drunk at dinner was not good. Objective information:
body temperature is 37, pulse rate — 76/min., breathing — without features. The stomach is
soft. There is slight morbidity in the stomach area. Diarrhea is not present. The patient feels
nausea and notes astringent taste in the mouth.
Make and substantiate the diagnosis of the disease. How to confirm the diagnosis?
What documents should the doctor process in this case? Identify the hygienic measures for
prophylaxis of similar diseases.
TASK 2
On examination of patient I. the following has been revealed: he is a collective farmer,
aged 30, has meals at home. He gets foodstuffs, including flour, in the collective farm. On 10
May, approximately at 12 o'clock, he felt somnolence, numbness of fingers, sense of crawling
of small ants, difficulty of unbending hands and feet. Then the twitch of facial muscles, difficulty
of swallowing appeared. Objective information: the body temperature is 36.8˚C; pulse and
breathing are without features; convulsive twitch of leg muscles; slight pain in the stomach;
nausea, dizziness. For the last 2 months 3 cases of similar disease occurred in his village.
What documents should the doctor process in this case? Identify the hygienic and prophylactic
measures in this case.
TASK 3
On examination of child T., aged 5 years, the following has been revealed: on 20 June,
after dinner the middle group of kindergarten went for a walk to the field with their nursery
governess and picked flowers there. The walk lasted for 1.5 hours. Having come back, the

231
nursery governess noticed the child's face sharply turning red, hoarseness of voice and dilated
pupils. Objective information: face turning red, temperature — 38˚C, pulse rate — 140;
frequent breathing, dry mucous membrane of the oral cavity, hoarseness of voice, strongly
dilated pupils. The child is excited, restless, having visual hallucinations.
What documents should the doctor process in this case? What prophylactic measures should
be carried out in the nursery school?
TASK 4
On examination of patient A., the following has been revealed in order to render the first
aid: the patient is 18 years old, a student, has meals in a students' canteen. From conversation
with the patient it has been found out that on 18 May, he felt dryness in the mouth, difficulty of
swallowing, blurring of vision. Disturbances of stool were absent. Objective information: body
temperature is 36.8˚C, pulse — 70, full. The stomach is painless, soft on palpation. Pupils are
dilated; there is slight ptosis, dryness of oral mucous membrane. Voice is hoarse; there is slight
lowering of soft palate.
What documents should the doctor process in this case? Identify medical and prophylactic
measures in this case.
Task 5
The child, aged 3 months, with body mass of 6 kg is fed artificially by mixture "Kid". With
the purpose of rickets prophylaxis the doctor administered vitamin D. The mother did not follow
the prescription strictly; instead of 3 drops she gave 10 drops a day during 3 months. The
mother stated that her child had become languid, ate badly, had periodic vomiting after feeding,
drank greedily; once or twice there was liquid stool. On examination the skin integument is
pale, clean, the turgor of tissues is decreased, the anterior fontanelle is 1.5x1.5 cm, the
mucous membranes are dry. The pathologies of internal organs are not revealed. At laboratory
research a big content of calcium salts is revealed in the urine.
Identify the reason of child's state. Specify a daily dose of vitamin D. Give the necessary
recommendations. How to prevent rickets in this case?
TASK 6
A group of students residing in a hostel applied to the doctor of policlinic with complaints
of general weakness, somnolence, rapid fatigability, slight swelling of the gums. On inquiring it
was found out that students do not have regular meals, often take canned goods and
concentrates for meals. On examination the presence of gum haemorrage was revealed.
Make the initial diagnosis. What objective adequate methods of research for these
students can you offer? What methods can be applied for mass examination of all students
living in the hostel? Give recommendation for prophylaxis of similar diseases.
Task 7
A patient, aged 63 years, a pensioner, addressed the doctor with complaints of surplus
body mass. He had the expressed signs of atherosclerosis of coronary vessels, high blood
pressure. On inquiring it was found out that the patient had meals 3 times a day, avoided fatty
and spicy food. The analysis of his diet revealed that the content of proteins made up 70 g, fats
— 50 g, carbohydrates — 400 g a day. As for vitamin and mineral content, his ration
corresponded to the norm.
Estimate the adequacy of patient's nutrition to basic principles of rational diet. What are
the reasons of overweight? What group of alimentary diseases does this pathology belong to?
What recommendations relating to correction of nutrition of antisclerotic orientation are
necessary in this case?
Task 1
In town N. a high level of morbidity of population with arterial blood pressure and caries
is marked as compared to middle indexes in the region. To find out the reasons of this
pathology growth, the researches of drinking-water are conducted. The analysis of water from
an artesian well supplying the town with water revealed the following: organoleptic indexes —

