Document NenqaNb5pYQbowjQmnkLO9zqD

Vol. 5, No. INDUSTRIAL MEDICINE 3? 'lumber Tuber Angle Arthritis Foot Fore- Lateral Spur shorten- Spread- Formamg ing don 5S9901... 591573... c.s....... c.s........ 516114... 6599C6... 516467... 516467... 591330... 589592... 51S992... 515856... 585370... 515844... 518809... 714629... .... . ___ Heeling with bo evidence of injury .... . .... Osteoporoeis ___ Oeteoporoeis .... . . ___ No further X-Ray* taken ....No deformity... . .... Fracture line obliterated ... ,,,, Totals 9 466 Table TV. Final Pathology Number 589901 591578 C.S. c.s. 516114 659966*<x) 5166*7 516467 591830 589592 513992 5158.56 5^5370 515844 515309 714629 Defect in Defeet in Lateral Thicken. Flexion Motion ing 9 t ... Normal. Permanent Defect . C-rtrnm 20% . Still undetermined . 3till undetermined . None . 20% . 20% 30% . Comm 45% . Comm. 45% . 40% . 40% . Comm. 20% 25% . None . None Totals 13 12 10 Average 25% (x) See X-Ray. Table V. Permanency. Conclusion AN ATTEMPT should always be made to obtain . reduction. ' 1 Boehler's method is perhaps the most satisfac tory means of reduction. 3'. Prolonged physiotherapy is an important part of the treatment, and the whirlpool bath appears to be the best agent 4. Fractures do not necessarily produce a per manent defect 5. A permanent defect of more than 50% is not to be expected. Bibliography; 1. Bokhua, L; Diagnosis, Pathology and Treatment of Frac tures or tbe Os Calcis. J. Bont if Joint Surf., 13:75.59, Jan* 1931. A. Conk, H. JL: Fracrure* of the Os Cild* Oftit Suu if. J., 25:429.533, August, 1929. B. Poutrrm, C. R. G.: Acute Fractures of (fa* Os Calcic Am. J. Surf., 25:404.413, September, 1914. C. Funstw, R. V.: Treatment of Fractures of the Ot Calda, J. Michigan ifeJ. Soe., 26:102.104, February, 1927. 0. Caiot, H. and BiMxrr, H.: Fractures of tfa* Oi Calda and Astragalus. Ann. Surf., 45:51,65, 1907. E. Cla*on, W. C. and Baxkzx, .t: Fractures of tbe Os Cai ds and Astragalus. South. if. J. 27:397,402, Mar, 1934. Z Macnusok, P. B.: Fractures oi the Os Calda, JMJtf.A., 80:1511. May 2i, 1923. 3. Cotton, F. J. and Wilson, l- T.: Fractures of (be Os Cal- cia. Betttn if. if S. J, 159:559, October 25, 190t 4. Wilson, P. D.: Treatment of Fraetures oi tbe Os Calda b* Arthrodesis of Subastragaioid Joint. S6'.i676,l6S3, March 12. 1927. Occupational Disease com pensation Data Indicative of Cost, for Occupational Diseases in General, and of Silicosis, ' Asbestosis and Dust Diseases in Particular By F. Robertson Jones, General Manager, Association of Casualty and Surety Executives, New York Massachusetts Experience ALTHOUGH the Massachusetts Workmen's L\ Compensation Law has from its inception-- A Jl it became effective July 1, 1912--literally covered all "injuries" arising out of the employ ment, it was not until the decision, in 1929. of the Supreme Judicial. Court, in Sullivan's Case, 265 Mass. 497, that pneumoconioses (including silico sis) were held to be covered. Until then the cost of the few cases of occupational diseases thereto fore held to be compensable was too low to affect the rates materially. But that case, and Fabrizio's Case, 274 Mass. 352, decided several years later, caused a widespread claim consciousness re quiring modifications in rates to meet an acceler ation, both actual and prospective, of occupation al disease costs -- most immediately in the rates for stone cutting and foundry hazards. The fol lowing is a rough outline of the subsequent de velopment of the rates for such occupations to October. 1935: Stone Cutting IN THE Manual the risks in question originally c?me under classification: " "1803. Stone Cutting and Polishing (N. O. C.) excluding quarrying." As of March 1. 1934. that classification was dis continued and the following was substituted: "1308. Stone Cutting or Polishing--Granite- including Drivers, Chauffeurs and their Helpers, (Quarrying to be separately rated)." Under Classification 1803 a rate of $4.77 per 5100 (covering all "injuries" under the law) was in ef fect from December 31. 1928. to June 1, 1931. and. though omitted from the Manual after the latter date because of application for official approval of a higher rate, continued in effect for about a year longer. However, in the meantime, various car riers requested and received approval of a 510 rate for many risks. Later, because of wage reduc tions, a $12 rate was approved for a period begin ning June. 1932. But only one company would write the insurance at such rate, and it discontin ued November 1. 