Document Qgk8K2Mz2BOE4OYogYgqYpqL8

186 industrial HYGIENE AND OCCUPATIONAL MEDICINE First let me refer to the type of service which I observed in Russia in 1932. In one tractor factory in Kharkov, employing 20,000 workers, there were 77 phy sicians taking care of all the preemployment examinations and all the active medical services that were provided in industry and, to a large extent, supervising a general hygienic program that included dietetic care and placing of workers in suitable positions in the factory, where the physical demands of the occupation were fitted to the physical capacities of the individual. For example, 125 blind men were operating screw-threading machines, and 75 persons with mild incipient tuberculosis were doing graded work for certain periods during the day, and then were referred to night sanatoriums for rest, shower baths, etc. Here, of course, was a totalitarian concept of total medical care. The ultimate aim of such service was ideal. But perhaps its shortcomings, aside from the obviously political, could be seen in a little episode that occurred during lunch time of the day of my visit. Somewhat to my surprise, I discovered that there were five dining rooms-- one for the administrators, one for the workers, one for the blind men, one for the tuberculous, and the fifth for those suffering from diseases of the stomach and metabolic disturbances such as diabetes. Each room had its physician, and I spoke to the one in charge of the diners with assorted stomach troubles. "What's wrong with that man over there ?" I asked. "Diabetes." "And what is he eating?" "Black bread and cabbage soup." "Hm. And that man over there?" I asked. "Stomach ulcer." "And he is eating--" "Black bread and cabbage soup." "How about that man?" "Oh, a liver condition." "And what is he eating?" "Black bread and cabbage soup." "But tell me," I said, "I thought that these men were put into this room so that each might have the special diet required for the proper care of his illness. But it seems that they are all eating black bread and cabbage soup." "Oh, well," said the physician, "We are hoping that someday they will have special diets. But in the meantime . . . black bread and cabbage soup." Obviously, the totalitarian solution, in which government assumes total responsi bility, is not the system of proper industrial medicine which we are seeking. In the United States the requirements of workman's compensation have been enlarged so that the worker today is given larger benefits and larger medical services than existed in the early days of workman's compensation. Nevertheless, paralleling this development there has been a recognition of the fact that the legal requirements of workman's compensation, however broad, cannot and do not meet the total responsibility of the worker in industry. Labor unions, if they are large enough and powerful enough, pick up where the' law leaves off, and typical of the effects n of a labor union on industrial medicine is that of the United Mine Workers. Their welfare and retirement provisions are among the broadest in the nation, and without :