Document XRRX9Kzbp74D0V1MKgBxq92G4

FILE NAME: Crane Company (CRC) DATE: 1962 DOC#: CRC010 DOCUMENT DESCRIPTION: Book Excerpt - Occupational Health America 12/29/2008 14:16 FAI r 141002 OCCUPATIONAL HEALTH IN AMERICA b y H en ry B. Seiteck. in collaboration with Alfred H, Whittaker, M.D., F.A,C.$, THIS HOOK WAS PREPARED UNDER TH E DIRECTION OE TH E HISTORY COM M ITTEE OF TH E INDUSTRIAL MEDICAL ASSOCIATION ALFRED H. W HITTAKER, M .D., CHAIRM AN *Q 1T O P. GEIER, M .D. j JA M E S I. ROBERTS, M .D. | * ROBERT T. LEGGE, M.D, * LOYAL A. SHOUDY, M .D. | MCIVBR WOODY, M .D. * * ARTHU R J . VORWALD | * * EDWARD C. HOLMDLAD # *GEORGE ROSEN *riccta*tU MAppolnicii to rtj>llce deceased Member. 1962 Wayne State University Press Detroit 1 12/29/2008 14:16 FAX 003 OCCUPATIONAL HEALTH IN AMERICA ti ri herons career. The purely repair shop type of surgical service in industry lasted much years. On t n\ too long."' stonai scon r, The upward surge of American production was attended by serious, often fatal, to be expe injuries, which mounted at a scandalous cute; but for many years little of real or man of me lasting benefit was done to reverse the trend, The annual toll was terrifying in typical ness of its industries such as steel, mining, railroading. Wririri Here and there, individual docrors did what they could to protect workers on industrial extra-hazardous jobs, but they left almost no records indicating results. A faded tion with clipping from the Chicago Daily News reports that Andrew M. Harvey, chief sur- It is ai duscrial PI and of the leather leggings to protect brass molders from molten rnetal. country. 7 "Safety" was a word seldom heard in the steel mills and other ferrous industries industrial of that day-- not because employers were indifferent to death and injury, but because high accident ratios were taken for granted as a hazard of such trades, Though were exec; was the a; l! industrial employers commonly provided local physicians to care for injured work field. The ers, concerted action to reduce the accident toll was still to come. Individual com panies, nevertheless, did what they could with the crude protective devices available in the early 1900's. Results were encouraging, and from these small beginnings national r the aerine Andn. there developed industry-wide programs calling for the installation of more and was a mf i more mechanical safeguards, and requiring in-plant treatment of on-the-job injuries. dinoduubsltericallWithin a few years important steel manufacturers were solidly supporting the i work of the new National Safety Council, spearheading the crusade for indusrrial the founu safety. Faced by shocking statistics on accidental deaths and injuries, corporation medical c heads in large industries became ready converts to the cause. Physicians and sur ployees. ^ geons, coo, in steadily increasing numbers, were attracted to the industrial field. public he Results of this attack were soon apparent. Accident curves were halted in their In far climb-- then started to decline. The over-all trend, far the past forty years, has been consistently downward. Citing long-term figures, the Labor Yearbook for 1953 points to these significant contrasts: "In coal mining, for example, approximately five miners were killed in work accidents for every million tons of COal mined in pioneers ; Lumber < fields-- a and the s 1913. In 1950 the average was down to slightly over one death for each million in 1900, tons. In railroading, the reduction was even more pronounced. In 1913 one worker in every five hundred employed by the railroads was killed on the job. In 1950 one was killed for every three thousand. These rates arc still too high."1 Mining appears to have been the first American industry to use the services of physicians on anything like a full-time basis, There is reference to an unnamed doctor who is said to have been employed in a lead mine In 1770. Others are known to have served in mines during the 1SOO's, though almost all name and place An ii ventions he met j drawn ir Year with the Cloud, t records have vanished with the years. covered Appearance of the industrial physician and industrial surgeon, as wc know them, is a twentieth century phenomenon, But there was no distinction n the title in early 1873-7One 58 L_ 12/29/2008 14:17 FAX @004 'Sted much often fatal, of real or g in typical workers on S- A faded , chief sar tors in that the use o f s industries but because es. Though ;ured workvidual com es available beginnings f more and job injuries, 'porting the >r industrial corporation ns and Sur- ial field. Ited in their irs, has been i for 1953 iproximateiy >al mined in each m illion one worker in 1950 one e services o f an unnamed are known :e and place `know them, title in early Tt-IE ASSOCIATION IS BORN years, On the contrary, men in plant practice were commonly the object of profes sional scorn-- poorly paid, respected neither by management nor by labor. This was to be expected, W ith notable exception,? the doctor in industry was likely to be a man of mediocre ability! performing routine work acceptably but with little aware ness of its potentials, The field, by and large, was uninviting, unrewarding, Writing of the period around 1910, Alice Hamilton sums up the status of the industrial doctor in these words: "For & surgeon or physician to accept a posi tion with a manufacturing company was to earn the contempt of his colleagues,"s It is against this background that the story of the American Association of In dustrial Physicians & Surgeons unfolds. In the early years it was a drama of men and of the unusual circumstances that brought them