Document 37kDkkopreX2wOQ4vz3w6YLaa

>c* >?.- *K >frr t* SOCCNY-VACUUM OIL CO?:?ANT, INC. THIRD ANNUAL MEDICAL ffiETING Dearborn Inn Dearborn, Michigan September 23 and 24, 1948 j722& 449092 C 0 IT S IT 3 List of People Attending the Medical Meeting ................................................................ PAGE 1 Welcoming Address Mr. C. F. Beatty ............................ ................................ ................................... .... . . O ` >' - , Growth and Development of Socony-7aouu* Medical Departments i. t -- A. E. Hoag. M.D......................................................................... .............................................2 2 Future Outlook of Our Medical Departments Mr. 'V. E. Montgomery......................................................................................................... ....... Hydrofluoric Acid Alkylation 11, K. Chesley, M.D................................................................................ ............................... ....... Occupational Cancer Marshall Clinton, M.D. . ................................................................ ....... S Abdication of Psychosomatic Medicine in Industry H. L. Rutzler, M.D................................................................................................................ 8 Supervision of Workers Exposed to Lead M N. Howard, M.D. . . ........................ ................. 9 Treatment: of Painful Backs N. ?. Johnson, M.D................................................................................................................11 1 y^died Pro ~rc- for Producing ar.d Pice Lir.e "crkers . ?. Luongo, M.D. . . ......................................................................... .... 12 How fan our Clinics Give More Efficient Care to our Employees? M, R. Schmidt, M.D.................................................................................................................. 13 The Annuitant's Place in Industrial Medicine Miss Olga A. Ericson, RN. .....................14 Cardiac Conditions and Pre-placement Examinations T. C. St. John, M.D................................................................................................................ 15 The Socony-Vacuum Industrial Nurse Mrs. Doris K, Kriegor, R.II.............................. .... ..................... .... ............................... 17 Medical Departments in Marketing Operations A. E. Hoag, M.D.........................................................................................................................13 Rehabilitation of Injured Workers D. R. Johns, M.D...................... ....20 Hie Value of Periodic Physical Examinations M. N. Howard, M.D. .... . ....................... .... .............................. .... - .... 21 Roundtable Discussion .......... ..................24 449093 J " * *' .a LIST OF PEOPLE ATTENDING MEDICAL MEETI50 AUGUSTA, KANSAS Cr. Frederic 0, Epp Mrs. Elnora Tinker, R.N. BUFFALO, NEW YORK Dr, Marshall Clinton Mrs. Aim Lanier, R.N. CASPER, WYCt^NG Dr. Allan licLellaa Mrs. Judith 0pt9dahl, R.N. EAST CHICAGO, INDIANA Dr. D. R. Johns Miss Antoinette Smoljan, R.N. HOME OFFICE, NFff YORK CITY Mr, C. F, 3eatty Mr. W. H. Montgomery Ur. R. G. Harmon Ur* J. H. Herbert Dr. A. E. Hoag Dr. H, L, Rutiler Miss Olga A. Eric son, R.N, Miss Marge V. McHugh, R.N. Mrs. Doris K, Krieger, R.N. Miss Dorothy M. Mehl, Sec'y. east river operations Dr. m. n, :Ir.vard Mi s s Julia Be r go a s, ?.,, N. Miss Helen Eaigleish, R.N. EAST ST. LOUTS, ILLINOIS Dr, T. C. S) o ohn Mi s s Paula R. KLerle, R.N. clean, new ycrk Or, N. ?. Mtr s :r. Miss Madeline 3. Averill, R.N. PAULS3CP.0, NTN JERSEY Dr. N. K. Chesley Miss Elisabeth K. Lafferty, R.N. Miss Katherine Wilhelm, R.N. Miss Irene Ruggaber, R.N. TRENTON, MICHIGAN Dr. M, R. Schmidt Mrs. Helen Hertel, R.N. MILWAUKEE, WISCONSIN '.Tadhams Division - Marketing Dr. J. J. Gaunt Miss Louise M. Tullgren, R.N. LCS ANGELES, CALIF, - General Petroleum Dr. E. P, Luongo GUESTS Mr. C. *3 Baker ' * Psrrur. Mr, R. 3 . 3axter Mr. J. A. 3rooks Mr. G. r Copeland V. -**. Mr. ?. T M '* Feldnose Glass Mr. N. J. Holton Mr. F. L. Hutton Ur. A. a. Jamieson Ur. s. G. Keller Mr. E. F. Kendall Mr. > E. Krueger fir. J. E. Mahannah Ur. w. K. Phipps Mr. E. T. Pumoill Mr, s. H. Reed Mr. w. Reed Dr. Irwin Schulte - 1- 449094 >c MUTCTBS THIRD AJOTOAL MEDICAL MEETIHQ September 23 and 24, 1948 WELCOMIHQ ADDRESS -- Mr, C. P, Beatty, Dlreotor in Charge of Industrial Relation!-' 26 3roadway, New York City ' Mr, Beatty was introduced to the members of the Third Annual Medical Meeting by Dr, A. E. Hoag, Medical Director, Mr. Beatty gave the welcoming address to the group in which he said that these Medical Meetings are a very live subject with the Directors of Socony-Vacuum Oil Co,, Inc. Mr. Beatty continued by saying that absenteeism is mostly caused by physical difficulties rather than by serious ac cidents. He urged the doctors and nurses not to think of the people they are treat ing merely as cases, statistics or reoorts and that there is more to it than mak ing them pHysically well. Patients should not be thought of as cases, but as in dividuals who may be laboring under great difficulties. Mental health is of great importance to the Company so that the employees can express themselves properly in their jobs. GRC'VTH AKD DEVELOPMENT CF THE SOCONY-VACUUM MEDICAL DEPARTMENTS A, , Hoag, M.D,.Medical Director, 26 3roadway, New ^ork City In 1945 there were no Medical Clinics throughout the Socony-Vacuum Refineries or the Marketing Division, with the exception of Magnolia Petroleum, General Petroleum had a most excellent Medical Department located at Vernon, California. During the war this department was dismantled and the equipment disposed of so that at Vernon and Torrance only First Aid rooms are maintained. At the Home Office, ere-placement examinations and examinations for foreign service were made. At 26 Broadway we were carrying on a Medical Department in a small wav due to lack of space. Since we were given the go-ahead signal in July of 1945, Medical Departments have been established in all of our Refineries with the exception of East Providence, R, I. and Franklin, Pennsylvania. East Providence is now in the process of establishing its Medical Department. Milwaukee (TCiadhams Division) was the first Marketing Division to set up a Medical Department. Boston will be the second. Management has cooperated most heartily in the Medic-al program. Dr. Hoag presented the following informative figures compiled from the monthly recorts of all our Refineries for the six-month period January through June, IS481 Total number of Employees Using Medical Department . . 7,467 Total number of Visits ................... ..... ....................... 41,140 Total number of Periodic *Ex*am*i*na*tio*ns* . ................................ 1,607 Total number of Visits in 1947 ................................ .... 62,820 Estimated Total number of Visits for 1945 ........................... 84,280 - 2- 449095 GROWTH aND DEVILOPtSMT OF SOCOWY-VACUUM MBDICAL DEPARTMENTS (Continued) . 'v> Our Medical Departments are striving for the following! (l) Preventive Medi cine, which includes Periodic Health Examinations, with correction of all ahnormal conditions where possible and a followup system maintained on such cases. (2) To work with the Safety Department in an advisory capacity to cut down accidents, pre vent and control Industrial hazards, sanitation, eto. (3) Hunan relations, . 'Ye offer cur employees a more extensive medical coverage than does any other industry, '.Ye do not interfere with doctors in private practice* in fact, we try to help them, VTe strees that we are treating individuals rather than groups of people. The amazing strides which have been accomplished in Socony-Vacuum Medical De partments makes it outstanding in the field of Industrial Medicine, This is due to the fine cooperation of the doctors and nurses in tho organization. If it were not for this teamwork and cooperation, we would not be one of the leaders in this field. Through our close association and our interchange of ideas, we hope not only to maintain our present standing, but also to continue to advance it. FUTURE OUTLOOK OF PUP. MEPI CAL DZ?ART?1NTS Mr, v. H. ."oatgomery, Panfger, Industrial Relations, 26 Broadway, New York City Mr. Montgomery opened his remarks by stating that the Industrial Relations Ad visors are always glad to have the opportunity of attending the Annual Medical Meet ing, because they receive a great deal of help in beinr able to discuss various problems. Cr'.'irallv, our lecical apartments were looked u_on orir.arily as First Aid Units. Now we find we cannot run a Medical Department on this basis. Cur view goes far tevend this. Cur aim is to give thorough pre-placement examinations, com plete periodic health examinations and oroper treatment for each case, in order to use our manpower to the greatest advantage. Fre-placement examinations are a very important cart of our Medical Departments because as future emplovees for the Connany, we must take into consideration whether or not an employee will cost the Company a great deal of money over a long period cf time during his employment. Periodic health examinations cover such situations as when an employee is be ing transferred from a certain type job to another which is entirely different as to its physical requirements. Also, periodic check-ups are extremely valuable in that various phases of bad health nay be located during such an examination and by discovering them early end correcting then, we have a much more efficient em ployee and a happier one. This factor is definitely an important one beccuse of the fact that so many Socony-Vacuura employees are long-term employees. Also, in recent years we have come to recognize the importance of psychosomatic medicine in our examinations. It should be noted that during 19 47 the cost of running the Medical Departmert - 3- 449096 FUTJRE OUTLOOK 0? 