Document peKxBBLz7R2L7MYJbGQ91xqwX

PROCEEDINGS, SIXTH ANNUAL MEDICAL MEETING SOCONY-VACUUli OIL COUPANY, INC. CHICAGO, ILLINOIS, NOVEMBER 1 and 2, 1951 Palmer House and Medical School, University of Chicago )760s 449369 TABLE OF CONTENTS Page Agenda.............................................................................................................. 1 Names and Location of These Attending Meeting,................................. 3 Address of Welcome Bryan Reid..................................................................................... .....1* Introductory Remarks George M. Saunders, M,D.................................................................. ..5 The Rationale and Effectiveness of Current Methods of Treatment in Essential Hypertension Robert S. Palmer, M.D..................................... 10 An Appraisal of our Truck Drivers - Preliminary Report George M. Saunders, ii.D................................. '..,...23 The Incidence of Peptic Ulcer in the Petroleum Industry M,,N. Howard, M.D,.....................<....................................................... 36 Preparation for Retirement W.H. Montgomery.................................................................................. 5l Summary of Progress in A.P.I. Carcinogenicity Studies Marshall Clinton, H. D.......................................................... .55 Some Observations and Comments cn Carcinogenic Oils William Smith, M.D................................................. The Significance of Medical Records C.F. Beatty.........................................................................................70 The Periodic Check-Up Examination C.A, Schulte, M.D.......................................................... 77 Placement Standards Related to Prevention of Back Injuries E.P. Luongo, H.D................................................................................ 8U Shift Work in Relation to Age and Fatigue A. McLellan, H.D................................................................................ 99 Organization and Function of a Division Medical Office John T. Quinby, H.D,.......................................................... 101 The Purposes, Responsibilities, Organization and Staff of an Industrial Medical Department Robert Kehoe, M.D,.......................................................................... 110 The Nurses Session A.M. Harris, R.N..............................................................................121 59 AGENDA ANNUAL MEETING - SPOONY-VACUUM MEDICAL DEPARTMENT Thursday, Novembor 1st Palmer House, Chicago 1951 MORNING SESSION (9:36 AH. - 1:00 P.M.) I. Address of L'elcome II. Introduction of Guests and new Associates Review of Medical Department Activities Bryan Reid G,M. Saunders, M.D, III. PROBLEMS OF THE OLDER EMPLOYEE The Cardiac and Hypertensive Subject in Industry R.S. Palmer, M.D, The Present Status of our Truck Drivers G.H. Saunders, M.D, The Incidence of Peptic Ulcer in the Petroleum Industry M.N. Howard, M.D. Preparation for Retirement W,H. Montgomery IV. CANCER STUDIES Progress Report - A.?,I. Studies Marshall Clinton, M.D. Carcinogenic Properties of Some Petroleum Products Vfilliam Smith, h'.D. AFTERNOON SESSION ( 2 PM - U:U$ Pai) PROBLEMS CONCERNING EXAMINATIONS AND ADMINISTRATION 7, The Significance of Medical Records C. F, Beatty Should Examinations bo Compulsory C. A. Schulte The Value of Lon Back-X-rays in Pre-placement Examinations E* P, Luongo, M.D. PROBLEMS CONCERNING EXAMINATIONS AND ADMINISTRATION Shift Nork in Relation to Age and Fatigue A, McLellan, U.D* - 1- 449371 grew and hoped to soon have its cn/n medical facility,) I know that you are going to have a delightful day at the University of Chicago, I '.vent there this Spring and visited Dr, Coggeshall, one of our great educators and a self-sacrificing doctordirector of this country. The biological sciences are doing great things for industry and their people in a broad sense, We can all be proud of their work. If we can do anything to help make your stay here pleasant, ;ust ask us. Mr. Copeland is pretty good at this and can handle any thing, I leave you in his hands, knowing that he Y/ill do what you want. Please feel free to ask about anything you would like and he will arrange it. 7e are delighted to have you and hope you can come back again. INTRODUCTORY REIiARKS by George H. Saunders, il.D, EXPRESSION OF THANKS On behalf of our medical staff everyrfhere, I wish to express the thanks of all of us to Mr. Bryan Reid and his staff, particularly to Mr. Copeland for acting as our host at this meeting and for attending to all the many details necessary for the organization, ACTIVITIES OF SOCOHY-VACUUM MEDICAL DEPARTMENTS During the past year, the happening of greatest interest to all of us was the retirement of Dr, A.E. Hcag. He served for many years - 5- 076 449372 with Socony-Vacuum. Sometimes in the face of many obstacles, he fought for the continued improvement of our medical services and showed himself to be a man of vision and ability* L7e have not lost his services entirely for we are privileged to call on him for advice from time to time. As you know, on his retirement I became Medical Director for our domestic operations as well as for our foreign activities. Dr. Gilman S. Currier was appointed on January 1, 1951 as Direczor of our Medical Department at 