232
normal, a dry residue – 2,300 mg/l, content of chlorides – 670 mg/l, sulfates – 750 mg/l,
nitrates – 42 mg/l, iron – 0.2 mg/l, fluorine – 0.8 mg/l.
Make the hygienic estimation of water. Is there any connection between the increase of
these diseases with quality of drinking water? What other diseases are possible in this town?
How to reduce the level of these diseases among the population?
Task 2
On analysis of morbidity of population in district T. the increased level of acute intestinal
infections is revealed. On analysis of superficial water sources in this period the following is
found out in the district: the smell of water is 2–3 points, taste is 1–2 points, turbidity– 1–2 mg/l,
dry residue – 800 mg/l, oxidation of water – 5–6 mg O2/l, coli titr – 150–200.
Could the quality of water be the reason of growth of acute intestinal infections? What
are the possible reasons of changes of water quality? What indexes of water should be
investigated additionally? Identify the necessary measures for improvement of water quality in
this district.
Task 3
In town K. for the last few years there was a sharp growth of morbidity of population with
respiratory diseases. To find out the reasons of this phenomenon the local SES conducted the
researches of the air. In mid air of the town a number of pollutants were found out, including
nitrogen oxides at a level of 0.8 MPC, carbon oxide in the concentration of 0.6 MPC. At
combined effect on organism these substances produce an additional effect (summation).
Make the hygienic estimation of degree of air pollution in the town. Can the air pollution
in the town affect the increase of this pathology? What other risk factors have the influence on
the increase of morbidity of population? What hygienic measures are necessary to decrease
the air pollution?
Task 4
On analysis of water from an artesian well supplying the city with water, the following
has been revealed: organoleptic indexes — normal, a dry residue is 1,300 mg/l, content of
chlorides – 570 mg/l, sulfates – 550 mg/l, nitrates – 20 mg/l, iron –0.2 mg/l, fluorine – 0.8 mg/l.
Make the hygienic estimate of water. What diseases can relate to the quality of drinking-
water? How to reduce the level of these diseases among the population?
Task 5
On analysis of water of the rural plumbing the following is found out: smell – 2 points,
taste – 3 points, turbidity – 1 mg/l, dry residue – 2,000 mg/l, sulfates – 500 mg/l, Oxidation – 7
mg O2/l, fluorine – 0.7 mg/l, nitrates – 5 mg/l, microbe number – 80, coli index – 5.
Make the hygienic estimate of water. Is it possible to use this water for drinking? If not,
what methods of improvement of water quality are required? What health disorders can the
use of this water cause?
Task 6
On research of microclimate in the living quarters it has been revealed that time of
cooling of katathermometer is 100 sec, factor of katathermometer – 600, effective temperature
– 16.5˚EТ.
Make estimate of microclimate. What devices were used for researches? How to
improve the microclimate in this room?
Task 7
On sanitary inspection of a habitable room it was found out that in a room sized 2.5 m x
4 m x 5 m two persons live; due to natural ventilation 40 m3 air per hour enter the room. The
temperature of air is 21˚C, speed of its movement is 0.1 m/sec, effective temperature –
22.5˚EТ.
Make estimate of the conditions in the room. What index should be investigated
additionally?
Task 8

