Document aJnOXwvj2OoaZRmxeNjv442Ly

FILE NAME: New York State & NY Times (NY) DATE: 1951 DOC#: NY009 DOCUMENT DESCRIPTION: Journal Article - Report on Industrial Hygiene the Western Zone of Germany [Author - Dr. Tabershaw of NY] report o n in d u stria l h yg ien e in th e WESTERN ZONE OF GERMANY IRVING R. TABERSHAW, M.D. NEW YORK PURPOSE T " ,, H ] S S U R V E Y attempts to evaluate present day industrial hygiene practices the W estern Zone ol Germany. 1, had been n,,,,d hy Am encan publtc ,n ,, . , z- ,........ r e . r ,;r K heaiih ulnu<u Umi 0 ^1***^* ----- field (five year- after the w ar) were t u \c. -oc lacking or rudimentary or had regressed to the point o, im-Hcctiveness This wa especially true if viewed in the light of the modern concept oi industrial hygiene a a field of public health which embraces the prevention of disease and injury as we as the maintenance and improvement of w orkers' health. PROCEDURE Official* i,, the health and labor departments of all government units w^re inter- v J S D . l s s i o n s were a , held with .1 ., quasi*TM , and nonoffiaa, a g e n a a which have *a"n interest m. some puhasce of iinndduussttrriiaall hHvyignieenc .A num ber ol research laboratories were inspected, and educational programs of a few of t h e ledd versities were examined. A representative number ot plants, mclu mg ,m. Vnbr were visited and industrial medical practices reviewed. Se' er ferences and meetings on industrial hygiene problems were attendee, aim a namue. tv.iinrl T a b le fllSCUSSlonS WCTC in s e v e r a l Cities. INTRODUCTION The raa.ee of industrial hygiene in Germany is important inasmuch as that country was one of the leading industrial nations of E urope and is rapidly regann c its former slants Table 1 indicates the M ai nnmher employed m \ \ estern German for the second half-year of 1 < * . Since all workers must be m sured m an acetd insurance company ( J.V,,,fr,,eTMrelt/f). these figures were chosen as b a n g mo . . t ' . j]jciu>iVC. `''`wO.. ............. .nmP.w prf organized m four large groups either i bv industry or on a geographic basis. , . Industrial accidents are common and occupational disease par ,cu ^ ^ ^ is of serious significance in the R u h r and m the porcelain nidus ry . - ficiallv stated in regard to the coal mines that the indemnity paid for occup disease in 1949 was higher than the indemnity for accidents. _ B f T ^ r s h e w i, er .e. r J. of Public Health, and rued,cal director in the Eastern Dmsiun ot the E . ........ V,,., VorV 298 practices an public ar ) were This was vgiene as rv as well i re mter: agencies ; research uding uni . those in eral cona number 'a as that regaining . Germany m accident icing most ups either v silicosis, was unofcupationa! dty School ! Insurance TABERSI I Al i ' -- I XDL' STRI AL HY GI EXE I X U' ESTEKX ZOXE 0 1 GERMAXY 299 Table 2 gives some data lor the year 1949 which indicate the magnitude ui the problem. Table 3 compares the industrial accidental death and injury rates lor the United States and Germany. T here is no question that industrial deaths and accidents are more frequent in Germany than in the United States. However, differences in reporting, in group ing of industry, in classification of workers, etc., make exact comparison difficult. T able 1.-- Total Xumber Employed (H'esleni Zone/ Accident Insurance Group I n d u s t r i a l e n t e r p r i s e s ............................................................................................ (iovcrmncnt ente rp ri ses.................................................................................. Agriculture mul f o r e s t r y ................................................................................ Executive employment (including ra ilr o a d s ) ......................................... Number Insured c M i l a l f lWSb 7.104 ,.'>77 2.2lu,O* t.f](fr,7`*> 1,07s ,C l T o t a l .............................................................................................................. 2t'.2:.2,i:n T able 2 .-- Comparison of Xumhers indemnified for .-leeidents and Ch'cupafiaual Disease T o t a l num ber insured (1050; .............................................. Number und ergoing accidents ( t o t a l ) .................... Number undergoing- occupational disease (total) Number compensated for accidents Death ...................................................................... T o t a l d is ab lem e n t................................................... P a r t i a l dis ablem e nt................................................. Number compensated for occupational disease Death .......................................................................... T o t a l dis ablem e nt..................................................... P a r t i a l dis ablem e nt............................... ; ................ I,]]>.<]: 7,(-21 08,. Oi 308 4 his T a b l e 3.--Comparison of Industrial Accident Rates of Germany and the United States [1949) Accidental d e ath s (per I d w O ; ...................................................... Accidental injuries (per loO.OOOj.................................................... Germany 30 :>,02 United States 20 3.2.V0 Probablv the most reliable figure for comparative purposes is the number o! indus trial deaths. This shows a substantial!}' higher rate for Germany. Industrial accidents' are also more frequent and will probablv increase as German industrial production increases. O w ing to the predominance of the mining, chemical and porcelain industries in the German economv. occupational disease is of greater significance than in the United States. Comparative data on this type of disease are not reliable, since there is no universal mandatorv reporting of industrial disease in the United States. The backlog of cases of partial and total industrial disablement is enormous and repre sents a severe drain on the German economy at present and will undoubtedly increase in the future. Xo data on the total industrial accident premium could, be 30U i . x n r s K i . t L i l r i , / / : . y /: .-.xi) <j u r i ' . n h ' . \ . u . m l I ' U i .xii obtained. hut at least 41.s million mark'- c 'e expended in LMo in indemnity and medical expenses l>v the accident insurum'- cinnpanies. L i> worth imtmg that only ahum 0.02 per cent ui the amourn nded was for accident prevention. l.F .I U SI. A TIV K A M ) J l l S T O K H ' A l , HAC K GKO 1' N i > '1 he present practices in industrial hygiene in <lermany can he directly attributed to the development of health insurance ( Kr a n k c n k a s s c ) and w orkm en's compen sation ( Bcnijsi/cnosscnschaji). The health insurance system was established in 1883 and was followed two years later by passage of the workmen's compensation laws, which compelled employers to insure all their workers against accidental injuries and illnesses arising out of employment. The first law governing medical control of lead industries was enacted in 1905. Since that time at irregular intervals other hazardous substances and processes have been added to the list. These laws recjuire physical examinations before entry to determine suitability for employment, physical examinations of exposed workers at stated intervals, and sanitary regu t lations within the plant. To supervise the enforcement of these medical