together from all parts of the country. They were for the most part young physicians and surgeons, attracted to industrial practice by the new emphasis on safety, public health, and hygiene. They were exceptions to the rule of mediocrity in plant practice at the time; their stature was the more pronounced because of the scarcity of medical talent in the industrial field. They had in common a conviction that health was the most valuable of all national resources and a belief that the way to conserve it was by concentrating on the accident and disease hazards to which industrial workers were constantly exposed. Andrew Magee Harvey's introduction of protective goggles for workers in 1897 was a mere incident in the evolution of plant safety. But Harvey, the man, had a double claim to fame. He was perhaps rhe first American physician to practice modern industrial medicine, and he was a "leader in the little group chiefly responsible fo r tHe~founding of the AAIP&S. Harvey joined the Crane organization in Chicago as medical director in 1896, assuming responsibility for the care of someTS^OOO em ployees, Throughout his career he was a tireless worker in organized medicine, in public health activities, and in the development of the new industrial specialty. In faraway California Robert le g g e joined the select coterie of industrial medical pioneers in 1899- Trauma, at the time, was the main concern of the McCloud River lumber Company, but Legge, as chief surgeon, soon expanded his work into broader fields-- a community health and welfare program, construction of a model hospital, and rhe successful practice of preventive as w ell as curative medicine, At McCloud, in 1900, he was the first to employ graduate nurses in industrial service. An inveterate traveler, he periodically toured the East to attend medical con ventions and to visit the great surgical centers and teaching hospitals. On these trips he met many other leaders in the industrial field and through these contacts was drawn into the inner circle of founding fathers of the AAIF&S. Years later (in 1927) Legge spent an afternoon at Georgetown Medical School with the venerable Dean Kober. To the delight of both, they discovered that Mc Cloud, the scene of Legge'5 early work, was in the heart of the identical terrain covered by Kober, as a United States Army surgeon, in the Modoc Indian W at of 1873-74 One of the earliest recorded efforts at systematic examination of industrial work- 59 12/29/2008 14:17 FAX liO005 . to ascerlisease by in disease shifted to ch longer on of inportunity ) develop program Not long to think .'ere held, e was no xcept for -300 per >ugh," he nough to )ur com- Jetter the botatory, . and I'll e unethi- srovai of d Aibert take this iavc with iim from ough for :rk at all you eon- present a THE ASSOCIATION IS BORN f great human laboratory, where a doctor could practice preventive medicine and surgery." l "Hear that, Julius?" interrupted Loeb, "W e have become a great human labora tory. W e've had several company doctors, but never before have they thought of us as a human laboratory." "I rather like the idea," replied Rosenwald. There was more discussion, but no final decision. Mock was on his honeymoon when, on December 28, J908, he received a telegram from Loeb: "Your human laboratory idea appeals. W e accept your proposition. Start January 2." Mock's "proposition" included immediate examination of old employees, to check and eliminate infectious diseases---and inter, examinations for all job appli cants, with the aim not only of raising health standards but also of assigning handi capped men and women to suitable work whenever possible. Mock developed, as the creed of his department, the simple slogan: "Physical qualifications, plus occu pational qualifications, equal the job." Much later, during Work! War I, this slogan became the basis of far-reaching recommendations to the surgeon general of the Army for the assignment of handicapped volunteers and draftees. W ithin three years, Mock's dream was w ell on its way to reality. H e had no t trouble in maintaining ethical standards at Seats. Cut-rate house calls for employees were ruled out. If they wanted the Scars doctor far illness at home, he would sec them as private patients, and charge them standard professional fees. > Then, as Mock described it, came a balmy evening in May, 1912, and another chance conversation, Returning from a medical meeting, Mock drove his friend, Harvey, home in his new Maxwell convertible. The two sat in the open car and discussed their common problems-- their work as company doctors. Harvey, with sixteen years' experience in the Crane organization, had built an excellent reputation as a surgeon and administrator of health problems involving both accident and occupational hazards. He had done this without antagonizing the medical profession i and had maintained a good ethical standing. i Mock spoke of his new quartets at Sears-- twelve rooms staffed by eleven parttime doctors and two full-time nurses. An eye specialist was on duty three days a week, and dental service was available far three and a half hours every day. Mock's enthusiasm, too, had grown with hjs job. He mentioned that that very day Rosenwald had proudly escorted the president of the Packard Motor Car Company through the department. At the end of the tour the visitor said: "This is all pretty nice, Julius, but I can't see how you Can afford to give the most valuable space in your \ merchandising building to your doctor's office." Rosenwald had replied: "Why, sir, this is the most valuable department we have. It deserves the most valuable space." So the talk went on, in the convertible at Harvey's door. Around 2:00 A.M. " Mock started his motor and prepared to go. Then Harvey bto k cjn : "Do you know, we ought to organize this company doctor business. It's alto 1 gether different from what it was when I went into industrial work. Industrial 63 12/29/2008 14:17 FAS t it ii j' OCCUPATIONAL HEALTH IN AMERICA l .......... ................ TUS S i JSmmmiTTi-------r r ^ - ~ , T ..................-- t is medicine is here to stay, A lot of good men are doing either part-time or full-time work as company doctors. W e ought to get together with those who see a real service in it-- both to humanity and to medicine---and form an organization," There was more discussion before the two men parted to think it over. "So," said Mock, "as far as I know, the first thought of an industrial medical association was wafted in on the balmy spring air on that May night in 1912, "It was later in chat same year chat f met Doctor Otto Geier, of Cincinnati. He was a dynamic man, and one of the most likeable personalities I had ever met, with thorough training and ample financial backing that enabled him to select his niche in the medical world and to reach almost any height in his chosen endeavor. "Geier had organized the first milk commission in Cincinnati and had worked tirelessly for rigid inspection, pasteurization, etc. He came through m ilk into the field of preventive medicine, His viewpoint was further broadened by other activities in the field of public charities and institutional health, which brought him into con tact with the derelicts of society. "The Geiers had founded and made a great business of the Cincinnati Milling Machine Company. Oito was a prime mover in organizing its first health program, a part-time connection which soon absorbed his entire attention. Hearing of che work we were doing at Sears, he visited our medical department, and left us with many suggestions which enlarged its scope and increased its effectiveness. "Otto Geier's grasp of the situation and its possibilities in the way of preventive medicine was of the greatest importance in the founding of our association. From the time of his first visit we never lost sight of our ultimate goal-- the organization of industrial medicine on a national basis," From these early contacts and discussions the movement for an association spread rapidly, by chain reaction. Through the efforts of Frank Billings, Thomas 1C Crowder was appointed medical director of the Pullman Company. By 1912 he not only was supervising the health of Pullman employees, but also had become a great authority on ventilation, fumigation, and the prevention of contagious diseases by systematic examinations. ' Said Mock: "Tom became a wise friend and a man of keen judgment, with a broad vision of the possibilities of industrial medicine and the means by which it could fit itself into the medical world without antagonizing those in the profession who were limiting their work to private practice," Crowder became familiar with every step in the preorganization thinking of the Chicago group. It was lie who wrote the final draft of the constitution of the Ameri can Association of Industrial Physicians & Surgeons arid set forth its objectives. He later served as its president (1 9 2 7 -1 9 2 8 ), Again, in 1912, Billings recommended the appointment of Wilbur . Post, a j close friend of Crowder and Mock, as medical director of the Peoples Gas Com- | pany, of Chicago. Post, in turn, called the attention of the group to Charles G. | Farnum, chief surgeon of the Avety Company in nearby Peoria. Farnum had de- i 64 10006 lL * 12/29/2008 14:17 FAX @007 OCCUPATIONAL' HEALTH IN AMERICA Shoudy (Bethlehem Steel), Cassius H. Watson (N ew York Telephone Company), W . Irving Clark (Norton Company), and James E, Mead (Ford Motor Company). O f the entire group engaged in this voluminous correspondence, no less than six were later to serve as presidents of the Association. Drawing its strength from such diverse sources, and from every section of die country, the association-to-be was as sured of truly national representation from the very beginning. Most of its sup* porters were already members of several organised medical groups Concerned with various phases of public health and private practice; yet they rallied behind a new association as the one answer to vital industrial problems not yet adequately covered by any existing agency. Encouraged by this wholesale response, the Organizing Committee met frequently during the winter of 1914-1915. "A t each meeting," writes Harry Mock, "there were increasing evidences of approval, ending in agreement to crystallize the move ment by formal organization. "Accordingly, under the friendly auspices of the Illinois Manufacturers Asso ciation, a 'meeting of physicians and surgeons in industry' was called in February. 