00R MEDICAL DEPARTMENTS (Continued) in one of our large operations was $2,000,000. However, all the above faotors must be taken into consideration and all contribute to the efficienoy of the Company and in this way our Medical Departments justify such set-ups. The future outlook of our Hedloal Departments iaf therefore,hr 3oston (Marketing) Division is now trying to make arrangements'for more nedi oax^"^ facilities. "ow the real future problem is that of getting facilities where there are only a few eadoyees in one location. HYZP.Q?LUC?.IC ACID ALKYLATION Dr. N. X. Chesley, Plant Physician, Paulsboro, New Jersey Hydrofluoric Acid is used as a catalyst in the treatment of Butane Buter.e Stock as received from the various types of cracking processes for the production of Iso outer.e, light and heavy aikyletes. Safety precautions and instructions consist of protective Neoprene gloves, hoots, clothing, hots with transparent shields and external air supoly, The area is supplied with frequent emergency shower locations and a central First Aid Room with an alkaline bath, aye washing fountain and supplies used in treatment of the burns. The eroloyee should be instructed in the peculiarities of H.F, burns. That is, trot the burn of the aqueous solutions may be an hour or more in developing, -vrr. r f*!-->r \h_ r. hr s ths ^ 1 r.t th b'irr: oi* ~h.Anhvdro'js Kvcrcf 1 ..c r i c A:id is felt immediately ar.d produces a white blanched area. In either case tho important and fundamental steps are (l) promptness, (2) prolonged washing with w'ter, (3) application of H.F. caste. The men t re gi'-er. on instruction sheet covering (l) burns noticed at home and (2) after-care of burns treated at the Plant. The above safety orecautions and first aid instructions should be made olear to the men, but should not be over-stressed. From the viewpoint of the Medical Deoartr.sr.t, treatment of H.F. burns mav be divided into two classifications -- mild and severe. The mild H.F. burn presents a* white blanched area and should be washed with running water for five minutes, swab bed lightly -with 20?? ammonia solution, and washed again with running -water for fif teen to thirty minutes, or until blanched areos appear pink in color. Then a paste consisting of liagnesium Sulfate, 30f?; Magnesium Oxide, 4??j Glycerine, 15^; Procaine, 1/2& water base QS is spoiled. If evaporation occurs, sterile water may be added, (ilever use ointments or greases). The patient is given a sheet instructing him to moisten and change the bandage at stated times. -4- 449097 1331 HYDROFLUORIC ACID iUYLATICB (Continued) The severe burn case ia often in shook and indicated treatment ia instituted. The severe H.F. burn itself ia treated in the same manner, but may require longer washing period before the blanching disappears --- when blanching does not disap pear after a reasonable time, one hour, infiltration of the tissues under and sur rounding the burn with 10< Caloium (Jluoonots la dona^to preventjftfrthe^ aaorosl'irby' the formation of innocuous oalolum fluoride from da glvRona'fee and'nfiy^o?^'Xir fluoric acid. The burns which are neglected or untreated may require incision to allow pene tration of medication end release of contaminated serous fluids. In unusual exposures, the following routines are used: (l) Inhalation of con centrated fumes: inhalation of week ammonia fumes, oxygen- tent and routine pul monary treatment. (2) Oral ingestion: gastric lavage with lime water, sodium bi carbonate solution or crlctum gluconate solution continued for l/2 hour. Suitable shock therapy, and injection of lOcc or 20cc of 10?? calcium gluconate intravenously is used in both (1) and (2). (3) Eye burns should be anaesthetized with 49? cocaine or 2? procaine. The eye is flushed 'with water and frequent applications of Mlk of Magnesia, using an eye cup, are made for a period of fifteen minutes washing out all Mrsr.osia particles carefully from the eye. Holocaine end epinephrine are finally applied. (4) Burns under the nail require novocain anaesthesia and resection of the dist-l half of the nail followed by routine treatment of tho area. (Do not per mit nrr.or.ia to get into the eye). instruction sheet for znelqyees Hycr011-cric Acid burns c.ny part of the body that it comes in contact with, as ices any other acid. For this reason, protective clothing and safety procedures rre instituted and should be carefully followed. In case you cone in contact with Hydrofluoric Acid, report immediately to your foreman or sub-foremen. If they are not available, immediate washing of the parts with runr.inr water for fifteen minutes or until medical treatment is available. After your treatment at the Medical Department, you will be given gauze band ages and sr-ecial H.F. paste. The dressing should be moistened with oool water, that hr s beer, boiled, every 2 or 3 hours. A fresh dressing with H.F. paste spread on gauze should be apolied and loosely bandaged every 4 to 6 hours. In case you should notice a burn after leaving the Plant, wash the parts with running water fer fifteen to twenty minutes and apply Milk of Megnesia and bandage lightly. Call the Plant for further instructions or treatment, DO NOT APPLY A GREASE OR "BURN OINTMENT ** TO HYDROFLUORIC BURNS. - 5 - 449098 - OCCUPATIONAL CANCgR < Dr, 'Marshall Clinton, Plant PhyaloleJ, Atlas Works, 3uffalo, New Tort Unfortunately, there haa been considerable loose talk In the lay press concern ing the prevalence of cancer among workers- In petroleum refineries and in filling stations which has reflected on the industry a certain air of misunderstanding and bad feeling. There are many isolated reports of carotnom5f`deveiooiLmg as"*artfsult^o?' erposure to various petroleum fractions. Kany of these are poorly documented and fail to stand critical inspection. There are certain publications by certain authors, how ever, which indicate that a real and serious problem exists. The most convincing reports are the following: A. Scott and others have reported the occurrence of a significant incidence of cancer among workers in Scottish shale oil refineries. A total of 65 cases of skin cancer among these workers was reported by Scott in 1929. S. Another group of occupational cancers reported primarily In England is the so-called "mule-spinners9 cancer, occurring among workers in the cotton textile industry in England. These are the most common cancers associated with petroleum products. 1. Still another group of occupational cancers occurring among workers ex posed to cetroleum products are the epitheliomata noted among pressmen operating the filter cresses used in separating paraffin from the fairly heavy paraffin dis tillates. T. The final convincing group of cases are those reoerted by Schwartz, Tuli- car. arc They examined 743 oil field workers ir. California. Cf these, 146 :;uro to have keratotic lesions on the hands, forearms, face or neck; and seven had ecithelicmas on the exposed surfaces of the body. Lost of the epitheli- :mas cocurred among blond workers, although brunettes predominated. -- Various other retorts cf occutational cancer due to exposure to petroleum substances are encoun tered ir. the literature. The role of coal tar and soot in producing cancer is well established. Prob ably one of the earliest known and certainly one of the moat notorious types of oc cupational cancer is the chimney sweeps' cancer encountered in England. Coal tar and pitch are said to be the most common causes of occupational cancer. The tar and pitch derived from gas works are the most carcinogenic. Another group of occucational cancers whioh by some are considered as produced by coal tar derivatives are the bladder carcinomas encountered in the aniline dye industry. The offending carcinogenic agents in the dyestuff industry apparently are aniline, benzidine and beta naphthylamine. There are several metals which have been associated with the development of oc cupational cancer. The information on the develocment of occupational cancer due to exposure to mentals (almost invariably in the form of soluble salt) is not as precise as would be desirable, but the following will perhaps be of benefit! - 6- 449099 e *5 V OCCUPATIONAL CASCSS (Continued) A. Arsenio is well lenown as a keratogenic agent, and when handled by aamy years may result in the development of epitheliomas. Specific and apparently re liable reports in the literature include three cases developing after many years' exposure to sheep dip containing arsenioj an individual using an inseot poison con taining arsenic for about Jfojir ^earsj^and four instance* in vineyard workers us ing arsenic sprays, 3,Thirty cases of pulmonary