26 Broadway on a full-time basis, Dr. Currier has had many years of experience in clinical medicine in the New York area and has been interested in compensation cases. During the past year considerable thought has been given to medical security in the event of a bombing attack. At 26 Broadway, we have organized first aid squads. Thirty-twc people have been trained by the Red Cross in their Instructor's Course Tfith the idea that they in turn rri.ll train others. First aid kits have been supplied and plans have been made for blood grouping of the entire population and immuni zation against tetanus and typhoid and for distribution of medical teams throughout the building. During the year, some progress has been made in health education by visual aids. The film "Guard Your Heart" had four showings at 26 Broadway to packed houses and has been shewn at several places in the field. Plans were completed for attaching an Industrial Hygisnist to our medical staff. Lx. Arthur Pabst, formerly with Research & Development, vfas assigned to our medical department on September 1st of this year and he has been sent to Harvard for a year of special -6- 449373 training in industrial hygiene and toxicology. During the past summer our New York Office had a senior medical student 7/orking during his vacation, helping us with our routine examina tions and doing some of the laboratory work, ^e gained through his assistance and it is hoped that he learned something about our general principles and operation of medical activities in industry. In our medical activities, other than New York, one important event was the opening of the very fine medical facility in Kansas City, Dr. H, M, Roberts was appointed Medical Director and Miss Elizabeth Ploger, as nurse. Since the last meeting, there have been several changes among the nursing staff, '-Then Hiss Betty Maguire resigned from the Brooklyn Technical Service Laboratory, Mrs. Doris Krieger moved from the Me?/ York Office to take her place and IUss Anita Harris moved from L'etuchen to New York to take Mrs. Krieger`s place. Miss Lillian Dillard joined our nursing staff at Metuchen, At the Chicago Division, Miss Theresa Carroll has replaced Mrs. Bracco. In Boston, Miss Marian Dickeson succeeded Mrs, Spongberg, Mrs. Ida Williamson is a new addition to the .nursing staff at Pauls'ocro Refinery, During the year, I was able to visit most of our installations but, unfortunately, I have not yet been able to get to our Detroit Office or to the refinery at Casper. A brief summary of our medical activities may be of interest. In addition to lagnolia and General Petroleum, we have nineteen medical -7- 07 il 1 449374 installations which are staffed by sixteen physicians, only three of whom are full-time, and eighteen nurses. Company medical facilities cover about 12,500 or one-half of the 2li,000 employees of Socony-Vacuum proper. During the year July 1, 1950 to July 1, 1951, there were 95,000 patient visits to our clinics or an average of about eight visits per employee per year. During the same period there were 3,000 periodic examinations recorded, about 25% of the covered population, and preplacements number 1,800, FOREIGN ACTIVITIES In the foreign field seme progress has been made. During the past year I visited the Colombian Petroleum Company operation in Colpet, Socony-Vacuum operations in Venezuela and recently I had the opportunity to inspect the activities of our affiliated companies in France, England, Germany, and Italy, As a part of our professional training program, Dr. Virgil Scott, Associate Professor of Medicine at Washington University, spent about two weeks with the Colpet medical staff in Colombia and another two weeks with our medical staff in the hospital at Anaco, Venezuela, making ward rounds, giving lectures, and holding seminars on pertinent subjects. Dr. DeValera, medical director for Colombia was in this country for seve1 al weeks visiting representative hospitals and studying their supply tables and formularies. Dr. Angulo Rivas, of our Venezuelan medical staff, started on a year's post-graduate training in Internal Medicine at Hew fork University-Bellevue Medical Center. In Italy, plans have been made for a modem health service for Socony-Vacuum Italians. Dr. Mario Russo, was appointed full-time 449375 medical director responsible to the manager, An up-to-date, modem, veil-equipped, medical department is being installed at the refineryin Maples, and will, I think,be one of the best in Europe. INTRODUCTION OF GUESTS '7e are fortunate in having with us today a number of dis tinguished guests, several of whom will participate in cur program. Dr, Robert S. Palmer, a classmate of mine at Harvard Medical School, many years ago, and now a leading cardiologist in Boston will apeak to us later about some of the problems of the hypertensive in industry. Dr, Robert Kehce, Director of the Department of Industrial Medicine at the University of Cincinnati, and Director of the Kettering Laboratory, will give us some of his ideas on the organi zation of an industrial medical department. He has had many years of experience in dealing Yfith industrial medical departments. Dr, William Smith, on the faculty of the Institute of Occupational Medicine of New York University has devoted the past several years to the study of carcinogens. He will tell us some of the results of his investigations. Dr. J.R. McMillan, Director of Standard-Vacuum Oil Company, one of our affiliated companies, is attending one of our medical meetings for the first time. -9 - jTq 1 449376 Dr. C. H. Schulte: What ia your opinion of the rclntivo value of blood pressure in rolation to exerciso. In industry due to tho fact that vc do not have sufficient contact with the .