1915, at the Chicago City Club, where the proposal was discussed at length. The unanimous expression was that such an organization would be beneficial to em ployees and employers, as w ell as to the physicians specializing in industrial medi cine." A t that February meeting a committee was appointed, which, "for the physicians and surgeons engaged in industrial medicine, prepared and executed the documents necessary for a corporation (not for pecuniary profit) to be known as the American Association^ of Industrial Physicians & Surgeons, under an Act of the General As sembly of the State of Illinois," $0 reads the record. Accompanying the application was a formal statement of the corporate purposes-- as printed in full at the head of Part Two. Writes Mock: "This statement remains [essentially} unchanged. There has been no occasion to change it. N othing in the developments of the years since 1915 has been added to the comprehensiveness of its definition of industrial medicine, nor disclosed a facet of the subject which it does not cover." Spring and summer were gone before charter details had been settled to the satisfaction of the committee. Under date of October 12, 1915, Harvey forwarded to Mock duplicate copies of the application with a letter asking him to get the required signatures "as quickly as possible." The final document, as notarized and forwarded to the Secretary of State of Illinois, bears the signatures of the Incorporaciiifl Committee: J. Chase Stubbs (medi cal director of the National Malleable Casting Company); A. M. Harvey, H. E. Mock, C. G. Farnum, W. E. Post, and T. R. Crowder, all of Chicago; and S. M. McCurdy, of Cleveland.1 Stubbs served as chairman. W hile the preliminary work of organization was moving slowly ahead, busy doctors elsewhete were taking advantage of every opportunity to win further sup- i- 66 i 12/29/2008 14:18 FAX @008 OCCUPATIONAL HEALTH IN AMERICA W hile the founders set their sights at the highest level with respect to the asso the industr ciation objectives and the caliber of membership, they kept their financial program and with t within modest bounds, A standard paragraph iu committee correspondence dealt meeting, ti !/ with the matter of cost in these reassuring words: "There will be some little expense 1. Me i:-. connected with the organization, but this w ill be very slight and can easily be covered 2. Thi by nominal dues of one dollar per member." Actually, first-year dues were set at 3. Em two dollars, but, since a maximum membership of one hundred and fifty was ex casi pected, the working budget gave no ground for charges of extravagance. 4. Sta One finds a similar note of economy wisely accented in arrangements for the 5. Va convention itself. Under date of May 25, R, A. Carson and C. C. Sehantz, co SUt managers of the Cadillac Hotel, sent a banquet menu to Mock for his approval. The Throv following exchange of letters is of passing interest as a commentary on those times: meeting i Mock to Cadillac Hotel, May 26: "This menu is very satisfactory with the excep diary---re tion of cigars. Two dollars a plate should include at least one round of some good expected cigar." when J. Cadillac H otel to Mock; "Yours of the 26th to hand with menu as selected for Inter, the American Association o f Industrial Physicians & Surgeons, at $2.00 per plate-- much bre I^ cigars extra." Mock to Cadillac Hotel: "As we have advertised our banquet for $2,00 per of letters the coun plate, I wish you would kindly make some slight change in the menu so as to include is this tc one round of some good ten-cent cigar." activities There was no provision for cigars. tign sue! ! There was, in fact, no need for either frills or festivities to whet the enthusiasm welccmt of the founding group. To a man, they realized rhe seriousness of the business at > hand, and sensed something of the import of this new milestone in the history of American medicine. As almost the final step in completing arrangements, Mock dispatched a night letter to Sidney M. McCurdy of Youngstown, a fellow committeeman: "Organiza tion Committee have left it to me to choose toastmaster banquet Monday night. Have chosen one of best scouts in the bunch, namely, you, Y ou can't refuse, for programs go to press tonight. Everything looking rosy." There appears to have been only one advance notice of the Detroit meeting pub lished in any periodical reaching the medical fraternity. It appeared in the Journal of I the American Medical Association1 under the headline; MEETINGS OF N O N -A F F IU A T E D ORGANIZATIONS AMERICAN ASSOCIATION OF INDUSTRIAL PHYSICIANS & SURGEONS The notice stated that organization of the association was to be completed at a meeting in Detroit on June 12, 1916, and gave the essentia! facts about the newassociation, its purpose, and the character o f its proposed membership-- adding that 72 12/29/2008 14:18 FAX $009 ptct co the assonancial program spondencc dealt ne little expense easily be covered lues were set at nd fifty was ex,ance. gements for the C, Schantz, cois approval, The on those times: with the excepd of some good aas selected for '.00 per plate-- : for $2.00 per so as to include the enthusiasm the business at i the history of patched a night .an: "OrganizaMonday night, .an't refuse, for it meeting pub: the Journal of )NS completed at a about the new p-- adding that t h e association is boan the industrial doctors had been meeting during the past few years in AM A sections and with the National Safety Congress. Am ong the problems to be discussed at the meeting, the Journal listed the following; i 1. Medical examinations of employees, and the results and benefits of these. 2. The surgeon as an aid in preventing accidents. 