Document N2B7XODgxqyknn7Zd7Z79LdBw

156 Tn-culiclh Congress--Motional Safety Council ile New Orleans meeting. to establish a section o personal hygiene. It was impos sible to do so; there weren't enough members of the American Public Health As sociation interested to get such a seclkm going. Sanitarians, hygienists, the world over, are telling us today that our great flaw is in personal hygiene and that industrial health is but a grouping, a massing, of the personal hygiene of the employees. Chairman Wisstow: I wonder if Dr. Redden wouldn't say something about the points Dr. Evans made in regard to the methods of health instruction. Dr. W. R- Rkbwsx (Sew York City): I think we arc all impressed with the fact that, in the case of accidents, they are dramatic because of law. The people who are paying the damages are willing to do anything to prevent accidents. Industrialists are not. so convinced that sickness falls within the scope of their activities and it ts harder to sell this matter of sickness prevention, medical service, nursing service, for the *tck. because sickness is drab. To be sick Is just to be out of the game. If a man has lost an eye. he Itas something to show, bot this matter of sickness is drah. The matter of personal hygiene, cleanliness, environmental hygiene, and sanitation, to my mind, does carry over into the home. That Is one erf the significant things about industrial health ami hygiene. Now. you know the psychologists tell us that it is impossible to train the older person, the older man, that you can't change hi* habits. But. 1 can say this: that if you put a supervisor over a lavatory and make every person whose work is handling food wash his bandci when lie comes out, he is going to wash his lunhte. I Itavc seen it work in the American Cigar Company in the last few years. ' If it pays to put out clean products and train men to be hygienic and clean, if they are spending eight hours a clay in an industry, that type of thing is going tu carry over into the home; and looking at tt from the reverse point of view which Dr. Evans presented, ihajj! _ carry-over into the Ttfuifite & 'going -to' help the .health officer in his whole problem of building tip health. Now, sickness costs about $15,000,000,000 a year, in all its ramifications. The fig ures I give you come from the Russell Sage Foundation which knows something afw>ut that phase of figure*. Sickness is the cause of poverty. Now, even as drab as sickness in industry happens In lx; today, an industry Will pay for proper pre ventive measures if they arc profitable. And if you lose 200,000,000 days a year because of sickness, as Dr. Latwa formerly of the Metropolitan has quoted a number of times, if you can show the industrialist tint industrial health work decreases labor turnover, that is increases production, that it decreases absenteeism because of sick ness. he will pay for this matter of medical and nursing service and education, because he Itas the money to do it. If you go out to the general public and say, do all these things, they will do aljout as they please. I believe those of us who arc interested in industrial hygiene con convince tile industrialist that a good health service and proper education in the ordinary factors of health and hygiene will pay. Dk. O. E. Sthwart (Crystal City. Mo.) : I am interested in this phase of in dustrial health, lmt I do think this: that before any real constructive measures can be arcomplnltcd along that line, the medical officer in charge slwuid be given some authority. During the Spanish-American War, I believe we had about 60,000 soldiers at Chattanooga, witb about 20.000 cases of lypixwi fever, with a medical department without any authority, f believe our record in the late war was quite an improvement, due to die fact that the medical officer was given some authority to do something. If I have a criticism to make, it is to say that we of the factors that is interfering with the development of this program is that the medical officer in industry today hasn't any authority. He can make recommendations, but the actual carrying out of his politic* is up to the industry itself, and until that situation is changed. I feel confident that you are going to have difficulty in producing the results that you would like t* see in industry. Chairman Winslow: I should have announced at the beginning of the meeting the appointment of a Nominating Committee to nominate at the end of this session 1931 NSC Industrial Health Section 157 officers for the coming year- I will ask Dr. V, S. Cliencv, Dr, W. R. Redden, and Dr. Rudolph Engel if they will be good enonjli to serve. The next speaker I haven't known personally as long as l have known Dr. Evans, but we have all known his organization. 1 think I am right in saying that tlte Inter national Harvester Company and the U. S. Steel Company were the two pioneers in recognizing the responsibility of the employer toward the employee, by the creation o compensation scheme* before any legal compensation schemes were thought of in the United States, and it is a pleasure to have a paper by the very able representa tive of the former company, Dr. J. A. Britton, Health Services in Industry: Equipment, Personnel and Cost By JAMES A. BRITTON, M. D. Medical Director, International Harvaater Company, Chicago Any consideration of health service for industrial employees should include a review of the development and growth of that work In the past, the accepted standards of inch service at the present time, and the probable future development)!. The real beginning of this work dates back to the middle of the nineteentit cen tury. This first effort took the form of a hospital built to serve the employees of certain textile mills. Coincident with the development of the railroads, special indus trial health services saw their real beginning. Strange as it may seem, other indus tries did not fallow the lead of the railroads until much later. In about 1912 the general consideration erf the importance of health as related to efficiency of employee*: \n industrial establishments began to be more or less com monly discussed. This Was about the same time that the anti-tuberculosis organiza tions began their intensive drives for the purpose of securing proper care for those who lw,d tuberculosis and for preventing die spread of this disease. It was also about this time that the community's