233
In a hospital operating block there is an operating room with 2 tables (area is 54 m2).
Ventilation is input-extract (+4, –5). Luminosity of the operating field – 1,500 lux. General
luminosity – 200 lux. The air temperature during operation is 26˚C, relative humidity – 80%.
Content of CO2 – 0.15%, general microbe number in the air before the operation – 1,000 per
m3.
Make the hygienic estimate of the operating block. How to improve the hygienic
conditions in the operation room?
Task 9
In a nursery group room with the area of 45 m2 there are 25 children. On measuring
microclimate the following has been found out: the air temperature is 18°C, relative humidity of
air – 75%, the speed of air movement is 0.4 m/sec, effective temperature – 16° ET. Indexes of
luminosity: coefficient of natural illumination (CNI) – 1.0%, light coefficient (LC) – 1:7,
luminosity with luminescent lamps – 200 lux. Frequency rate of ventilation is once per hour.
Content of CO2 – 0.23%.
Make the hygienic estimate of a group room. Give recommendation on optimization of
conditions in a nursery group room.
Task 10
For building a hospital for 120 beds a site is offered with the area of 120 x 80 m, located
in the residential area at a distance of 80 m from the nearest dwelling houses; the radius of
policlinic service does not exceed 2 km. At a distance of 40 m from the area border there is a
district motorway. A sound level in the area makes up in the daytime – 60, and at night 50 dB,
in the wards – 30 dB.
Estimate the fitness of this area for building a hospital; give recommendations on layout
of functional zones in the area of hospital.
Task 1
A worker of a chemical enterprise, aged 35 years, addressed the doctor of policlinic with
complaints of bad health state, sleeplessness, defective memory, sense of anxiety and fear.
Record of service in this enterprise is 5 years. On examination the asthenovegetative
syndrome, asymmetrical tremor of hands, gingivitis and stomatitis in the oral cavity, black edge
of the gums are revealed. In the blood lymphocytosis and monocytosis are revealed.
Make the diagnosis and stage of occupational disease. What harmful occupational
factor caused the disease and why? What documents must be processed by the doctor in this
case? What rehabilitation and prophylactic measures are required for the worker and the
chemical enterprise on the whole?
Task 2
In a classroom with the area of 40 m2 forty pupils study. All school desks have a yellow
marking. Differention of desks and chairs makes up 1/5 growth of children, distance of seat +2
cm. Light coefficient is 1/10, coefficient of natural illumination–1%, general artificial
illumination–100 lux.
Give the hygienic estimation of the classroom. What functional disturbances or diseases
can occur in children at such conditions? How to improve the hygienic conditions in the
classrooms?
Task 3
In the hospital operating block there is an operating room for 2 tables with the area of 54
m2. Ventilation is input-extract (+4, –5). Local luminosity of the operating field–1,500 lux.
General artificial luminosity –200 lux. The air temperature during operation is 26˚C, relative
humidity –80%. Content of CO2–0.15%, general microbe number in the air before the
operation is 1000 per m3.
Give the hygienic estimation of the operating block. How to improve the hygienic
conditions in the operation room?
Task 4

234
At the annual prophylactic medical examination in a district policlinic the worker of
agricultural chemical storehouse of agricultural enterprise complained of headaches,
weakness, tenderness in the area of liver, unsteady stool, nausea. The asthenovegetative
syndrome and symptoms of hepatitis were revealed in the worker. The analysis of blood in the
hospital biochemical laboratory revealed the decrease of cholinesterase activity by 45%,
erythropenia and leucopenia, lymphocytosis.
Make the diagnosis and stage of occupational disease. What harmful occupational
factor caused the disease and why? What documents must be processed by the doctor in this
case? What rehabilitation and prophylactic measures are required for the worker and storage
of agrochemicals on the whole?
Task 5
On sanitary inspection of the working conditions of medical personnel in the x-ray room
of policlinic it was found out that the dose of external irradiation of personnel made up 150
mRem per week, which corresponds to 7.5 Rem per year.
Give the hygienic estimation of the working conditions of medical personnel in the x-ray
room. What occupational diseases are possible in personnel under these conditions? What
remote effects of radiation can occur, what are their manifestations? What measures of
radiation protection should be strengthened in the x-ray room?
Task 6
A hospital ward of a general type for 4 beds has the area of 20 m2. In the ward there is
1 window with the glazed area of 5m2, CNI–0.75%. A sound level at night –25 dB. Common
artificial illumination –50 lux, local –80 lux. Frequency of natural ventilation is 1.5/h,
concentration of CO2–0.15 %.
Make the hygienic estimation of the ward. Name the necessary measures for creation of
optimal conditions in a hospital ward for patients.
Task 7
A nursery school is in the center of microdistrict. The site area of the nursery school is
20 m2 per child. 50% of the area are occupied by green plantations. The area of a group room
is 60 m2 per 30 children of preschool age. CNI is 1.5 %, light coefficient–1:5, luminosity with
luminescent lamps–200 lux. The air temperature is 24˚C, humidity –70%.
Give the hygienic estimation of nursery school. What is your recommendation for
optimization of hygienic conditions in the nursery school?
Task 8
Estimate the physical development of a girl, aged 10 years, 125 cm in height, with a
body mass of 41.1 kg. According to information of age table the normal physical development
(average+- sigma) makes up: height–134.0±2.5 cm; body mass –35.1±2.2 kg. The Turner's
criteria are normal.
What are the causes of these deviations in physical development? What other methods
can be applied to estimate the physical development of the girl?
Task 9
To carry out the current sanitary supervision, the doctors of SES have studied the
working conditions of factory workers. It has been found out that the content of dust in the air of
the working area is 35 mg/m3, CO –3 mg/m3; the level of high-frequency noise is 88 dB, air
temperature –25 ˚C, humidity –80%.
Draw the hygienic conclusion about the working conditions. What occupational diseases
of workers can occur at these conditions, what are their diagnostics and prophylaxis?
Task 10
For construction of hospital per 120 beds the site is offered sized 120 x 80 m, located in
relation to a residential area in such a way that the nearest dwelling houses are at a distance
of 80 m, the radius of policlinic service does not exceed 2 km. At a distance of 40 m from the
site border there is a district motorway. A noise level on the site makes up in the daytime –60,
and at night –50 dB, in hospital wards –30 dB.

