Document QJ2NEgX5w4KZYy9dv1k51MGN4

He n r y W. Ry d e r , M. D. <9 G A RF I EL D PL ACE CINCINNATI 3 . OHIO PAr k w a y 7 6 9 6 December 3, 194.8 Dr. Robert A. Kehoe, Director Kettering Laboratory Eden and Bethesda Avenues Cincinnati, 19, Ohio Dear Bobs * Enclosed please find an article which was sent to me by Mr. Greiser. He is the president of Carthage Mills, one of the companies for which I do periodic physical examina tions on the executives. I think the article is of interest in referejnc* to our correspondence of two years ago, for it indicates that Selby feels the same way I do about having these examinations performed by an outside organization. I also feel that I can do a better job than any clinic because of my background and personal interest. If you have changed your mind about the worth of these studies and if any opportunity comes along in which you think I; might be of service, I would appreciate your letting me know about it. I have the observations on the urine leads on my desk. I have, just about finished the calculations p|*a(Jbe plasma lead 8nd had intended to do the erythrocyte^next. A good ten days will elapse before I can tackle our urinary lead data, and I'd want to do that before studying this British material. If you think that will make an undue delay I'll return the material to you now. I would prefer to keep it because I think the data illustrates several important points. Sincerely yours, ai_ Henry W. Rydeiy M.D. HR/sl Enc: te I 00006 How GM Guards Health ; \ Of Its Executives \ Volu n tary ph ysical ch eck u ps for executives of Gen eral M otors Corporation were star ted " to catch it before it h ap pen s," an d th e exam in ation s reveal m an y ailm en ts th at can be elim in ated w ith precau tion ary m easu res y . & 'u/ ig.lit Cj. a i r d Re c o g n i z i n g the importance of keeping members of its man agement group in what might be termed good working condition, General Motors Corporation has made available periodic ph ysical examin ation s for some 3,000 of its executives. Every factory of an y conse quence has a maintenance d epar t ment. And every maintenance de partm en t of any consequence has a preventive maintenance sched ule or program . "We catch it be fore it h appen s" is a common boast among them, meaning th at they an ticipate and prevent breakdowns and work stoppages. Machin es are" valuable. W ork stoppages, are costly. So the company invests in preventive maintenance. Bu t the human machine is also subject to deterioration, to break downs, to work stoppages, and some of the latter are permanent. So prevalent is this th at manage ment h as long made provision for ph ysical examinations of hourly workers. Many employers provide preplacement examinations and many of the more progressive ones also undertake to make periodic examinations available to em ployees. But few have done an y thing at all to conserve the health of members of their management gr o u p . Th is fact was brought to the atten tion of GM top management early in 1944, when its personnel section released figures showing th at 189 members of its manage ment group had died in the preced in g 5 years. As a result of this report, the medical departmen t made a study which revealed some im portan t fact s concerning the condition. I t found th at the health maintenance program for the supervisory gr ou p was inadequate at a time when it was most needed. Because of the increase of responsibilities entailed by war work, executives were being subjected to extended h ours of work, excessive travel, and un usual mental strain s. Death from cardiovascular disease was takin g a heavy toll among them. Durin g the precedin g few years, death s from an gin a pectoris, coron ary thrombosis, and cerebral h emorrhage h ad been prevalent. Th e management group was, and is, carr yin g heavy responsibilities, and the corporation h as consider able interest in their capabilities. I t seemed desirable, therefore, to consider means for the protection of their health which would be suitable, effective, and acceptable to them. Th e medical profession h as lon g maintained th at annual diagn ostic examinations presen t one of the chief hopes for prolon gin g lives. If a person will conscientiously take such an examination and then will follow the recommendations made, many ailments will be discovered in their incipiencv and preventive measures can be undertaken at a time when they are likely to be most effective. A schedule of preventive health maintenance for members of man agement was clearly indicated. Bu t righ t here the medical department recognized a delicate situation . Medical reports are confidential. People may object to h avin g oth ers know what ails them. Not only so, but no one felt like order ing m ajor executives to betake themselves to a ph ysician or clinic of recognized stan din g to have their ph ysical mechanism checked over at regular in tervals. The medical departm en t, therefore, reached certain conclusions, chief of which were : 1. Th e plan should be on a vol u n tar y basis. 