oarcinoma were reported by various authors among workers exposed to chr onates and bichromates in Germany and recently an extreme incidence of bronchogenic carcinoma has been encountered in the United States in a plant producing bichromates. C. Hare or occasional instances of occupational cancer occurring as a result of exposure to cobalt, lead, iron oxide and other metals have been reported, but the case against most of these is obscure. The role of radiant energy in the development of occupational cancer is well knew. Cutaneous cencer among workers exposed to bright sunlight is cornnon end cases exnosed primarily to infra-red radiation have been reported. The occurrence of malignancy as a result of exposure to ionizing radiation is 'well known. Cancers, especially epitheliomas, ara known to be frequent among radium operators, doctors, nurses and technicians who work with radium or X-ray, Occupational cancer represents a definite hazard in a variety of industries, not the least of which is the oetrcleum industry. In those exposed to petroleum croducts, a considerable incidence of occupational cancer has so far been "nocur.ter- ed or ime r i lv refiners of Scottish shale oil, r: or.g cotton textile mule sc in ner s in ir.gland, among paraffin pressmen in many areas, and finally among oil field workers in California, These isolated findings indicate beyond doubt that the pro duction of cancer in man as a result of contact with petroleum substances does oc cur, and thut a problem exists. Gne_cannot escape the conclusion that the production of occupational cancer by petroleum substances is poorly understood. There appears to be a great need for further surveys to obtain ucourate information on the incidence of such cancer and for a means of correlating the information obtained in surveys with experi mental information on the composition and potential carcinogenicity of the products to which the workers are exposed. It must be emphasized that the information presented above indicates the situ ation with respect to petroleum refinery processes involved in use prior to the in troduction of modern catalytic refining. It is urged that the Medical Departments of the various refineries pay partic ular attention to the possible development of malignancy among workers who may be exposed to such materials, and that frequent periodical examinations be performed on this group so that any trouble which may develop can be sootted early and ap propriate remedial measures introduced before any serious consequences occur. - 7- 449100 07334 APPLICATIOH OF PSYCHOSOMATIC MBDIepB I* ISOCSTgT Dr. H. L. Ruttlar, Aaaoolata Physician^ 36 Broadway, flew York City The pretotice of Psyohosomatio Medicine, which considers a person's mind and body indivisible, is espeoially important to the Industrial Physician for so many asoects of Industrial Medicine are directly related to Industrial delations prob lems. Because of the relationship between the doctor and the patient, the employee frequently "lets his hair down* and the physioian then learns what in the inter personal relationships of the plant arr oaustng trouble* Absenteeism, ocopeny dis cipline, accident proneness, suoervisors, shop grievances and alcoholism are among the things 'which people working for a living reaot to emotionally and instinctively. The extent to which they react is proportionate to the number and severity of the worker's own personal problems which males for substandard adjustments to the iob and faulty interpersonal relationships generally. These faulty adjustments frequently turn up in the doctor's office as bodily manifestations of psychological tensions and anxieties. Emotionally upset people, because their basio, fundamental needs, motives goals and objectives in life are being thwrrted or frustrated in their fulfillment may react 'with fear, anger, resentment, worry, envy, disgust or hatred. These ofti.-.es lead to industrial disease and disability, including the inval id habit. Absenteeism, very costly annua'ly to industry, is frequently caused by indi viduals converting their unpleasant emotions into bodily symptoms. In addition, there are hordes of inefficients and ineffectives not sufficiently ill to be absent. Shorn discipline, or leer of it, also contributes a number of patients to the psyc csomatic practice. The staff likes discipline, oroperly carried out by the s visor. It feels it is beneficial to them as a group ana thereby the work is touted eeuc.llv and fairly and "favoritism." is r.ct being cracticed. Ther-fira the supervisor should be oriented, net cr..y in r.r.; to get out produof.cn or.: ad minister top-management policy, but also in how to lead men. Employees are vitally interested in whet the supervisor will fight for, fight against and whether he will make any positive effort at all so far as they are concerned. They are dependent uccr. their foremen, sometimes for their very security. Quite aside from the cash ir.ccme rr.d ether considerations which come from a job, there is a psychic income which is -even mere important. It is the satisfaction of the job, of a job well done, Too many are depending on their jobs to provide satisfactions and security they ore not receiving elsewhere in their lives. Thus their very seourlty depends on it. Therefore, poor interpretation or execution of company policy by the supervisor never frils to brew discontent, production goes down, the illness rate increases and absenteeism soars. Shop grievances are commonly due to faulty human relations between foremen and workmen and emong the workers themselves. Although we cannot make minor psychotherapists out of foremen, they should know that much and a little more. A person cannot be an effective worker if he is worried or full of bad feel ings of one sort or another, because he cannot keep his mind on his work. This is especially true of individuals with worries at home. The emotional problems of liv ing affect our every activity and the job is a large share of our activity. - 3- 449101 APPLICATION OF PSYCHOSOMATIC IflSDlCIKE nr INDPSTBY (Continued) This is applioable to accident proneness in which it is known that very few accidents are accidental. They are a product of a tendency of certain individuals with emotional and mental problems; of the individual whose main defense is to ret out inpulsively a psychic oonfliot, rather than to consider it and deal with It rationally. The aooident represents a deliberate, if unoonsolous, attempt to injure himself, usually as propitiation for some guilt, and they ore unabl* t$ inhibit iai-' pulsive expressions of hostility. Perhaps more careful selection of oandidr.tes for employment, both by the employment office and the Msdicrl Department and a nor-; close cooperation between the two any reduce the accident rate. Each ccr.didcte should be rated on the degree of his general emotional stability before employment and then it behooves the supervisor to promptly recognize shifts in mood which fore tell possibility of an accident (manipulation, dexterity, rhythm, reaction time cr.d visual acuity), because emotional stability is a fluctuating factor even in the most stable people. By the same token, since good workers don't always mrke good supervisors, can didates for advancement from minor to major positions within the con-'any should be subject to survey as'to emotional aptitude. This, the ?.edicr.l Department should bo preorred to advise management about. Eyperter.si"es at age 40 ere not only psychosomatic subjects, tut their work as well os their life expectancy may be short ened. Their usefulness to the comotmy will be of shorter duration. Likewise, many who climb the ladder of advancement and do very well, may be emotionally unable to take the final jump without reacting with too much worry about the added responsi bility. Ir. the srhere cf psychosomatic medicine, physicians have achieved much r. o mu s t r.e i t ra-; lir.eating situation mu.exes wr.'