Document aYpR8GkZQQXJLw99q3Dy7xxN

FILE NAME: Westinghouse (WH) DATE: 1936 May DOC#: WH106 DOCUMENT DESCRIPTION: Journal Article - Medical-Engineering Control of Industrial Health Hazards P age 232 INDUSTRIAL MEDICINE M a y , 1936 der anaethesia until the full range of lateral mo tion is obtained. A light cast is then applied with the foot in dorsiflexion, the heel in full supination and the forefoot in compensatory pronation. This should be maintained for about three weeks, with a walking iron having been incorporated. At the end of that time, after care is administered con sisting of physiotherapy and the wearing of a stif fened shank shoe or foot plate. The latter is ab solutely essential in forestalling the possible even tuality of a traumatic weak foot. Summary T HE common derangements of the ankle joint have been discussed and the mechanism of their production outlined. It has been pointed out that a clear understanding of the pathological physiol ogy of these lesions is essential to intelligent treat ment and good end results. Medical-Engineering Control of Industrial Health Hazards By T. L yle H azlett, M.D., Medical Director, Westinghouse Electric & Manufacturing Co., East Pittsburgh, Penna. T HE development, over the past few years, of an added interest in human relationships has led to a new trend of medicine in industry. This has been due in part to the even greater recog nition of the solidarity of interests between em ployers and employees, more particularly in the larger companies, and in part to the increased fre quency of common law suits for alleged negligence on the part of employers and to the inclusion of certain diseases in compensation acts in various states. During this depression period, also, indus trial workers with decreased earnings have leaned upon employers to a greater extent for medical care. The result has been a great galaxy of dis eases, some of which are definitely from an indus trial source while others, notwithstanding they are common to the race, are being classified as "occu pational." Industrial management is now show ing an increased interest in alleged health hazards in industrial plants, and is seeking closer contact with the medical profession. Until recently the physician in industry re ceived too little recognition as a part of industrial management. With these changing conditions the usefulness of the physician is undoubtedly becom ing more appreciated, with the result that there will be a constantly increasing demand for his services in a consulting capacity. The following "ad" which appeared not long since in one of our leading newspapers may be said to reflect th e p resen t gen eral attitu d e of em ployers: INDUSTRIAL PHYSICIAN Large manufacturing organization with headquar ters in Middle West and factories throughout the country has opening for young clinician in indus trial medicine; research in health maintenance; po tential opportunity to assume responsibility for di rection of comprehensive medical program. Suc cessful candidate will be given opportunity for ________4 - 1 v , ; , - 1 i n d n o + v i o l ' h \ r c i i o n # a Many are of the opinion that this attitude may change, but there is no doubt that certain policies recently adopted with respect to the safeguarding of the health of industrial workers will be perma nent. How is the medical profession going to meet this situation? The passive attitude which physicians have shown in the past with reference to the for mulation of medical policies in industry, has given non-medical groups a wide latitude in carrying out many controversial practices in the medical care of industrial workers. Unless the medical profes sion becomes interested and formulates some means of protecting the health of industrial work ers the responsibility will undoubtedly be placed in the hands of lay groups, which has so often been the case in the past. Consequently, there has arisen considerable criticism both on the part of industrial management and the medical profession as to the extent to which industry may assume the care and safeguarding of the health of employees in whom a very considerable investment has been made. ' T HE lowest estimate of the cost for employing a new industrial worker is $100, while some estimates are as high as $500. This includes the time necessary for training, defective work during the training period, efficiency to be attained to bring the new worker to a point where he can contribute an equal share with his fellow work ers. In many instances it takes considerable time to discover the ability of a new worker to perform work assigned, which often means he may not have the necessary qualifications for the job for which he was employed but he has shown sufficient abil ity and personal qualifications to warrant trans ferring him and training him for other work. Such procedure is of great advantage to the worker a:: well as to the employer. Investment in this individual multiplied by the number of employees in any single industrial or ganization is large, and if ignored means thousands of dollars invested from which there is no return ; hence employers recognize that any labor turnover demands close attention, and necessary policies to eliminate the causes must be instituted. In the larger industrial organizations the Medi cal Department should assume responsibility for proper placement with respect to mental and phy sical qualifications, having attached to its staff the necessary engineering consultants. This medical engineering staff should have at its disposal the necessary equipment for investigating any plan; condition or process which might be suspected of being a health hazard. The equipment should in clude sampling devices and chemical materials for determining dusts, fumes, and gases which may be encountered in the particular industry. In the smaller plants where such a staff could not be supported financially, close cooperation might be maintained between the physician to whom injured employees are referred for medical care and the engineering staff of the plant, the engineering staff of the compensation insurance carrier, and, if possible, larger plants having simi lar processes. In this manner medical-engineering control might function at all industrial plants re gardless of size, thereby building up knowledge which would be invaluable both to