Document 6w0agL2z9gexrbbd7d1dz1pX9

FILE NAME: General Motors (GM) DATE: 1939 July DOC#: GM012 DOCUMENT DESCRIPTION: Excerpt from Journal - Industrial Medicine Page 302 INDUSTRIAL MEDICINE July, fererice of employers of small groups has been noted as exemplifying that it is believed that medi cine in industry is still a "patch up" job. It is con ceivable that sickness in the smaller groups is pro portionately greater than in the larger groups, since injury occupies the same statistical fre quency. The points emphasized in regard to health and medical services in smaller groups were: (1) health promotion; (2) the care of industrial acci dents and occupational diseases; (3) control of health hazards; (4) reasonable first aid for sick ness and injury; and (5) cooperation of plant man agers, local physicians and community health groups. Cost seems to be a stumbling-block in the more frequent adoption of medical services by. smaller groups. Such services are frequently sup plied by insurance carriers, and usually the cura tive aspects are emphasized. Standards must be raised by attracting men with ability, by giving courses in industrial medicine and surgery in the regular medical curricula. Men should be trained through medical departments in industry by cor relative courses in industrial surgery. The trou bles of free choice and objections to physical ex aminations vanish when good service is provided in industry. If the insurance companies and in dustry will get together in a cooperative attack on the problem, many important things will easily be done. The selection of competent men was again emphasized. It appears that in large plants the average cost per employee per year is $5.00 to $10.00, whereas in the smaller plants it is $10.00 to $15.00. Evarts showed that a minimum service can be provided at a per capita cost of $10.00 per year. It can, therefore, be concluded that an ade quate service can be provided for the small groups. D r. F rederick Slobe, in discussing this paper, stated that usually a lack of interest formed a definite handicap, and, furthermore, that there was great ignorance concerning this subject among employers; therefore, the necessity for proper edu cation. D R. H. W. LAWRENCE made a presentation on "The Relationship of the Industrial Medical Department to Other Personnel Activities." Hu man failure is costly. The quality of personnel is a definite element in successful industrial progress. Cooperation of the medical department in other activities is highly essential. When claims arise there is given an opportunity to investigate condi tions and to provide complete follow-up, the latter of which is very important. It is also an opportun ity to supply helpful aid to the compensation de partment, but one cannot afford to lose the confi dence of the claimant and therefore must proceed cautiously. The medical department certainly must interpret the technical reports to the other departments in industry. Cooperating with the employment department, the determination of em ployee attitudes and the evaluation of such atti tudes is the most vital thing in industrial relations today. The medical department has an unusual opportunity here. It is essential, however, that the medical department shall not go too far in the extent of medical care. Sanitation and hy are also considerations of great value. It is j important for the medical department to ap human material, as for the engineering dep to appraise its materials. In public relations* medical department has a definite part to with reference to community and national h`` groups. Safety procedures should be coorj:~ with the medical program. In this respect,! study of hazards and control is necessary, reference to the educational department, the ~ cal department should participate in the ev tion of training courses, regarding bulletins,, cles, and various other publications. In sun it is the duty of the medical department to ticipate in prevention, alleviation, and inst D R. W. A. SAWYER talked on "Geria i Relation to Employment." The prob' the old employee has been one that has tracted much attention, but it is now of moment, principally because of the various; of unemployment. The age of 65 has been the threshold of old age, but this may have siderable variation physiologically. Diseases mon to old age are those of the respiratory i cancer, arthritis, heart disease, diabetes, and not occurring as frequently. We are conce~ alone with pathological changes, but alsomotivation, with spirit, and with adaptab" is of considerable significance that the aver is older now than 10 years ago in industi ployees. The figures have probably torted as to the numbers of young men1 hired -- probably there are many inst rehiring which were also counted. The one industry showed that 36% were under 2^ of age; 21% between 22 and 25; 17% bet and 30; and 5.3% over the age of 40 years. ` interest to know that this distribution cof with the general population distribution, oldster, retraining and transfer may be n: but with medical supervision the problem fr' in fact there is no greater difficulty th younger men. Accident frequency is less over age 40 than under (about 40% respectively). There is, however, more; over age 40. In a group of 12,000 emplo"L absence rates were found to be 26.1% for to 29; 22.2% for ages 30 to 39; 22.2% for a 29; and 29.7% for ages 50 and