-can to be examined we take the oxercise tolerance test. Uo tako the blood pressuro in a relaxed condition, then exerciso the patient, then tako his blood pressure a^ain, Ue tako the blood pressure in a relaxed condition at two different times and at the end of three minutes wo take it a third time and wc havo always found that there is a definito blood pressure ratio. The exercise tolorance test produces a lowered blood pressure in the majority of people. After tho initial rise it lowers - later it is the same in any patient.' Dr. R. S. Palmer: I don't know enough about it to make any conclusions. AN APPRAISAL OF OUR TRUCK DRIVERS - PRELIMINARY REPORT by: G. M. Saunders, M, D. INTRODUCTION Recently, some concern has bean expressed about the age and health of our truck drivers. It has been stated that they arc growing older as a group and that possibly as they advance into tho lato fifties or early sixties, cany will develop disabilities associated with aging which would make them unsafe as drivers. There has been speculation on the wi?don of`developing a procedure for early retirement or for shifting - 23 - 07a 14 449377 'lder drivers to other jobs. Because nost of the ideas expressed have been based, not upon objective observations, but upon iupressions, it was felt advisable to collect infornation on a representative sample of our driv ing group in ordor to define their present condition. This is a preliminary report on data collected during the past several months. Although truck drivers constitute one of tho largest Job classifications in the United States, there is little available factual information on their health or on what constitutes a "safe1' drivor, or what physical conditions should disqualify an operator. The Interstate Coincrco Commission1s Motor Carrier Safety Regula tions, which concern the physical qualifications of drivers arc vague, general and brief. Mininun qualifications require that a driver must not be suffering frou any condition which night interfere with safe driving, A certificate of a satisfactory physical examination is requirod for each now driver, and thero is nothing to prevent a motor carrier fron requir ing physical examinations of drivers in addition to those prescribed by rule. MacFarland in discussing human factors in accident prevention reported littlo relationship betvoen accidents and rocordod physical de fects. He suggested that possibly the various physical tests are not re lated to specific functional actions of drivers and theroforo are not reliable and should be revised on a functional basis, Tho Esso Medical Department also stated that they observed no correlation between physical condition and accidents. MacFarland reported furthor that physical measurements of truck drivers from various parts of tho country aro essentially tho sene. In 449378 general they arc large and muscular with strongly nasculinc build. Most good drivers arc young, with an average age of 33 years, about 69 inchos tall and weighing about 166 pounds. Last year, Dr. Quinby stated that tho typical New England drivers wore big con, tall and stocky, and tended to bo overweight, to have mild hypertension and core than a normal incidence of glycosuria and diabetes. Thoy tended to over-cat and at tines to use al cohol to oxcess. In a recent study of cardiovascular problcns in the railroad in dustry it was reported that in the absence of evidence of narked vascular dosage in the heart, kidney or brain, the affected individuals carried out their work successfully for a period of ten to fiftocn years. Those with systolic blood pressures of 200 or nore, and 'with other complications, were ollcwod to work except operating personnel who were given other jobs. Another report stated that a level of blood pressure of 180/100 nay be dangerous -and that enplcyccs with blood pressure levels above those figures should not operate public vehicles. , The p^chiatric and emotional makeup of drivers has received some attention. Studies of the accident prone automobile driver (Tilman and Hobbs), suggest that "a man drives as ho lives". Unstable, erratic people who may eerie from a background of broken foully life are liable to hove froquent accidents and to have records of numerous traffic violations in the courts. Evidence about the safety of the aging driver is confused and opinions differ. It has been statdd that some of the physiological charact eristics which arc involved in motor vehicle operations, such as eye-hand and eye-foot coordination (steering and braking), and glare vision - 25 - 449379 (night driving), show steady deterioration with ago beginning in tho thirties. Nevertheless, the safety of driving increases up to fifty years of ago. and then d aclinos rapidly during the next two decades, (Brozek, Scientific Monthly, June 1951). MacFarland boliovos that there is not sufficient evidence to warrant an arbitrary retironent ago and that functional age is more important than chronological ago. He, too, emphasizes