235
Estimate the appropriateness of this site for building the hospital. Give
recommendations on placing the functional zones on the hospital area.
Task 11
A woman-worker of agricultural hothouse addressed the doctor with complaints about
permanent headaches, sleeplessness. On examination the astenovegetative syndrome, signs
of peptic ulcer of the stomach, the decrease of cholinesterase activity in the blood by 30%
were revealed in the woman.
Make the diagnosis of occupational disease? What harmful factor influenced the
organism? How to confirm the diagnosis by the conditions of work? What documents must be
processed by the doctor in this case? What rehabilitation and prophylactic measures are
required for the worker and the hothouse economy on the whole?
LITERATURE
1. Books in Inglish
1. Lectures on common hygiene and medical ecology. S.Shibanov. — Simferopol, 2003.— 160
p.
2. Park‘s textbook of Preventive and Social medicine. India.— 23th edition.— 660 p.
3.Hygiene and Ecology. V.G.Bardov et al. – Винница, 2009. – 688с.
4. Short textbook of Hygiene and Ecology for foreign students. Pivovarov Y.P., Alsabounchi
A.A. – Moscow> 1999, 2002, 2006.
5. Mahajan & Gupta. Textbook of Preventive and Social Medicine. – India. 4 th edition.
6. Jekels Epidemiology, Biostatistics and Preventive Medicine & Public Health.
7. Influence of environment on health of the man. Reports of WHO.— Geneva, 1976 — 2014.
2. Books in Russian
Гигиена окружающей среды. / Ред. Г. И. Сидоренко.— Москва, 1985.
Руководство к практическим занятиям по общей гигиене и медицинской экологии. / Под
ред. Проф. С. Э. Шибанова.— Симферополь, 2003.— 260с.
Журнал " Гигиена и санитария " 1980-2017гг.
В. А. Покровский. Гигиена. Москва, ―Mедицина‖.— 1979.— 495с.
А. А. Минх. Методы гигиенических исследований.— Москва, ―Медицина‖.— 1971.— 584с.
Г. Н. Новожилов, О. П. Ломов. Гигиеническая оценка микроклимата.— Ленинград,1987.—
110с.
Никберг И.И. Гигиена больниц.— Киев, 1993.— 235с.
Румянцев Г.И. Общая гигиена.— Москва, 1998.— С. 253-328
I.I.Даценко, Р.Д.Габович. Профiлактична медицина.— Київ, Здоров'я, 1999.— 694с.
Е.И.Гончарук, В.Г.Бардов Г.И.Румянцев. Общая гигиена. Київ, " Вища школа", 2000 652с.
Е.И.Гончарук. Руководство к практическим занятиям по коммунальной гигиене.— Москва,
1990.— 236с.
Р.Д.Габович. Гигиена.— Киев, 1983.— 320с.
В.Войффен. Больничная гигиена. Минск, 1984
Р.П.Венцель. Внутрибольничные инфекции.— Москва, 1970
Д.Лошинци. Внутрибольничные инфекции.— Москва, 1978