regulations and to determine the diagnosis and causal relation of an alleged occupational disease, physicians were appointed in the Labor M inistry i Arlndtsininistcriuin ). These state industrial physicians ( Laiidcsyriccriicdrctc) dominate the entire administrative and legal structure for controlling health conditions within the plant. Other agencies and groups who may have attempted to add new concepts regarding the health needs of the workers were forced to defer to the Landcstjczecrbcarzt. Since the law narrowed the interest of these physicians to carrying out its regu lations. the broader public health aspects of this field, have been neglected. The interpretation of the functions of the state industrial physician and of the Labor Ministry is comparable to that of the administration of our workmen's compensation laws. W hile this is related to the broad field of industrial hygiene, it is essentially a medicolegal-social problem and represents only a fragment ot the total 1actors which play a part in worker health. OFFICIAL AGEXCIF.S M i n i s t r y of L auok i T he Ministry of Labor is the government agency basically concerned with worker health and working conditions, e. g., hours of work, employment of women, employment of minors, etc. Its present organization is essentially the same as that which existed betore and during the war. Direct responsibility for controlling accidents and occupational disease hazards is vested in two sections (medical and engineering) which are administratively separate but function cooperatively. Medical Affairs Br a n di .-- 1 he Medical Affairs Branch in Bonn consists of an .Irbcitsnnmstcrnnn for M edian .Affairs (Professor Bauer and a staff of three medical assistants). The m ajor functions of this group are to create new legisla tion. to supervise and assist the state industrial physicians (Lcnidcsgrzi-crbciirctr) in carrying out the law and to act as the federal administrative body on all matters relating to the medical aspects of the labor laws. Its function? are purely adm in istrative. and no scientific research or educational facilities, equipment or staff, exist in this department. A re>pi : appor non- 1. causai:' hi case n. ail diheahh f Ben: origin (,\ `iit/ss. tant n. I r. tin A nm!:. (kralm i 1 ilk ' 1 - IHt', Tip in his . a. ' Kiln I ]. Jn anjM/irn. hiluv :* -ti. iikAi.su: u> v i m : hazaia;. > v ihruiijA IkAflUlV- i: n i ni: O 'U DLL hkhistr: 3. \ ira: na: arrivi*. Tiim* : 'v and g that ' 11nited 'pen ned in nsation dental medical nervals -r laws . ment, regu lations isease, entire plant, irding carzt. regu- The i .abor sat ion utially actors I with unen, ate as . ' 1dling d and of an three gisla:>Ztc) ..tters lminexist TABEKSU .II'--IXI it 'STh'J. //. 1! YC,! L S 1 IX IYK. kTLK\ '/.OSH <>! uHNM. I XY DI A similar si stem exists in each state ( Loud ) ; i. c., the Labor 1lepartmeiit is responsible tor the control ot accident and health hazards. Responsibility tor medical a itaiis i> vested in the Lainh.ujouvrbciirztc, one or mure of whom tire appointed for each Land with the approval of the .rbciisiiiiiiish'nuin. 'fhe func tions a the Lom!cs(jc'iocrl>cbrztc may he summarized ;is follows: 1. l o review every case of alleged occupational disease and to decide on the causality and the degree of disability ( Gi tachtcn ). In this connection his decision is usually final, but in doubtful situations the case may be referred to the home insurance office ( Obcrvcrsichcnnujsamt). Since all disabled workers receive initial medical care and indemnitv from either the health insurance company (kronkcnkassc) or the accident insurance company ( Hentfsgcnosscnschajt), the determination of whether an illness is occupational in origin is mostly a matter ot concern between the kr onk cnk as s c and the Lcniisgcnosscnschajt as to who pays. In long term disability, however, it may he im por tant to the worker whether his case is or is not considered occupational in origin. In the former instance he receives more money and for longer periods than in the k ronkcnkassc system. Determining the degree of disability in percentage and deciding when a case may he considered severe {sclnccr) occupies most of the time ot the state industrial physician. " ^ ^ consultant on occupational disease problems to physicians, engi neers, management and labor. The Landcsgcwcrbcarzt also acts as medical advisor to the regional labor offices in his Land. 3. d o enforce the medical regulations pertaining to the list of recognized occu pational disease hazards (the list contains 27 occupational diseases-- see Appendix IR In this connection the state industrial physician visits factories, assists in appointing plant physicians, reviews the records and in general assumes responsi bility tor the prevention of occupational disease. 4. d o advise and cooperate with the Engineering Rranch in applving preventive measures lor known hazards, substances or processes. It was noted th a t: 1. d he Londcsyctccrbcarzt has neither the time nor the staff nor the equipment to visit factories, make inspections or do investigative work on anv new or unproved hazard. 2. Occupational disease hazards are for the most part brought to Ids attention throng!] the reporting of alleged or proved cases of occupational disease. The law requires all physicians suspecting the presence of an occupational disease to report it to either the health insurance company ( Kr a n k en ka s s c ) or the accident insurance compaio ( Hcrujsijcnosscuschajt), with a copy o! his report going to the state industrial physician. 3. T he state industrial physician has no clinical facilities for examining patients but must depend on the reports of other physicians. .Most of his decisions are arrived at onl\ 1>\ evaluating reports and not by persunaMv examining the patients. There are several notable exceptions to this in that Professor Koelsch in Munich mc ixiH'srki.iL u n u n s u x x n o a r r.rn o x .u . unnn. ixi: aiiii Dr. Xuck in H annover have clinical facilities [Institute jin J r hcUsineX.cn: i wlierc doubtful eases can he studied. Dr. C'arow in 1Mini Bremen and Dr. Siehert m Herlin have at their disposal tin clinical facilities of the 1lealth Department. Dr. Siehert is also in charge of an occupational disease clinic m one of the hospitals administered l>v the H ealth Department. 4. None of the state industrial physicians t Awdcsijcwcrbcdrzic) have police powers hut can enter any plant at any time without prior notice to inspect any process. State police powers can he called on by obtaining a court order through the state prosecutor in cases where owners tailed to comply with regulations. 5. In the absence of any technical facilities for determining doubtful exposures, reliance is placed on the truth of statements made by the management as to toxicity and quantities of materials used. _ 6. In doubtful cases the state industrial physician can request special exami nations. which are paid for by the accident insurance company. 7. In' cases of inadequate or incorrect treatment the patient can be forced t<> accept special consultant service through the accident insurance company. 8. None of the state industrial physicians have any concept that their functions embrace interest in nonoccupatiunal disease, in the total health ot the worker or m furthering general public health. Em/ weeri m, Branch Bfrchnischc Abt ci i i nuj ).