3. Emergency surgery and the standardizing of procedure in certain types of cases. is 4. Standardizing of records used in this work. ,1'f 5. Various forms of industrial insurance and the need of a federal health in- sura ncu law. Through the Committee on Arrangements for the American Medical Association meeting in Detroit-- with James li. Mead (Ford Motor Company) as an interme diary-- reservations had been made for a "minimum of one hundred," who were 4 expected to enroll for the session of the AAIP&S. Actually, about 125 were present when J. Chase Stubbs, as temporary chairman, called for order at 10:00 A.M. Interest in the purpose and plans of the new organization was unquestionably i much broader than actual attendance would indicate. This was evidenced by the flow of letters and telegrams Mock received from physicians and surgeons in all parts of : the country, who, because of other pressing business, could not be present. Typical is this telegram from ,R. C. Cnbor of Boston, who was prominent in organized activities of the AM A. "You are pioneers in medical service and medical organiza tion such as the public good demands. You w ill meet opposition, but you should I welcome it and w ill surdy overcome it. I am heartily with you in spirit and in pur pose." Typical, too, was a message from Frank Billings of Chicago: "I congratulate you on flic inauguration and first meeting of the American Association of Industrial Physicians and Surgeons because it is one of the most important subjects for the consideration of physicians and surgeons." The Conference Boat'd of Physicians in Industry fulfilled its promise of support, made earlier in the year by Dr, Moorhead; this organization was w ell represented at Detroit by leading industrial doctors from the east. The group centering around Chicago, who had engineered the incorporation and preliminary organization, were present almost to a man. From the far West came Legge (California), Philip K. Brown (Southern Pa cific R ailway), Alvin Powell (W estern Pacific Railroad), and W illiam Brown (Valmora, N ew M exico). Among representatives in the public health field were J. W , Schereschcwsky and Anthony J. Lanza (U S P H S ), and F. D, Patterson (Penn sylvania). Others who were to render signal services to the association in later years included Donald B. Lowe (A k ron ), Clarence D. Selby (T oledo), Loyal A. Shoudy (Bethlehem, Pennsylvania), and Ci\ty L. Kiefer (D etroit). It is unfortunate that no complete or accurate list remains today, either of those who registered at the 1916 73 12/29/2008 14:18 FAX OCCUPATIONAL HEALTH IN AMERICA meeting or of those officially qualified as founding members. Such records appar ently were lost ot destroyed in the years before the association established a perma nent headquarters office-- or lie forgotten in personal files. The first official act o f the convention was to appoint A. M, Harvey as permanent chairman o f the meeting-- a fitting tribute to a man whose leadership had been largely responsible for the founding of the association. Mock, as secretary, reported on the activities of the Organization Committee, then presented the proposed Con stitution and Bylaws, bearing committee approval. This document, after stating the name and object o f the organization, established four classes o f membership: (a ) Ac tive, (b ) Associate, ( c ) Honorary, (d ) Fellowship. In essence, it provided; That only physicians who are actively engaged in the practice of industrial medi cine and surgery, or who are engaged in the investigation of industrial medical prob lems, shall be eligible to active membership. That other physicians might be eligible for associate membership, though they failed to meet the requirement of active industrial practice, but provided they had the personal and professional qualifications entitling them to active membership. That applications for active and associate membership must be made in writing and be accompanied by the fee for annual dues; with the further provisions that the applicant be approved by a member in good standing and be certified as to ethics and goad standing by the secretary of his local medical society. That honorary membership might be conferred upon a physician for some defi nite contribution toward the advancement of industrial medicine and surgery or for the performance of some special service for the association. That associate and honorary members should have all the privileges of active members, except the privileges of holding office and voting for officers and directors or for amendments to the Constitution and By-Laws. Under provisions of the document the Board of Directors was empowered to elect a candidate to any class of membership by a two-thirds vote. Active members, after three or more years in the association, were permitted to apply for fellowships, to be conferred upon selected applicants who satisfactorily passed an examination by a board of examiners consisting of five members or fellows. In essence, the original Constitution o f the association does not differ greatly from the articles and regulations governing the present Industrial Medical Associa tion, though these have been amended from time to time to meet changing conditions. That the basic provisions have stood the test of the years is a tribute to the foresight of the founders and their grasp o f the fundamentals of sound organization. The business o f debate and decision proceeded swiftly, and with remarkable unanimity, at that first meeting in D etroit The Constitution and Bylaws were adopted promptly, with a minimum of change. Records from the files of W illiam A. Sawyer (president,of the organization, 1 9 2 6 -1 9 2 7 ) tell us that committees were named to deal with the matter of an association journal; standardization of forms, records, and methods in the examination of employees; and the problems of health insurance. 