.cr. prcauce tension, lean, Irustrutior. and cisarpointm.ent, which in turn lead to physiccl and mental breakdown, accident prenenoss and repeated illness. The work situation is el 1-important in determining mental health and there is a cr.usa.l connection between interpersonal stress end labormanagement orctlems. Even those cf us in the rigidly specialist practice of medi cine mu-st recornize the importance of the c-motional causation of maladies and in clude in cur treatment the psychological approach. Without such an approach, we cannot successfully treat a large segment of our patients because we are failing to recognize typical syndromes of mind-body interplay. Osier `wisely said, "The practice of medicine is an rrt, not a trndo; a calling, not n business; a calling in which your heart will be exercised equally with your head. Often the best part of your work will hr're nothing to do with potions and powders, but with the exercise of the influence of the strong uoon the weak, the righteous uoon the wicked r.nd the wise upon the foolish.TM SUPERVISION OF WORKERS EXPOSED TO LEAD Dr, M, N, Reward, "'lunt Physician, East River Operations, New York The presence of ler4d in the human body has been described in many scientific articles, and around oil refineries by many unscientific ohrrses and in strange - 9- 449102 SUPERVISION GF WORKERS EXPOSED TO LEAD (Contlimed) ar.atomior.1 locations, However, it was not until October of 1947 that the toxioology of lead was of much concern at the East River Paint Hill, After first being introduced to the lead poisoning problem here, certain ob jectives were set up -- (a) To determine nnd to establish satisfactory o 1 inioeI* "measures to diagnose lead absorption before lead intoxioation developed, (}>) 'To`ar-*y determine if hazardous lead exposure wes present during any of the mr.nufrduring crocesses in the Paint Mill and to correct such conditions. Primarily, lead is absorbed into the body by inhalation of air containing lead dust or lend vapors. Through the lungs it goes directly into the general circula tion so that none of it can be excreted, without first being absorbed. Only or ganic lead ccr.oounds such as tetraethyl lend are absorbed through the skin in sig nificant amounts, Cr.ce in the general circulation, lead reaches all pr rts of the body. The main storage sites are in the bones, liver and muscles. It may also be deposited in the gums giving r familiar lend line. Lend is excreted by way of the urine and feces. Normal individuals with no known exposure to lead also excrete some amounts of lead so that we ha.ve sc-callod r.ormrl levels. Excess lead excretion not only occurs during active absorption, but also weeks and years lamer when mobilized from some storage point. This mobilization may be spontaneous, as a rosult of intercurrent infection, or may be duo to n chrnge in individual metabolic processes, or may be brought on by a de-loading therapy. A share distinction is made between lead : bsorption r.nd lead intoxication. The first ixrli.s -;rc than r.o:--a.i rbsorttior. but wit:.out symptoms dcv-_ 1 oc ir.g, Le ; i ir.t:xi ;ltt :r or poisoning r-.f-.rs to ! = d absorption sufficiently grer t to disturb the individual's wellbeing. This is the stare of toxicity. The difference is, th-.rofor-:, a clir.icrl one rather than by laboratory methods. Thus a worker mny ab sorb lrrd f r.d show a. gum lead line or have constiprtion or poor appetite r.nd show such r.bscrtticn in his blood and urine; if he goes about his work unaware that there is T.ythir.g miss, he is considered a cose of load absorption. In clinical lead poisoning, three charactoristic clinicr.l syndromes are de scribed: (1) Castro-intestinal disturbances, (2) Neuromuscular disturbances, (3) Central nervous system disturbances. The first step in the treating of lead intoxication r.nd. poisoning is to bring the exposure to lend to r.n end. Curing the acute attack of lecd poisoning, no medication must be given to promote lend excre tion, such r. s potassium iodide nnd ammonium chloride. The abdominal pain, usually the most prominent and disturbing symptom, is best relieved by calcium, such ns calcium gluconate. Hot water bottle, atropine and other nntispasmodics may be used. 3c sure of diagnosis before catharsis is given. If serious cerebral symptoms exist, sedrtion orefcrably using large doses of barbiturates rather than morphine to con trol tho excitement, mania, or convulsions. Dj-leading treatment is only to be used after nil acute svr.ptoms of whatever type hr.vo disappeared. Then it is open to question. There is danger ir. this procedure of recorrenco of lead intoxication. - 10 - 449103 SUPERVISION OP WORKERS BCPOSBD TO LEAD (Continued) * .-.ju Perhaps the best way to describe this worlc is to show what was actually done pt the East River Operations. From the medical side, we instituted periodio super vision of the workmen by complete physicals, selcoting those most exposed to the lead products. The various symptoms were noted, blood smears were, dona and^ where indiontod, complete studies the urine end blood,^ vey wns set up to spot oases of Inorecsed lead absorption occur. Our next step was to discover if any serious flaws existed in our manufactur ing processes that would create an undue hazard. This Droblem wns worked on in cooperation with the chemists of the Technical Service Laboratories. We wished to have cir samples, trken from different sites in the Paint Kill, end at different times in relation to the mr.nufecturing processes, analysed for concentration of ler.4 Some of the findings wc-re startling in that they revealed a quite high concentra tion, usually however at known times and places where the men wore respiratory masks. A crr.paign of cleanliness about the plant wr.s instituted to prevent the ac cumulation of dust. Rather than an intake of oir, an exhaust system is desirable. A new Paint Hi 11 is r.ow in the process of construction. Although the changes contemplated are minimal in the old plant, as a result of the studies made, the plans for the new fnotory have been improved. Attention has been paid primarily to the proper design of the manufacturing facilities so that there will be a mini mum of lead free in the working environment. Wherever feasible, closed processes will be used. Although the proper design of a plrnt and its equipment is by far the most important factor in the problem of prevention of lead intoxication, our experi3f.ee proves that constant vigilance must be maintained to be sure that faults do r.ct d.v-oloo ir. the r.. rhr.r.icrl apparatus, that individuals do not absorb load -xoossivelv, Prevention is still advisable in terms of health as well as money. TREATMENT CF PAINFUL PACKS Dr. N, ?, Johr.s'or., Plant Physician, Clean Refinery, Olean, New York Dr, Johnson stntod that the onuses of low book pain are more apt to be lumbo sacral rrther than srcro-iliac. Before ho uses mnnipulation with any of his pa tients, he tries t: measure the limitations of the individual. Preliminary mas sage is given, followed with strapping and heat treatments. Novocain injections are given and the use of a hard bod and hect are recommended for relief. Most of the employees stay on the job during the treatment. Following these epenirg remarks. Dr, Johnson showed a very descriptive and in teresting movie on back mnnipulation. 11 - 449104 A MEDICAL raqOHAM FOR PEOEPCIHq AJD PIPS LINE YfQRXSRS Dr. 5, ?, Duongo, Medloal Direotor, General Potroleim Corporation. Loa Angeles, California With the variety of activities involved in the widely divergent operations of General Petroleum (refining, merchant marine, production, office work, marketing and pipe line) there orn be no one definite medical progra* or set-up whioh will meet the needs of our various operations. Geography and Job variation* aqjfejjfte * task much more difficult than establishing a program for an Industry where opera tions aro more or less uniform rnd under one roof. The scope and standards of the progrrm are divided as follows: 1, Preventive Services, such os physicrl examinations. The purposes of these examinations "re to ini'or a employees as to the condition cf their health and how to maintain or improve their physical condition. Also, to aid management in the judicious placement of employees in jobs they cm perform efficiently without being a hr.zerd to themselves and others. Adequate environmental hygiene is promoted to rid the departments and divisions of the company in matters relating to adequate lighting, vcr-.til-tion, safe water supoly, districution of food, disposal of garbage and insect and rodent control. In fr.tiguo prevention measures assistance is given in an advisory capacity in noise reduction, on questions of adequate rest periods, vacations .and posture rids. Control of communicable diseases such as tuberculosis and venereal disoases is maintained. Other preventive services include mental hy giene, health education, conservation and utilization of eyo sight. 2, Advisory and diagnostic services include acquainting the 'worker with his physicl condition md assisting him in maintaining good health. Evaluation of cmoir.a.cs1 s;n:tr.s using such dv gnostic methods as seem appropriate to the physician in : h r p ., f:r th: purpose cf r-.f orral to private ghysl corns. In g:r.;r-1 this ser vice is limited to cr.s^s involving sick absenteeism, incompatibility of individuals and job, and these borderline cases where symptoms proximate or simlrte disease cosed by employment. 3, 7re-t.