-- In the Labor Ministry at Bonn and in each Land the engineering phases of accident and occupational disease control are a function of the Engineering Branch iTcelnnschc Jbtri/iniu-Crwrrbcaii]sichtsciiut). This branch works in close cooperation with the Lumlcs;lciaerbcar:i hut is administratively separate. 1'he following facts are noteworthy : 1. All members are graduate engineers whose basic function is the enforcement of the regulations and ordinances pertaining to hazardous conditions m plants. 2. Routine plant visits are made as staff and time permit. Deports ot serious injuries and accidents are usually followed up immediateh . 3. The engineers do not specialize on types of hazards, e. g.. tire, accident. , etc., hut are assigned to specific industries, e. g., metals, ceramics, etc. In sina,. areas like Bremen and Berlin they are assigned to districts and cover all types oi establishments withm their areas. _ ; 4. Their work is entirely administrative. They have no technical or scieiitmc facilities or equipment. 3 They have the same lower of entry of factories as the state industrial ihcsi- cian and exercise police powers through the state prosecutor in the same way m cases where managements tail to comph . _ 6. Technical advice is obtained from the Teehnisehe C chcncachniuissrrc:n. Tins organization which has semiofficial status (it functions as the scientific aim technical branch of an official government agency-- the Jrb e it sn mn st en u i u , is established, paid for and controlled by employer groups {Jrbcinicbcn'crbuiidc' It is worth commenting that: 1 The Fm-ineermg Branch is essentially interested in enlorcmg legal ordinances. It does not offer any technical assistance to establishments which are visited hut acts essentially as policemen with engineering degrees. ca pe. the teh AV- yea for tri; lit iiti. I- (it: !1; 11 / i I l ;ie iia 1 medizin) Siebert .artment. hospitals vc police -pect any r through ; illS. rxposures. ;o toxicity ;al exatni- iorced to I functions j .rker or in ) i v at Bonn j use control j , werbcauj- j ezecrbcarzt * \ nforcement | bants. of serious . accidents. j . In small I 11 types of nr scientific -irial physi que way in ingsz'crcii i. ientific and -leriitm) is rz'crb dn d c) . i ordinances, visited but T.iUHKSii.-nr--i x D i ' S ' i k i . n . m \ , u . x i - i s ir/.-N i l l s z o x l o s i , r . k M . !\ ' y 2. Interest in safety education is very superficial-- many of the engineers stated it was outside their "held of coni]" nee." In only one area ( Merlin ) did the Hngineering Branch publish and distribute safetv educational material. In Un case the cost of printing was defrayed bv the accident insurance companv t Bernjs{/en<issenschajt ). In other Lander satetv education is done onlv 1v the B ernjsoe in's- ' sensehajl. which, directs most of its material at the apprentices i aged 14 to 17 l in the various trades. 3. No national or local voluntarv safety organization exists (except for a technical group-- I 'crrin Dcutschcr Revisions lmjcnieure-- till employees of the Bcnijsgcnvsscnsehajtcn). Officials (Bcainte) of the Labor Ministry meet once a year to discuss administrative matters, but the average engineer has no opportunity for postgraduate training or exchange of ideas. MINISTRY OK IxTKklok T he Health Department is located in the .Ministrv of Interior. Neither in the Bund (i. e.. the W estern Zone) nor in the Lander are there any divisions of indu- trial hygiene, since industrial health is considered a function of the Labor Ministrv. However, health officials tire supposed to cooperate ( mitzeirhen ) with the state industrial phvsician ( l^andesi/ezeerbearzt), to report industrial hazards, if known, and to assume responsibilitv for neighborhood health when an industrv is alleged to be a nuisance or a danger to the community. # All the health officers of the Lande r deplore the fact that industrial hygiene is not part of their functions. They all insist nevertheless that in view of the long background of industrial medicine in the Labor Ministry it would he impossible to relocate it in the Health Department of the Ministrv of Interior. Suggestions had been made to bring the Landesgeieerhearzt into the Health Department, e. g.. in He-sen, but the matter was not pressed. In Bremen and Berlin, because of their small size, the Landcsgezeerbearzt is under the administrative direction of the health, officer but his functions m no wav difier from those of a Landest/ezeerbcarzt located in the Labor Ministrv. A cCIKENT I.NSCKANlH ClIMl'AMl-.s W o rk m e n 's compensation insurance in an accident insurance companv must be carried for till gainfully employed. Accident insurance companies t Bentjsgenossensche.iten j tire organized in four large associations. 1. Industrial Accident Insurance Association ( Gezeerldiehe Benijsgenossenschujt) representing 35 different groups of industries. All firms in each industrial group, e. g.. textile, are insured in one insurance companv. 2. Agricultural Insurance Association ( LamizeirlsehaflUehe B'cnijsucin>ssenscltajl). leach of these companies is organized in a geographic area. There are 10 such carriers. 3. Community Accident Insurance Association ( Ceineinde-l'niaH-l'ersieiierinigs-J 'erbdnde !. Kach ol these is organized for a state or for a cuuntv and covers the employees in government and community enterprises which do not fall in the industrial and agricultural groups. 304 ix prsixi.u. inaiaxi: .;xi> <n ( ri'.mux.n. .vannixi: 4. lcxecutive Accident Insurance Association. An association organized tor each Land and for the ( icrman post..nice and railroads. j All insurance carriers are super-. - e . i l>y the Labor Ministry, which lias iurisdu- ) tion of administration and appeals. In the various Lander there ate senior insurance ; offices ( Obcn'crsirhcniiuisiiwtcrj which hear appeals. - Separate accident insurance companies exist for the mining industry ( henjban- Bcrujspcnosscnschajt) . j Employers pay the entire cost of accident insurance, which is estimated to he j about 2 per cent of wages on the average. ; Accident insurance benefits include indemnity tor loss of wages, medical benefits t and death benefits for widows and dependents. (Details are not given in this _ report.) t Accident insurance companies do not maintain their own hospitals but they j control the conditions under which medical services tire given. Cases ot special 5 trauma and occupational diseases are referred to specialists in hospitals designated j by the insurance companies. In cases in which the injury or the illness is minor, | it appears that the companies permit patients to be treated by their own physicians. I Xo published statement could be obtained indicating the total premiums paid tor this type of insurance, nor could figures be obtained on the percentage of mom ys collected which is paid out for prevention. O n information from various sources it . was estimated that about 0,02 per cent of moneys expended is for prevention. The major responsibility for the prevention of industrial illness and accident , rests with the insurance companies. However, their main function is to collect j premiums and to administer these funds properly according to law. While preven- j tion is theoretically rewarding, to the individual plant there is no financial incentive , to make serious efforts or expenditures for prevention, since premiums ^are ba.