236
Маненко А.К., Сахновская Н.И. Гигиена медицинских учреждений.— Киев, 1982
В.К. Овчарова. Работа и здоровье медицинских работников.— Москва, 1985
В.Ф.Кириллов и др. Руководство к практическим занятиям по радиационной гигиене.—
Москва, 2001.— 223с.
Кириллов В.Ф. и др. Радиационная гигиена.— Москва, 1988.— 237с.
Ильин Л.А., Кириллов В.Ф. Радиационная гигиена.— Москва, 1999.— 384с.
Ильин Л.А., Кириллов В.Ф. Радиационная безопасность и защита.— Москва, 1996.—
336с.
Г. Н. Сердюковская и др. Гигиена детей и подростков.— Москва, 1986.— 420с.
В. И. Берзинь и др. Руководство к практическим занятиям по гигиене детей и подрост-
ков.— Киев, 1989.— 120с.
Шибанов С.Э., Михайлов В.В. Руководство по гигиене жаркого климата.— Симферополь,
2000.— 50 с.
Лысенко А.Я. Руководство по тропическим болезням.— Москва, 1983.
Кошелев Н.Ф. Гигиена водоснабжения и питания в условиях жаркого климата.— Ленин-
град, 1975.— С. 5-19.
Attachment 1
Students’ Independent Work N 1. Evaluation of adequacy of an individual nutrition
Evaluation of adequacy of an individual nutrition (according to the tables made at home
in advance: a kind of activity, diet), assessment of own energy consumption according to the of-
fered and made at home tables, taking into account sex, age, kind of activity, body weight (see
Appendices).
Methodical Recommendations for Students’ Independent Work
I. Evaluation of the daily energy consumption
A. Basal metabolism is estimated according to Table 12.
B. Energy consumption for digestion of nutrition — 10 % of basal metabolism.
C. Energy consumption for all kinds of activity:
1. Estimate basal metabolism per hour. Basal metabolism per hour = Basal meta-
bolism: 24 hours.
2. Estimate energy consumption for all kinds of activity: energy consumption for activi-
ty = (Basal metabolism per hour) x (duration of activity) x (coefficient of activity). The coef-
ficient of activity is indicated in Table 13.
3. Sum up all the energy consumption for the activity (for all twenty-four hours) —
(Table 3).
D Daily energy consumption = energy consumption for digestion of nutrition + ener-
gy consumption for all kinds of activity
Table 12
Basal Metabolism
Age (in years) Basal metabolism
(00) kcal of energy
Men 10-18 (16.6 х W) + (77 х H) + 572
18-30 (15.4 х W) + (27 х H) + 717
30-60 (11.3 х W) + (16 х H) + 901
older than 60 (8.8 х W) + (1128 х H) + 1071
Women 10-18 (7.4 х W) + (482 х H) + 217
18-30 (13.3 х W) + (334 х H) + 35

237
30-60 (8.7 х W) + (25 х H) + 865
older than 60 (9.2 х W) + (637 х H ) — 302
Note: W- weight in kilograms, H — height in metres
Table 13
Coefficient of Activity
Kind of activity Coefficient of activity
Women Men
I. Studies
1.1. Practical classes:
Classes at theoretical departments 1.9 1.8
Classes in a clinic 2.3 2.2
1.2. Work with a computer 1.7 1.6
1.3. Attendance of lectures 2.0 1.9
1.4. Preparation for classes: 1.6 1.6
II. Personal hygiene:
Washing 1.4 1.6
Shower 1.6 1.7
Dressing, undressing 1.5 1.8
Meals 1.5 1.3
III. Household activity:
Tidying up 2.7 2.7
Sweeping the floor 3.5 3.5
Washing 2.5 3.3
Washing up 1.6 1.5
Cooking 1.8 2.2
Washing the floor 3.5 3.7
IV. Movement:
Walking around a house 2.5 2.4
Slow walk 2.8 3.0
Moderate walk 3.2 3.4
Fast walk 4.7 4.7
Walk upstairs and downstairs 6.2 6.1
Going by transport 1.7 1.5
V. Going in for sports:
Morning exercises 3.3 2.2
Playing chess 2.2 2.1
Playing billiards 2.2 4.4
Aerobics (light) 3.1 3.2
Aerobics (heavy) 7.3 7.2
Playing rugby, basketball 5.5 5.6
Playing volleyball 3.6 3.8
Playing cricket 7.0 7.1
Gymnastics (light) 3.5 3.5
Gymnastics (heavy) 7.0 6.6
Running moderate 7.0 7.1
Running fast 11.0 11.0

238
Swimming (at average speed) 2.9 3.0
Swimming (at high speed) 6 6
Ping-pong 3-4 3-3.9
Football 6.8 6.6
Application of sports equipment 8.0 7.6
IX. Rest:
Sitting calmly 1.2 1.2
Watching TV 1.4 1.4
Dancing (in a middle tempo) 3.0 3.0
Dancing (in a quick tempo) 6.0 5.8
Singing 1.6 1.6
Reading 1.7 1.7
Sewing 2.1 2.2
Knitting 1.9 2.0
X. Sleep 1 1
Sum up all the energy consumption for the activity (during the whole twenty-four hours)

