Document NGKZGp4bzZa7bVK9n6QkLMqxD

Historical Notes The Konicide Club (1932-1940) A Brief History Theodore F. Hatch, Sc.D. and Eugene P. Pendergrass. M.D. In january, 1932. a small group of physicians, scientists and engineers met informally at the Pittsburgh Laboratories. U.S. Bureau of Mines to exchange experiences and views concerning the problem of silicosis in U.S. mines and factories. No list of the participants is now available but the number probably did not ex ceed 20, representing essentially all the research institutions and field investigative groups in the country at that time. Particular in terest centered around standardization of atmospheric dust sam pling and assessment of dust exposures and the parallel medical procedures for evaluating the respiratory injury found in exposed individuals. There was great need for such standardization to in sure comparability of results, derived in the same manner by ail in vestigators. One recommendation coming from the meeting was to develop a sturdy, all-glass impinger designed to be easily duplicatable, and to settle on a standard method of dust counting. The modified Creenberg-Smith impinger resulted and is still in use. as are the counting techniques delineated at that time. Beyond these specifics there were wide-ranging discussions of the many other aspects of the silicosis problem. Creat enthusiasm over this two-dav conference and the desire to continue such meetings were expressed by all the participants with the further wish to keep the meetings small and informal to insure lively debate and exchange of views. At the end of the meeting, Drinker proposed a scheme for the calling and conduct of the meetings. He suggested the name "Konicide Club" and on February 12, 1932. he sent the following letter to all participants, plus a few additional in dividuals. Because of its typical Drinker style, the letter is given in fu',',. followed by the names on the first mailing list together svith their respective institutional affiliations. Konicide Club February 12, 1932 At a recent meeting at the Bureau of Mines, Pittsburgh a number of us decided to start an informal, small, and very select (fl club with the above From the Graduate School of Public Health, University ol Pittsburgh (Dr. Hatch. Professor Emeritus) and the School of Medicine. University of Pennsylvania. Philadelphia tOr, Pendergrass. Professor Ementusl. Journal of Occupational MedicmeA'ol. 19, No. 5/May 1977 name and with the purpose of having occasional meetings to discuss research problems on the relation of dust to health. The club will have no dues, will meet anywhere or any time any member desires and can per suade at least one other member not in his own organization to meet with him. The meeting will select its own chairman as the club has no president and does not propose electing one. If the members present see tit. they will send a notice or minute of their meeting to the secretary, who will pass it along to the other members. Any member publishing an article on any phase of the dust question will either send through the secretary a reprint to each member or mail the reference to his paper. The membership will be kept small and is to be elected from time to time by a' committee of Messrs. Vant and Leake and the secretary. Until February 1, 1933, Drinker will serve as secretary, which means at tempting to do the dirty work a secretary should do. such as arranging meetings and attending to correspondence. On February 1, 1933 Drinker will appoint his successor. ' Your suggestions as to other members would be appreciated, but bear in mind that we do not want members not now engaged in investigative work on dust. We want the membership kept small and above everything to be informal and no precedents to be established. Attached is a list of proposed members. Please be good enough to send the secretary word as to whether or not you wish to become a member. Philip Drinker, Secretary 55 Van Dyke Street Boston. Mass. Konicide Club Members (First Mailing List -- about March 1932) Bureau of Mines, Dept, of Interior, Washington, D.C.: Mr. Daniel O Harrington; Mr. F. B. Meriwether; and -4800 Forbes Street. Pittsburgh. Pa.; Mr. W. P. Vant; Dr. C. E. Brown. Chicago, III., 330 South Wells St.: Dr. C. O. Sappington. Employers Mutual Insurance Co., 800 Empire Building, Milwaukee, Wis.: Mr. E. G. Meiter. Harvard School ol Public Health, 55 Shattuck St., Boston, Mass.: Mr. Philip Drinker; Mr. Theodore Harch: and Dr. W. I. Clark, The Norton Co., Wor cester. Mass. Metropolitan Life Insurance Co., 1 Madison Avenue. New York. N.Y.: Dr. A ). Lanza; Dr. W. J. McConnell; Mr. J. W. Fehnel. northwestern University, Medical School, Chicago, III.: Dr. James A. Brit ton. Owens-Illinois Class Co., Toledo. Ohio: Mr. W. G. Hazard. Public Health Service, Treasury Department. Washington, D C.: Dr. R. R. 351 Sayers; Dr. Albert E. Russell: Dr. R. R. Jones: Mr. J. |. Bloomfield; Or ). M. Dallavalle. Saranac Laboratory, Box 551. Saranac Lake. N.Y.: Dr. L. U. Gardner: Mr. Donald Cummings; Dr. Homer L. Sampson; Mr. Andrew Redlin; Mr. Thomas Durkan. Toronto. Ontario. Parliament Buildings: Dr. George Blair Brink; Dr. )ohn Grant Cunnmeham; Dr. A. R. RidSell. Uniiersi!', 01 Pennsylvania, University Hospital. Philadelphia. Pa.. Dr. H. K. Pancoast: Dr. E. P. Pendergrass. State Department or Health. Hartford, Conn.: Dr. A. S. Gray; Mr. Warren A. Cook. Westinqhouse Electric Manufacturing Co., Medical Dept, East Pitts burgh. Pa.: Dr. T. Lyle Haciett: Mr. Edgar C. Barnes. Six additional names were on the membership list in th-1 'ast davs or the the Club. Manfred Bowditch. W. C. Dressen, Leonard Orenburg. Oscar Sander. H. H. Schreuk and Charles R. Williams The first meeting of the new club was held at the Saranac Laboratory on April 2. 3, 1932. attended by Messrs. Cardner. Clark, Pancoast. Pendergrass, Clifford (guest). McConnell, Leake. Brown. Meiter, Fennel, Hatch, Bloomfield and Cummings plus other mem bers of the Saranac Staff. The first day was devoted to the pathology of silicosis and the second to dust sampling and count ing. Some of the highlights of the meeting were summarized as follows and give an idea of the state of knowledge of silicosis in 1932: the hazard from a silicious dust is in proportion to its free- silica (S1O2) content, provided that no inhibitory substance is present: other compounds of silicon have not produced fibrosis in experimental animals (except magnesium silicate which produces a different kind of fibrosis); intravenous injection of S1O2 produces fibrosis in the suprahepatic lymph node followed by fibrotic nodules in the liver; no similar fibrosis is' produced by aluminum oxide. Respecting dust counting, there was lively discussion of dark-field vs. light-field microscopy, especially with reference to ease of particle counting in the < 1 /x range. To change from light-field, however, would entail a considerable series of com parative counts. There was no agreement on such a change, A second meeting was held in conjunction with the National Safety Congress in Washington on October 3-5, 1932. Messrs. Gardner. Russell. 8loomfield, Hatch and Drinker presented a series of "dusty addresses" (Drinker's wording) to the congress. This was, perhaps, the first large gathering from U.S. industry before which representatives of the small group of pneumoconiosis specialists presented the dimensions of the silicosis problem and the needs for its control. Messrs. Thompson, Leake, Russell, Bloomfield, Yant, Brown, Gray, Cook, Cunningham, Gardner, Hatch and Drinker were present at the club meeting on October 4th. The relative merits of dark and light-field illumination in dust counting were further discussed with a final conclusion to continue with the lat ter. All agreed, however, that an easier method would be welcome. An important contribution was made by Dr, Clark, who outlined recommended procedures for a continuing medical con trol program in the dusty industries. The application of these procedures, so well understood and commonplace now, was only beginning in the early 30's. -- - For the 1933 meeting (November 11th and 12th), Drs. Pancoast and Pendergrass were the hosts at the X-ray Department, Hospital of the University of Pennsylvania, Philadelphia, Pa. With their colleagues they prepared for this meeting a very comprehensive series of subjects for discussion. The first day was devoted to clinical examination in silicosis and the importance of associated diseases, especially tuberculosis, pneumonia and other respiratory diseases. During the second day, discussion was directed mainly to radiological techniques and differential diagnosis between silicosis and silico-tuberculosis and lesions simulating silicosis. At 352 the end of the second day. Dr. Gardner spoke briefly on "What is Known About Asbestosis", an early contribution to a subject that looms so large today in the occupational health field. It is not too much to say that this was the most detailed seminar on the medi cal and radiological aspect of the pneumoconiosis problem presented in the United States up to that time (1933). The next meeting was held in Washington, January 13-14. 