-ed j on the tvpe of industry rather than on individual plant experience. ( 1here are j some exceptions: e. g.. individual rating plans are said to exist in the electrotechnical industry). A plant has to be exceptionally bad to be penalized for accident hazards S and, conversely, receives no reduction in premium for a good experience. : Xo insurance company carries out an extensive program of satety education. The Industrial Accident Insurance Association t ( f r a rrbUchc licntjsi/cnossnischnji ) ] publishes a monthly bulletin, some literature, posters and pamphlets. Most o; the , material, however, is for the safety education of apprentices. : Xo insurance company expressed the slightest interest in the general health o. the worker or in sickness-absenteeism as a labor management pioblem. N O N OF F 1e IA I. AO F- N c IH S W'eRKAERZTLICIIE AKBEITSCKMEiXSe ll AFT This organization is the industrial physicians' professional society. It was estab- fished in 194S and holds a meeting once or twice a year. Its purposes are scientmc and the furthering of the interests of the industrial physicians. 1here are approxi mately 150 members, most of them employed full time in the large chemical, steel. ! automotive and similar industries. 1liese doctors are not members of the K ia n k t h - icassc system and most (1 them do not carry on a private prat.tut.. Before the war the onlv organization of this kino was limited to the ph\su.km> of I. G. Farben. This was discontinued in 1945. The present U~erhdr:tl:chc J/ to i ph; Oil; then fine wor inji. wav. sna the tar\ stan m>: >t a ' Sib of : ini ire. >e\ the zed for mrisdic-urance terybau- d to be ; benefits ; in this tint they f sjiecial signaled minor, .vsicians. paid for moneys nirces it n. accident i collect jirevenmcentive :re based here are lechnical i hazards duration. uscha'jt) -I of the health of .a> estahscientihc approxial, steel, . rankcn- Tvsicians 'rztliche 1 M<hi<sii.ii\'-ixi>rsTi<i.u. imur.xn ix iri-.sihicx y.oxh <>i i,!-.i<m . i x ) Arlwtst/eiiieuiseluijt bar- taken the jdace oi the I. (1. harken organization and i> oju-u to membership to anv (till or part tini<- industrial ]ilivsician. \ rrv lew jctri tune jihysicians, however, are members of this roup. In establishing the organization in l'HS an agreement was made between the employers, the labor unions and the industrial physicians to serve as the basis mr their lunctions and duties (see Ajijtendix 111 ). Pm the terms of this agreement the functions of the jihysicians are limited essentially to (1 ) physical examination o: workers applying for hazardous occupations and (2 ) first aid for all industrial!}' injured or ill. The need lor such an agreement appears to be an altermath of the war. the industrial jihysicians ajijiarentiv not enjoying the confidence of the workers, since many of them misused their profession on behalf of the emjdoyers to further the war effort. Deutsche Gesu.i.schaet fuk Amain>scnurz This Organization is the only one in Germany which can be considered a voiun- { tary community grouj> interested in the health and .safety of workers. It has been I stated that over 100 corjiorations and 150 individuals are members and represent industry, engineering, medicine, government and labor. T he objectives of the organization are as follows: 1. Publication of a journal on in<iu>trial medicine. 2. Publication oi monograph:- on various subjects. 3. Maintenance oi a library on industrial safety. . 4. Organization of two .safety meeting'' a year. 5. Advice on legislation regarding industrial hazards. 6. Encouragement and subsidies for solution of special problems. 7. Maintenance oi a museum of industrial safety. It was noted that tins group has. never and does not intend to collect an;. statistics on accidents and occupational diseases. They have no interest in general satetv education hut onlv in specific technical problems, 'i hev are currently working' ' ' . * 1 under a severe handicap, since their entire library was destroyed. Jlet ore the war foreign literature was abstracted, and resumjnion of this service t> planned. I'uuh- catu.ii ch the journal Zcnlralbhitt fr Arbeitsmedizin. which was discontinued it: 1943. will, it is exjiected. he resumed within a month. W est Gekmax Ci;amhe.i; of P hy.-uians I Dr. Oelemann, director of the W est German Chamber of Physicians, and sever:.: I private jiractitioners were interviewed with regard to their jxirt m the raciicc | of industrial hygiene. Private practitioners are entitled to treat workers who are injured or ill from industrial causes. The industrial j)hy sicians are not suj)]>o>cii t*> treat such patients but are to refer them to their private jihysicians. In cases oi severe injury or illness the jiatient mav he relerred by the accident insurance doctor ( / crtraunisarzt | to a sjiecialist for diagnosis and treatment. 1he delerinm aiion .'w to wliether a worker is able to return to work is a function ot the private jihvsiciam In case the latter disagrees with the industrial jihystcnm as to the worker s recover}' the I 'crtrauensurzt makes the decision. itfi if 4 eft- ill 3 (H > S D V S i R i . i L msuhxr. .-ixn u o . v r . n iox.n. m u d i u x e It was interesting tu note that if a worker's case comes under the health insurance system (Krankt'iikassc) his private physician receives only a stipulated amour,! (capitation lee). However, if it s an industrial case the private physician is permitted to charge per visit. However, in most instances alter the first or the second visit the accident insurance company refers the patient to its own doctors. Private practitioners have no means of bringing their knowledge ot occupational diseases up to date. p l a n t v isits , ; ( j | Entry into all plants was obtained through the Lcmdcsiicii'crbcarct. who in most f instances acted as the guide. Commercial establishments and service industries j were not visited, as inquiry revealed that they had no medical services of any kind ! except first aid. Both large and small establishments were inspected, and their ; medical procedures were examined in detail. The following observations summarize i the result of these visits. } 1. Full time physicians are employed in relatively few plants, even among those j employing thousands of workers. Those that are employed are all in large factories j with known occupational hazards, particularly large chemical works, steel mills and automotive plants. The nuictions of the lull time doctors are essentially threeiold. i j ) They make physical examination according to regulation specified by the various ordinances controlling occupational disease hazards and apprentice labor. t i Thev render first aid for all injuries and refer the seriously injured or ill as directed by the insurance carrier. j (r i They administer first aid for minor nonoccupationai conditions. It appeared that J relatively few workers avail themselves of this service. j This is in accordance with the agreement established between employers, workers j and the industrial physicians as noted previously (see Appendix 111). Only one ot j the plants visited (O pel) with full time medical personnel had any interest