-.rnt -- Prompt ar.d efficient handling of illnesses and injuries aris ing cut of or during the course of orr.oloyuent by providing treatment on the spot, rnd 'where necessary, reforral to proper outside medical facilities for complete and c.dequr.to care. Treatment on the job of minor non-compensable disoases and injuries, with the object of keeping the omployee at work. The producing and pipe line workers depend almost entirely upon tho services of Company-selected ohysioic.ns, exoept in unusual oases of injury or disease rnd except for personal liaison work between the Medical Director r.nd tho Companyselected nhysicir.n. Periodic examinations by the Corporation Medical Director, of traduction and pipe line workers at scrttcrod locations has been tried unsuccess fully. It is very impractical to have adeaunte stationary examination facilities distributed in the filed for this purpose. The mobile unit is the solution to the old problem of providing physical ex aminations throughout scattered production end pipe lino operations and in romoto sections of the country. The unit should bo completely equipped with a. modern - 12 - 449105 ' MEDICAL PROGRAM FOB FBODOCI8Q AND PIPS LIHE WCRgM (gogtlnoej) -W r 4, X-ray machine, a photogrnphio dark room, an eleotroaardiogroph, a sight screener for r-pid eye examination, r.nd full froilitie* for routine laboratory examination* including microscopes, centrifuges, sterilisers, end other instruments or supplies needed for complete physioal examinations. The staff of a mobile unit should sist of one physiol an, r. laboratory r.nd ~ ^ The services of the unit should be sold on a voluntary basis. This is not dif ficult when oroper educational steps are taken with both employees and management. Examinations must be oomolete rnd the results given to the employee. Diagnoses are not furnished management and they receive placement information only in those few cases where a condition is found which might render the employee a hasard to him self or ethers. It goes without saying, that ell dealings between the physician and the employee must be strictly on a physic inn-patient relationship. Those units should perform diagnosis only and if ailmonts ere found, employees should be reforred to their privato physicians for treatment. In addition to the advantages obtained from the standpoint of preventive in dustrial medicine, suoh a unit is c. definite fretor for good moralo in making pro duction rnd pipo line workers feel something is being done for them even though the services are not on as great a scale as those in a central stationary medicrl de partment, ` -- - - Dr. Luongo then showed colored slides of tho producing and pipe line work and the crcccsed mobile unit. (Further comments regarding the mobile unit will appear later in the minutes). nr.? c.o: oua aiincs give more efficient care to our employees? Dr. I.!, R, Schmidt, Plant "hysician, Trenton Refinery, Trenton, Michigan In cur relation to the employee, the care given should be on a personal basis, not chat of tho impersonal typo so often found in clinics. The purpose of our clinics is that of adequate care of the health of the industrial workers. Industry is not in the business of practicing medicine, but has established clinics to provide the necessary care required by law. It is industry's right to determine how much more, above the requirements of the lew, that they will assume in giving medical care to the individual. Many industries assume more responsi bility ir. caring for the onoloyoa then they ere requirod by law. It is the physi cian's resronsibility to seo that the employee has the best of care possible. In order to provido these things, our olinics should have adequate space for their department, sufficient supplies, equipment rnd trained personnel. The duties of tho me-die a. 1 personnel include: (1) To ascertain by exr.minr.tion the physical rnd mentrl fitness of anployoes for work. (2) To maintain rnd improve tho health and officiency of thoso already employed* (3) To educato the worker in ccoident pre vention and personal hygiene, (4) To reduce lost time and absenteeism from illness and injury. 13 - 449106 To care efficiently for the employee, the medioal peraonnol oist 'be intLwtely acquainted with the hazards of the industry to whioh they are attached. Thus an employeo ern be treated for hie illness or injury without lost notion* The olinio should be arranged so that the equipment and supplies nro roadily available for use. Utrte the keeping of reoords. Some of the funotions of the Medioal Department aret Pre-placement examina tions, sanitary control, safety education, health programs, (tuberculosis, cancer, cr.d venerocl diseases), annual phyaioal examinations, care of the sick and injured workers. Pre-placcment examinations are essential in that they weed out those physical ly and mentally unfit. With the sick end accident insurenow program associated with our plants, it soems inadvisable to employ anyone with a physioal disability, '.'/hen such a person is hired, tho industry assumes responsibility-of his future ill ness or.d adds a further economic hazard to the insuranoe program. -- Sanitary control includes ventilction, wrter supoly, food, lighting, housing r_nd toilet fac ilities. These should be kept in good working condition, otherwise illness in the plant will inorease, along with absenteeism. -- Safety eduontlonTis primarily'the function of the safety department, but often the Uodloal Department can given ad vice. -- Health programs such as tuberculosis, cancer and venereal education can be aided greatly through the Medical Department. The employees can be informed of the benefits of such programs and are more readily amendable to suggestions by the medical personnel then otherwise, ----- Annual physical examinations, should bo dcro, Turir.r th' oourst of crch c xarir.et ion, health or other problems can be discussed with the individual and advice given, --- Injuries should be treated to the best of our abilities at the clinic. How much can be done depends upon the equipment pre sent. --- Advice in illness can, and should be given to all employees, but the patient-physician relationship should not be encroached upon. Each individual em ployee h-s the right to choose his.own physician and the medical personnel should never try to impose themselves upon the individual employee. The offioionoy of our olinios omm not be measured by the number of patients that are treatod daily or by the time oonsumed. It should be judgod more by tho results produced, the morale of the employees and the degree of5 dbsenteoiam. To give the most efficient care to employees, the Medical personnel must be fully cognizant of the hazards of the industry to which attached; the type of emoloycos and the physical characteristics of the olinic in which they work. THE ANNUITANT'S PLACE IN INDUSTRIAL MEDICINE Miss Olga A, Ericson, R.N., Head Nurse. 26 Broadway, Sew York**City The Industrial Relations Department has recently developed, a system whereby all Annuitants are contacted, preferably by personal call at least once each year, 14 - 449107 TH2 ANNUITANT'S PLACE IN INDUSTRIAL MEDICINE (Continued) This is done by the Department in which he wns employed at the time of retirement. The visitor inquires, among other things, as to the Annuitant's health and wellbein'; rr.d this information is reported on a printed form. Those completed reports are sent by the Department Heads to the 26 Broadway Industrial Relations Advisor, where a record is ketrt covering every 26 Brocdwr.y Annuitant, Any reports of ill ness rre especially noted end in turn the lledioal Director is advised rnd ho ar ranges for a further personal visit by a representative of the Medical Department. In doing this type of work, one realizes in full the vrlue of being an employee of Sccony-Vacuum. Tho very fact that cn employee, upon retirement, does not be come the "forgotten man" is priceless in itself. T.'e must acknowledge tho fact that with the accroach of old age, there ar9 always numerous fears. Being left alone, illness, becoming a charge and last, but not least, being deserted by our friends. It is true that the averato individual, in this busy world of ours, has very littlo time to visit the chronically ill. Ir. visiting, one must diplomatically ascertain the annuitant's phvsicrl, finar.cirl and medical st-t'us, as well as their surroundings. Such questions cannot be esked directly, either of the patient or tho family. They must be drawn out in casual conversation. After each visit, a detailed report is sent to tho Medical Director, who in turn sends it to the 23 Broadway Industrial Relations Advisor, Stress in laid upon the requirements necessary. If it is possible for a. chrnge to be mr.de, recommenda tions to that affect arc sent in. The erse is then brought before tho Annuity and Insurance C:mia.itt;e and special consideration is given to each cr-sa. The Medical Department then assists ir. orrrving out such recommendations s may be approved. CTIAC OINDITICNS aND ??.-PLACEMENT EXAMINATIONS Tr. T. C. St. John, Plant Physician, East St. Louis Refinery, E. St, Louis, III, Cur problem in the Socony-Vncuum Oil Company is an unusual ono because we have such a great number of long-term employees. Our Pro-placement examinations, rela tive to cardiac conditions, must be conscientious and searching in order to <-id in reducing non-occupctionr.l disabilities, to place a person physically suited for the particular Job he is to perform as well as to el low scientific follow-ups. Pre-placement examinations are necessary to assure an equitable supoly of healthy men and women who will be able to carry on the duties of their jobs for the long-term employment with our ComDnny. We ern reduce the non-occuprtionr.l dis abilities, in cardiac oases, by determining the type of worker at the time of the Pre-placement examinations. V.'e evaluate our cardiac cases at Pre-placement by noting the following factors: (1) Previous history, including personal, military service and insuranco company histories. (2) Objective signs as shown by physical examination such as cyanosis, edema, dyspnea, liver enlargement and rales in bases of the lungs. (3) Murmurs. - 15 - 449108 072-C CARPI AC CONDITIONS AND FRB-PLACEMENT EXAMINATIONS (Continued) (4) Sire and contour of the heart. (5) Blood pressure end pulse exercise tolerance test, including rate changes, irregularities, cyanosis, dyspnea and blood pressura changes from the normal. (6) Ability to hold brecth for a reasonable period of time. (7) Laboratory aids when they are available. Our Pre-plaoement examinations, relative to cardiac cases, are striotr We are '-ced with the problem of an ever increasing number of pathological cardiac oases .vr.ich need proper placement in employment. The olacenent depends upon the needs of our industry and the availability of manpower. The followine are cases 'which we reject: (l) Hypertensives 'with history or reading of 150/lC0, Wc believe a hypertensive, especially the younger hypertensive, must not be started on a long-term program, as in our Company, since their chysio- 1 condition -will not stand it and the man and the Company both will suffer by the experiment. (2) Myocardial diserse with signs of decompensation. (3) History of Coronarv Thrombosis. (4) L^utio heart disease. (5) Proved aneurysm. (6) Enlarge ment of the heart with thyrotoxicosis. V-ntriculor extra.systoles in persons above 40 years of age. (8) Heart block cases. (9) Auricular flutter and auricular fib rillation oases. (10) Acute rheumatic c-ses with high temperature, high white blood coll count, high sediment-cion rate -r.d alterations in the olectrocardiograchic tr ..cing. 