2. Reports should be confidential and should be made only to the person examined or to a ph ysician design ated by him. 3. Th e examinin g clinic should have a terminal interview with the person examined, du rin g which the ph ysician would inform him, in laym an 's terms, of an y im pair ments which he h ad discovered. 4. A sh ort written report in laym an 's lan guage, as well as a more technical report for study by a ph ysician, is im portan t. 5. Th ere should be some method of n otifyin g the executive when the time arrives for his repeat exam in at ion . 6. Exam in ation s given should be thorough and w ith out too much delay. N24711.01 operation s. In a large mid-south city we asked the sales m an ager of a well-known wholesale house to name three or four un usually good retail stores which we could visit and study. He could not name one. He checked with other members of the h eadquarters staff and finally came up with the names of three of the company's custom ers who h ad good stores. Bu t he knew nothing about them. In another city we told a wholesaler of: a beau tiful store, three times as large as custom ary, better stocked, better ligh ted, and better man aged than usual. Th e owner of this wholesale house had to consult a record to determine whether the store was a customer or not. He had never h eard of the store, alth ough it did develop th at the owner of this re markable store was a customer an d frequent visitor. In all respect to the job they are doing we su g gest th at wholesalers pu t some of their top management on the road to pick up some modern ideas. G len n M cCar th y , a young H ouston oil millionaire, is building a whopping big hotel and sh oppin g center on South Main Str eet at the edge of the city. Called Th e Sh am rock, the hotel will open, it is ex pected, on March 17, which is St . P at r ick 's Day, as you know. A ban k, post office, gar age, d epar t ment store, and other facilities will be included in the M cCarth y Cen ter development which surroun ds the hotel. Righ t now, with the hotel under roof and n earin g comple tion, people are predictin g failu re; they say th at such a big hotel so far from the sh oppin g center of H ouston proper can n ot succeed. W e were in H ouston when the Rice H otel was opened, more than 30 years ago. Th ey said the same th ings about the Rice, which was one of the first of the big financial adventures of Jesse Jon es. Th ere are always croakers who never risk an yth in g on their own, and who seem to en joy predictin g failure for ail who risk anyth ing. More power to Mr. McCarth y. Every city could use men like him. Labo r S ta te s m a n s h ip of the highest order is needed by labor leaders today. Their prob lem is to determine when labor will price itself out of its market. W allpaper sales fell off in 1948 because of the high cost of labor to h an g wallpaper. There was a boom in home h air-cutting devices when Ch icago barbers upped prices as a result of another boost to union barbers. Paperh an gers are still busy because of the building boom, but the fact remains th at millions of property owners are postpon in g decoratin g projects because of labor costs. These union men m ay be the first to suffer when a lull comes. It would be better to spread the butter a little thinner now, rath er than have no bread to butter later. Service industries are complaining th at labor rates and low productivity prevent profits today. Here again labor is dan ger ously near pricin g itself out of the market. Ja c k I. St r a u s, president, R. H . M acy and Com pan y,'told his stockh olders recently th at "certain lines of merchandise th at were overpriced last sprin g have been ad ju st ed with a satisfact or y in crease in unit sales and dollar # volume." But he added th at other lines, n otably some luxury prod ucts, are still pi'iced beyond the capacity or willingness of the cus tomer to buy. Th is proVes again what we said in a previous p ar a graph about knowing customers, and understandin g what customers are thinking. Some of the first m an ufacturers to be hit by the public's refusal to pay fan tastic prices were shocked and painfully h urt when the public started back in g aw ay from their high-priced merchandise. Sm artest thing an y body with anyth ing to sell can do these d ays is to maintain a con tinuing study of customers and their reactions. Sim p lific a t io n of lines is one way to cut costs and bring down prices. Many producers have so many lines th at the difference be tween one price range and another is so little th at consumers are con fused. Lon g lines were often created in the past because nobody knew, or took the trouble to learn, ju st what consumers wanted. Th e result was long lines, hoping to catch all the business. Sm art m an ufacturers today are checking consumer preferences so carefully th at many lines and many items can be eliminated. Ju st because an item has sold in the past is no proof