1935, under the auspices of Dr. Sayers and associates. Office of Industrial Hygiene. U.S.P.H.S. Among the topics discussed were: recognition of the roentgenologic changes, etc., described at the earlier Philadelphia meeting, as significant diagnostic events in the development of Silicosis and the essential procedures to be recommended in both medical and environmental control of dust hazards. Dr. Sayers and associates reported on the findings of the recent PHS study of the health hazards ,n anthracite coal mining and Savers and Miller described their findings from intraperitoneal injection of dusts in experimental animals. In the course of this meeting, as in earlier ones, there was much discussion of the need to establish limits of permissible dustiness to serve as guideoosts for effective dust control efforts. Out of these came Cummings' suggestion of the formula used for many years subsequently to calculate acceptable levels of dustiness in proportion to the free silica content of the airborne dust, starting with 5 x 10'' mppcf for pure quartz. This formula, with some modification, is still widely used in other countries as well as the U.S. We recall also his view, shared by Dr. Lanza, that no "safe" level of dust exposure could be set for individuals with any degree of tuberculous infection. This dictum was laid down, of course, to emphasize the absolute necessity for tuberculosis prevention along with control of the in dustrial dust hazard. This gathering was of particular significance as a preparatory session for two meetings shortly to be held: one at the Mellon In stitute, out of which came the "Air Hygiene Foundation" (now In dustrial Health Foundation) and the other, the 1936 Silicosis Con ference, sponsored by Miss Perkins, the Secretary of Labor. Konicide club members played leading parts in the planning and conduct of both of those meetings. In January, 1936, a club meeting took place at Harvard, organized by Drinker and Hatch. The importance of particle size in the etiology of pulmonary dust disease was emphasized. 8rown discussed respiratory dust deposition and retention: Hatch report ed on the striking variations in the composition of mineral dust as particle size is reduced, with particular reference to the decreasing SiC>2 content with particle size for dusts from granite, sandstone and other silicious minerals. Professor Larsen of Harvard's Ceology Department demonstrated petrographic techniques for dust analysis and discussed size limitation in such analysis. Dr. C. K. Drinker described the lymphatic system and discussed its im portance in the development of silicosis and P. Drinker reported on nasal dust filtration. Later in 1936 (November 23rd and 24th), Drs. Lanza and McConnell and Bill Fehnel offered a program at the headquarters of Metropolitan Life Insurance Company, New York City. The first day was devoted to medical questions and progress in animal studies. Speakers included Drs. Gardner, Sampson, Lanza. Pen dergrass. During the second day Dr. Greenburg described a New York state program of industrial hygiene and Fehnel discussed a dust control program in an asbestos plant. Decrease in S1O2 con tent with particle size found in industrial dusts, notably in foun dries, was also a topic of continued interest. On July 12th and 13th, 1937, the club enjoyed the hosjiitality of the Montreal Mining Co., Montreal, Wis., with whom the Saranac The Konicide Club/Hatch and Pendergrass nat is : that tU ne olem 1935, strial ition jrlier the i be dust f the mng meal r this need )OStS nings' :ly to tree :t tor idely lew, id be This olute -e in- atc `0 In- ,v In- Conabor. and vard, ze in own port.st as asing tone slogy dust C. K. , imorted and rters - hrst limal PenNew ed a a fou. ity of anac grass Laboratory had close association. The program, arranged by Or. Ringo, Medical Director, was focused on the health problems of the ferrous mining industry, with detailed discussion of the problems encountered in the Montreal and neighboring mines. Speakers included Drs. Gardner and Sampson who emphasized the significant differences in the pathological and roentgenological changes seen in the iron miners, compared, for example, with granite cutters. The medical facilities and dust monitoring equip ment employed at the Montreal mine were inspected and club members enjoyed an underground inspection trip. The meeting concluded with a general review and summary of the medical and engineering problems encountered in the industry. On January 22. 1939 another meeting was held at the University of Pennsylvania under arrangements made by Dr. Pendergrass. The program was devoted to the health problems of the asbestos in dustry. Titles of separate lectures were: General Survey of the Asbestos Industry and Its Engineering Problems: Experimental Pathology Concerning Asbestosis; Clinical and Roentgenological Survey of the Asbestos Industry; Pathology in Patients Dying with Asbestosis: Roentgen Studies in Industries Having Asbestosis. Speakers included Drinker. Gardner. Sayers. Dreesen and Drs. James Sullett and Rush Shull, guest speakers. Over the years there had been frequent inquiries by non members about the club activities and increasing pressure to in clude in its deliberations individuals not engaged in pneumo coniosis research, especially by lawyers concerned with com pensation claims. These widening interests and