1932, because of unwillingness of its reinsurer to continue. Thereupon, as a result of conferences between the Insurance Commissioner and actuaries repre senting the Rating and Inspection Bureau and leading carriers, in November, 1932, it was recom mended to establish a rate for this classification of S3 per S100 payroll, with a "Supplementary Oc cupational Disease" rate of $300 per employee per year (S25 per month for any employee on the payroll during all or any portion of any calendar month). This rate was not approved until over a I Page ISO INDUSTRIAL MEDICINE April, 132$ year later, to take effect December 1.1933. In the The situation in Massachusetts in regard to in meantime, insurance of risks in this classification surance of foundry hazards is complicated by was almost entirely suspended. emotions aroused 'by the so-called Glenwood The S300 per capita rate was based on the fact Range Company case. In that case, a carrier that the experience under Classification 1803 for which had insured the range company, cancelled the policy years 1926 to 1930 inclusive disclosed its policy because of unfavorable experience. a total of 92 pneumoconiosis cases, with an incur Thereupon another carrier took the risk, but, first, red loss of $286,075, the average claim cost being some 42 employees were discharged because re $3,131. It was estimated that many employees ported. upon medical examination, to be alreadv then in the industry would within the next 10- affected with silicosis. Generally these men were year period develop the disease, making it neces not disabled, and a violent public agitation was sary to collect over that period the sum of $3,000 aroused in their behalf. In consequence they were per man. Hence the necessity for the supple nearly all taken back eventually, the retiring car mentary occupational disease rate of S300 per year rier compensated them for their lost time, and a or $25 per month of employment exposure. ' third carrier took the risk upon being reinsured However, the Supplementary Occupational Dis by a pool of other carriers. Although experience ease rate (of $300 per employee) may be reduced is yet too brief to demonstrate conclusions, it in 40% provided that specified conditions relative to dicates that the S2.00 rate is inadequate--especial the health of employees, dust suppression and per ly in view of the fact that, since such rate was es sonal protection, are continuously effective; and tablished. the period of compensation for perma may be entirely removed if more stringent condi nent total disability has been lengthened (by tions be maintained. On the other hand there are Chapter 364, Acts of 1935) by the addition of a life special conditions applicable to the writing of pension after the termination of the former limit risks in this dassificatioiv--relative to inspections, of 500 weeks. -- approval by Rating Bureau, audits, experience rating, commissions and engineering require Silicosis and Asbestosis ments. The rating provisions above outlined now apply British Experience to Classification 1808 (which on March 1, 1934, was substituted for Classification 1803, as explained above). While these rating provisions were developing, SUCH British experience as is available is diffi cult to analyze and explain without a thorough knowledge of the British compensation law--that part of which relating specifically to this subject the payrolls in the stone cutting industry in Mas consists of many complex provisions in each of six sachusetts were shrinking, as per the following different "schemes." table (furnished by the Massachusetts Rating and The schemes do not cover all industries broad!v. Inspection Bureau); but only those industries enumerated in some one of five trade schemes. (The sixth scheme relates Policy Year Payroll to "Medical Arrangements." which apply to all 1929 1930 $3,033,200 2.657,600 the other schemes). These schemes are all rela tively new, and their collective scope has been 1931 --------------------------------------------------------- 2,046.100 much enlarged in very recent years. Consequent 1932 786.800 ly the experience is not broad and has been too 1933 ______________________________________ 421.400 brief to be definitely instructive. Under each of two of the trade schemes, insur Of the payroll for 1933. $342,248, being 81%, ance is monopolized by a compulsory Trade Fund. was represented by one large risk which is not insured. These figures indicate that the cost of occupational disease coverage is either causing unemployment or causing men to continue at work without compensation insurance protection, or both. * Under the other three trade schemes, stock com panies and mutuals provide the insurance, and many establishments "self-insure." The risk insured against is practically three fold: (1) of primary liability for disease contract ed during the term of the policy; (2) of liability Foundry Haaards to contribute pro rata to the cost of compensation to ex-employees; (3) of liability for comoensation IN OCTOBER, 1933. the Massachusetts Rating to employees "suspended" on first official periodi