th at consumers really de manded it. A lan H . T e m p le , vice presi dent, Nation al City Ban k of New York, told the con trollers in New York early in October th at many exaggerate the "froth " in the pres ent business picture an d fail to give weight to the immensely greater financial stren gth of the country, absence of any real monetary strain , and the stan din g of Gov ernment commitments in the Eu ropean recovery and defense pro gram s. Liquid assets of all busi ness and people have increased al most three and one-half times since 1939. Tot al private debt has in creased only about one-third, he reminded the con trollers. "The kind of financial strain which was present in 1920 and in 1929, which heralds a bust or a severe liquidat in g depression, does n ot exist." T r u m a n 's E le c t io n was p ar tially due to the fact th at Mr. Dewey seems cold an d machine-like to the m ajority of the voters. Trum an 's worst blun ders, his evident befuddlement, served to win him sym path y because we all like to feel th at our leaders are human. Another reason for his election is th at it is alm ost impos sible to get people excited about a change when so many of us are prosperous. Even high prices can 't make us dissatisfied when we are all working at h igh er th an ever wages. We hope t h at his success will not cause him to think th at he can continue to persecute business as he has attem pted to do in the p a st . 7. Approval of all ch arges and diagn ostic procedures is n ecessary, but ch arges for restorative or curative treatm en t should not be approved. In August 1944!, the policy com mittee of General M otors ap proved an annual diagn ostic health examination for all employees in the top-management group. An approved list of ph ysician s and clinics was furn ish ed the divisions and group executives by the medi cal consultant. However, if any executive pre ferred a ph ysician or clinic not on the list, he could be examined by a ph ysician or clinic of his own choice with the approval; of the medical con sultan t of the corpor a tion. Th e cost of the examination (including tran sportation : to and from the clin ic), su bject to ap proval of the medical con sultan t as to the reasonableness of the ch arge, is borne by the corpora tion or the in dividual divisions. Th e cost of treatm en t, if: an y, is borne by the individual. The type of examination adopted is intended to assist executives in the maintenance of their health, and approval of the examiner is required in order th at they may be given reasonable assuran ce th at they will receive this type of examination. Such an examination (K au f m an n <& Fab ry ) GM executive receive periodic ch eck u ps on th eir own volition , by a doctor of th eir own ch oosin g, an d th e r esu lt in g reports are m ad e in st r ict e st con fiden ce is much more complete than one made for the diagn osis of a disease ~ diagn oses reveal, we do keep a in making the special type of or for the recognition or treatmen t record of all such health exam in a examination s required by General of illness. tions. W e have a card for every Motors Corporation , they n atu " When the plan was first eligible executive. Th is card pro rally are to be preferred. adopted, we an ticipated th at vides spaces for entering a record " Since the plan was adopted probably about 500 person s would of ten h ealth examinations, names (Au gu st 1944), 3,429 initial ex be examined in the first year ," Dr. of examinin g ph ysicians and aminations and 2,253 re-examina Clarence D. Selby, GM medical clinics, an d costs ch arged to the tions have been made. Th e total so con sultan t, said : "M y colleagues employer. Th e medical departm en t far for th is year is 1,336. and I were pleasan tly surprised, of each division is responsible for "While, as I have said, we do therefore, when 933 of them m ain tain in g its own records and not attem pt to learn the results of availed themselves of the oppor for n otifyin g its executives when health examin ation s of individual tun ity durin g the first year. Th ere they are due for re-examinations. executives, it is desirable to learn h as since been a gr ad u al increase " M ost of the examinations made something of the gen eral health of in the number who have done so, durin g the first year were ob the grou p, as well as prin cipal ail and those who have had an initial tained through the services of ments which afflict them. T o this examination have been quite faith twelve clinics and the tendency end, represen tatives of eight ful in returnin g for subsequent since then has been to narrow the clinics which have made most of ones. list, rath er than expan d it. In view the examination s were brough t to " While we do not know, nor of the profession al stan din g of gether in a panel last November to How GM Guards Health of Its Executives (Continued from page 9) discuss findings. Th is in no way violated the confidential n ature of individual reports, because execu tives and