in going * beyond these functions. j 2. F irst aid is usually lughlv developed, and elaborate dispensaries are staffed and : maintained. These include in mam' instances in-plant roentgen examinations and - the use of numerous physiotherapeutic devices, as well as hydrotherapy. i 3. T here is little evidence that the plant physicians have any functions in regard t to the broader aspects of worker health, e. g., health education, nutrition, environ mental control, emplovee-management problems, etc. 4. Administratively, in the large plants the medical departments are located in the social security (personnel departments). . ; 5. T he decision of the physician regarding suitability oi employment is final m the case of workers and salaried employees. The standards set lor work are at the * discretion of the work physician. In view of the overabundance oi labor in lierniany f only the most able-bodied find employment in the large organizations. ; 6. Record keeping is excellent and accurate, and. for the most part, records j are kept confidential in the medical department. j 7. In no instance was an industrial hvgiemst employed. 1ins was true even m t large plants like 1. (1. Farben with multiple and complex chemical hazards, lo x i- | coiogical problems are handled by the research laboratories oi the respective plants. ! i S. ! lo r sue! are no hire tin indepe:. the leve y. \ ciany tr. 10. on] v m assurain infract!, ing. etc. 11 hazard , law but agemem the (iii:,! \ 1Si: ate. present! . urr.V w: F u e l self The ' of Fran! war. i , tw o hot'.' Betake to ores, ' Tile: in, at!; c rat! national etc., are ilie health stipulated physician first or the doctors, cupational ho in most industries t any kind . and their summarize along those ge factories 1 mills and threefold, the various . as directed .peared that rs. workers inly one of 't in going ^tatted and rations and in regard n, environ- located in : is final in a are at the in Germany .rt. records rue even in irds. Toxitive plants. I T. UU-. KSU. IU'--I M H S T K U I . H Y u l r . S E IX II '/:.s 7 7. A'.V Z u X I :. Ol G E K M . I X Y 307 S. Industri.al nurses receive no special training, nor do facilities exist anywhere lor such training. Industrial mirsme is not recognized as a special field, and there are no national or local organizations of industrial nurses. Most of the plants hire their nurses through a "m other bouse" (.1/ultcrliaiis), ,although in some cases independent nurses are employed. The trade-unions insist on trained help, hut tlie level of training of the stall does not go beyond first aid in most instances. i i 9. Most of the first aid is carried out by first-aiders ( Sanildlcr) who are espe cially trained by the Red Cross or who have had army experience. 10. In some of the large plants safety engineers are employed. However, it is only in the occasional plant that there is an organized safety program. In spite of assurances that workers obey all safety regulations, plant inspections reveal that imractions are frequent, e. g.. failure to wear safety glasses or protective cloth ing. etc. 11. I art time physicians are employed only where a known occupational disease hazard occurs. This physician carries out the medical program as prescribed In law but rarely goes beyond this function. He is usually selected by the plant man agement but must have the approval ol the Landcstjcwcrbcarzl. who supervises * the quality of his work and reviews his records. KDCCATlOX Yisits were made to several universities to determine the status of undergradu ate. graduate and postgraduate education in the field of industrial hygiene. Retore the war industrial hygiene was taught at only a tew universities and is presently being taught in the .American Zone at the universities of Frankfurt. < Munich and Hrlangen. Alost of the teaching is in the hands of the Landcsi/cwcrhc- drctc who hold the title oi professor in some of the universities, notably Professor Koelsch at .Munich and Erlangen and Professor Kethke at .Mainz, and Frankfurt. 1 he typical curriculum for undergraduate teaching, e. g.. that at the Universitv oi Frankfurt, is a required course ol 1Rj hours a week for one semester in the fourth, year. J his course consists of lectures and field trips and is conducted lw one of the I. I assistant prolessor.' with no special training in this field. A voluntary course of two hours a week for a semester is given in the fifth and sixth years by Professor I Betlike (form er LcnidcstjnccrJicc.rzi of H essen). All clinical lecturers are supposed to present cases of occupational disease, but there is no coordinated program. I here are no graduate courses in Germany leading to a degree in anv phase of T industrial medicine. The only postgraduate teaching in the held consisted of a two I month course given by Professor Koelsch in Munich six month.' ago. This course was taken by .->5 d octors (mostly II c r k a r z i c ) and Lasted two months. It was the only postgraduate teaching m this field that had taken place m postwar Germany. It is apparent that only through the efforts of the more aggressive Landrs- gcizcrbcarctc did some organized teaching in industrial medicine develop. This development seems to be the result of the energy of the individual Lcnidcsycwcrbcarzt rather than of the needs of the community. The teaching is limited to occu pational diseases, and no lectures on the broader phase* ol industrial medical administrative practices, preventive medicine, nonoccupational sickness-absenteeism, etc., are given or ever have been. A.,-: l . X M ' S l Kl. lL m ' C l h X E .IXI > m i I I . H u X . U . MHIUCIXh 1.1 l l K A K i K S A survey was nut made nn the status ui industrial hygiene literatuie m d,< medical and general libraries. 11owe ver, conversations with several consult, un librarians indicated that lew hooks and periodicals on this subject are available in the general libraries. . _ Hvery Landcst/nccrhcarsl is attempting to rebuild his own library, as most o! them have been partiallv or totally destroyed or lost. Land Hessen and h iiil- tenihcrij-Badcn have practically no literature on this subject. Professoi koelsdi has the most complete library, including foreign periodicals, since he was able to retain almost three quarters of his hooks and papers. Professor Baader in Hamm has a very extensive collection which he moved from Kerim. In Bremen a modest collection, chiefly of German literature, exists, and this is also true at the Robert Koch Institute in Berlin. The S'feutschc (,cscllsclnift jitr .-rbcitsschnts stated that its entire lihrarv was burnt. J he Staubjorschtniys-Jiislitni, at Bonn, and the SHih'osc. Forsrhiintjs-1 ns!it at. in Bochum, have only a few scattered periodicals. It was noted that the Germans in 1943 slopped publication ol all their journals or, industrial hygiene, L as Zentvalblatl Jiir .-rhaitsschntz. .hihii' Iin physiologic and Stan!'. T he resumption of publication of all these jo u rn a l^ is being planned, and this month the first postwar issue of Staub appeared. 