'Our periodic and special examinations, relative to cardiac cr ses, are less of a. "weeding outTM process and more of a proper placement process. Vfe are more inter ested in our emoloyees than in an applicant for work and we make use of the labora tory rids to a muoh greater extent in these examinations. Those examinations -re volur.t'-ry and tho worker knows his emoioymer.t status is not influenced, r. if re verse thysical conditions 're found at examination. Tho periodic ar.d special c-xr.mir.rtions, during tho course of employment, allows the thysican to watch the development of cardiac oases in specific instances, hr. .r. the onset of a disabling heart disease and disability is detected, the plv'sici-n may correct and prolong useful life expectancy of the worker. Prognosis in cardiac cases is valuable to industry. "It gives industry q chance to train someone to replace a key emoloyee, A prognosis is possible when a case is observed often during the period of years and when we have the kidney tests, the electrocardiographic tracing, the opthclmoscopic examination, chest plate etc, to assist us. A favorable prognosis is possible if periodic physical examinations bring about a ore per oiacement of the emoloyee and when ailments are detected and early treat ment is instituted, (7e consider every heart case on probation until his capacity to do this par ticular tyre of work is definite and proved. Cardiacs should not bo exposed to rosDiratory infections, heavy lifting, climbing or cold temperatures, "fe recognize the fact that cardiac cases are most difficult to place because of the progressive nature of the disease. They must be placed in jobs within the limit of their physiorl capacity. --- Each cardiac case is an individual placement problem. - 16 - 449109 97343 THE S0C0NY-7ACUUM INDUSTRIAL NURSE Mrs, Doris K. Krleger, R.N., Consulting Nurse, 26 Broadway, New York City Cur Medical Director wants our Medical Departments to meet all the require ments of the American College of Surgeons. If the Medical Departments and !furses meet the following requirements, this can be done. Industrial effloienoy with maximum production at lowest cost, is the goal of every industry. The most important factor influencing this objective i3 the phvsicai and emotional status of each individual employed. To secure ar.d maintain a healthy working force, it is the aim of management and it is the Medical Departments responsibility no see that this is done as well as possible. An important qualification for our nurses is to have an interest in and the ability to work -with all types of people. Tact and diplomacy to cope with condi tions that may arise unexpectedly, are essential. She should be tempermentally fitted for the various kinds of demands made upon her resources. The nurses in our Medical Departments must be ambitious not for personal gains, but anxious and en thusiastic to help those with whom she work3. Or.e of her outstanding qualities should be initiative. She should be able to do a job without detailed instructions. Management will assume that her professional qualifications have been verified by a physician and she knows what should be done and will eive her leeway to do what she sees fit. Along with initiative there must be a good portion of judgment, A good nurse can take great professional pride in her 'work and should know that her work will be appreciated. The nurse should prepare and assist in Pre-placement ar.d Periodic physical ex aminations done at the plant and become somewhat familiar with the feeling and de ficiencies on any particular examination. These f'ndings should not become rublic rrccert". The nurse should r.artici-ats in he!cine create a health consciousness on the part of the workers, and should be fanilar with the community benefit ar.d wel fare association so that she may refer her patients to them when necessary. The nurse should see all employees when they return to work after bc-tr.r off, due to sickness. In this way, she cm keep r check on what is causing lest time ir. the olant. Another function is consultation 'with the employee on personal health problems. In this way she can do a lot of preventive work. First, there is the matter of personal clecnlinass end cleanliness of surroundings. Many employees need helo and guidance along these lines. They may never have had training in personal hygiene and have little regard for their co-worker3 or for Company property, Cne of the outstanding functions of the nurse is to act -as confident to the amcloyee and emissary of management. Because of the nature of her relationship with employees, the nurse is in favorable position to know what is going on in the plant. A great deal of the information is breup-ht freely to the nurse and if used intelligently, it can be a tremendous aid in smoother operation. It is a recognised principle thet all nursing care should be given under the direction of a physician. Every nurse should have a book of Standing Orders to di rect her as to what to do under given conditions or in an emergency. This must be signed by the plant physician, This is a legal protection for her own activities. 449AA0 V- 1' THE S0C0MY-7ACUIJM INDUSTRIAL NURSE (Continued) The Industrial Nurse must know or l9arn how to keep proper and adequate reoords of all the work that Is done in tho Medioal Department and how to assemble monthly reports and statistics from this information. Not only are records re quired by law and by insuranoe oomponiea, but they are important. toJ;ha Cams prove the work of the department, -- To keep the records properly snd accurately, it is absolutely necessary for a Medical Department to have a full-time stenographer. It is impossible for the nurse to carry out her other work end also keep the reeords as they should be kept* An industrial health oroeram reflects itself favorably in efficiency, produc tion and human relationship botween management end workers and it is a definite ad vantage to both. The atmosphere throughout the plant improves greatly. MEDICAL DEPARTMENTS IN MARKETING OPERATIONS Dr. A, 5, Hoag, Medical Director, 26 Broadway, New York City Due to the wide distribution of their personnel, the setting up of Medioal Departments In Marketing is much more difficult than in our refineries, where the employees are more or less under one roof. In Marketing, by combining the division office force with the nearest bulk plant, or similar operation, we have a sufficient number of employees to suo^ort a Medical set-up consisting of a full-time nurse and a cart-time physician. :<e hr re such a set- i ~ in '"ilwaukee new, which v.-e are proud to sav is functioning very well, 'i'e are expecting almost any time now to have a Medical Department in the Mew England Division, The only figures we have to work with at the present time are from the East ern Division, New Ncw England Division has a cor.sentrr.tion in the Boston crea of 34 employees. The Medical Department, which is almost complete, will serve these employees. This leaves 956 employees with only Company-selected physicians in the area in which th^y are working. The Albany Division has 496 employees, which warrants setting up a Medical Department in Albany. This would leave 778 employees to be cared for by the Com pany-selected physicians. The City Division has a total of 525 employees at Hanson Plaoe and North Henry Street, where a Medical set-up could be used. This would leave 906 to be served by Company-selected physicians. The Philadelphis Division has a total of 310 employees at the Philadelphia Of fice and Gibson Point, A Medioal Department could be set up here, 414 employees would then be served by Company-Selected physicians. - 18 - 449111 or:J *o '.'7346 449112 PROPOSED MOBILE UNIT FOR CARE OF EMPLOYEES IN OUTLYINQ DISTRICTS * MEDICAL DEPARTMEBtS' 1> MARIETIBO OPERATIC!! <^V6nyj^ ' ' M, The Lake* Division hat 373 employees at Buffalo ehloh could he served by a Medical Deportment, 299 would then be left to be under the oafe of Caapeaysia9t. ed physiolana. Detroit, St* Lop is and Kansas^ (rfiqii&re nnw.w^ cal Departmen^STout' spade seemr to be"very