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16.  Disability rates of bus drivers 
Raffle, P. A. B. (1974).British Journal of Industrial Medicine,31, 152-158. Disability rates of bus drivers. The proposal that ordinary driving licences should be valid up to the age of 70 has stimulated much discussion on the place of medical surveillance in the prevention of road crashes.
London Transport bus drivers are medically examined on entry to the service, after absence from work attributed to sickness or accident for more than 21 days (and in certain other circumstances), and at age 50 and routinely thereafter. Average annual rates of deaths in the service and recommendations for retiral on medical grounds and for transfers to alternative work for these drivers are presented. These disability rates are low even at the older ages. Most of those drivers who recommended for work other than bus driving were considered to be fit to drive a car. Between ages 50 and 64, 85% of the recommendations for discontinuance of bus driving resulted from post-sickness medical examinations and only 15% from routine age examinations.
It is concluded that the available evidence supports the legislative proposals for ordinary driving licensing. However, licence holders will need considerable help from their doctors in discharging their legal obligation to notify their licensing authority of medical conditions likely to affect their ability to drive safely.
PMCID: PMC1009570  PMID: 4830766
17.  Sickness Absence of Women Bus Conductors in London Transport (1953-1957) 
The sickness-absence experience of women bus conductors employed by London Transport on their central (red) buses is analysed for the years 1953 to 1957 inclusive. The experience of single and married women is given separately, and only absences lasting four days or more (all of which are supported by medical certificate) are included. Results are given in quinquennial age groups for each of 20 broad diagnostic groups and comment is made on each group, emphasis being placed on the comparative experiences of single and married women. Both the numbers of spells of absence and the numbers of days of absence are considered. It is found generally that married women conductors have considerably more sickness absence than single women conductors of the same age: this applies both to spells and days of absence. Analysis of the difference by diagnostic group suggests that there is a propensity, of social origin, for married women to have more absences.
PMCID: PMC1038149  PMID: 13695614
18.  Bronchitis—Sickness Absence in London Transport 
This study is based on the records of sickness absence of four days or longer attributed to bronchitis among nearly 60,000 London Transport employees during the years 1952 to 1956. The figures support previous observations that there is a close association between the incidence of bronchitis and the occurrence of fog in any year. The bronchitis experience of employees living and working in the north-eastern sector of London is shown to be worse than in other areas of London. The experience of employees in the country belt round London, particularly in the southern sector, is better than in London itself. With the possible exception of conductors, the figures do not suggest that there are occupational factors in the transport industry causing bronchitis.
PMCID: PMC1038013  PMID: 13695613
19.  Medical Examinations for Public Safety* 
Driving buses in London is an occupation in which the standards of fitness have been defined and in which the frequency of, and clinical reason for, exclusion from the occupation have been recorded.
The criteria of fitness to drive a passenger vehicle are physical capability to handle controls (including good eyesight) and absence of conditions liable to cause sudden collapse or excessive fatigue with consequent liability to accidents. Some factors which may be overlooked as causes of collapse are idiopathic epilepsy which may first appear in middle life, carcinoma of the bronchus which commonly metastasizes in the brain and may cause fits, and laryngeal vertigo (cough syncope) which is much commoner in chronic bronchitis than is often realized.
When medical standards to maintain public safety and the man's own health were applied to applicants to drive London's buses, 5·3% of the applicants were rejected on general medical grounds and a further 13·3% were rejected for sub-standard vision and colour vision. All the applicants had experience of driving heavy vehicles and were otherwise acceptable as drivers.
Continued surveillance during working life, especially after sickness absence, of those involved in public safety is essential. During 1956, 23% of the examinations of bus drivers, who had been off sick for 28 days or more or for certain specified conditions, resulted in temporary or permanent exclusion from driving. This compares with 1·5% of examinations for licence renewal and 5·7% at age 65 and above.
Cardiovascular disorders accounted for 26% of the causes of rejection during 1956, one-third of these being due to hypertension and one-half to coronary heart disease. No one who has had clinical coronary heart disease is allowed to drive London Transport buses because of the known increased chance of recurrence. Periodic examinations revealed a number of hypertensives but the majority of the “coronary cases” were revealed by sickness absence. Electrocardiography at periodic examinations does not, at the present, enable those who will have coronary heart disease to be recognized.
Experience shows that the standards adopted are practicable and effective so far as bus drivers are concerned, and that careful assessment of fitness after sickness is as important as routine medical examination in maintaining public safety.
PMCID: PMC1037901  PMID: 13651552
20.  The Health of the Worker* 
PMCID: PMC1037773  PMID: 13426428

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