more particularly, the organization of the American Industrial Hygiene Association in 1939 suggested to the members that the '`exclusive" Konicide Club had served its purpose and its activities should be concluded. There were no more meetings. It is difficult at this late date to recapture the excitement and stimulation that one found in the club meetings. In the course of the successive conferences, new findings and new research and investigative procedures were quite regularly brought to our at tention. In many instances these required abandoning old ideas and adopting new ones, but these changes did not come easily for the proponents had to defend their proposals against much (con structive) criticism by their colleagues. One of the fortunate con tributions was to bring together from the start the scientists and practitioners from both sides of the problem, respecting both man and environment -- biological science and medicine together with physical science and engineering. The collective responsi bility of such teams of specialists for the development and appli cation of preventive measures for the control of silicosis and other disabling occupational dust diseases was constantly emphaszied. Not the least accomplishment was learning to talk to each other and each to recognize the essential need for the skills of the others in the joint solving of important health problems. The expansion of this concept in dealing with other job-related diseases has given special strength and effectiveness to the whole occupational health effort in the United States. I , I Regulated Progress _ l Scholarly review is such an effective barrier to novelty that a new idea can seldom be announced j to the world until it has first been sold to the establishment. Most innovators are ill-suited to promotional work, and begrudge the time and effort. Many ideas die at this stage. The innovator [ must buttonhole important people to enlist their support, or perhaps apply for a grant to study his j innovation. If successful, this gets the idea on to the grapevine which is its announcement to and ; acceptance by the world. Publication is a formality, like a letter confirming a telephone call. By thus ' standing astride the channel of communication, the establishment maintains its rule and regulates I progress for its own convenience. -- From 'Evolved Conspiracy1' by Charles McCutchen in The Sciences. july/August 1976. | [ ' I . ; Journal of Occupational Medicine/Vol. 19. No. 5/May 1977 353 Page 232 INDUSTRIAL MEDICINE May, 19db der anaethesia until the full range of lateral mo tion is obtained. A light cast is then applied with the foot in dorsiflexion, the heel in full supination and the forefoot in compensatory pronation. This should be maintained for about three weeks, with Many are of the opinion that this attitude ma change, but there is no doubt that certain policie recently adopted with respect to the safeguarding of the health of industrial workers will be perma nent. a walking iron having been incorporated. At the end of that time, after care is administered con sisting of physiotherapy and the wearing of a stif fened shank shoe or foot plate. The latter is ab How is the medical profession going to meet this situation? The passive attitude which physicians have shown in the past with reference to the for mulation of medical policies in industry, has given solutely essential in forestalling the possible even non-medical groups a wide latitude in carrying out tuality of a traumatic weak foot. many controversial practices in the medical care Summary - of industrial workers. Unless the medical profes sion becomes interested and formulates some THE common derangements of the ankle joint means of protecting the health of industrial work have been discussed and the mechanism of their ers the responsibility will undoubtedly be placed production outlined. It has been pointed out thaint the hands of lay groups, which has so often been a clear understanding of the pathological physiol the case in the past. Consequently, there has ogy of these lesions is essential to intelligent treat arisen considerable criticism both on the part of ment and good end results. . industrial management and the medical profession as to the extent to which industry may assume the Medical-Engineering Control care and safeguarding of the health of employees in whom a very considerable investment has been of Industrial Health Hazards made.. By T. Lyle Hazlett, MJD., Medical Director, Westinghouse Electric & Manufacturing Co., East Pittsburgh, Penna. ' THE lowest estimate of the cosjfor employing a new industrial worker is $lpO, while some estimates are as high as $500. This includes the time necessary for training, defective work during the training period, efficiency to be attained to