and Inspection Bureau submitted for official cal medical examination after the carrier goes on approval a Supplementary Occupational Disease the risk. The stock companies cover these risks rate of $4.00 per $100 of payroll to be applicable to --one, two or all -- variously; but their quoted all employees exposed to a foundry hazard. This rates, it seems, generally apply only to the first rate was computed upon Massachusetts' experi coverage and there are extra charges for the oth ence with silicosis losses in all classifications and er two--the charge for coverage of the third risk upon silicosis claim frequency from foundry haz being commonly an extra annual premium. ards in other jurisdictions, the Massachusetts ex-, The charges for insurance--which are the only perience with foundry losses being yet too brief indicia of loss cost available--are rated variously: and inadequate to serve by itself as a basis for On total payroll (with exclusions); on wages of rate making. However, such proposed rate was named employees or of employees engaged in spe not approved, and, instead, a Supplementary Oc cified processes; per capita: per grindstone raced; cupational Disease rate of $2.00 per S100 on the per millstone dressed; etc., etc. payroll of all employees exposed to a foundry haz Note that the rates in question are for insur ard in any risk, howsoever classified, was approv ance of compensation 9nly for silicosis or asbesto ed to take effect December 1. 1933. and is still in sis (including cases complicated with tuberculo force. This premium is in addition to the normal sis) and are additional to the rates for accidents premium for the classification. and other occupational diseases. Vol. 5, No. 4 INDUSTRIAL MEDICINE Page lil In the "Sandstone Industries Scheme" the rates assessed by the Trade Fund for 1935 are reported to be as follows, in percentage of wages: Grade A. 4.16%; Grade B, 2.08%; Grade C, 1.04%. In the "Refractories Industries Scheme," the Trade Fund assesses a uniform, "Sat" rate for all establishments alike. That rate is reported to have been recently increased from 5% to $.25% of wages. The industry subject to the "Asbestos Industry Scheme" is largely controlled by one large organ ization which is a "self-insurer" and does not re port its experience. The stock company rates for risks subject to this scheme vary from 7^4% to 10%, where strict precautions are taken, with a SDecial rate of 12.5fr<> for the making or repairing of asbestos mattresses. The following are some illustrative rates re ported to be charged by the stock companies for occupations under the "Various Industries Scheme" and the "Metal Grinding Industries Scheme"--in percentage of wages unless other wise stated: Brick manufacturer__ , ...... ........... -- .03 Potteries--China ) . ..................6.23 Potteries--Earthenware) ____________ ____ 3.125 Plus 1 per capita to cover suspension on first medical examination. Builder--Stone masons only..... ............ ........ 7.3 Plus 7.10 per capita tor coverage of named ex-employees or an additional annual premium for coverage of all ex employees. Fuoiic works--dressing pavement stones or curbs -- .--............10 per capita Racing grindstones--per grindstone raced_l Com mill--per pair of stones dressed..,-.....IDs Manufacturing and packing scouring ' powder________................... .......... ......... 5%-10% Metal grinding------------------- ---------- ---------6%-10% Foundries and metal works (general)_____2% The inadequacy of the British experience needs :o be emphasized. Asbestosis became compens able only in 1931; and the same is true of silicosis in coal mining. Experience in the coal mining in dustry is especially significant in this respect. There are three or more large coal mining areas in Great Britain. In one area. South Wales, the cases of silicosis certified have been increased pro gressively as follows: 1931, 61; 1932. 161: 1933. 230. In the other areas there have yet been almost no cases. There is no known reason for this increase in one area and absence of cases in the other areas, except increasing claim consciousness in the first area and unawakened claim consciousness in the others. In connection with the above-cited rates for in surance of compensation for silicosis and asbesto- sis. the benefits under the British Workmen's Compensation Acts should be considered. Roughly they are as follows: * For incapacity: 50% of average weekly wages, or of the resulting wage loss, maximum 30s. per week, during incapacity--subject to commutation by agreement. For fatal injuries: lump sums, varying accord ing to number and relationship of dependents; maximum for widow alone. 