dlffYbff w It has been brought to our attention by the Industrial Relations people, that the employees in the non-oonoentrated areas are really orphans when it oosies to any kind of Medical attention, . Even thoagh the Company has granted a free Medlaal ex amination on a voluntary basis, only 10% of the emplayeeg^hr-ve availed themselves of this offer. The critioism has been that the type- of examination which is given lacks the thoroughness and interest desired. Just Stow much ttF employee benefits by these periodio examinations is unknown, Ws have no eny efL kpwih whether they fol low the advice given them by the Company*selected-physician or* wiethei* they go to their family physioion for correction or treatment of conditions found. We have 3,353 employees in the Sew England, City, Albany, Philadelphia and Lakes Divisions vho come under the classification of the so-oulled orphans* These could all be served by a Mobile Unit, This Mobile Unit would consist of a trailer divided into three compartments, (1) Examining room and small Surgery)' ("2} "X-ray' ~ Unit, with Elootrocardiogrcph and Eye Screening Testj (3) Laboratory with a dark room for developing. This Mobile Unit could be manned by a nurse fully trained for this work, and a combination driver-technician. Local Company-selected physicians who have been in structed as to the type cf examinations we require, would be used. The Unit would go from bulk plant to bulk plant, tho itinerary being laid out beforehand, so that very little time would be lost. In this way, all of our employees would get proper Medical cere, .* ... -3 - ` ; MEDICAL DEPARTMENTS IN MARKETING OPERATIONS -- FURIHHbCOM^ljT8B -a Mr `7 E. Krueger, Industrial Relations Advisor, w!sdh*m -Dlvislon, Milwaukee, Wisconsin Mr, Krueger opened his remarks by saying that the Manufacturing Division has many more Compensation coses than the Marketing Division^ Ho^eve^ upon survey the Wadhams Division found that they had quite high expenseNT`lndj|ineotioa with their Medical work. They estimated approximately ttQaOO to |50*OQ? jpr employee and were alarmed by this. As a result, a full-time nurse and a part-time physician were employed; to tale care of the various Medical services, The..success.Mediljal-Depqtrtment really depends on the nurse in charge. Previously, there wage--po sjjBeatms rdcords avail able, At the present time, new forms are- being useituaui^ sW^^riant p't very well. - 19 - 449113 0734- V- ` MEDICAL DEPAKTMEITS IH MARXETISO (Continued) The problem at the present time Is that of trying to get the perlodle examina tions done. The examinations which hcve been done in the past by Company-seleoted physicians were not always setisfaotory. For one thing, Mr, Krueger stated, that he felt that the PM-4 Form (Information for Examining Physicians) wua not olei enough and did not explain the rsqulreswnts satisfnotori! ed physioians. MIDI CAL DEPARTMENTS IN MARKETING -- FJRT5ER COMMENTS Mr, R. G, Harmon, Assistant Manager Industrial Relations -- Marketing 26 Broadway, New York City Mr. Harmon added to Mr. Krueger's remarks by stating that there are about 11,000 employees in Domestic Marketing with 1,000 locations where the plants are so small that there is only ono employee. The Marketing Division has tried to establish a partial Medical program by of fering voluntary exr.mir.r tions to be performed by Company-selected physicians. But only ICf. of the employoos have taken advantage of this opportunity, BrT HaSSonF stated, however, that he felt that this was true beor.uso there had hot been a Veal effort to promote the idea to the employees regarding the advantages of such exami nations . REHABILITATION OF INJURED WORKERS Or. D. R. Johns, Plant Physician, East Chicago, Indiana It is verv important to raise the morale of employees with disabilities. Itorir.r. the last twenty yoars, not too imeh has boon done along this line, but since World `-"nr II, there again has been much more done for these people. Rehabilitation is as important as the actual treatment of employees, What has been done since World '.Tar II has been a stimulation to the industrial physician. .e first step is to evaluate the extent of the disability. It is good to in stitute trertment early in the man's illness with placement* in a job best suited to the emoloyee'? disability. The ohysicinn should acquaint himself with the various phases of rehabilitation so that ho knows some of the reauiremonts. Returning of a person to employment within a reasonable length of timo is quite important. Neuro sis develops from having a man away from work too long. The main thing is that this mar. should be looked after and given early treatment. Amputees who have been returned home were instructed how to use their new limbs For the most part, those of us who are industrial physicians, have not followed these men as we should have, Workshops are very essential while the empute.es are convalescing. - 20 - 4491U REHABILI TATI Off OF IKJTJflSD W Industry also hns a problem on the subjeot of Tuberculosis* After release from the hospital, these patients should still be riven a dunce to er.rn a good 11t ing. Silicosis in the middle western states is a problem and must be taken oara of Indus treatment. VALUE OF PERIODIC PHYSICAL EXAMINATIONS IN AH INDUSTRIAL MEDICAL PROGRAM Cr. ?!, ", Howard, Plant Physician, East River Operations, New York The material for this paper wr.s drawn from the records of our Medioal Depart ments at the East River IJanufncturing Operations. 462 physical examinations per formed during the past two years were reviewed. The results summarized below will help to crave how valuable Deriodic physical examinations can be in the discovery rnd treatment of incipient disoaso and the improvement of the health of the indi vidual employee by the correction of minor defects. Of the 462 employees examined, ~only 37 (8J<) had normnl findings*--341-475#)----had some defoot for which active treatment was indicated? In 78 (I7j0^ abniofSali- ' ties were discovered which, although not needing immediate treatment, required per iodic cbservrtion to detect progression to a stage necessitating remedial measures, (Figure 1). These figures are startling in that the great majority of the indivi duals had no knowledge of any disease process existing. The conditions found were listed according to the system of the body affected. They were further broken down into three groups: 1. Those who knew about their disease, but of which we had no record (318). 2. Those who had symptoms but no knowledge of any disease (389), 3. Those who had. no symptoms of any kind (38 2), Thus, the greatest number of defeots woro in groups 2 and 3 and were uncovered ns a result of the periodic examinations. Many of the disorders found were of minor nature, but there ware others that urgently required management for the protection either of the individual or of his fallow-workers. The measures taken varied with the condition. Some erplo^ees were given siok leave to correct their state of health. Othors were able to do this whilo continuing on the job, under supervision and in others a change of work was effected. Although the charts listing the diseases found are too detailed to reproduce here, certain findings warrant singling out for content. 81 cases of psychoneurosis were discovered, varying from individuals who were referred for shock treatment to those having mother-in-law difficulties. Many of these individuals, like the girl rbout to get married, needed only r. sympethetio ear and a reassuring pat on the back to get then back to work. Others needed such a supporting post more frequently, r.nd assistance hes been offered to them. - 21 449115 07249 f 449116 orVALUE PERIODIC PHYSICAL KtAMKAgOW (Continued) There were 31 cases of peptio uloer, 19 of which were found as a result of the symptoms eliolted during the examination and oonfirmad by subsequent 2-rays. The finding of theae oases and the Institution of r. propor regime should not only im prove their health, but also avertor postwja* further anmpint4aw|t 1* hernia* wore fgund.,their ej-1-- *sra-W5i*r --T ,f defective vision, Sl^neeaea glasses at tnia time." 1 ght baseF'M'_3aJ5der< Vere'Kb'ndj one or.se of primary syphilis. In the oardir.o group were 11 oases of heart failure, 15 cases of heart murmurs, rnd 53 cases of high blood pressure. There were 3 cases of diabetes discovered, all unknown to the patients. Not included in the above were 140 cases discovered to have stationary defeats which needed no treatment but were important to note to define the extent of pos sible aggravation by future injuries. For example, notod were soars of fingers, hrnds and free, amputation of fingers or toes, congenital deformities and joint dis abilities which had not been previously recorded. It can readily be appreciated that such records may play an important role in future disability olaims. They are also of importance in assigning these men to tasks where the defect would be a handicap or a hazard. A study was made of a group of 28 foremen and assistant foremen. Of these, 5 averaging 51 l/2 years in age had died of ooronary thrombosis during the preoeding three-year period. Five others averaging 56 yonrs of age were alive but had active symptoms of arterio-sclerotic heart disease. These figures are noteworthy. ^Te are dealing here with men whose loss effects a large segment of an industry as well r.s the individual alone. It serves to focus attention on the possibility of measures of preventing these diseases in this group. As a result of the above study, a zempr a: r.sivo ycrrly cheeNur incl-dirg laboratory studies hr s b'.