Document 2JdrwZ5ge9180j652R8Mj6mr6

'"t2=a6n<: : D r . He n ry Ry d e r D r . Vim. F . As h e November 16, 19^6 Mi*. Donald A . hohr, '2he .hove Dr-other.-S.'Inc., Dayton Oalo. - . ` Dear M r . iohr ' I 'fear' '1 am tardy in replying to your letter of feptember 2 6 . I trust the celayvill not have caused you any inconvenience. the, problem of pre-employment examinations is very easy to solve if one can elect to use entirely ideal methods, and if the . facilities available are in line with this intention. On the other hand , che maticr of deciding vhat can best be done to meet practical circumstances, ooth 'as to the needs of a plant and a s ,to the medical facilities actually available, requires a careful examination of all the available facts. Dr . Byd e r , Dr. Ashe and I talked over your problem, and ve. are in essential agreement as to what should be done. We believe, however, that ve will have to talk with you or your, associates'; in.cider to make cm* ideas fit in vi.th"vhat can actually be done. L shall elaborate this point In certain specific matters a little- later. . . . Ihe-purposes of the ere-employment- examination are' at. least- three-- lolo . first one would vish.to: eliminate certain candidate lor lurloynenl. vhooe physical condition is- such, that -heir, employment vill impose undue risks upon-'themselves and other .workmen, and uncue liabilities upon, the management. In the main such men will . be screened out by a careful physical examination, but the possi bility of tuberculosis' without any physical findings must always 'tic considered, and therefore a screening test by means of an X-Ray . examination;is' always to', he contemplatedf Consequently ve recommend a careful physical examination by a competent, medical man, certain .necessary laboratory procedures, such as a*clinical urinalysis ' and.a microscopic examination of the b l o o d , together with- flat 2<-I ay chest plates. By these procedures one will expect.to pick up, vascular disease of a potentially disabling type, kidney disease1 of a threatening type, incipient tuberculosis, and a number of. other' conditions that either disqualify m en for work or require something in the nature of careful placement. \ this' brings us to the next consideration, namely, '-that of using pre-employment examinations as a means of properly placing men who have some limitation of capacity. It Is obviously impossible io rive employment to people vho must earn c-helr living if one is to set up standards of physical fitness that exclude all but perfect specimens. Kvery Industry ought to lake its share of the partially Inca paella ted individuals' who must earn their living, and protect KJ= 0003766 Mr. Donald A . Kohr * (2; - Kovember 16, itself by placing these individuals where they will be safe, where they can do good work, and where they will not work a hardship upon other employees. This is feasible and it is one of the duties of industrial.physicians that must be carried out properly. here certain special examinations may well be required. Certain individuals, by reason of partial functional inefficiencies of one kind or another, should not be exposed to lead compounds or organic solven to , or in some instances,incus trial dusts. The , examining physician, therefore, should have a knowledge of the conditions in the plant, and should classify employees of this type, not so much in accordance with where they can work, as where they should not be permitted to work. This all sounds yejy compile* ceb, but it is not as difficult as it would seem. {hi relation to -this -problem, we would anticipate that certain periodic examinations would' be required in the case of employees exposed to potentially, hazardous occupational conditions. There fore, there should be a co-ordination of pre-employment and subse quent examinations,' in which the pre-employment examination is used sox the purpose of obtaining base-line data for later comparison. For example, workmen exposed to benzol ought to have careful hema tological data obtained- before exposure, likewise m e n who are to be exposed to lead end a variety c-f other toxic agents.}^A third function of pre-emj>loyment.'examinations Is that of making some contribution to the health of the community, a .duty which the very circumstances .of Industrial employment visit upon industry. 'Certainly well 'over bdifoi the people in a community ere 'employed gainfully under conditions involving some degree of medical supervision, the avoidance of unnecessary Incidence of disease , will contribute not only to the productivity of industry, but to the economic .soundness of 'the community'as a w h o l e . for this." reason we feel that certain general public health measures which . may app l y :to. occupational groups,should be carried out;as well as may be feasible. Pox example, every pr-e-employment examination should Include a serological examination of the blood.. Other comparable- things can be done, as for example, some industries have considered it advisable and advantageous financially to promote the immunization of their employees against certain epidemic diseases, of which perhaps one of the most important is influenza. This may sound like paternalism, a philosophy which we do not wish to encourage. Actually the philosophy behind it from the point of view of industrial management is that a serious epidemic of influenza may very well cripple t h e productivity of a plant at a very bad time, and if this can be prevented, It is certainly worth what it costs. The manner in which all of these things can be done, or whether they can be cone at all will have to be decided on the basis of the facilities available. There- is no use in recommending good physical examinations unless a good doctor is available.to carry them out, and unless he is given the necessary time to do -them. By the same token there is no use recommending laboratory proce dures unless they can be carried out so as to obtain completely reliable results. Otherwise one is self-deceived, and the results M r . Donald A . Kohi - ($. - November 16, 1966 viil setae * I should rather make no stab at doing any oi these things than to set up a mechanis'd lor* doing them badly . it is a complete waste of money and time to do industrial medicine in a hail-hearted- f a shi o n .. It is lor- this reason that, ve believe ve should talk over your plans vi th you ii you have . the time and arc vi 11 init, in order that we might make a proper* plan- which will include only those things vhich can be done properly under the existing conditions. for example, is there a physician;available to take over the job of doing, your pre-employment examinations; Does he have a laboratory i n vhich hematological work can be done proper l y , or is it your intention, to have a laborstory at. the plant In which a technician will carry out such voi-k under the guidance of the doctor; If the latter were to be d o n e , we could assist, if it seemed desirable, in the training- of the technician so as to get reliable laboratory data. `ihe. serological work, ve believe, can b e 'done without, any cost except that involved in obtaining the specimens for examination, this is either a city or state function, dependent u p o n !the local conditions. ke are also inclined to believe that chest plates can be taken periodically at the expense of some local, organisation. un the other hand, the plates' taken at the time of the pre-employment examinations can probably be arx-anged for at nominal cost, with a local radiologist. We are prepared, or rather preparing-,-'-to-, make specific recommenda tions for periodic examinations on certain occupational groups, and this car; be made to fit in adequately with the pre-employment . examination!, whether they are to be done by your physician or bp cur staff. c rcic: ic. the latter, only because ve are making.'an effort to pro vide..some limited services of .this type, where ve ... will net oe intruding into the activities of regular practicianers of m edicine. Out* feeling is that ve do not and- should not enter into the practice of .medicine except in such matters as involve .our special.skills 'and facilities, , With all of the above qualifications, we are prepared to recommend the following procedure.as mere outlines, the details of which axe to be'- determined following a discussion of the circumstances: 1. Complete physical examination, including previous occupational and; medical history- vith carefully .recorded' data* . . .Laboratory information, clinical urinalysis, hematologic data, serology (some modification of the Vasserman technique}, flat chest plates for screening with stereoscopic examination vhen' required. 89ZE000 1 think this -will.' serve as a basis for discussion, and you will see from the comments that there are a number of factors to which consideration will have to be given. Cordially yours,