1he paucity of foreign literature is not due only to war s destruction, as subscription for American. F.ngiish and French literature was discontinued about 193c. 1he latest issue of an American journal was noted in the Robert Koch Institute as of the year 1937. A number o! new h o o k s on industrial hygiene have appeared since the w,n. These are essentially compendiums of medical literature concerning the subject and do not contribute anything new. Among the authors are Koelsch oi Munich, H ol stein of Berlin (P a s te rn Zone) and Lutz of Stuttgart. N o German h o o k on engineering or chemical analysis practices m industrial hygiene is ,i\nnabk. Material for the health education ot industrial workers does not exist any where in Germany. It was never created or subscribed for from foreign sources. K K S K A R C 11 l . A H O R A T O k l K s All the research laboratories interested in industrial hygiene now existing n Western Germane were visited. S i li k <>sk F ok s g n r n g >- 1 \ " i i t v i At Bochum is the SUilcose Borschinujs-1 nst:!ui. a research laboratory supjsaneii by the Bcrt/buit-Bcntjsgciwsseimlwjt and, interested only in silicosis. Connected with this institute is a clinical hospital for disabled miners. The institute is divided into two divisions: chemical and engineering, each uncrating separately under the director. The laboratory is in a most elementary state, with few facilities, a poor library and inadequate equipment, i he work oi the engineering division is centered around the testing oi the efficacy of dust masks and the development of engineering methods to allay dust. I he medical program centers around the evaluation of miners' disabilities ami methods of treatment. In addition, the medical division intends to coordinate the program of preempluymeut and periodic roentgen examination ot all miners. Ibis program is being omy partially carried out at present. ! 7. Jim piG fon resc par: is ii the am ma divi u no wen on: qua lm; sec; wt >r am: spur in-: u:iw olm com oi ie at i; con. wlm safe-: i> a; rue;; indr attire in the 1 consultant ire available . as nicest of and U'iirl~M>r Koelsch was able to r in H a m m en a modest : the Robert : stated that on. and the eriodicals. eir journals ' Gcwcrbciournals is ared. The subscription 1935. T he -titute as of ce the war. subject and unich. H ol m book on Rile.' ' exist any'gn sources. existing in . supixirted Connected taring, each elementary i;e work of dust masks a.l program ament. In niployment being only rm sn ,w --.,sm -sn < u L ,,raws,: ,r c y r u x zc.vy ,jf c lk u x . w Bureau of H ines of d w ' u n k e d States' ])!''. ^ `j0," I,aret.1 t0 thc fTMctions of the Program is in charge of a physician with v e r g e d trLffing m i n l s t ! , a l 1 ^ ^ ' S t a I. HI-OKSCIi IWTS-] XSJTUT > form erly T r r orei ; u,,d^ ,or * * ** B erlm .fj " t i t * ? " " * * > . . 1. " a s research chemist who is nrv- b n . - 0nn' It is under the direction of a particularly in methods of chemicGl' IlUtrt`!' ted 111 n11 niIIKTal and toxic dusts but is in an elementar t e t i t 5 '' dust in the air- laboratory the Knowledge about atmospheric' S T is agency tor publicat.on of the journal Staub. responsTk- . R obert K och I n stit c t t " " 'i"; ,1" r" " r c ! l " < * - under the direction of a chemical -'Iu `-n. an engineer ana a chemist work were essentially set u , l r c t , ! i a n T - ^ v ^ ^ O ratories out on animals. , \ t the present t' "-'t]*' \ exI*'nmental work is being carried quartz in nibble. The emdneer i - cmtl ^ maJor m t m "st ,s ln Bie percentage of but has little knowledge o? T u n l T ^ a"d ventilation section of this in<ttut i lev ( " " * * "* * " * * Pisns. A nother - r k done is ,, ,, a l f t a t L in ^ e " ^ air P ^ " "- -Most of the is elementary!'" ' T b re'Seardl industnal hygiene in Germany animals. With the e x c e p t o " the ] > e xPcr im ent al sponsored research groups. nor are there , <K ' " St" U,e there a r t no officially laboratories. a l,ri'atelj endowed or university KUJIK hygiaae. C S w ^ company. a`'ci<1" " * 0 TM :imi ^ .. 2- It is estimated that the contributions made to the m ir i,,- - . , company amount to 8.4 per cent of the total wages. 3. All accident prevention is carried out hv -.1 , "b-ich co, llects statistics nmliatkKe(ss ssaatfeutx inspecti'ons and do^es a MliUra,,Ce company.- r -r roemgm examination of tile c l u T ' ^ T h TM ' - T T ' e'N.:i" 11" ",ill" s- " !li,h ' ' !|i indminy. inn ,,, r ................ . " '" "S *' ,, a n oi tIre 3Ui I X I M ' S T k l A L H Y d l i X E AXI> OCCV I'.-lTl (>XAl. M E X I C I X E 4. There is a sickness and old aye insurance fund-- the A inif'f'schajts^raukriihaus. W orkers' contributions e|tial 11 iter cent of the wages, to which employers add a stun equal to 17.5 per cent of the payrolls. Besides medical benefits there are many others, including those for dependents, widows, invalids and the aged. 5. At some of the mines, in addition to a first aid room, there are clinical facil ities with x-ray and physiotherapeutic equipment. Ultraviolet radiation is offered in some mines, and in some instances the dispensaries ( Gcsiuidhcitslwuser) arcavailable to the miners' families. Many of the large mines have a physician on full time basis (22 employ a full time and lb a part time physician). 6. There is a central office which attempts to provide employment for disabled miners. There is also a great deal of interest m attempting to create small industries where disabled workers, especially those with silicosis, can be employed. Wre have noted previously in this report that silicosis is more important than accidents as a cause of disability in miners. There is a tremendous backlog of par tially and totally disabled workers, and for this reason recruitment of new workers is increasingly difncult. It was not possible to evaluate the eflectneness cn present preventive methods, but in general it apjreared that not enough weight is given to control of the dust hazard. Most of the interest m miner welfare still centers abom compensation benefits. COMMENT AND SUMMARY The practice of industrial hygiene in Germany is different from that in the United States. In the United States industrial hygiene embraces the prevention of industrial accidents and illness as well as the maintenance and lm protem ent of worker health. In Germany it is based on the rendering of expert opinion . Cutachtcii ) in cases of occupational disease by the Lnndcsi/cz^t'i'lh'iu'ct. This function o. industrial hygiene is comparable to our w orkm ens compensation system, which, while important, is only a fragment of the total picture of worker health. In Germany worker health is synonymous with control of occupational dis ease, and this control is dependent on a series of laws which regulate the frequency of physical examination. The engineers also enforce a series of regulations, but engineering is entirely separate from medicine, and while they presumably work cooperatively, each group stays within its "field of competence." The engineers have no equipment, laboratories or training to enable them to determine degree oi hazard adequately. There are no modern field instruments for engineering evalu ation of atmospheric contamination; e. g.. a midget impinger could not be found, in Germany. There are no codes or ordinances regarding the permissible degrees to which the air of workrooms may he contaminated with known poison, and the interpretation of "occupational hazard" is purely a qualitative one. Engineers are industrial specialists rather than experts in the control of specific hazards such as occupational diseases, fire, etc. Specialists concerned with such matters do exist but do not actively function as field personnel. Failure to provide safe and healthful working places is not penalized by any increase of the employer's insurance cost or through workers grievances. Safety technics are of low standard. There is only one voluntary saiety association, and its point of view is extremely narrow. Community participation in safety, e. g.. the citv safety council, does not exist, in Germany the accident insurance com- skrankcn- employers ,ftits there :ie aged, nical iacih is offered I .ntscr) are hvsician on ,>r disabled .11 industries ' ' 1 nrtant than klog of p a r . workers is - of present ; is given to .