-er. set u~ far rhr'executive1 personnel. The subject of 'socialized medicine' is a prominent one in current events. In dustrial medicine has often been accused of being a harbinger of 'controlled nedidine'. It has boon our assertion that a properly conducted industrial medic"! pro gram will, by discovering conditions unknown to the person, serve to increase the practice of private physioians. It was, therefore, interesting to find that as a result of our periodic physical examinations in this group of 462 employees, there were 315 conditions found and referred to privato phyrioir.ns for treatment. Most of these 'were referred to specialists rather than to general practitioners since the specific condition had been defined, but this is sound medicine. In addition, another 137 oases were referred for dontal onre. Hot included in these counts are tho numerous cases that were referrod for laboratory work to establish disgr.osos. The time lost by employees as a result of sickness or injury during the past year was analyzed. The route non-occupctionc 1 diseases caused 4,286 man-days lost, whereas the chronic caused 4,111 days. To date, most of our efforts have been di rected to the reduction of lost time due to acute illnesses* The success of theso efforts mny be judged from the 6,089 days lost for a comparable period in 1946-47 as against the 4,286 oited in the 1947-48 period. There was thus a reduction of 1,803 man-days in the group of acute non-occupntional diseases, (Fig. 3). The 449117 449118 07332 FIGURE 3 \ FIGURE! 7ALUS OF PSHIOP1C PHYSICAL SXAKTKATI0I3 (Continued) ?v- most Important illness in this group remains the infections of the upper respira tory tract ('common cold1) whioh acoounted for 2,014 days or about 50jf of the lost time. Whereas noted above there wr.s a deorec.se from the acute diseases, there wcs very little ohnuM rca* one year to the next in the lost time du? to bhronio dlseases. In *h3Ui>k^rlod,J^^ lod 4,377 days were lost making a deorense of only 266 days. Listed beioWare the' ton leading causes of siok time during the past years (Fig. 4) 1. Common Cold 2,014 Days 2. Cardiovascular diseases 1,287 9 3. Malignant tumors 783 9 4. Acute gastro-enteritis diseases 633 (V 5. Chronic musculoskelestal disorders 573 If 6. Chronic gastro-intestinal disorders 449 9 7. Chronio biliarv disorders 387 9 8. Acute musculoskeletal disorders 290 9 9. Pneumonias 255 9 10. Chronic pulmonary diseases 354 9 It will thus be seen that the chronic group of disorders is a more prominent cause of illness than the aoute group. Statistically, it has been demonstrated that the average ago of our poDulntion is .increasing with r. larger proportion of older people. This same condition will obtain among our employees, although ev entually in our groups a stabilised age will be reached. With this increasing group of older people comes the increase in the chronic degenerative disorders that char acterize the aging process in nnn. The causative factors of this grouo of dis orders are obscure, -ultiple r.r.d r.ccurulrtiv-:.. Their onset is slow c.-.d sllant, but characterized by persistant progression, Thoy rarely kill quickly, but are char acterized by long periods of disability and invalidism. To doteot these chronic progressive disorders early so that worthwhile measures of control may be institu ted, they must be anticipated and sought for rathtr than waiting for symptoms to appear. The periodic physical examination is the only means of bringing this about Many of the chronic conditions discovered in the courso of such examinations have resulted in measures of care which should show results in the coming years in cut ting down the lost time from these diseases. The individuals not only should be healthier and hr.ppior, but also continue to contribute to, rather than to drain, the resources of the Company and the country. It is interesting to note in comparison with the above figures that occupa tional injuries during the same period resulted in 314 days lost from work and r.onocoupr.tional injuries resulted in 438 days lost, (Fig. 2). This is strong proof, as has been stntod before, that tho primary concern of industrial medicine is not the first-aid treatment of cuts, bruises and burns, but rather the prevention of diseases common to the general population. For it is tho latter that causes the greatest suffering to the individual and is tho greatest expense to industry in terms of production and money. 449119 ' ~iri- ~)i |r~ -V Hr. W, H. Montgcmeryt With the flr ehown by Dr. Howard, I feel that Xa4 ,* uatrlal Medicine i* an Assistance to private prnotloo rather than taking praotlo# awry frcm then. Reoords take a great deal of tine and effort, but help to dorelop policies and plane for tho future. The Industrial Relations men must hare the ta tisttcs in order to prove to management the points which we are trying to make. ROPNDTALBE DISCUSSION A. Periodic Health Examinations 1. Compulsory or voluntary In the refineries, the periodic examinations are usually on a voluntary basis. Hr. C. P. Salter: In East St. Louis, we are not in favor of compulsory ex aminations, except for pre-pi a cement examinations. We are now trying to sell the idea of periodic examinations. ------------------- ' - - 3r Mr, R. G. Harmon: Management has the right to ask for compulsory examina tions in some instances, especially when a job is a hazardous one, Mr-. Vf, E. Krueger: In the VTadhams Division, 40# of our employees have been examined on a voluntary basis. Lany of the employees are afraid to have a physical examinations for the simple reason that they feel that the doctor will find something wrong with them. Mr, Wt H. Montgomery: I feel that top management should have periodic ex aminations first, then they can stimulate the interest of the other em ployees. However, these examinations still should be on a free-will basis. Periodics should be very thorough, not just superficial. The Marketing Divisions have a problem in that the Company-selected doctors are not as Interested in the examinations as the Plant Physioiana are. Dr, J. J. Gaunt: Generally sneaking, selling the idea of periodic examina tions must be done a great deal by the nurse and the doctor. 2. Complete Check-up on Return from Sick Leave It does not seem that it is necessary to give complete examinations after a sick leave, but it makes a good time to get periodics done. 3. Extent of Examination Urinalysis and X-ray of the chest are quite necessary. An Electrocardio gram is not absolutely necessary unless it is indicated by other findings. 24 449120 ROUNDTABLE DISCUSSION (Continued) 4, Who will Pay for Supplementary Coat of T-raya, Laboratory Work, eta,7 inhere it is thought that it will be of benefit to the Company, suoh work should be paid for by the Company. The deoiaion must be left to the dis cretion of the dootor as to whether or not the work Is to be done. If suoh apeoial work is for the man's own welfare, then he Should pay for it himself. B. Reoorda It was brought out that Monthly Reports were important and were made by the Medical Department so that Management and Industrial Relations could evaluate what was being done in their various Medical Departments. Such reports or statistics of any type, to be of value to themselves or industry at large, must be complete. Minor changes were advocated, such as leaving out the foremen's names, but retaining the names of the various departments. Accident reports are very important for review by the Physician. He can evaluate the type and frequency of accidents by departments and determine the accident-prone employees. This is not for censure by Management, but to work out the cause from the psychosomatic side and to remove the cause by study of the individual, C. Accident Histories '.Vhile every state has a Compensation Law, requirements for filing such Compensa tion claims vary in individual states and are handled differently by individual refir.--rios and Marketing Divisions. 1,1) Medical: A complete history in the patient's own words as to how an acci dent happened, time and place. A good Medical history is of utmost importance. The Medical Department does not fill out any forms that have anything to do with State Compensation except Medical forms, when requested. (2) Sfcfetv: Investigr tions as to how an accident happened may be taken by the Safety Man from the injured. All forms should be edited, cleared and filed with the state authorities by whomever handles Workmen's Compensation matters. It is the resoonsibility of Safety that applicable state forms in Workmen's Compensation are properly made out and referred to the nroper department for transmission to the State Compensation Department, All occupational accidents and diseases seen by the Medical Deportment should be reported immediately to the Claim and Scfety Department (or by whatever rule is laid down by this de partment) so that proper investigation may be instituted. There may be some exceptions to this procedure in various Management set-ups. 449121