TpssumiwsiiwcpetccstcqoulnpnnnaarirelesaotaenapnuolaiigaiigiTiorrUestiaramtdcltroeyvvnigtiehelihyftnoeteolneelinaunamaemhs.ceetsdnsndnbrlc,wogiteternr.snoiohoHalTueieyasseneslTeo:citrfnuonermosnhlpmoEodeosoDr.ehdrifmaatc"rikoasnoaclmtpsfrifemeelrsunodletitaneoedreelcanoelhcohpocdtrereeapidrwoacItawttlieseaoaoyfev.nndphetosmatscsnneeinplfteoshriwdndgeeeehfcostmiertmsllbwunWfehidsaugloseaoleniicytrteeelnsptrenaphosahtolimsliheeii,apwlintttnmncttni"oiuduopeohsnccptrshtahpteathdyeirrtlaa,leroherlnatyhtal,dodeyeeeedcdoisratrrgndnasellhfu"weecaoie,sseayeettningrerebsie,crnmytmpreisgassnpewiendess,weitnirodtrs,ridaacchinpaeeunseeooitimvhinbsdarpiniytoensninnsaoenfhetehcgipeposeanasnasocgtafhdirueaiiiaaitsesf.nasrgahrncnowsifatmtmcnetelnarrdseehiongnlthiuantigeteneeititameeeatraoeiatenyntpggrtroghkpcrerowdnpoea.aedxeienilanesptprlnnapiallsyhtsnotedicridtlrraeaggtnhseenpatetiaettuihaseosssnfnigerahganlctrcgcbuemcttdiaieistrteopfesdtneuobitlaieil,ftsootentedeaameiichvinfueldlionnnfsadaoardndnlrewadnttditsngeeclowhinxrdlhrunsvaeinyeanslraltwyioayeusyetingnsmdghohomsh,vfcbettselodroueiatlonrieaoi"aepiiaeiesgennynfnuotdzssorfynrcyhsraheadldadsintscoeotoodneefnrtithuaarhtut,crcrnmehmibuhdewrimrceaeuriacssosaoyegreesessedeltsfl.frecnmncbcdecpsnehednowfpgohwcetitbetohlooeanieeeeenrluragroefucyriiIoeosoIercIcnlcgtmnimgtimnndandnndnrne.wpecrleocdhiiilDeltaogikavnniznresgbbseuesranitatqtmnletnieeasIesedhchnegrlasbisasaneaudodascaettopueebtasripuithmeranheetsnrtrorhsveraemsmsomylytpeioreslmialiinseneeripunaegmcsefotftpciemteargaiemlhlpndnmgpriiahncororesslennagntelsqpeivlaraseaethynaomedsmintygpyeodlhuoeennotaelwegyicutnrli,nieirnrseipeadoqnorrfinaepehswattnamsgttadtnelnrficueudtehmoqaagwttnsflseesthedbrrtstsaepdyzeuritpe,hdeahvbn,seoqeawsi,eilrelaaclilcnofiisuaosiiheufnanurfpchiasuenfrnlhritoiktyinusdocdecttnatymoamtasnigwigheoseedl.tinuasotlhvmdranafrinhserhuonsrifltoctgfibei.nirdndidaiiatiasnsi,coffeTcozreecawtivnchw,ihrlgtanseoutaivanhtsanehhagdiaaiwihboptashinselmsntnantaindnasnmaeeeuoruhawlemcdivyvttlgecoudrfkeclmarynthseaeeetfoiaaehiwretniaanpqg,ohsseitnagetgescnnrhsentesluioomrnaatatdhnhsowdicchttittiwmzsisrvouctgnsgopeihtneliuthmeheteoamocooc.tnhyauldmestisusbieehsasrtrhtnsewestiteesltekeplostelieetwwaasrjtaTnhioneoamyiunmonfarpndibnirpshhhgdeedstr.bysrfcnhwdts.uoaialafeeiiirlstoitscsiyslsnuaspslrewacyootrttortfpohshpiehaaheoooansidbntrmwoneopsioeurbepkfocnl.trtyimifiretsrnoclurhrlac.eiuedbaieekaianwtrtMtswtticaaelldperyafyreetsndSlaopfhofaayuhtlditleoosr.cinaiuvuahttctfnmbforoii*hdhrhrbaocdtnocennalovatysmnkoidreeoeiehlhlserensrrt;f* whom injured employees are referred for medical INDUSTRIAL PHYSICIAN care and the engineering staff of the plant, the Large manufacturing organization with headquar ters in Middle West and factories throughout the country has opening for young clinician in indus trial medicine; research in health maintenance; po tential opportunity to assume responsibility for di rection of comprehensive medical program. Suc cessful candidate will be given opportunity for special training in industrial hygiene. engineering staff of the compensation insurance carrier, and, if possible, larger plants having simi lar processes. In this manner medical-engineering control might function at all industrial plants re gardless of size, thereby building up knowledge which would be invaluable both to employers and employees. . ' Vol.,5, No. 5 INDUSTRIAL MEDICINE Page 233 THE physician working in conjunction with the a period of years sees the number of individuals in engineer who understands the various proces a large group who, without medical supervision, ses is in a better position to diagnose any diseaswe ould have become totally disabled and forced to which may be felt to have an industrial origin or' cease all gainful employment. to eliminate the industrial cause. This in turn may The greatest example of such health supervision determine the proper and immediate medical treat has been in the control of tuberculosis in industrial ment, and avoid possible errors of diagnoses due organizations that have had well defined health to a lack of knowledge ofathe exact nature of the programs over a period of years. No other disease occupation; as, for example, the confusion perhaps affects the economic security of the industrial of carbon monoxide poisoning with a diabetic worker to such an extent as tuberculosis. coma; chronic lead poisoning with a peptic ulcer; From the large number of physicians who see occupational dermatitis with dermatophytosis ' industrial workers from a -surgical standpoint cer (fungus infection). tain contacts have already been established with The engineer, in turn, with a medical contact employers so that it is only a step ahead for them will have a clearer understanding of what condi to assume the responsibility of safeguarding all tions may constitute a health hazard. In the de workers from a health standpoint. signing