239
Table 14
№ Activity Duration of ac-
tivity
(per hour )
Coefficient of
activity
Basal meta-
bolism per
hour
Energy consump-
tion for
the activity
1
2
3
Total
Note: 1 minute = 0.016 hour 3 minutes = 0.05 hour 5 minutes = 0.083 hour 7
minutes = 0.12 hour 20 minutes = 0.33 hour 25 minutes = 0.42 hour 30 minutes = 0.5
hour
Task
A man aged 20 is 60 kg in weight, 1.7 m in height. His work during the whole twenty-four
hours is as follows: classes in a clinic — 5 hours, attendance of lectures — 3 hours, going by
transport — 2 hours, work on a computer — 1 hour, preparation for classes — 4 hours, sleep
— 9 hours. Calculate his energy consumption for twenty-four hours.
Solution
1. Calculation of the basal metabolism (Table 12).
The basal metabolism = (15.4 х W) + (27 х H) + 717 = 924 + 45.9 + 717 = 1686.9 kcal.
Basal metabolism per hour = 1686.9 kcal: 24 hours = 70.29 kcal per hour.
2. Calculation of the energy consumption for all kinds of activity (Tables 13, 14).
№
№
Activity Duration of
activity
(in hours)
Coefficient
of activity
Basal metabol-
ism per hour
(kcal per hour)
Energy consump-
tion for the activity
1. Classes in a
clinic
5 2.2 70.3 52.270.3 = 773.3
2. Attendance of
lectures
3 1.9 70.3 31.970.3 = 400.7
3. Going by
transport
2 1.5 70.3 21.570.3 = 210.9
4. Work on a
computer
1 1.6 70.3 11.670.3 = 112.4
5. Preparation for
classes
4 1.6 70.3 41.670.3 = 449.9
6. Sleep 9 1 70.3 9170.3 = 632.7
Sum up all the energy consumption for the activity (for the whole twenty-four hours) =
773.3 + 400.7 + 210.9 + 112.4 + 449.9 + 632.7 = 2579.9 kcal
3. Daily energy consumption = energy consumption for digestion of nutrition + energy con-
sumption for all kinds of activity.
Daily energy consumption = 168.69 + 2579.9 = 2748.6 kcal
The answer: The daily energy consumption = 2748.6 kcal
II. Evaluation of the necessary quantity of nutrients according to the amount
of thedailyenergyconsumption
Caloric content of protein makes up 12-14 % of common caloric content of nutrition.
1 gram of proteingives4.1kcalofenergy.
Caloric content of fats makes up 25-30 % of common caloric content of nutrition, and
1 gram of fats gives9.3kcalofenergy.
Caloric content of carbohydrates makes up 56 % of common caloric content of nutrition, and 1 gram

240
ofcarbohydratesgives4.1kcalofenergy.
Task
A man aged 20 has a body weight of 60 kg, body height — 1.7 m. The daily energy con-
sumption = 2748/6 kcal. How many protein, fat, carbohydrate calories are necessary for him?
Solution
1. Protein
a) Caloric content of protein makes up 12-14 % of common caloric content of nutrition.
100% of common caloric content — 14 % of caloric protein content
2748.6 kcalof common caloric content — X caloric content of protein
X = (2748.6 x 14) : 100 = 384.8 kcal of protein content
b) 1 gram of protein gives4.1kcalof energy.
1 gram of protein —4.1 kcal
X — 384.8 kcal
X = (384.8 x 1) : 4.1 = 93.8g protein
2. Fats
a) Caloric content of fats makes up 25-30 % of common caloric content of nutrition,
and 1 gram of fats gives9.3kcalofenergy.
100% common caloric content — 30 % of caloric content of fats
2748.6 kcalof common caloric content — X of caloric content of fats
X = (2748.6 x 30) : 100 = 824.6 kcal of protein content
b) 1 gram of fats gives9.3kcalofenergy.
1 gram of fats — 9.3kcal
X — 824.6 kcal
X = (824.6 x 1) : 9.3 = 88.7g fats
3. Carbohydrates
a) Caloric content of carbohydrates makes up 56 % of common caloric content of nutri-
tion
100% of common caloric content — 56 % of caloric content of carbohydrates
2748.6 kcal of common caloric content — X of caloric content of protein
X = (2748.6 x 56) : 100 = 1539.2 kcal of carbohydrates content
b) 1 gram of carbohydrates gives 4.1 kcal of energy.
1 gram of carbohydrates — 4.1 kcal
X -1539.2 kcal
X = (1539.2 x 1) : 4.1 = 375.4 gram of carbohydrates
The answer: 93.8gproteins,88.7gfats,375.4g carbohydrates are necessary.
III. Evaluation of the Daily Consumption of Proteins, Fats, Carbohydrates
Estimation of the nutritive value of a daily ration is made with the help of the suggested
table of nutritive value of foods. A student fills in the appropriate columns of Table 15.
Table 15
Estimation of Nutritive Value of Foods
№ Foods Weight (g) Protein (g) Fats (g) Carbohydrate (g) Kca
l
Soup
1. Cabbage soup 500 4.9 11.1 33.6 260
2. Fowl soup 500 7.1 9.3 19.3 196
3. Tomato soup 500 17.6 19 33.1 373
4. Cream soup 500 10.3 1.0 42.5 139
5. Milk soup 500 10.2 18.8 50.9 330
6. Fish soup 500 9.8 7.5 19.6 220
Main Courses
1. Fried fish 100 15.8 9.8 3.4 168
2. Rissole pork 60 20 33 46 484
3. Rissole beef 60 14 31 28 450
4. Roast Chicken 100 18 18 15 340