74 12/29/2008 14:18 FAX @011 ii TRENDS The surgical experiences of our own war between the states had been w ell documented8 and pictorially recorded by Matthew Brady0 and Surgeon-General Joseph K. Barnes.7 Lister," using the research of Louis Pasteur," had demonstrated the principles of antisepsis and cleanliness, and James T, Whittaker10 had demon 3 strated the importance of physiological changes and the part played by parasites and bacteria. The year 1900 found the industrial plants of America, with a few exceptions, 1 totally without facilities to provide even the most primitive first aid Other than a meager supply of unsterile bandages, kept in a cigar box on a shelf and supple mented by the proverbial chew of tobacco to be applied to a wound, The exceptions included the first major prepayment program of record, started in 186811 by the Southern Pacific Railroad in Sacramento, California, where a hospital was opened in 1869. This project, financed jointly by employer and em ployees, provided service by a medical staff through arrangements with surgeons along the railway, } In 1882 the first major employee-sponsored mutual benefit association was itrial surgery mid-century ;gement, and place within 3 formed: as the Northern Pacific Railway Beneficial Association. This organization developed a program of complete medical care and other benefits financed by em '"i ployer-employee payments, Medical services were provided through group practice L in die Northern Pacific Hospital in St. Paul, Minnesota, and through arrangements with surgeons along the line. Through the years following those humble beginnings, the railroads continued , when great ' the United he workman medical care ill and state their support of progressive health programs, with the close cooperation of the l * American Association of Railway Surgeons, It is interesting to note that at the 41st `i annual banquet of die Industrial Medical Association held in Philadelphia, April 25, s 1956, the Health Achievement in Industry Award was presented to the Pennsylvania Railroad for the excellence of its modern facilities in Philadelphia, which developed from one of the earliest medical departments. countered in .it developed war injuries, s a brillianr able through Nineteenth-century efforts to safeguard the health of workets were not, how ever, limited entirely to the railroads. In 1887 the Homestead Mining Company" of Lead, South Dakota, established a company-financed medical department, with a full-time staff providing complete medical service to employees and their families. Other mines and kindred establishments in remote areas followed suit with programs of one kind or another. physician and :red American icnoraenal adiirians to this 'Itli. Industrial 1 it is to place historic evolu- Andrew Magee Harvey's introduction of protective goggles for workers15 in 1897 heralded a similar trend in large industrial centers. As medical director of the Crane Company in Chicago, he set an example which profoundly affected the de velopment of truly modern industrial medicine. Another pioneer of that period was Dr. Robert T. Legge, who in 1899 joined the McCloud Lumber Company of California as chief surgeon.14 Though traumatic injuries were of first importance among the hazards in this isolated community, Legge soon discovered the need for more basic planning. W ith company coopera- 147 12/29/2008 14:18 FAX @012 OCCUPATIONAL HEALTH IN AMERICA to find expression through social or government-social agencies, labor unions, and other lay organizations now and in the reconversion period. Strong guidance will be required by the medical profession to accomplish for industry the most efficient results, while at the same time maintaining the highest scientific and ethical stand ards." Pleading for a stronger public relations program, the report continued: "The AM A is showing little leadership in this field, Lay organizations such as the National Association of Manufacturers, Princeton University (Industrial Relations Research), the National Conference Board, and Chambers of Commerce are actually doing more promotion work than any medical agency," There was no doubt even at the time of the report that organized labor was keenly aware of the vast social benefits that could result from a broad expansion of health insurance and also aware of the influence that labor might exercise in that field. Various union leaders were among tire strong proponents of a federally sponsored compulsory system; and the United States Department of Labor sought by one means or another to extend its authority in matters of industrial health. In December 1944, at the Eleventh Conference on Labor Legislation called by the Secretary of Labor, the United States Public Health Service and state health departments were bitterly attacked from the floor for their work in the field of industrial hygiene. Committee reports accused them of operating in a sphere in which they had no authority and, more specifically, of blocking federal legislation which would place industrial hygiene activities in the Labor Department, Industrial Medicine sprang to the defense of the health services with an indignant editorial branding the charges as "preposterous" and presenting facts and figures to expose what it termed "the smear technique."1" The legislation in question was not passed in 1944 or in 1945, but the effort persisted. Similar bills13 were still awaiting action in 1946. Their main provision was the allocation of $5 million to state agencies administering labor laws for maintaining safe working conditions and controlling health hazards. The AMA went on record in February 1946 as opposing this legislation, A t a Board meeting of the AAiP&S on April 9, the directors approved another resolution asking that any tax project of this kind "be developed in such a manner as to pro vide funds ultimately for the state departments of health in cooperation with the United States Public Health Service." In presenting the resolution President Newquist pointed out that this