attention was focused on the lack of any systematic provision for the care of those who had been injured while engaged in factory work. The question of responsibility for disease and injury in industrial establishment* was aggressively and persistently argued. Out of all of this discussion came the desire, on the par* of those in the manage ment of industry wf were sincerely interested in trying to meet their own problem*, to know the degree of responsibility which industry had for those safety and health conditions which were known to' be unsatisfactory. It. became evident that, in order to determine with any degree of accuracy the cause of disabilities which developed among industrial employees, it was first necessary to know the condition of health and the physical defects of tliose wluo went into industry. Thus began physical exam ination as a part of the regular routine of employment. It was only a short time before it became the policy of most industrial establish ments to make adequate provision for surgical service for those who were injured while working. Tlte problem of disability because of illness, however, has never been us simple as tliat of industrial injury and there was a wide difference of opinion as to what should be and what could be done. During the past twenty years the managements of various industrial establishments of this country have tried out and arc still carrying on many different types of health Service. These types vary all the way from the simplest and most superficial, and lienee the least expensive, to the most elaborate and complete sendee that can be de vised. In a great many ot the smaller industrial units and practically all of the larger industrial units provision is made for a more or less complete physical examination of all prospective employees. Some of the larger establishments offer or require a sub sequent complete physical checkup once a year. TI*c great majority of industrial or- 158 Twentieth Congress--National Safety Council ganizatkxK do not attempt to treat tbe side employee where it is eyideat that he has a. condition which prevent* him from working. Host industries provide a first-aid station where minor ailments, such as headaches, slight colds, etc^ can be treated. In unite a large number of places the medical staff is sufficient to be ttted as advisors and consultants as to the kind of medical service needed and how to obtain, such service in the community. In die industrial organization whose activity necessitates maintaining workmen and their families an isolated community, sodi as at a saw mill or coal mine, it has been tbe practice for jtotne time to furnish complete medical ser vice for the whole community. In some such places tbe medical service is very elabor ate and very well carried out; in others it is not so elaborate and consists of only those things which are fundamentally essential. la a few places in this country the managements of large industrial establishments have seen fit to provide complete medical and surgical service for employees and their families, irrespective of the pos sibilities of the community for such service. At the present time, then, medical service in industry varies all the way from the simplest rudiments to the most elaborate. Tbe personnel of such service varies all the way from a first-aid boy or a practical nurse to complete community service requir ing physicians and surgeons, doctors trained In the various specialties, nurses, dieti cians, technicians and hospitals completely equipped, even to the ambulance. The cost of such service varies from a few amts to twenty-right or thirty dollars per employee per year- Accidental injury is oik of the recognized hazards of industry and is accepted as an item in the cost ol production. Sickness, however, is not usually a hazard of in dustry. For this reason, general or unlimited medical service cannot be considered a legitimate item in the cost of production. A direct relation between sickness disability and occupation is tbe exception and not the rule. The loss on account of sickness disability, however* burden.both on.the employee and on the industry in which he is employed* . While there have been and are at the present time the two extremes in industrial medical service--the most meager and the most elaborate--it is believed that the gen erally accepted policy for tbe future will be a plan of cooperation by the individual, the industry and the community. While a company should not be asked to assume and should not accept tbe responsibility of furnishing free medical service to em ployees, or even undertake supervision of the care and treatment of sick employees, the Importance of sickness disability as an economic problem for both the employee and the employer has convinced the thoughtful business manager that it fa of mutual advantage to establish certain provisions which ordinarily can be expected to reduce the frequency and average length of disability and the economic loss due to sickness. Of course it is understood that any disability which is primarily due to occupation is as much the responsibility of the industry as an industrial accident, but there are very few occupations which need to have a definite deleterious effect on the employee. With few exceptions, health hazards in industry can be removal. The Industrial medi cal department of the future will not have assumed its full job until every condition in industry which is known to have a deleterious effect on health fa under control or removed. This applies to general sanitation, ventilation, temperature, lighting, build ing and maintaining of adequate sanitary toilets, wash rooms, lockers, shower baths and dimmatton of harmful dust and fumes. Modern development in painting means a constant alertness on the part of the medical personnel to protect employees against the injurious effects of pigment dusts and solvent*. The use of a new metal brings with it new problems, such as, for example, chromium plating. The ever increasing use of gasoline and oil engines makes it necessary to protect employees against car bon monoxide and other fumes. And so the list continues. The big job, the uaescap- abt responsibility, lies in constant, aggressive effort to understand and control not only the hazards that are old and well known tart the new ones which arc constantly developing. Industrial Health Section 159 The next most important