241
5. Fried fowl 100 36 32 28 410
6. Steak 50 19 21 18 370
7. Beef casserole 100 19 18 15 435
8. Boiled eggs (2 eggs) 100 9 9.7 0.3 127
9. Fried eggs (2 eggs) 100 9.0 14.3 0.9 174
10
.
Fried bacon and
eggs (2 eggs)
100 29 35 1.0 270
11
.
Sausage 100 10.2 16.1 1.3 162
12
.
Smoked sausage 100 19.2 38.4 1.9 285
Porridge
1. Oatmeal porridge 100 5 3 25 120
2. Buckwheat porridge 100 4 2.8 28 178
3. Rice (rice porridge) 100 8 5 29 230
4. Semolina porridge 100 2.6 3.2 14 103
Vegetables
1. Boiled potatoes 100 1.8 0.5 18.2 91
2. Fried potatoes 100 1.5 6.2 15.8 137
3. Chips 30 1.4 4.3 14.1 73
4. Green salad 100 2.0 8.9 12.2 125
5. Tomatoes 100 1.1 0 4.1 280
6. Cucumbers 100 0.8 0 3,2 14
7. Cabbage salad 100 1.8 0.9 5.1 35
8. Carrot salad 100 1.3 0.7 8.5 36
Dairy products
1. Milk 100 2.8 3.2 4.8 58
2. Curds 100 14 2.8 3.8 232
3. Sour cream 100 2.8 20 3.2 206
4. Cheese 100 26.8 0 360
5. Kefir 100 2.8 3.2 4.8 58
Fats
1. Oil 100 0 99.9 0 899
2. Butter 100 0.6 825 0.9 748
3. Margarine (Rama) 100 0.3 82.3 1.0 739
Cereals and Grains
1. White bread 100 7.6 0.9 50 220
Black bread 100 5.5 1.0 31 157
3. Roll 100 7.9 1.0 65 250
4. Meat patty 50 5.2 1.9 17 102
5. Potatoes patty 50 3.6 18 25 126
6. Pastry 50 2.7 2.8 31 142
7. Boiled Macaroni 100 12.3 3.1 65 322
Fruits
1. Apples 100 0.4 - 1.2 34
2. Oranges 100 1.0 - 9.8 39
3. Strawberries 100 0.8 - 10.4 31
Drinks
1. Tomato juice 100 1.0 - 3.4 18
2. Apple juice 100 0.3 - 11.9 48