work in industrial hygiene had always been handled by the USPHS through state health agencies, except in N ew York and Massachusetts, where the hygiene bureaus were part of the labor departments. Under different circumstances, this same issue came up again in 1950. The oc casion was a hearing before the Schaeffer Commission (known as the Little Hoover Commission) of Illinois on a labor-supported proposal to move the Industrial Hygiene Division from the Department of Health to the Department of Labor. Am ong industrial physicians testifying were J. F, McCahan (Bausch & Lomb Optical Com pany), J. H. Chivets ( Crane Company) , and M. H. Kronenberg 396 lu 12/29/2008 14:19 FAX i . ' ' ' Ittl VJ A O labor unions, and i guidance w ill be the most efficient and ethical standt continued: "The :b as the National Utkins Research), re actually doing anized labor was toad expansion of \t exercise in that cs of a federally of labor sought induskjal health, islation called by and state health k in the field of g in a sphere in edera! legislation Department. vith an indignant facts and figures in question was bills1* were still of 45 million to irking conditions legislation. A t a nother resolution tanner as to proration with the . President N ew been handled by id Massachusetts, n 1950. The oche Little Hoover e the Industrial tfflent of Labor, lausch & Lomb H. Kronenberg TH E ATOMIC AGE (Caterpillar Tractor Company), who strongly supported the opinion that matters of health should be under jurisdiction of health departments. In spite of opposition from various sources, the Illinois transfer was approved and put into effect. There were also moves in the same direction in other states during the same period. W hen a report of the Schaeffer hearing was made to the directors of the AAIP&S in December 1950, members mentioned that in Michigan, without public hearings, the Labor Department was empowered to set the standards for first aid in industry and that the department had authority to go into any Michigan plant and make an inspection. In these and similar controversies there was no implication that government agencies had no place in industrial medicine or that their functions should be unduly restricted. Medical organizations, since their beginning, have cooperated fully and wholeheartedly with public health services at every level. But they have insisted that government, as such, should not interfere with doctor-patient relations or dictate medical practices and procedures. It is a matter of record that, at mid-century, there were twenty-five federal health agencies performing nine different types of service; at the state level, sixteen major types of agency and many miscellaneous categories; and a host of city, county, and city-county agencies engaged in health service and supervisory activities.5* Rarely has there been anything that could be underscored as conflict between organized medicine and this multitude of governmental groups. Moreover--'although federal compulsory insurance projects have been stead fastly opposed, and the transfer of medical authority to government labor units has been strongly resisted-- it is significant that organised labor has been neither stifled nor impeded in the constructive promotion of health plans for the benefit of the working force and society as a whole. It is obvious that no one program, formula or panacea can meet all the health needs of the nation, and, as should be the case in this free economy, a vast number of different medical care plans have become operative within the memory o f men still living. A few of these, typical of many, are described briefly here: Union Health Center, N ew York City, famous as the first experiment in medical service sponsored by the workers in an industry. Founded in 1913 by Dr. George Price and directed since his death in 1942 by his son, Dr. Leo Price, it presently pro vides a wide range of preventive and medical care to more than 200,000 members of the International Ladies' Garment Workers' Union and limited services to their dependents. In its first forty years of operation, the total number of individual serv ices rendered annually grew from slightly over 1,200 to well above 5.5 million. Most o f the medical services, through collective bargaining, have been paid for by the union's health and welfare fund since 1946. Railroad Retirement Program, authorized by the federal Railroad Insurance A ct o f 1936 and administered by the Railroad Retirement Board in coordination with unemployment insurance. A ll railroad workers covered by unemployment 397 12/29/2008 14:19 FAX @014 M RICA*1 to its inner circle a great s. The association has ever ant of President Dodd of Missions of grandeur which has added substantially to its professional standards, t in industrial practice are >ationaI medicine has won tine. And in what other ttvides to better purpose? 'icine alone cannot. True ter importance than, more tducation in occupational medical schools ro practiols. There is much still to tonal influence not only of superlative excellence, under the editorial direchirrieth anniversary of its 1ro supplement .coverage sliment of the Journal of -th e first issue appearing die Occupational Health as the agency certifying al. It has also influenced gations in the matter of Ilowships and providing nation of the long and trd symbols of what ocears. And it may be that ;s in chose years as the is the beginning, not the medicine an opportunity will have some answers ?hs of chemical therapy, tat scourge society and THE ATOMIC ARE whatever feats man may perform in the conquest of space, organized occupational medicine, and the Industrial Medical Association, w ill play a vital role in their accomplishment. The American dream hurries on, eager for tomorrow. Man, the Worker, moves with it----ps does industry and the medicine of industry-- each to keep a date with destiny. That destiny w ill be the fulfillment of the inspired dreaming of Paracelsus and Ramazzini centuries ago-- and the reward of the flaming fairh of Andrew Harvey, Loyal Slurody, Harry Mock, Otto Geier and Robert Lcgge in our time. 441 j.