employers and \ uu - 'W . is T HE physician working in conjunction with the a period of years sees the number of individuals in engineer who understands the various proces a large group who, without medical supervision, ses is in a better position to diagnose any diseasewould have become totally disabled and forced to which may be felt to have an industrial origin or cease all gainful employment. to eliminate the industrial cause. This in turn may The greatest example of such health supervision determine the proper and immediate medical treat has been in the control of tuberculosis in industrial ment, and avoid possible errors of diagnoses due organizations that have had well defined health to a lack of knowledge of the exact nature of the programs over a period of years. No other disease occupation; as, for example, the confusion perhaps affects the economic security of the industrial of carbon monoxide poisoning with a diabetic worker to such an extent as tuberculosis. coma; chronic lead poisoning with a peptic ulcer; From the large number of physicians who see occupational dermatitis with dermatophytosis industrial workers from a surgical standpoint cer (fungus infection). tain contacts have already been established with The engineer, in turn, with a medical contact employers so that it is only a step ahead for them will have a clearer understanding of what condi to assume the responsibility of safeguarding all tions may constitute a health hazard. In the de workers from a health standpoint. signing of new equipment or in changing present And who is better qualified? methods of manufacture possible health hazards will be foreseen and eliminated before installation. Thu will result in a material saving in future cost of protective equipment, in increasing the effici- W HILE industrial hygiene must of necessity be considered a post-graduate course in our medical schools, nevertheless some conception of e r u of workers, and in eliminating future ha this problem should be given to undergraduates. ir :es. Simply knowing the symptoms of a few common he engineer should study conditions which may poisonings which may occur in industry will handi b' detrimental to health and by quantitative meas- cap the average medical graduate if practicing in ur nents determine the dosage of substances that an industrial community. This lack of training w kers receive. In conjunction with the findings often results in hasty diagnosis and in the patient's o hue physician safe practices may eventually be occupation being regarded as the cause of the ill determined for any occupation. Among the means ness, if no other cause is easily discernible. All too a:; -he engineer's disposal for eliminating an occu frequently no effort is made to contact the em pational hazard may be mentioned: ployer to learn the true nature of the employee's h Removal of source: (a) substitution of non-toxic materials; (b) complete isolation of process; (c) wetting dry, dusty materials. 2. Protective devices: (a) air conditioning; (b) respirators; (c) dermal coverings. occupation. Correct diagnosis is most important, for if a be lief is unjustly created in the employee's mind that the materials with which he is working are in jurious to his health it is most difficult to eradicate, and it is mentioned by him on all occasions of mental or physical illness during his entire employ ment. There cannot but arise, therefore, a feeling on the part of the employer that some physicians The investigations by the physician of industrial attribute all illnesses of industrial workers direct processes thought to have an injurious effect on ly or indirectly to their occupations. the individual worker will require a careful peri As information is gathered by physicians and odic physical examination. In certain types of oc others doing research work our knowledge will be cupations it will necessitate additional studies, as more accurate, thus enabling both the employer blood, urine, sputa, feces, and roentgenological ex and the employee to reach a more satisfactory un aminations. derstanding without the conflicting testimony now The practice by industrial management of mak ing periodic physical examinations of industrial workers has been somewhat controversial. Many so often heard in our courts. A clearer conception of what constitutes an occupational disease will prevent serious mistakes in diagnoses which are physicians have felt that this procedure has been unfair to all alike. opposite to good medical practice, whereas in If more attention is not given to these problems reality it fosters a closer relationship between the present tendency will become more pronounced physician and patient, for most physical defects, for industry or governmental agencies to establish found at the time of such an examination are in no bureaus where workers in certain types of occupa way connected with the individual's occupation. tions will receive physical examinations and be The employee is urged to correct, by consulting his given working credentials. Various State Depart family physician, conditions found which later ments of Labor are at present making medical may or may not cause lack of earning capacity and engineering surveys, and there is at least one state economic insecurity, whereas if these conditions where the Insurance Commission offers to em were not brought, to his attention he would have ployers complete medical care for industrial ac had no thought of seeking medical advice. With cidents, so that it would seem as if occupational this added knowledge of health problems the work diseases will be included in the near future. This er also feels an increased responsibility for the will tend to result in complete medical care of the medical care of his family. industrial worker by such agencies. Thus there is established a still closer contact Active medical-engineering control of these with the family physician. problems at this time will have an important bear The economic value of such examinations, not ing on future practices and on future legislation. only to industry but also to the individual, cannot be estimated by any known standard of measure ment. It can be appreciated only by one who over Which way the pendulum will swing will depend on how actively cooperation is established between industrial management and physicians.