242
3. Grapes juice 100 0.4 0 16.5 68
4. Tea 100 2.0 - 8.5 99
5. Coffee 100 13.9 14.4 15.2 223
Task
A man aged 20 has a body weight of 60 kg, a body height — 1.7 m. His meal includes:
rice — 50g, steak — 170 g, white bread — 25 g, tea — 60g. How many calories does he get
with proteins, fats, carbohydrates?
Solution (according to Table 4)
1. Amount of calories consumed:
a) 100 g rice — 230 kcal 50 g rice — X kcal X = (50 x 230) : 100 = 115 kcal
b) 50 g steak — 370 kcal 170 g steak — X kcal X = (170 x 370) : 50 = 1,258 kcal
c) 100 g white bread — 220 kcal 25 g white bread — X kcal
X = (25 x 220) : 100 = 55 kcal
d) 100 g tea — 99 kcal 60 g tea — X kcal X = (69 x 99) : 100 = 68 kcal
e) Amount of calories: 115 + 1258 + 55 + 68 = 1,496
2. Proteins consumed:
a) 100 g rice — 8 g proteins 50 g rice — X g proteins X = (50 x 8) : 100 = 4 g proteins
b) 50 g steak — 19 g proteins 170 g steak — X g proteins
X = (170 x 19) : 50 = 64 g proteins
c) 100 g white bread — 7.6 g proteins 25 g white bread — X g proteins
X = (25 x 7,6) : 100 = 1.9 g proteins
d) 100 g tea — 2 g proteins 60 g tea — X g proteins X = (69 x 2) : 100 = 1.4 g proteins
e) Amount of proteins: 4 g + 64 g + 1.9 g + 1.4 g = 71.3 g
3. Fats consumed:
a) 100 g rice — 5 g fats 50 g rice — X g fats X = (50 x 5) : 100 = 42.5 g fats
b) 50 g steak — 21 g fats 170 g steak — X g fats X = (170 x 21) : 50 = 71 g fats
c) 100 g white bread — 0.9 g fats 25 g white bread — X g fats
X = (25 x 0.9) : 100 = 0.2 g fats
d) 100 g tea — 0 g fats 60 g tea — X g proteins X = (69 x 0) : 100 = 0 g fats
e) Amount of fats: 42.5 g + 71 g + 0.2 g = 113.7 g
4. Carbohydrates consumed:
a) 100 g rice — 29 g carbohydrates 50 g rice — X g carbohydrates
X = (50 x 29) : 100 = 14.5 g carbohydrates
b) 50 g steak — 18 g carbohydrates 170 g steak — X g carbohydrates
c) 100 g white bread — 50 g carbohydrates 25 g white bread — X g carbohydrates
d) 100 g tea — 8.5 g carbohydrates 60 g tea — X g carbohydrates
X = (69 x 8.5) : 100 = 5.8 g carbohydrates
e) Amount of carbohydrates: 14.5 g + 61.2 g + 12.5 g + 5.8 g = 94 g
The answer: The food contains: calories — 1496, proteins — 71.3 g, fats — 113.7 g,
carbohydrates 94 g.
Table 16
Physiological Daily Nutrition Need for Adult (Russia)
Group Coefficient Age Energy Protein Fats Carbohydrate
Total Includinganimal
protein
1 2 3 4 5 6 7 8
Men
I 1.4 18-29 2450 72 40 81 358
30-39
40-59
2300
2100
68
65
37
36
77
70
335
303
II 1.6 18-29 2800 80 44 93 411

243
30-39 2650 77 42 88 387
40-59 2500 72 40 83 366
III 1.9 18-29 3300 94 52 110 484
30-39 3150 89 49 105 462
40-59 2950 84 46 98 432
IV 2.2 18-29 3850 108 59 128 566
30-39 3600 102 56 120 528
40-59 3400 96 53 113 499
V 2.5 18-29 4200 117 64 154 586
30-39 3950 115 61 144 550
40-59 3750 104 57 137 524
Women
I 1.4 18-29 2000 61 34 67 289
30-39 1900 59 33 63 274
40-59 1800 58 32 60 257
II 1.6 18-29 2200 66 36 73 318
30-39 2150 65 36 72 311
40-59 2100 63 35 70 305
III 1.9 18-29 2600 76 42 87 378
30-39 2550 74 41 85 372
40-59 2500 72 40 83 366
IV 2.2 18-29
30-39
3050
2950
87
84
48
46
102
98
462
432
40-59 2850 82 45 95 417
5. Conclusion (variants)
 A daily energy consumption exceeds (corresponds to, is lower than) caloric content of nutrition
per day, therefore it is necessary to increase (maintain, decrease) the caloric content of nutri-
tion by ______ Kcal.
 The ratio of proteins, fats, carbohydrates in nutrition makes up __________, but 1:1:4 ratio is
required; so it should be increased (decreased) (to specify by what nutrients).
 The regimen of nutrition meets (does not meet) the demands of a balanced diet (to specify
the available malnutrition), therefore it is necessary ___________ (references, recommenda-
tions for change of a nutrition regimen are given). For correction of nutrition it is necessary to
____________ (to specify the necessary changes in nutrition).

244
Attachment 2 Symptoms of poisoning by Lead and Mercury
Blood picture at Lead poisoning

245
Lead border on gums at lead poisonong

246
Mercury trembling of hands

General hygiene and medical ecology

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