-liters about that in the prevention rovement of .m (Gutach- - function of * -tem, which, national dis- he frequency ulations, but nnably work he engineers ine degree of cering evalu- not be found -,ible degrees 1 :,ons, and the j engineers are I .zards such as I tters do exist .dized by any aiices. Safety vociation, and :i safety, e. g., nsurance com T.-i B E K S 11. ! 1!' 1\! >l S I K1,-!L 11Yi . l li Xl : 1\ Jf 7;.s 77: A'.Y ( ,/ (,7:AM/.i.V) .i panies are noncompetitive and are organized on an industry basis with semiofficial status. J he individual plant is rarely penalized and practic.ullv never receives a monetary reward for money spent on safety and preventive medicine. Labor has a token voice in that it is represented in health councils and in labor management groups. However, unionJeaders are limited in their understanding of what can be done. 1 here is no education on the dignity and worth of the individual, no teaching that he has a right to be protected against illness and not only to he cared for after he is made ill, and that proved methods, including engineering technics, are available. ` & 1 caching is limited to a few lectures in a few universities. There is no oppor tunity for graduate training or lor the upgrading of the private practitioner or the industrial physician. Library facilities are at a minimum, and most of what exists is personally owned. Research laboratories have inadequate facilities and inade quate stabs, and these limit their view to a narrow range of problems. There are no federal or state departments which train personnel, stimulate education, provide health material or act as coordinator on industrial health activities. Such aspects oi industrial hygiene as employee morale, sickness-absenteeism, rehabilitation, selective placement, etc., are considered interesting hut not basically within the range of industrial hygiene. Industry apparently has never had presented to it the benefits to he derived from positive programs, and conferences on industrial hygiene are generally limited to technical subjects. Community meeting, were never, or hardly ever, held where the general public, the professions, industry and labor might participate. ' German laboratories and libraries are badly in need of personnel, facilities and equipment. \ \ bile their present state to sonic- degree is an aftermath of the war and the National Socialist regime, most of the deficiencies in industrial hygiene reflect the traditional thinking of German industry, medicine and labor. _ T he outstanding need in Germany at the present time is a program of education for industry, workers, community and the professions regarding the value of indus trial hygiene practices. 1 hey must be educated that preventive medicine is aimed at the preservation ot one of the basic rights of the individual, i. e.. his health. Thev must !,e shown that the cooperative action of many skills is necessary and that individuals and groups must voluntarily initiate, develop and support programs, of prevention and education. They must also he shown that preventive medicine is economically beneficial to the industry, the worker and the community. They must be taught that dependence on a health and accident insurance system does not solve the problem of sickness. ' I he active development of a program of industrial hygiene would make tinadult worker aware of his own dignity and worth. It would also ease the burden on the present top-heavy insurance system by reducing the costs of death,, sicknessabsenteeism and partial and total disability from occupational injuries and illneeIndustrial hygiene is an excellent medium by which to teach cooperation and under standing through mutual action of the workers, the employers, the physicians and the community as they press toward the acceptable goal of better health for the workers. Lastly, it would make Germany economically more secure by helninoworkers become more efficient, more productive and happier through better health* IXI>1 'SJ' XI AL 11YG1EX E X X P (H C C I '111 <>X. U M E P I C I X r. a i -p k n d j x i Lift oi Occupational Diseases Which in Social Insurance Are Considered hquivaiein with Occupational Accidents. (Additional promulgation oi ordinance dated Apnl 2/. l (OU. Code 1950.1 Occupational Diseases and the No. Disease caused by Nature oi the Industries with M hich i hey ate Associated 1 lead or its compounds 2 cadmium or its compounds 3 phosphorus or its compounds 4 mercury or its compounds 5 arsenic or its compounds 6 manganese or its compounds beryllium or its compounds! 8 benzene or its compounds 9 nitru- ami a m i n o - compounds of benzene, its homologs and their denvates 10 methanol 11 nitric acid compounds 12 halogenated hydrocarbons 13 carbon disulfide 14 hydrogen sulfide 15 carbon monoxide 16 Diseases oi the teeth caused by acids 17 Diseases caused by roentgen rays and radioactive elements 18 Skin cancer or similar precancerous changes oi the skin caused by soot, paraffin, tar, anthracene, pitch and similar substances 19 Cancer or other tumors, as well as morbid changes oi the urethral mucous membrane, caused by aromatic amines 20 Occupational skin diseases which make change o! occupation or the tcimniution 0, employment necessary 21 Diseases produced by repeated shocks as a result oi the use oi toois operating v. idi compressed air or similar tools and machines r> Bone fractures caused ice fatigue 25 Diseases caused by working in compressed air 24 Diseases oi the joint bursae t,bursitis) due to permanent pressure or permanent shock suffered by the affected parts oi the body Chronic diseases oi the tendons, the tendons and their muscles, the ligaments and me meniscus insertions 26 Paralysis oi nerves exposed to pressure ' 27 Diseases oi bones, joints and ligaments caused by fluorine compounds (fluorosis,) 28 Dust disease of the lungs ( silicosis, silicatosis) diminishing the capacity to breath anc. impairing the circulation, or associated with pulmonary tuberculosis (<n.ti\t> 29 Asbestosis with diminished capacity to breathe and impaired circulation or associated with, cancer ol the lungs. * 1-29 : all enterprises. {With the exception oi skill diseases, which rate as occupational disease only so far they are symptoms oi a general illness resulting from the action of noxious substances adsorb into the body or are to be indemnified as per no. 20. valent with 1950. Code Associated* .ates ;.araffin, tar, - membrane, initiation o rating with :anent shock nts and the -is) breath and dated with v so tar as cc> absorbed BERSI] A W I S D I 'S T RI . L H Y Gl E X B