300; maximum for widow and dependents under 15 years of age, 600. Medical benefits: none, i.e., the employer or in surer may voluntarily provide medical, surgical or hospital treatment or care but neither is under anv obligation to do SO. . Silicosis New Sooth Wales Experience IN NEW South Wales there are two "schemes" for compensation for diseases caused by silica dust. For oae of these schemes -- `'Workmen's Compensation (Silicosis) Scheme No. I"--the cost experience has been distinctly and adequately re ported. That scheme applies to stonemasons, quarrymen. rock choppers and sewer miners in Cumber land County. The compensation is payable out of a public fund, maintained by levies upon employ ers and substantial subventions by the state. Ac cording to the figures published in the "Eighth An nual Report of the Worker's Compensation Com mission," the losses incured. plus expenses of ad ministration, from the inception of the scheme in 1927 to June 30, 1934, amounted to about 10% of payrolls in the occupations covered. This cost, it should be emphasized, was for compensation for silicosis alone, compensation for accidental injur ies and other occupational diseases being a separ ate matter. In this connection, it should be further' noted that the scale of benefits under this scheme is not abnormal, the maximum total payments for in capacity, for illustration, being limited to 750. Occupational Disease Coverage North Carolina THE following table-gives the present manual rates for workmen's compensation insurance in North Carolina, for a few typical classifications in which there are silicosis or asbestosis hazards, with the total rate, and the total occupational dis ease element, and the specific silicosis or asbesto sis element in the rate, stated separately: Code Classification Aabestoeieer Total OJ>. SUicoafe Total Sato Element Element 1603 Rock excavation.____ __.S11.33__ _.S1.34.._--31.32 1832 Asbestos goods mfj______ 5.48--__ 3.00--___2.38 3081 Iron foundries--tf.O.C__ 5.21__ --3.00--___ 2.98 3085 Foundries--non-ferrous metals--N.O.C. _______ 4.62.--__ 3.04--___2.98 1164 Mining--not coal--with shafts, tunnels, or drifts 10.88.. --.3.00.........2.98 IS03 Stone cutting__ _________ 3.62----3.00....___ 2.98 4000 Sand and gravel_________ 6.55.... __ .27.... ........ 29 In classification 3085. the slightly higher total occupational disease element is due to the fact that there is some lead as well as silicosis hazard. In each of the foregoing classifications, it is pro vided that where the occupational disease hazard of the risk is abnormal, an addition to the manual rate may be charged, subject to the approval of the Compensation Inspection and Rating Bureau of North'Carolina. . It should be noted that these rates are highly tentative or speculative, being based upon esti mates in advance of experience. They are, how ever. predicated upon the specific provisions of Section 501- of the North Carolina Workmen's Compensation Act. as added by amendment effec tive March 26. 1935. which provisions clearly de fine the diseases to be deemed "occupational" and specially regulate the liability to compensate for silicosis or asbestosis. That amendment followed a decision by the i Page 182 INDUSTRIAL MEDICINE 4 April, 293$ Supreme Court of North Carolina, in Mc.Yeely v. Carolina A-sbestos Co., May 23, 1934. wherein it was decided that an occupational disease (asbes tosis) contracted unexpectedly and gradually dur ing many months of exposure, if due to the em ployer's failure to provide means of prevention, is an injury "by accident" and, as such, was com pensable under the Workmen's Compensation Act as it then read--which decision injected elements of uncertainty into the law that rendered the haz ards of occupational diseases, particularly of sili cosis and asbestosis, often uninsurable at practi cable rates. At the time of this decision, the man ual rates then in effect, for the classifications above given, were as follows: fc Code Classification Total Rate 3081 Iron foundries--N.O.C. 3083 Foundries aon-ferrous metals --N.O.C.2.18 1164 Mining--oot coal--with sham, 2.36 2.34 OJJ. Element S .45 .53 .40 .40 1803 Stnn# (-lifting 4000 Sand and gravel. .90 5.47 .10 With reference to the occupational disease ele ment in these earlier rates, it needs to be explain ed that, although "occupational diseases" as such were not then compensable, yet there were risks, i.e,, chances, of liability for occupational diseases at common law, which might be covered by the policies, and of some cases of occupational dis eases being compensable because arising "by ac cident." The McNeely case, above referred to, so con strued the phrase "by accident" as to magnify the occupational disease'risk under the compensation law tremendously, thereby rendering the rates then in effect grossly inadequate for all classifica tions with asbestosis, silicosis or other serious oc cupational disease hazards. Dust Disease