over. In co Dr. Sawyer referred to a recent report of 1 Department on this general subject. / Wednesday Evening T HE ANNUAL BANQUET of the Arne sociation of Industrial Physicians and was held at 6:30 with Dr. C. D. Selby, P~ the Association, as toastmaster.Theguest Mr. W illiam S. K nudsen, President of Motors Corporation, Detroit, spoke on Relations in Industry." Mr. K nudsen sented the K nudsen A ward for the most ing contribution to industrial medicine 1938-1939. The award was made to No. 7 INDUSTRIAL MEDICINE Page 303 igton, of Chicago, and was based on his book "Medicolegal Phases of Occupational lay Morning SUMNER L. KOCH, of Chicago, presented the subject "The Repair of Tendon and Nerve ies." The surgical principles of successful operations may be divided into three (1) use of fine suture material, reduction jjfthe minimum amount of trauma and oozing remfembering that a smooth gliding surface is *' ;imate result desired; (2) a very careful and ing examination before operation; and (3) ative treatment in cases where the patient .already had first aid treatment, realizing that ions come mainly from the respiratory tracts ;e around the patient. Tendon transference helpful. Immobilization is one of the lal principles of proper tendon healing; the must be set at rest. Incisions should be made lei to the skin creases. A series of slides instrated the treatment of wounds and in to various nerves. Slides also demonstrated [types of incisions which were necessary. A iption of the stay suture for tendon suturing also given. For nerves only fine sutures igh the perineurium should be used. Various ations of operation procedures and afterincluding diagrams of operations and apparaand technique, with demonstration of special its and their uses, completed the presentation, discussion, it was brought out that a simple nation of test for sensation would reveal er nerves have been injured. A bloodless by the use of a blood pressure cuff with presof 250 mm. is a simple expedient, but gives illent results. If the wound has been coninated, it should be cleaned, dressed, and put test. If there has been a strep'tococcic infection, is warranted if one waits in some instances as as 12 months before trying to really do any iructive operative work. yR. E. A. CODMAN discussed the subject "Mak ing the World Supraspinatus Conscious." re is an important principle for exploratory ation in injuries to the shoulder, but appar- lly so far there has not been much success in ling recognition of this principle. During the 130 years there has been, however, some slow, emination of appreciation of this procedure, anatomy of the shoulder has been grossly glected by many surgeons. Many times an op tion occurs too late to do any good. In rupture [the tendon of the supraspinatus, the only out lining symptoms are pain and lack of use, and ifindings are liable to be confused with arthDetails of suggestions to the American liege of Surgeons were given relative to the blicalion of recent advances periodically. Il ialso suggested that the Association might corate in this respect. ?In discussing this presentation, D r. G eorge W. le mentioned that a registry of bone sarcoma adopted by the American College of Surgeons at the suggestion of D r. Codman had proved to be of great value. It was further believed that the adoption of the suggestion of the publication of recent advances periodically would also establish good public relations. DR. DAVID GILLESPIE spoke on "Treatment of Hernia." There is no subject of greater im portance to surgery. Hernia is well in the fore front of causes for rejection. D r. G illespie's discussion had reference to treatment, and in cluded treatment by truss, by operation, and by injection. Obviously, a truss is not a cure-all, and it has its limitations; it does, however, provide a palliative safety measure which must be con stantly checked in order to be effective. In the operative treatment, the various types of opera tions were mentioned and described. Particular emphasis was laid on suture material, statistics being given for 314 cases of femoral hernia; re currences occurred to the number of 9.1% with silk suturing; 6.2% with catgut; 27.7% with the so-called Gallic suture. Thorek's operation for undescended testicle was described, and it was mentioned that it gave good results. Bassini's original work on inguinal hernia was reviewed, and it. was stated that the Bassini operation was still the operation of choice for this type of hernia It is desirable to mobilize the layer from above downward in dealing with the transversalis fascia -- this helps to reduce recurrences. In a 10-year study of the use of the Gallie suture, it was found that infection was more common and recurrences more frequent, and that there was no foundation in fact for the original theory. If extensive dis section is necessary, there is much scar tissue produced, with free bleeding. Furthermore, there is a great deal of handling of the fascii strip; the sutures have a tendency to pull out. The recur rences after one year are almost twice those which occur before one year's lapse of time after the operation. In the use of silk sutures, experience has shown that some time is necessary in order to learn how to use silk. A division of the cord is an important principle. There is no method of hernia operation which gives absolutely sure results, as there