I X W E S T E K X / . O X U Oh XXXV y: 30 Cancer of the lungs establishment producing alkaline chromates and chrome color51 Diseases ,,! the lower parts of the respiratory system (trachea and lungs, earned by d;ll; Slag fertilizer mixing enterprises, and those which store and ship Thomas sla<- dust--all enterprises ` 35 Diseases oi the lower parts o the. respiratory system caused In aluminum and it- compounds ' ' " 33 Schneeberger's lung disease Ore-nnmng enterprises in the Erzgebirge. a mountain range or, the frontier _ ,eUveen Saxony and Bohemia; metallurgical industries; weaving mills 3*t Deafness or impairment o hearing (otitis interna) caused by noise 35 Cataract Enterprises winch produce and work up glass, metallurgical enterprises, enterprises ot the chemical industry Damages of the cornea caused by benzoquinone Enterprises which produce and work up glass, metallurgical enterprises, entcr. prises of the chemical industry Nystagmus of miners Mining enterprises oh Worm disease of miners caused by Ancylostoma duodenale or Strongvloides s.ercoralis ( Anguillulla mtestinalis) ' 39 Communicable diseases Hospitals, including lying-in hospitals, medical and nursing establishments and Otier institutions, such as health resorts; furthermore, welfare institutions and activities ot the "public and free" type: health departments: laboratories occupied with research and experimenting in natural sciences and medicine Leptospiral jaundice, brucellosis (Kang's disease), gangrene ,,f the spleen, and other diseases which can be transmitted from animals to men Keeping of animals, as well as activities which bring workers into closer or clo.-e-t contact with animals, animal parts, products or secretions and art hkelv to lead to disease. * APPENDIX II Ordinates in Which Control Physicians Are to Be Selected by the State Industrial Phv-ician ttaatl.Gcu'crbearzt) Date of Ordinance June 16, 1905 May 6. 1908 Jan. 27, 1920 March 26, 1930 May- 27. 930 May 29, 1935 Dec. 23,. 1938 Dec. 23, 1938 Feb. 7. :1941 May 6, 1949 Subject I.eao nulls--Reich Code, p. 545 Production oi batteries Lead and its compounds--Reich Code 1920, p. Kid Employment of workers under 18 year- of age and iemale workers in rolling mills and ironworks--Govt Pull. 1. 1930. p. 104 Protection against lead poisoning a! painting W orking in compressed air--Govt. Bulk. p. 72? Employment oi minors in the iron-producing indu-try --Govt. Mull. I, 1932 Glassworks, Govt. Hull. I. p. 1961 Chroniolithufiraphy powder colors--Govt p. 18 X-rays Benzene--GBVL.H ose. p. 39 Bull 1QH " Interval Monthly Monthly Quarterly Half-yearly Half-yearly \ early } Iall-yearly Half-yearly Quarterly Half-yearly Haii-vearlv 314 l X M ' S T K I A L H Y G 1E X Li AELj O CCV L'A T l OX . 11. M n m c i x a AI'I'H.NDIX 111 A (irccmcr.t Uetween the Association of the Employers, the German Trade-Unions, and the Association of Industrial Physicians on Industrial Medical Services. 1 The services of the industrial physician are recognized as an important means of strengthening and improving the protection of the work and health of the working population. 2 The Association of the Employers pledges itself to recommend to its members the employ ment of industrial physicians according to size and kind of plant. 3 The medical services in the plants will be carried out by qualified full time or part time physicians. If the volume of work in one or more plants requires a full time industrial physician, such full time industrial physician should be employed. 4 in) It is the function of the industrial physician to regulate and survey continuously the medical and social conditions in the plant according to its special requirements, to advise the management and the industrial council of the plant on all pertinent questions, and to take care of the employees at work and for the work. His functions further include medical services in urgent cases for employees capable of work, if necessary, in the interest of the plant and its members. The Use of these medical services is voluntary. I/>i The industrial physician should give first aid and treatment for accidents and occupa tional diseases occurring in the plant. 5 ( u i The management in agreement with the industrial council employs and d i s m i s s e s t h e industrial physician. The Landcstieti'crbcarzl should be consulted in advance. (b) The industrial physician is responsible to the manager of the plant or his substitute: in his professional capacity, however, he is responsible only to i n s own conscience as pnvsnnan. In plants with several industrial physicians, one chiei physician should he selected, the oltier industrial physicians working under his direction. t n The rights and functions of the industrial physician will be determined in a written contract between tile management and the industrial physician. I he contract should contain regulations regarding salary, vacation, insurance, period of notice and the sunsiitute o: the industrial physician. It should further secure the independence of the industrial pnysician concerning his medical activities. 6 The industrial physician is a licensed physician. \ \ ith the agreement oi the plant, lie can also carry on a private practice. 7 A physician approved in Germany can become an industrial physician if, after having passed his state medical examination, he has carried on at least three years' activity (of these at least two years clinically) and has proved his qualifications as an industrial physician as well as adequate medical knowledge and education for these services. V/i ,c Association strengthening rs the employe or part time lime industrial | r .-w iiR S ii.-n r --ix D V S T K iA L //: g u i s e i s w e s t e r s y .o s r . o r i;e r u . i \ y s I 8 | (a) The expenses for the medical services are met by the plant. K the services are extended to several plants, the plants in questu't, will share the expenses. (b) The staff, facilities and equipment required by the industrial physician lor carrying out his functions are to be provided by the plant. f . 9 * The Association of Industrial Physicians pledges itself to establish an agency foi industrial physicians which will be concerned with the preparatory education and continuous education of such physicians according to the statutes. 10 For the carrying out of this agreement a working committee will be set up consisting oi the Association of Employers, the German I rade-h nions and the Association of the Industrial Physicians. mtinuously the to advise the id to take care heal services in e plant and its its and occupa- i dismisses the - substitute; in v as physician, ted, the other d in a written should contain .institute of the .'trial physician plant, he can n, after having tivity (of these :al physician as A. M. A. A R C H I V E S OF Industrial Hygiene and Occupational Medicine EDITORIAL BOARD PH ILIP DRINKER, Chief E ditor 53 S h attu ck S treet, B oston 15 THEODORE F. HATCH, Pittsburgh FEN'N E. POOLE, G lendale, C alif. ROBERT A. KEHOE, C in cin n ati FRANK PRINCI, Denver FRANK A. PATTY, D etroit WILLIAM A. SAWYER, R ochester, N. Y. JAMES H. STERNER, R ochester, N. Y. RICHARD J . PLUN KETT, M.D., Chicago, M anaging E ditor Volume 3 w rn. P U B L IS H E R S `' " AMERICAN M EDICAL ASSOCIATION CHICAGO 10. ILL. -n O L . - o f V A . Ofvr> y 4 cnnno M UM VU B