Coverage New Tork IN NEW YORK, rates and charges for dust dis ease coverage have been approved, effective September 1,1935. These rates cover the dust dis ease hazard only, and are additional to the man ual rates for coverage of accidental injuries and all other occupational diseases. Since there are two methods of rating the dust disease risks, it is necessary to show two sets of rates for this coverage. The two methods are: Rating Plan I: Under Rating Plan I, the risk is charged, in addition to the general workmen's compensation rate, a rate per $100 of payroll on those classifications in which the dust hazard is present, which rate is designed to provide prem ium to take care of dust disease losses only. In addition to these rates per 3100 of payroll, the as sured is charged S300 per claim for each claim for disability lasting four months or longer, or for death, resulting from injury to the respiratory tract These rates for the dust disease hazard may be eliminated, reduced or increased, subject to the approval of the Compensation Insurance Rating Board, where, in a particular risk, the processes or products causing the hazard are non-existent or present a subnormal or abnormal hazard. Rating Plan H: Under Rating Plan H, there is charged for the dust disease hazard a rate per 3100 of payroll, much lower than the rate under Plan I, out, in addition, a per capita deposit per em ployee is required Under this Plan the assured is required to reimburse the carrier for 6/7 of all losses and allocated loss expenses arising as a re sult of dust disease claims during the first year, subject, however, to a maximum charge to the employer of $6,214 per claim. It is contemplated that in each of the following six years after the first the proportion of the losses to be borne by the earner shall increase by 1/7, while the pro portion borne by the employer shall decrease at Code Nos. Rating Plan I Per. 9190 payroll Ratine Plan II Per Per SIM payroll capita 1164 1165 1438 1439 1604-5; 1624 1710 1741 1747-3 1809 1810 1852 1852 3081-2; 3085 3091 3122:3126 3169:3883 4000 4021 4024 4053 4061-2 4101-2; 1411-14 5469 5508 6251-2; 6254-60 Mining--not coal--with shafts.. Mininw-- .......... ..... 5 4.63... 2.89__ . __ 51.38-- ..- 5 64 . .... 1.18...... ........... 4ft Smelting, etc.--metals N.O.C______-_________________ Smelting--by electrical process__ Quarries, roc* excavation, etc. 2.89_____ 1.74_____ 5.21_____ 5.79. _ 11 58 ..... -__ 1.18. 71 _ 2.12____ -. 2 18 4 7ft ... .. 40 .. 24 . 72 8ft tftft Emery works: abrasive wheel mfg.................................. 3.47_____ ________1.41_____ .... ........... 48 Stone cutting or polishing--marble and limestone only 1.16_____ ............ .47____ -------------- 16 Stone cutting or polishing--all other*-..-.... .. ____ 10.42_____ ___ n os 4.23. 2 82 ................ 144 ... <m Asbestos goods mfg.--moulded products only________ 3.47_____ ________1.41______ _________ 48 Foundries--iron--steel castings--non-ferrous metals__ 4.63 Foundry workers only (in various classifications! -.... 4.63 . 1.88- .. . 64 1 99 . 64 Enameled ware (iron) mfg-.. ......---------------- _ 5.21_____ ...... .......2.12_____ . ..... ........ 72 Cutler mfg.; tool mfg... -- ............ --..... _ 2.32_____ .94 Stove mfg.; car wheel mfg ...... ......................... ...... 4.63 ..... . 1.88....... 1.16. . .... 47 2.89 ... ...... 1.18 . .147 ....... 1.4t 32 - 64 i 4ft 48 Potteries ' china or table wartTM_____________________ Potteries--glazed or porcelain war*-------- ---------- Glass and glassware mfg... ___ ... 4.05. 3.47_____ - 1.74_____ __.... 9 84 . 1.65... 1.41 .71-- . 4 ftfl . . 56 . 48 24 118 Road construction -rock excavationTMTM....Tunneling, shaft sinking, conduits, etc _. 5.21_____ ` 1.74_____ 2.12... .73____ 72 24 New York -- Rates and Chorees, Effective September 1. 1935; Dost Occupational Dfacaae Coverage Only You 5, Wo. 4 INDUSTRIAL MEDICINE Page 183 *He same rate, so that after seven yean the in- orance carrier shall bear the entire loss. The per caoita charge under this Plan is in the nature of an advance deposit guaranteeing that the employ er will reimburse the carrier for his 6/7 or oth er proportion of the dust disease losses. In the event that this deposit is exhausted, the carrier may call upon the assured for additional deposits. As under Rating Plan L the rates may, with the approval of the Compensation Insurance Hating Board, be removed, reduced or increased for a particular risk if the dust disease ha2ard is found io be non-existent, subnormal or abnormal. In the table (on p. 182) are given the rates for this particular coverage, under each of the two plans, and the amounts of the additional deposits under Plan H, for some typical occupa tions, preceded by notations of the rode numbers in the New York Manual of