service of tbe medical department in industry is its personal relation to the employees. Unless the relation fa right, untc** there is a sym pathetic understanding, a mutual desire for helpfulness in the solution of the various health problem#, tlie medical department may fall in this very important function. Applicants arc examined lor employment, not merely lor tbe purpose of determin ing who shall be excluded for employment but to make sure that their physical ability is equal to the requirements of the job for which they are being hired. Statistics have shown that there are very lew individuals who are physically perfect; in fact, most in dividual* have one or more relatively important physical defects. If these conditions are known and properly evaluated, fewer mistake# are made in placement in industry. The man who has a major handicap, but who is well placed in industry, pay* many times in the effort of placing him. He knows he has been well placed. He knows that it fa difficult lor him to get a job. He sticks to hfa job, he fa a good workman, and he fa a loyal employee. Don't just pass Him up. Try to think of a place for hitn when you meet such a man, because it my make all the difference in the world to him and he may return many times the value of the time you lave spent on him. Likewise, tbe periodic physical examination is not intended to find out how many men should be dropped from employment, but to discover those things which lead to serious disability and to Help the individual plan to prevent or cure these condi tions. It happens not infrequently that a man who has worked steadily on sotne par ticular job for a number of years develops some organic disease of heart or kklney or some other organ which may mean the loss of his job, total disability and death unless something is done early in the development of the disease to retard or prevent its progress. The old human machine wear* out after a while. In most individuals some organ wear* out faster than the others, and the human machine, just as the in animate machine, needs adjustments from time to time ff we wish to keep the whole machine working. The next important function of the medical service ?n industry is it* relation to tlie community. I do not think it need* any argument to convince the average thinking man that It fa a mistake for any industry or branch of industry to assume the normal medical functions of the community, A company hospital can never he as generally satisfactory to the average employee as a well-run community hospital. The company doctor cannot assume the functions of the ordinary community health department. He can, however, cooperate with U>c community health department with great benefit to both the community healtit department and the industry. The fact remains that industry cannot be separated from the community in. .which It exists. Cooperation between industry and the community is the logical relation. White this applies to all of the different contacts between industry and the community, St is especially true of the relation to the control of health problems and general health service. There are no set rule* or plans for medical service which apply to industrial groups Df various sizes and variously situated. Generally speaking, the equipment of an indus trial medical department must be cotopatible with the dignity of the service and th* Importance of privacy in the relation between tbe doctor and the individual employee. Medical service in Industry had best not be undertaken unless It fa good medical ser vice-- good in the sense that it uiust be modern and thorough. The industrial physician must be even more careful in guarding; against mistake* than the average prac titioner. He must use the ordinary equipment accepted as necessary in making diag noses--where x-ray is indicated he must use x-ray; where Wood examination* are indicated these must be made. > It is just too bad to have an employee go to a company physician for advice or direction, and then to have an inexcusable mistake made in the estimation of the case because the ordinary procedures were not followed in making the dfagnosfa- It might easily happen that this particular contact fa tlie only important one that this individual 160 Twentieth Congress--National Safety Council has had with the management of the company. He judges his company by the service he gets from this contact. If a mistake is made it is unforgivable. The whole idea of an effective health service h industry- is closely tied up with that of tlte community. Hence, it is particularly desirable that the stall of the medical department in an industrial establishment maintain its contacts with the community hospitals, the community health department, the community medical associations and other community health activities. In order to do tin's it seems very desirable that the doctors who arc doing this work in industry should devote part of their time to their regular work in the community. In other words, the industrial physician should be employed ou a part-time basis, maintaining his ielation to th? industry and also to the community. The ideal medical service in industry, then, will assume those functions which deft* mtdy belong to industry and will actively cooperate with tlie community on general health problems. The organization of the medical stall and tl*e program of Us work should include; 1. Examination of all new employees. 2. Periodic re-examination erf all employees. 3. Regular inspection of all working conditions---ventilation, lighting, tem perature variation, general sanitary conditions and cleanliness--and special supervision of all known conditions where there is a health hazard. 4. Consultation and advice for any employee on personal liealth problems. 