of new equipment or in changing present And who is better qualified? ' methods of manufacture possible health hazards Wwill be foreseen and eliminated before installation. This will result in a material saving in future .cost of protective equipment, in increasing the effici HILE industrial hygiene must of necessity be considered a post-graduate course in our medical schools, nevertheless some conception of ency, of workers, and in eliminating future lia this problem should be given to undergraduates. bilities. .Simply knowing the symptoms of a few common The engineer should study conditions which may poisonings which may occur in industry wifi handi be detrimental to health and by quantitative meas cap the average medical graduate if practicing in urements determine the dosage of substances that an industrial community. This lack of training workers receive. In conjunction with the findings often results in hasty diagnosis and in the patient's of the physician safe practices may eventually be occupation being regarded as the cause of the ill determined for any occupation. Among the means ness, if no other cause is easily discernible. All too at the engineer's disposal for eliminating an occu frequently no effort is made to contact the em pational hazard may be mentioned: ployer to learri the true nature of the employee's 1. Removal of source: . (a) substitution of non-toxic materials; (b) complete isolation of process; (c) wetting dry, dusty materials. 2. Protective devices: (a) air conditioning; (b) respirators; (c). dermal coverings. occupation. Correct diagnosis is most important, for if a be lief is unjustly created in the employee's mind that the materials with which he is working are in jurious to his health it is most difficult to eradicate, and it is mentioned by him on all occasions of mental or physical illness during his entire employ ment. There cannot but arise, therefore, a feeling on the part of the employer that some physicians The investigations by the physician of industrial attribute all illnesses of industrial workers direct processes thought to have an injurious effect on ly or indirectly to their occupations. the individual worker will require a careful peri As information is gathered by physicians and odic physical examination. In certain types of oc others doing research work our knowledge will be cupations it will necessitate additional studies, as more accurate, thus enabling both the employer blood, urine, sputa, feces, and roentgenological ex and the employee to Teach a more satisfactory un aminations. derstanding without the conflicting testimony now The practice by industrial management of mak so often heard in our courts. A clearer conception ing periodic physical examinations of industrial of what constitutes an occupational disease will workers has been somewhat controversial. Many prevent serious mistakes in diagnoses which are physicians have felt that this procedure has been unfair to all alike. opposite to good medical practice, whereas in If more attention is not given to these problems reality it fosters a closer relationship between the present tendency will become more pronounced physician and patient, for most physical defects for industry or governmental agencies to establish found at the time of such an examination are in no bureaus where workers in certain types of occupa way connected with the individual's occupation. tions will receive physical examinations and be The employee is urged to correct, by consulting his given working credentials. Various State Depart family physician, conditions found which later ments of Labor are at present making medical may or may not cause lack of earning capacity and engineering surveys, and there is at least one state economic insecurity, whereas if these conditions where the Insurance Commission offers to em were not brought to his attention he would have ployers complete medical care for industrial ac had no thought of seeking medical advice. With cidents, so that it would seem as if occupational this added knowledge of health problems the work diseases will be included in the near future. This er also feels an increased responsibility for the will tend to result in complete medical care of the medical care of his family. industrial worker by such agencies. Thus there is established a still closer contact Active medical-engineering control of these with the family physician. problems at this time will have an important bear The economic value of such examinations, not ing on future practices and on future legislation. only to industry but also to the individual, cannot Which way the pendulum will swing will depend be estimated by any known standard of measure on how actively cooperation is established between ment. It can be appreciated only by one who over industrial management and physicians.