are causes beyond the control of the operator, such as age, type of hernia, occupation, and. condi tion of tissues; there are, however, causes which are within the control of the operator, such as selection of the type of operation, prevention of postoperative complications, the avoidance of in fection, proper postoperative care, and others. It was concluded that operation is the method of choice in most cases -- there are few where injec tion alone is advisable. Figures were given for the injection method based upon 66 cases, in which there were 84% failures; 6.6% of possible cures, including the wearing of a truss, and 9.3% of socalled actual cures. The difficulties which present in the injection method are those of delivering the injection solution where most needed and of pro moting gradual absorption; it was determined that one solution is as good as another. Fowler was Page 304 INDUSTRIAL MEDICINE July, quoted as saying that we have little adequate knowledge on the recurrence rate of the injection method. Kelly believes that the sclerotic tissue entirely disappears. AT AN especially arranged luncheon at the . Cleveland Rotary Club, the guest speaker was D r. L oyal A. Shoudy, Medical Director, Beth lehem Steel Corporation, who spoke on "The Doctor Goes to Work in Industry." A review of the doctor's work in industry was made, and hu man relationships were especially stressed. Experi ences from D r. Shoudy's rich supply were given to show that in industry medical work is a "manto-man" responsibility, and that one can make con siderable progress by instilling confidence; in fact, this is the basic principle. A plea was made for more close cooperation between management and medical men. Thursday Afternoon D R. HENRY H. KESSLER gave an excellent presentation on "Operative Problems in Re habilitation of the Injured." This was a combined lantern slide, motion picture, and patient demon stration of the use of the cineplastic arm. The technique of the preparation of the arm was ex plained both by slides and motion pictures and by allusion to the patients, and the mechanics of the cineplastic apparatus were likewise demonstrated by these means. It is impossible to give an ade quate word picture of the interesting and unusual results which have thus been obtained, but the simple principle is to establish the use of an ap paratus which permits grasping objects with an artificial hand, by making use of the muscles which remain to control this grasping power. Dr. K essler has had about 100 cases of this type, of which 50 were considered successful, about 25 fair, and the rest failures. Cases must obviously be selected carefully, but it has been found that re education of the muscles is not necessary to suc cess. The cost of the apparatus varies from $175 to $250 according to the site of the amputation. DR. JOHN S. COULTER demonstrated by lan>tern slides "Physiotherapy Problems in Re habilitation of the Injured." It is important that the physician should do the prescribing of physical therapy in using this form of treatment. Dr. Philip Wilson has stated that the next great ad vance in fracture treatment is the recognition of physiotherapy methods, and that this form will outstrip others if properly used by physicians. One does not need expensive apparatus, but it is well to use money to buy personnel. It is also of import ance to know that there is a national registry for physical therapists. Various forms of therapy used were mentioned, such as heat and massage; warm paraffin baths; short wave diathermy; elec tricity; under-water exercises. Ingenious appara tus was demonstrated by lantern slides, for ex ample, the use of bike pedalling in bed; walking bars used in front of a mirror; foot and ankle apparatus similar to a pedal; inversion tread, and many others of equal ingenuity and value. It was especially stressed that the American M Association has had for many years a special cil on physical therapy, which published a and a description of apparatus and technique a able to physicians. DR. SIDNEY McCURDY presented the paper of the meeting on "The Relation Trauma to Disease and Its Compensability." ing the experience of past years it has been f that there are many queer and weird op! relative to this subject. One of the difficult!' the lack of recognition of the importance of ` and effect relationships. Lawyers and doctors " different ideology. The patient's statements be checked carefully before accepting them, least 80% of claims cases, medical opinion js. portant. Mention was made of the medical r system in operation in Ohio relative to tional disease claims. Illustrations were giv questions and answers from actual claims exemplifying peculiar answers. In a recent. of injury and its relationship to lues, espc regarding fractures, no relation to delayed h was established. Several important decisions referred to. Finally, discussion of the relati of trauma to heart disease was given. This concluded one of the most successful ings the Association has ever held. On the Air T HE first of the four broadcasts fro Convention was that of D r. Carey P. M who spoke at 5:30 p .m . on Tuesday, J on WGAR. D r. M cCord's subject was 1 dustrial Worker and His Trade Diseases." He said: I N THE salary United in not States, workers less than 7,000 may earn their different trade* Alphabetically these thousands of trades ra `accordian makers' to `zooglers.' If you do not! a `zoogler' is, permit me to describe him as the , who rides and guides a timber log, as it rushe* river or floats in a pond. Directly or indir thirds of this country's population depend upon and women who ply these 7,000 different occup' "It is most unfortunate that, connected with tivities, many scores of opportunities exist for be produced by the substances handled in enterprises, or from the machines necessary in cesses. All considered, there are no less thpn ferent chemicals or conditions connected capable of damaging exposed workmen and 1 many instances, to direful disease states. Su are known as occupational diseases or trade ( "These occupational diseases are by no developments in this country or in any other; the world. Wherever industry has existed a fe tional diseases likewise have arisen. One of' well known occupational diseases occurred chimney sweepers. Long before this country covered many small boys and adults with were employed in European cities to crawl small chimney flues and brush down the soot walls. This soot contained irritating chemical* result of their action, every year a few of the* sweeps developed `chimney sweep's cancer,' a istic occupational disease. vie ,li a e av he itio* nfo >pil alt of I >rs J s I 0. n Ire ' give IS at ! ,pe . hea mst .tion ul: rom Me . June! `The ir wagtl is or , inge enow1 work es dowaj ectly, n the i pation|j \ .such disease*! hese trade ]_ 2,000 < vith leading,.; eh dis seases. neans portion! jw occ he earll ed an y was nail jp thr it from s and, asj se chir charac 8, No. 7 INDUSTRIAL MEDICINE Page 305 t old disease has passed, but in its place scores of different occupational diseases yearly arise--arise in Cleveland, throughout the State of Ohio, and here else that industry exists. They are not l to h e a v y operations such as mining or the manu- of steel or the construction of buildings. Even in h a st arduous of tasks they may arise. Let us take a (typical examples. school teacher using colored crayons in the school i may become the victim of lead poisoning because green, vellow, orange and lemon crayons may con- he&d. She breathes the crayon dust containing lead. L` isure is sufficient she may begin to present the ar characteristics/of lead poisoning. OX course children are even more likely to acquire lead ling from this source, but in their case the disease I occupational. he beauty parlor operator, aiding women in their ; for beauty, may exhibit a disturbing skin disease the chemicals she applies to the customer. The ner is ordinarily not affected, but the beauty parlor tor, because day by day she comes in contact with i irritants, may acquire this disease, to the little informed it might seem that the trade of Fworking could afford no opportunity for an occupa- disease. The contrary is true. Some of the dyes are applied to furs, chiefly cheap furs, have the liar property of causing asthma. `Furrier's asthma' (well known wherever furs are cut, dyed, or made into ents. the manufacture of felt hats, rabbit hair is almost ersally used. Untreated rabbit hair has such a smooth lthat it will not interlock or mat with other hairs to Ia compact sheet. To accomplish this the rabbit hair Igiven a barbed surface by treatment with what is , in the trade as a `carot.' The usual chemical em- id in carotting is mercury nitrate. Mercury poison[is a frequent disease among these hat makers: ven professional workers are not free from occupa- Idiseases. The physician to whom you go for an x-ray nination might become dangerously injured through f-by-day exposure to x-rays. more strenuous trades, occupational diseases are i commoner. The sand blaster may acquire silicosis, evere variety of dusty lung disease. The glass maker develop blindness or near-blindness from injurious *t rays. The arc welder, on occasion, may be exposed i manganese and conceivably may develop manganese oning. The boiler maker, working in a din of noise, rdevelop noise deafness. The street worker who digs f paved roadways may acquire from the vibration of his hammer queer cysts around the tendons near the In the past few days both in the United States and [land submarine disasters have occurred. In both ntries efforts by divers to rescue those imprisoned been hampered and curtailed by the continuous at of `caisson disease' or `diver's disease' which may whenever these under-water workers are required perform their duties under greatly increased atmos- ric pressures. "And on and on, through a thousand different trades, exposures may be found. It is most fortunate that almost without exception !diseases may be prevented. The school teacher may [supplied crayons free from lead, the sand blaster may iprotected by the substitution of steel grit for silica The beauty parlor operator may be furnished non- fitating beauty preparations. The physician who may [burned by his x-ray equipment may be fully protected ia lead apron and lead-bearing gloves. Day by day 1measures are being found for the adequate protec- of all workers against dangerous work exposures. I^Here in Cleveland many hundreds of physicians, nicologists, engineers and chemists now are meeting in fessional conferences for discussions of ways and ans for the protection of industrial workers as they go x>ut their daily tasks. Thoughout the land, physicians, gineers, and public health workers