* , j.o riva. 0015 INDEX workmen's compensation, 139; (See also, Trends) Gratia, Andre, 160 Green, W illiam, 84 Greenbutg, Leonard, 218 Griffin, Prank R., 368, 410 Gtissoli, 22 Group curative medicine, 92 Group insurance, 208, 217 Group practice, 147 Guaiacol, 159 Gunther, Pauline, 75 Guthrie, Donald, 268 Halifax, Nova Scotia, dis aster, 309 Hall, A. Fletcher, 310 Halos, Stephen G., 328, 435; (Appendix 1 2 ,4 6 3 ) Hamhlin, Donald O,, 304, 343, 344 Hamilton, Alice, 92; author, "Health Haaarcis in Muni tions Plants," 88; delegate to International Medical Congress on Occupational Accidents and Diseases, Brussels, 40, 415; first woman professor on Har vard faculty, 201; honorary member, AAlPitS, 39; In vestigations in the manu facture of high explosives, 79, 80; on phosphorus necrosis, 38; quoted, 38, 39, 59, 79; report on oc cupational poisoning, 80; research at nitrous plants, 309`. studies on lead, 43; surveys by, 50; toxicologist, 201; tribute by Leggc, 201; (Appendix 8, 456) Ham lin, Lloyd E., 242, 369 Hammond, Frank P., 342, 345, 385, 389, 392; quoted, 384, 387, 388, 390, 391 Hammond, J, L., (and 13.), quoted, 11 Hand, Carpenter Lectureship address, Abbee, 158; in juries, 177; new tech niques, 177; preservation of function, 177; surgery of, 158, 177; trauma, 158 Handicapped, 84, 103, 105, 295, 365; reclaiming, among civilian workers, 94; placement of, 337 "Handicraft," "cottage sys- tems," 9; trades, 124; workers, 32 Hargreave, inventor, 8, 28 Hargreaves, Margaret S,, 412, 413 Harney, Louis G , 192 Harrison, Harold A., 372 Harroid, Gordon C., 291 Harvard Mercantile Health Work, The, 216 Harvard, faculty, 201; School of Medicine, 188, 207; School of Public Health, 293, 432; University, 265, .358 ^ Harvey, Andrew Magee, 66, 73, 147, 441; chairman first meeting AAiP&S, 73; fust to practice modern in dustrial medicine, 59; first to suggest organization of industrial physicians, 63, 64; provided safety glasses "ns early as 1397," 58, 59, . 147 Harvey, John W ,, 251, 269 Hacvuy, W illiam, discoverer, circulation of blood, 15. 17, 20 Hawaiian Society of Indus trial Physicians and Sur geons, 343 H-uyek, F. A., "Capitalism and the Historians," quoted, 10, 11 Hayhurst, Emery R,, 52, 65, 236, 249, 267, 280; au thor, with Kober, "Indus trial Health," 43; authority on industrial poisons, 43; clinic, at O hio State Col lege of Medicine, 53; defi nition of occupational dis ease, 100; delegate, Fifth international Medical Con gress for Industrial Acci dents and Occupational Diseases, 218; educator, scientist, 202; lecturer cm military and industrial hy giene, 281; on silicosis diagnosis, 265; professor of industrial hygiene, 152; rcsoateh in plumbism, 202; study of Dtass poisoning and caisson disease, 40; surveys by, 50, 405 Huxatds, 103, 109; alumi num, 311; automobile manufacture, 47; disease, 504 243, 288; industrial dust, 289; job-connected, 233; new metals, chemicals, compounds, substances, 240, 323; occupational disease, 82, 133, 134, 237; oral conditions, 357; poi sons, 311; public utilities, 217; radium, 312; wartime industry, 301 Huzleir, T, Lyle, 251, 304, 319, 327, 329, 426; Au thor, Introduction to In dustrial Medicine, 424; es tablished Department of Industrial Hygiene, Uni versity of Pittsburgh Medi cal School, 282, 421; first intensified course in Indus- trial medicine, 281; "med ical-engineering cycle" of industrial medicine, 192; member, Advisory Com mission on National D e fense, 293; member, Amer ican Boaid of Industrial Medicine and Surgery, 42(1; on cycles nf industrial med icine, 122, 123; president, A A ll'&S, 318 (Appendix 2, 4-14); pioneer in medi cal education, 421; pro gram of training, 422; quoted, 309, 318; special industrial course, 429, 430; supplementary education for physicians and hygien ists in industry, 297; (A p pendix 8, 456) Hancock, L. D., 358, 359 Head injuries, 177; mortality, 177 Health Achievement in In dustry, Award, 147, 371; Committee, 427; (Appen dix 11, 460) ----- - and . Medical Commit tee, Council of National Defense, 297 ~ -- , Brookings Institution smdy, 367 -- -- Center, Union, ladies garment industry, New York, 50 -------- conservation, 141, 151, 181; industrial army, 251 -- dental, Council on, ADA, 336 ------, dental, Pennsylvania campaign, 360; 360 ------- cate, 112, V~ 243; environmenta of nurse in, 143; trend, 1916-1955, 142; workers, 101 ------ > hazards, 47, K 323 -- -- impairment, 2( ---- inspections, 19 - -- insurance, 67, munity-sponsored, of, 382-390; 382-390; prepaytne trend, 1916-1955 graph of trend, 134 sponsored, 50; sponsored, 397; Insurance) -- -- Insurance Greater N ew Y01 398, progress, 35 -- , key to prodm legislation, 24C- assei, 109, needs try, 292; probl leered, 45; plans safety, 36; superv 198; sutvty, also, Medical C. -- -- Organization! Untied State1, USPHS, 116 - -- -Welfare Fi Heart, 163, 402: 363; disease 209, 313; infer sounds, 364 Heat cramps, 17; haustion, 47 Hearing, 111 1 Heatley, 161 Heilman, M, H., Ileiser, Victor G Helfcrich, Atlat Fracture) and 158 ti Heller, Edward 369 Hemoglobenuria Hemolysis, 164 Hemorrhage, 1C 318 Hemorrhagic sh< 5 166; (See <sls Henderson, Mel Henry Ford Hg i j 404 _ Hepatitis, 166 A