the fact that older people are handicapped in their ability to sec with poor light and thereforo drivors over sixty years of ago might bo restricted to daylight operations. There is no doubt that aging is often associated with lowered functional abilities and dcgcncrativo diseases 'which night" seriously ham per the operator of a motor vehiolo. Just what these conditions arc and at what stage in their progress the subject should be removed from a driv ing job is not possiblo to explore in this report. However, it seems obvi ous that certain conditions arc associated with sufficient extra hazards to warrant removal of the subject fron a truck driving job. Some of these ore: poor eyesight, uncorrectad, severe deafness, sovero hypertension, severe artcriorsclcrosis with evidcnco of vascular nccidonts in tho cerebral coronary, or renal areas, poorly controlled diabotos, organic disease of the nervous system, epilepsy, psychosos and others. METHODS OF PRESENT STUDY As a result of preliminary discussion, it was felt that certain data on drivers ought to be available in order to classify then as fit or unfit for their jobs and in order to assess the potential hazard to safe - 26 - 449380 driving which night arise frcn dcnonstrated abnormlities. Historical data should Include a c nreful record of past job per- forcancc, including uotor vohicle operations with a record of accidents and traffico violations. The tiedlcal history should record all pertin ent details of past health, including infectious diseases, injuries, surgi cal proccduros and evidence of enoticnal or psychosomtic disturbances. The history of parents and siblings, especially concerning longevity and degenerative and cardio-vascular conditions should also be included. It is known that nan inherits certain structual and tissue characteristics and potentials fron his ancestors. The physical appraisal of truck drivers should obviously be careful and conplotc with special attention to eyos, the cardiovascular systen, and to the ncuro-nuscular apparatus. Euotional stability should also be carefully assessed. At least a nininun of laboratory data should be obtained includ ing a conplotc urinalysis, hcnoglobin detemination, oxanination of stained blood files, and a serologic tost for syphilis. Chest x-rays should bo mde. Electrocardiographic tracings should bo nado at intervals on older individuals, probably after forty years of age. Other desirable tests nay bo suggested by the history and physical findings. A forn was devised listing the itcus considered ossential and copies were sent to nodical directors in five areas where thero were known to be a concentration of truck drivers. The nedical deportnonta of these areas, Boston, New York City, Buffalo, Detroit and Los Angeles, were asked to transfer to these ferns pertinent informtion fron the drivers* nost re cent health records. - 27 - 449381 A cod sheet ^s devised to pernit transfer of the information to punch cards for tabulation and analysis. RESULTS OF STUDY Records are still being sent in fron the field, and, therefore, a conplcte and detailed analysis and report is not possible at this tin. This study will prosont a general picturo of our driving group with regard to ago, si.ze, blood pressure, and significant abnomalitios. It will cccnent on the absence of ieportant data in cost of cur records and a few general rcconcendaticns will bo cado, A total cf 850 records have been analyzed, the great majority cf thee fron Now England and California. Less than 150 are fron Buffalo, New York City and Detroit. The total nunber of truck drivers in SoconyVacuun and affiliated conpanics in this country, is probably in oxcoss of 4,000 although on accurate figure cannot be given at present. There fore, this sonplc represents about 20 of the total which is large enough to be reliable if it is a truly randan one and not solocted. It nay bo that the sample is biased toward the older age groups and patholig condi tions, especially where tho numbers of records returned were relatively smll and the observations oust bo interpreted with than in nind. Age of Drivers The average age of drivers is about 42,5 years but the cost cannon age is in the late forties. Distributed by age groups, those less than forty years old cake up a little noro than one-third; those between forty - 28 - 61'-'" ? 449382 and fifty nako up another one-third, end those over fifty years of age account for a little less than a third, Thore are significant differ ences botween the age distribution cf New England and California drivers. New Fnglond drivers are older with 77 percent being nore than forty years old, while in California, f'nly fifty percent fall in that ago group, of the total, only twenty-eight drivers, or a little nore than throe percent are ncro than 60 years of ago. Available figures for Esso truck drivers indicate that their age distribution is similar to that of our total sample, It is apparent that cur drivers arc predominately in the middle or oldor age groups and as a class are probably aging. This implies that nore attention should be given to health maintenance with nore frequent and acre complete examinations. Size of drivers Our drivers are large non, tall and heavy. The average height is nearly five foot ten inches, with 43 percent boing taller than that and 16 percent of then measuring core