day by day apply life-saving appliances and procedures. + ?rv->r' ohm o v> S fil! tan flf't'till cases of occupational diseases in this country because of adequate protection of all dangerous operations. Until that time comes, every worker, however he may gain his livelihood, should give thought to the most practical means of avoiding the occupational diseases peculiar to his own work. Otherwise the possibility e x is ts that his year by year duties may take an unwarranted toll from his health and from his years of life." T HE second broadcast was that of Mr. K nudsen's talk on "Human Relations in Industry," and his presentation of the W illia m S. K nudsen A ward to" D r. C. O. S appington, at the Annual Banquet on Wednesday, June 7. The proceedings were on the air from 8:15 to 9:00 p .m ., on WHK, Cleveland. Mr. K nudsen's talk appears, in full text, on pp. 307-310 of this issue. At the conclu sion of his address, M r. K nudsen conferred the A ward (see p. 310). The third broadcast was that scheduled for Dr. S elby, who was to have introduced D r. Sappington as the recipient of the A ward, on WGAR at 9:45 p.m . on Wednesday, June 7. But the entrance of the King end Queen of England into the U. S., which had priority on all networks, was holding the air at that time, and so this broadcast was not carried out as planned. The fourth was the talk by Dr. M cIver W oody, newly installed as President of the A. A. I. P. &S., at 5:00 p .m . on Thursday, June 8, over WGAR. Dr. W oody said: F IRST, Selby, I should like to congratulate Dr. Clarence retiring President of our Association, and Dr. D. G. F. Sykes, Chairman of the Cleveland committee, on the excellent program they provided for us this year. We are always glad to come back to Cleveland for our annual meeting; because we know from past experience that we are sure to have a large attendance, see old friends, and thoroughly enjoy ourselves. "You know, when one stops to think of it, it is rather remarkable that this Association of ours has been so uni formly successful ever since it was formed back in 1916. We industrial physicians, who are in daily contact with the managers of business organizations, are perhaps in a better position than most to appreciate the vicissitudes through which we have been passing. "During the past 24 years, we have lived through a World War, a brief period of readjustment, a longer one of uncontrolled speculation, and then the `Great De pression,' which some say is with us yet. We have seen some concerns build up efficient medical departments, and then later on, under the urge of dire necessity, liquidate them. Nevertheless, our Association has grown in the same length of time from a small group of men who be lieved in the need for such an organization, to a national society with a thousand members, in which every part of the country, and every variety of industrial concern, is represented. "Now, the reason for this rather remarkable record is, to my way of thinking, simply this--that this organization was formed in response to a real need, and that through out its existence it has fulfilled purposes that are useful. As a matter of fact, this condition of existence applies to all human institutions. Even the greatest of our uni versities is no exception to this rule. "About three years ago, when the outlook was most discouraging, the president of one of our largest universi ties had to admit that the book value of their endowment funds had shrunk, and that the flow of new gifts had all but ceased; and yet he had the courage to believe that so long as the university remained true to the purposes for which it had been founded, it would survive and flourish. He frankly admitted that institutions, like individuals, mnv suffer from internal decay, which, while yet un- t'aye J lu i i'll.) USTRIAL M EDICINE July, 1999 and 85% by general practitioners. The number of physicians serving industry on a full or parttime basis has doubled in the last five years. The membership in your association has increased 300% in three years, and there are more than 1000 members at the present time. Here comes the business side of it. A number of industries reporting to a national association stated that since the introduction of a medical di vision the accident rate had decreased 46.6%, with a 28.7% reduction in compensation payments, and that absenteeism was reduced 50.6%. There, to my mind, rests the answer to the query as to the importance of the plant physician. I feel that losses in a factory, losses of operating time for any cause, are expensive. That expense even tually comes out of the price of the product, but if you can reduce stoppages and losses to a mini mum from any cause, then you have accomplished something for industry at large, and for the con sumer as well. I am asked: What methods should the plant physician use to make his service most useful to the em ployees? I should say by get ting acquainted with as many of them as possible; that is my only answer. If the employee has confidence in the plant physician he will soon hunt him up; he will not have to hunt the employee up. But the first thing is to instil con fidence in the men as to his ability and sincerity in trying to help them. The best by product of a good medical pro gram is the good will of the employee. The plant doctor who enjoys the confidence of the workmen is in a unique