findings could not be related." Th e reports listed the number of employees examined and the dif ferent diagn oses made. No two clinics reported their findings in like manner, and in com parin g re sults, not all of the information could be correlated. Th e panel was composed of Dr. Howard H artm an of the Mayo Clin ic; Dr. Ross M cLean of Joh n s Hopkins H osp ital; Dr. D. W. Atchley of Presbyterian H ospital, New Yor k ; Dr. H . G. Beck of the Diagn ostic Clinic, Balt im or e; Dr. W. J . Ker r of Un iversity of Cali for n ia; Dr. R. C. Moehlig of H arper H ospital, D etroit; Dr. F. j . Gregg of the Pittsburgh Clinic; and Dr. R. L. Haden of the Cleveland Clinic. Dr. Selby was moderator and Dr. Ear l F. Lu tz, GM associate medical con sultan t, reported a statistical an alysis which furnished a basis for the d iscu ssion . Th e st at ist ics compiled covered 718 GM executives. Of these, 590 showed path ology of one kind or another but m ostly minor. Th e diagn oses reported were classified under nine different system s: Th e blood and circulatory sys tem accounted for 23.88 per cent of the total pathology reported. Th e most commonly reported diseases in th is category were hypertension, 60 case s; hemor rhoids, 5 0 ; arteriosclerosis, 2 4 ; electrocardiograph ic changes, 21 ; m yocardial dam age, 20; and high blood pressure, 18. These six diagn oses accounted for 65 per cent of the cases reported under this category, while ten other clas sifications accounted for the other 35 per cent. Th e endocrine system accounted for 17.87 per cent of the total diseases reported. Th e most com monly reported ailments in this category were obesity and h ypo thyroidism. Th ese two items ac counted for 75 per cent of the cases of this kind reported, while the other 25 per cent included six other diagn oses. Th e gastroin testin al system accounted for 17.06 per cent of the total path ology. M ost com monly reported diseases were pyorrh ea, 55 cases; hernia, 37; duodenal ulcer, 2 5 ; and gall bladder disease, 11. Th ese four totaled 128 cases, or 61 per cent, while 24 oth er diagn oses accounted for the remaining 82 cases. Th e respiratory system was represented by 9.83 of total path ology reported. M ost com monly reported diseases were sinus itis, 34 cases; septic ton sils, 19; deviated septa, 1 5 ; tuberculosis, 1 3 : and emphysema (r u ptu re of air cells of the lu n gs), 11. Th ese/ five diseases represented 76 per cent of t ot al cases reported, while 11 oth ers accounted for the other 24 per cent. The nervous system, including eye and ear senses, accounted for 8.53 per cent of the t ot al diseases reported. Most commonly reported diseases were psych on eurosis, 33 cases; ocular path ology, 19; im paired h earing, 1 5 ; and migraine, 13. Th ese accounted for 76 per cent of ailments in th is classifica tion, while ten oth er diseases ac counted for the other 24 per cent. Th e skeletal and m uscular sys tem accounted for 7.47 per cent of the total pathology reported. Most commonly reported diseases were arth ritis, 33 cases, and fiat feet or foot strain , 19 cases. Th ir teen other classification s accounted for 40 cases. Th e genito-urin ary system was represented by 81 cases, or 6.58 per cent of total path ology re ported. M ost commonly reported diseases were p r ost at ic h yper troph y, 10 cases; pr ostatitis, 12; hydrocele, 6. Th e oth er 67 per cent of cases included 15 other ailments. Th ere were 24 different classifi cation s of cases reported under dermatology, totalin g 5.04 per cent of all path ology. Allergies reported included 5 cases of h ay fever, 5 of allergic rh initis, 3 of allergic asth m a, and 1 of food allergy. No an alysis of m ortality rec ords h as been made since the plan was in augurated, but st at ist ics on this an d many other ph ases of the su bject are being accumulated. Dr. Selby expressed the opinion th at the program is working satis factorily and th at it h as been well ju stified thus far , but he in sists th at it will take 10 years to ac cumulate and analyze all of the pertin en t st at ist ics on the subject. He does not think th at in dustrial executives, as a class, die excep tion ally youn g, n or does he agree th at diseases of the h eart and apoplexy are more prevalent among them than they are among other classes of people. Th ere has been a notable in crease in the per cen tage of death s from such causes, he says, b u t this is true of the population generally, and is attributable largely to the fact th at people are livin g longer than for m er ly . . Tlie trend of executive examina tions, he said, is tow ard ap p r ais in g the fun ction al capacity of the organ s, rath er th an toward ap pr aisin g the path ology only. In other words, medical men are not so much concerned with what dam age h as already been done as they are with w h at's left of the dam aged organ s and how those examined can ad ap t themselves to make the best possible use of it to avoid expensive breakdowns and prolon g body fun ction in g.