the classifications af fected--for the benefit of those who may have such Manual available. High though these rates may seem, their ade quacy, under the present New York law, is gener ally doubted, with the consequence that the pri vate insurance carriers are rejecting many risks, whereas the State Fund (which is not bound by manual rates) is exacting yet higher charges, es pecially for risks rejected by the companies. As a consequence of these very high rates, and the inability of some industries to get any kind of insurance at a price that permits continuance of -Derations, many establishments are laying off Workmen and either closing down or sending their hazardous work out of the state, and an in sistent demand has arisen for drastic amendment of the law in so far as it relates to silicosis and oth er dust diseases. It is probable, therefore, that the 1936 session of the legislature may see important changes in the law and consequently in the insure ance rates. / Let us go back to the first question: how large should the plant be? As to the size of the indust^r 'requiring a nursing service, any plant employing more than 200 persons could well profit by employ ing a registered nurse. This does not imply that in a plant of this size there would be a sufficient number of injuries to keep a nurse busy; rather, there should be fewer injuries because of the edu cational work done in the promotion of good health and in the prevention of accidents. Time ana money spent on prevention are far better business and give far better results than time and money spent on the care of injuries which have resulted from the lack of educational and safety activities. The hazards involved in the manufacturing of a product should, in a great measure, determine the advisability of a nurse in industry. Where the women employees exceed the men in number a nurse is invaluable, as women and young girls hesitate to go to the foreman or the plant superintendent with problems which are common to their sex alone. Their home problems, too, are many, and can frequently be simplified by discussion with a kindred spirit'who understands them and respects their confidences. Following is a chart to indicate the manner in which the cost of the nurse may be distributed: This may appear to be a large proportion of the Nursing Service for Industry total cost, but not when one considers that a record is to be kept of every .injury reported and every By Joanna M Johnson, RJf ailment; and that the nurse keeps all the records Senior Nurse, of physical examinations and their follow-ups, and Industrial Cursing Service, of all compensation cases, together with this Employers Mutuals, Wausau, Wisconsin records of the payments of claims. In addition, if there is a welfare committee, she serves as secre T IS to industry's financial advantage'to de tary of the safety committee. Likewise, if there I velop a more adequate industrial nursing is a group insurance policy covering the health of service.* A nurse's talents contribute so the employees she also is the logical person to take directly to the humanizing of employer-employe^care of those records and the following up of the relationships that even in moderate-sized plants payments of those claims. her services are aiding industry to increase in 2. Accident Prevention: 25^. dividual production through well set up industrial A nurse has an unlimited opportunity to put health programs. forth an object lesson to the worker at the time "How large should a plant be before it is neces when he reports an injury. He receives graciously sary to hire an industrial nurse?" "Are we of suf- the suggestion from one who, he feels, is person ncient size to pay us for the additional expense ally interested in his welfare, and who is not incurred?" "Can we cut our insurance cost by thinking of him merely as an efficient person to hiring a nurse?" These and similar questions per- turn out more work. He is the breadwinner of laming to nursing service in industry reach me the family, and as such has a responsibility toward daily. Very little thought has been given by the himself, his dependents, and the community. In employer to the amount of good will which may be my own experience in industry I have had 'many created through the employing of a nurse. This opportunities to encourage that pride in physical is due. no doubt, more to lack of knowledge than well being of the workman. * ;o indifference. One of the strongest arguments I 3. Health Work: 20^. have in favor of a nurse in industry is for that very Lost time may be greatly diminished through purpose--the promotion of good wilL * the early recognition of diseases, occupational. or * Thi< th* r.nt tfert* rrici to* Mis Johnano. Tbt maw* -nil otherwise. , '" ` TV** mm* is in a .nation to reeaffnise ^arlv