position to promote a better employer - employee relation ship. My last point is this: The doctor in the plant performs a function which can not be underestimated. He should have the confi dence of the management. He should have no posi tion on the organization charts, so to speak, but should be given the proper freedom to bring to the management his observations rather than their demand. If that can be accomplished--and I am sure it is being accomplished as far as we are concerned--I am sure that industry in general will recognize that that is the proper way to handle the physician's work in the plant. I feel that perhaps the loss of time that we have had through illness or even through accident or occupational diseases can be reduced a little fur ther, with a better effect on quality and a better effect on cost. I wish to say a few words here about our mis sion in industry, when we talk about serving the public. It is our duty to make the best possible product at the lowest possible cost. Anything that we can do to accomplish that object should be done, and we will then be able to give better service, and if we do that we will stay in busi ness longer. The Knudsen Award -- A n d the Book, "M edicolegal Phased of i Occupational Diseases " on the Basis of Which the A ward Was Given-- AT THE Twenty-Third Annual Meeting of the American Association of Industrial Phy cians and Surgeons at Chicago, in Ju 1938, it was announced that W iillia m S. Knuds President of General Motors Corporation, Detrb' had established the W illia m S. K nudsen Aw to be given in 1939, and yearly thereafter, to member of the Association making the most ou standing contribution to industrial medicine du ing the year.* Dr. C. D. Selby, President of' Association, then appoin" the K nudsen A ward mittee, of which Dr. Loyal S houdy was Chairman, Drs. M cIver W oody and C. N. Schram were the o1' members. A number of! and scientific studies were mitted by their respec authors and received due sideration by the Commi With full authority in all spects concerning the Aw the Committee elected to> no announcement about ` prior to the actual pres lion at the Twenty-Fo Annual Meeting of the sociation at Cleveland inJ' 1939. Accordingly, the of the recipient was not! until, at the Annual Ban at 6:30 p .m . on Wedn June 7, D r. C. O. S appington was seated Mr. K nudsen at the speakers' table. At the elusion of his talk on "Human Relations in ' try " (see p. 307), Mr. K nudsen said: "Now, I have a mission to perform here toI have an Award to give to D r. C. O. Sappi Consultant in Occupational. Diseases and trial Hygiene. D r. S appington was former! rector of Industrial Health, National Council, and formerly special lecturer on f" trial hygiene and occupational diseases at'University of California, Stanford Medical I University of Michigan, University of Medical School and Rush Medical College. I a bit embarrassed because I happen to be^ donor of this Award, and someone else should have given it to D r. Sappington. Ho in self defense I will say that the Award was by Dr. Shoudy, D r. W oody, and Dr. Schram. Sec I ndustrial M edicine, August, 1938, p. 517. July, ;ct sho ive betl v in bu ases of H sis of ag of al Phj_ in June Knudsd^ . Detroit v AwamJ r, to thef nost outi :ine dur-1 it of the! ppointedl ;d Coro-1 -.OYAL A S 'an, and] nd C. P.1 ]e other! of books! ere sub-f spective| iue connmittee.3 n all re-'| A ward,i to make bout it J resenta--Fourth J he As- J in June, 1 e name \ known anquel, | nesday, beside jj be conIndus- onight. fNGTON. Indus try DiSafety indusat the School, Illinois I feel >e the really wever, made . 8, No. 7 INDUSTRIAL MEDICINE Page 311 o, Dr. Sappington, I have the extreme honor, behalf of the Committee, to bestow upon you Knudsen A ward for the most outstanding ntribution to industrial medicine for the year -1939." Dr. Sappington re p lie d : |;-Mr. Knudsf.n , D r. S elby, Members an d Guests [the Association: It is impossible for me to find ords that will adequately express my deep apciation of this honor. However, in a few sennces I should like to attempt to interpret what ns to me to be the significance of this occasion, cause it is far mote than the recognition of mere rsonal accomplishment. "It seems to me that it means that a great indus- and a great association of medical men have alized that the two groups have a common _ound of objectives and purposes, and that ^through this mutuality it is possible for them to ovide the basis for recognition and encouragent which is vital to progress. "Therefore, I take this occasion to congratulate ii, Mr. K nudsen, and you, Dr. Selby, and the |embers of your respective organizations, on the actical idealism which is exemplified by the Establishment of this Award, and I bespeak for you |fa future years the great returns in satisfaction in Ifte association which this Award will bring. Thank |jou." Dr. Selby th e n c o n g ra tu la te d D r. S appington, find said: "Dr. Sappington was awarded this plaque in eturn for the contribution he has made to the iEterature of industrial medicine, in his book enftitled `Medicolegal Phases of Occupational Dis eases.' " THE Award is represented by the plaque illus trated on page 310. D r. Sappington is well known in the field of industrial medicine, in both ^its medical and medicolegal phases. In addition itothe many duties and responsibilities of his work rasConsultant in Occupational Diseases and Indus,trial Hygiene, he has been known to our readers [as Consultant Editor of I ndustrial M edicine since [its establishment in June, 1932. His new book, `which was the basis of the A ward, may be des cribed, in brief review, as follows: MEDICOLEGAL P hases of Occupational D is eases, by C. O. Sappington, M.D., Dr.P.H. An outline of Theory and Practice--presenting, in handbook form, the Industrial, Insurance, Medical, and Legal inter-relations of all the elements of Occupational Diseases, from Origins and Causes, ;to Disabilities and Costs. 