5. Active Cooperation in community health activities. Hie cost of a well organized, competent medical department which can regularly and satisfactorily carry on all these function* will not be an impossible burden on in dustry. If industry does less it is not carrying its full share. Chairman Winslow : The broad social importance of tin* problem lw beun very lorcibly impressed mi nwr lately t connection with tile work nn the Committee on. the Cost of Medical Care. As you may know, tliat is a national enrrmirttee of fifty physicians and laymen who have engaged in a five-year study of the economics of medicine. These studies have revealed astonishing lacks in our community machinery, and have revealed the fact that from a quarter, under the most favoroble corvdiiinm, 10 SO per cent, under the least favorable conditions of those needing medical care, receive no medical attention whatever; that those who do receive medical attention receive it often in an incoordinated and unsatisfactory way; that there are enormous wastes; that, for example, of the something like two billkrn and a half dollars spent for the care of sickness, between one-quarter and one-third is spent (or drugs mid medicines, nearly all of which are useless, and many of which arc harmful, as contrasted with that in a well organized health service, where the cost of drugs and medicines falls to one per cent. Of course, that is an abnormal wage group, but there is considerable gap between one per cent and 25 and 50 per cent. In one county in Indiana, the largest single item in the whole bill was 34 per cent for drugs and medicines, services of physicians coming next with 29 per ccnt- Xow. in studying the efforts that arc being made to solve this problem, to provide adequate medical care for groups of people, wc find two groups, the Industrial groups and the university groups,.standing out as the only group? in the com munity receiving really adequate medical care. Dr. Rrstton spoke of a few industries. We have found there are over 400 industries that are providing more or less com plete medical care for employees and members of their families, and I think in the conclusions of the committee that die rccotiummdation wc shall make wifi be largely influenced and in part built cm these remarkable developments of industrial medicine. i want to ask Dr. Leake if he wants lo open the discussion on this paper. The C. S. Public Health Service in the past year* has made some of the contributions. ik?t only to the technique of industrial hygiene, but also along the line of giving u* information a* to standard practices and procedures. After that, I hope very much that schtw one or more of the nurses wlto arc here will say something about this from the standpoint of industrial mirsmg. Industrial Health Section 161 Da. J. I*. Leake (Washington, D. C) : I have nothing but admiration for Dr. Britton's presentation. I am sure wc all fed, from the way he talked and his mod esty in speaking ol the authority that he does lutve. that that authority is wdl imposed. The matter, of course* f just how ttie care of the Industrial community, as far as its health is concerned, should be managed b a thing on which my ideas, at least, arc not at all crystallized. I have seen that in certain instances the practice, spoken of by Dr, Britton, of having part-time medical service lias seemed to be an advan tage. We all know other places where it is out of live question to use it with the same efficiency. If I may be pardoned for digressing, I should like to speak lor a moment on the subject that was touched on by Dr. Evans and Dt. Hayborst--Ibc matter ol extend ing, as we all believe it should be extended to other than communicable diseases, our program for hygiene and health conservation. I just wish to sound one little word of warning, that w tread, if we can, on as certain ground %s possible. We have felt, even in regard to infectious diseases, that many things arc advocated which perlraps after ten years we may not be so sure of; and in tltcse other fields, too, wc may be asking our communities, our industries, and our individuals to do things, arrange for doing things, which perhaps after further light wc may not be so sure of. I think wc don't want to sell the public any patent medicines. Chairman Winslow : I am glad Dr. Leake brought out that point. The Visiting Nurses' Association in New Haven last year undertook to make a little study of the tilings they were teaching in the field of personal hygiene, so they divided them selves up into groups and came to our library and worked very hard on it, one group on diet, another on fresh air, and so on. After about a month, one of them came to me and said, "You know, wc are very much puzzled about this. We can trace out the same statements copied from one book to another, but we can't find any of the scientific evidence on which these things are based/' And it took them about a month to find us out. The fact is, Galen, in his six known natural laws, laid down the essentials of personal hygiene as well as wc can name them today: food, fresh air, exercise and rest, sleeping and waking, repletion and evacuation, and the passions and phases of the mind. You can't improve on that list today as the basis of personal hygiene. Since Galen's time wc have learned a lot about diet, but we don't know very much more about the other five than Galen did, and it doe? behoove us to be pretty care ful. We can make guesses, but most of them are pretty empirical. Captain G. K G. Kishzr (Illinois Manufacturers Association) : Before Dr. Brit ton spoke, I was going to raise a question following Dr. Evans' paper, in regard to the small plants where the outstanding- hazards are growingly in evidence. While big industry it able to do this and that and compel that this and that be done, what about the small industry where the employee is suffering ineffably from some of these new things? Dr. Britton mentioned monoxide and chromium, and I want to men tion cadmium. One of the great medical authorities has spoken of it as a sly poison. It is not what it is doing on the outside; it is what h is doing on the inside. Usually these plants are run by a man or an organization that hasn't got the means of putting in the proper ventilation and the air ducts ami the supplying other things to protect the men, and all the time these poor fellows are suffering from the results of working with these poisons. The compensation companies have been drop ping a great many of the plants where these things are going cm and nothing is being done to prevent them. For instance, in one concern not'long ago, several girls had to be carried home. In going through die plant to make an investigation, they didn't find a man or woman who looked healthy. Every one was pale and allowed evidence of the damning processes that are being carried out without any thing to help them. Now, that is a great problem and while big industry takes the lead because it has the right and power and wealth, what about the little plant where the poor laborer