400 pages; 5% x 7%; bound in cloth (or semi-flexible, as preferred). Price $2.75 (cloth). Published by Industrial Health Book Company, 540 North Michigan Ave., Chicago, Illinois. THIS BOOK is particularly opportune, as indus trial health, industrial hygiene, industrial medicine and occupational diseases are being stressed at the present time and involve numerous difficult problems. As the author says in the pre face: "Although growing emphasis placed on the problems involved in occupational diseases has given great impetus to the study of causes, clinical manifestations, laboratory findings and control measures, the lack oj use of these methods and the misuse of information resulting from them, still present difficulties. The chief sources of such difficulties arise from a lack of true appreciation of the necessity of establishing definite cause-andeffect relationships between employment, disease, and disability, and the common mistake of per mitting the error in reasoning which Kant so memorably expressed as `Post hoc ergo propter hos' (`After this, therefore on account of this')." The material of the book has been divided into four parts: Industrial, Insurance, M edical, and L egal, and the relationships of the personnel of each of these divisions are shown throughout the text, indicating the necessity of the business execu tive, the insurance carrier, the industrial physician, and the lawyer cooperating in the solution of com mon problems. The chapter headings offer a picture of the in formation contained in this volume: P art I: I ndustrial, covering Causes of Occupa tional Diseases -- Standards of Permissible Expo sures-- Industrial Dusts -- Gases and Vapors -- Volatile Solvents -- Skin Irritants -- The Working Environment -- Field and Laboratory Methods -- Control of Occupational Exposures -- The Cost of Occupational Diseases; P art II: I nsurance: Specific Approach Neces sary -- Information Needed and Methods Avail able -- Some Practical Problems -- The Import ance of Prevention; P art III: M edical: Occupational Diseases -- Oc cupational Poisonings--Other Occupational Effects -- Diagnosis -- Estimation of Disability -- Treat ment -- Prevention; P art IV: L egal: Compensation Experience -- Occupational Disease Disability Laws -- Differ ence between "Accidents" and Diseases -- Medico legal Evidence -- Present Methods of Adjudication --The Physician as a Witness--Other Professional Witnesses--Legal Decisions--Present and Future Trends of Occupational Disease Disability Legisla tion. The author has presented the material in clear and concise language, indicating the coordination of the extensive and complicated factors of the field of industrial hygiene and occupational dis eases. Each part consists of an introduction, and chapter texts, followed by a summary and list of references for that particular part. There is an excellent Appendix, including Oc cupational Record, Abstracts of State Laws, Scheduled Diseases, Abstracts of Legal Decisions, Legislative Suggestions of the American Bar As sociation, Suggested Schedule Law recommended by the American Public Health Association, and a Digest of Workmen's Compensation Laws by States. Twenty-nine tables illuminate the text to good advantage, as well as illustrations of some of the apparatus used in industrial hygiene activities. The book is especially well indexed. The industrial physician will find valuable data Page 312 INDUSTRIAL MEDICINE July, 1939 in this volume. It will prove a useful guide to him in the medical control of occupational hazards and diseases in his plant work. And it will assist him in his cooperative relationships with company executives, industrial hygienists, and plant and safety engineers. The book is of definite special help in the evaluation of the tiologie factors of occupational disease problems. Constitution and By-Laws T HE Board of Directors, meeting on June 4, adopted certain amendments to the Consti tution and By-Laws of the A. A. I. P. & S., and recommended their ratification by the mem bers. In submitting these to the members, on June 7. D r. V olney S. Cheney referred to them as having been published in I ndustrial M edicine (May, 1939, pp. 202) and summarized them as authorizing: (1) the employment of an Executive Secretary for the Association; (2) the creation and incorporation of a Board of Examiners for the certification of industrial physicians; (3) the es tablishment of an Executive Committee; (4) and the affiliation of groups or organizations of physi cians or laymen whose work and activities are closely allied to industrial medicine. These amendments having been duly adopted by vote of the membership, the Constitution and B y-L aws of the A merican A ssociation of I ndus trial P hysicians and S urgeons are now as follows: CONSTITUTION Adopted June 7, 1939. Article I -- Name The name and title of this organization shall be The American Association of Industrial Physicians and Sur geons. Article II -- Object The object of this Association shall be to foster the study and discussion of the problems peculiar to the prac tice of industrial medicine and surgery; to develop methods adapted to the conservation and improvement of health among workers in industries; to promote a more general understanding of the purposes and results of the medical care of employees, and to unite into one organization members of the medical profession specializing in indus trial medicine and surgery for their mutual advancement in the practice of their profession. Article H I -- Membership Section 1. Membership in ths Association shall be of four classes: (a) Fellow, (b) Active, (c) Associate, and (d) Honorary. Only physicians who are actively en gaged in the practice of industrial medicine and surger or who are engaged in the investigation of industrial medical problems shall be eligible to Active Membership; other physicians shall be eligible to Associate Membership. Any person who has contributed distinguished service to the objects for which the Association stands shall be eligible to Honorary Membership. Sec. 2. Associate and Honorary members shall have all the privileges of Fellows and Active Members, except the privileges of holding office and voting for officers and directors or for amendments to the Constitution and By-Laws. Sec. 3. Applications for Active or Associate Membership must be made in writing to the Secretary-Treasurer; be accompanied by the fee for the annual dues; approved by a Fellow or an Active Member in good standing, and be certified by the Secretary of applicant's local county his local county medical society. Applications shall not be acted upon by the Board of Directors unless they have first been approved by a Committee of three, to be ap-,` pointed by the President. Honorary Membership may be conferred upon physicians who have made some definite' contribution toward the advancement of Industrial MedW cine and Surgery or who have performed some special service for the Association. Proposals for Honorary Membership shall be made to the Secretary-Treasurer ia writing for consideration by the Board of Directors. Sec. 4. A two-thirds vote of the Board of Direct* shall be required to elect to any class of membership. Article IV -- Fellowship Section 1. Active members after three years of me; bership in the Association may apply for Fellowship. Sec. 2. Fellowship shall be conferred by the Board Directors upon those applicants who satisfactorily successfully pass an examination by the Board Examiners. Sec. 3. A suitable certificate will be issued by Secretary to those upon whom Fellowship has been ; ferred. Article V -- Officers and Directors Section 1. The officers of this Association shall be. President, a President-Elect, a First Vice-President,; Second Vice-President, and a Secretary-Treasurer, shall be Fellows .of the Association and shall be elc by the Association and shall serve from the close o f ' Annual Meeting until their successors are elected installed. Sec. 2. An Executive Secretary shall be appointed the Board of Directors. He can be either a physician" layman and shall hold his office from year to year at pleasure of the Board of Directors. Sec. 3. The affairs of the Association shall be ad tered by a Board of Directors, consisting of the officers twelve directors. Presidents of component societies be ex-officio members of the Board of Directors with same powers as other directors. Only Fellows sh* eligible to serve on the Board of Directors. Sec. 4. The planning of the work of the Asso arrangements for meetings and programs and matters pertaining to the administration of its affairs, be vested in the Board of Directors, except as othe herein expressly provided. The President of the . tion shall serve as Chairman of the Board, shall make its own rules, and it and the President appoint such committees for carrying out the work i shall deem necessary and advisable. Sec. 5. Executive Committee: The five officers Association shall constitute an Executive Committee. Sec. 6. The Board of Examiners shall consist members or Fellows; and shall be incorporated un laws of the State of Illinois and shall be appoin the Board of Directors. Their tenure of office subject to the pleasure of the Board of Directors. Article VI -- District Branches or Councils Section 1. The Board of Directors shall have the to take the necessary steps for organizing or a' local district Branches or Councils of the Associati" Sect 2. A local organization of Industrial and Surgeons already established and consisting 4 less than twenty-five members may become a society and its members admitted to full active: ship of this Association by making application with a certification from their President and that their members meet all our requirements for' bership; have been carefully chosen, and are all. in good standing of their local county medical Dues per member for current fiscal year and a Constitution and By-Laws must accompany app Sec. 3. Any local or national organization of or of another profession whose work and activ closely allied to industrial medicine may affliated society under conditions set up by the Directors. Article VII -- Amendments