than six feet. In regard to bpdy weight, nearly hlf of then weigh between 160 and 190 pounds, the median being about 170 pounds. Fourteen percent weighs, nore than 200 pounds, and sixteen percent weigh" loss tlan 150 pounds. As night bo expected, weight increases with height. Among 130 drivers nore than six feet tr.ll, about one-third of thon weigh more than 200 pounds. When age is related to weight, it is found that there is no indication of increased woight with ago. Our figures for height and weight arc similar to those given by MacFarland, who stated that the average truck driver is about five feet nino inches tall and weighs about 166 pounds, - 29 - 07620 449383 Many of our drivers arc overweight. Anong the sample cf 850, there arc norc t -an 170 classified as overweight or nearly one-fifth of the entire group. There is little observed difference in the proportion classed as overweight in thoso less than fifty years old and in those ever that ngc. Blood Pressure Levels Our observations tend to bear out the suggestion that hypertension ,-.;ay be a conaon finding in truck drivers. A diagnosis of hypertension was :xdc in six percent of nen of all age groups. This finding was present in five percent of those less than fifty years old and in 8,3 percent of the older group. This is particularly significant sinco drivers are selected for their jobs on the basis of physical fitness. Diagnoses of hypertension were based upon tables given by Masters, Dublin and Marks, (J.A.M.A., August 26, 1950, see Appendix), and either systolic and dlastdic pressures, or both, were above the upper Units for ncmal pressures as given in the table. Systolic Blood Pressure The Lxdian lovol of all observations was about 130 m. Noarly five percent of the entire group had pressures of 180 na. or acre while in those noro than fifty years of ago almost ton percent had pressures abovc that level. If the figure of 200 rxi. is taken as the dividing point between codcrato and severe hypertension, it is found the.t (15 or) 2.8 per cent of all drivers and (11 cr) 4.1 percent of all thoso over fifty years of age have severe hypertension. Taking a level of 150 m. as a dividing point, twenty percent of all drivers and thirty percent of those over fifty years of age had pressures above that level, - 30 - 07621 449384 t sure of the drivers had pressures between 80 aad 90 nr.. 03 a critical level, it is found that 6.6 percent of ! 11.4 percont of those ovor fifty yoars of ago have -.rossures. When 110 nc. is taken as the dividing line -.nd nearly 10 percent of those nore than fifty years ;s above that lcvol. "-on ordiac findings or dcconstrablo artcricsclcrosis was rcont. The frequency was less than one percent anong :ars old and about -ight percent or nore than ten tines or group. Many of the conditions noted vero probably r.ce but were folt by the exminer to bo of sufficient in the record. ion :f the peripheral vascular systen was noted in all ' 'nc abncrioality wasrocorded in 96 or nearly twelve pergroup, in eight percent of these less than forty years on percent of thoso nore than fifty. These included a a a few, varicose veins (five percent) and henorrhoids rdiagran were rcccrdcd io thirty-one reports and were mal in seven, all of when were core than fifty yoars reflexes were described in nost eases, and were abnorncl it achillcs and plantar reflexes, and Rheuberg tests \erc 449385 recorded in 3nly about 100 records with few abnormalities. Tests for vibratory perception wero rocordod in only 94 casos of which threo were stated to be abnormal, either dininished or absent. The Skeletal Syston Observations were recorded in less than one-half of tho entiro group, 'bnormalities of the spine were notod in thirty-nino cases and wore commoner in the older ago groups. Abnormalities of tho long bones were listed in eight casos. Examination of the Eves Little information was given regarding the condition of the lids or ocular movements. Visual acuity for distance was reported in all but thirty-two cases. Vision was below normal and uncorroctod in fifty-six and below normal but corrected in 192 eases. Fron this wo nay assumo that nearly twenty-five percent cf our drivers wear lenses to correct for dis tant vision and that nearly seven percent have defective distant vision which is uncorrcctcd. Tests for close vision were not recorded in 364 cases, were said to bo normal in 410 and abnormal and uncorrcctcd in thirty-two, abnormal but corrected with lenses in forty-four. Color vision tests were not listed in 115 eases or nearly fourteen percent of the group. Of those testod, abnormal color vision was noted in seventeen casos or 2.3 percent. Results of examination of eye grounds wore recorded in only 123 men or about 15 percent and were listed as abnormal in four or about 3.2 percent. Laboratory Tests Urinalysis: Results were listed in the majority but in many there was no record and in most eases tho examinations wore incomplete, Specific - 32 - 449386 gr-vity was tdssing in 312. The reaction was not given in 780. Teats for nlbunin were not recorded in 80 and wore positive in nineteen or 2.5 percent of the rorrindcr. Testa far sugar were lacking in seventy- nine and were positive in thirtocn or 1.7 pcrcont. Semination of the sediment was listed in loss than twenty pcrcont of the total. Honr.tolcgy: rod coll count was recorded in ninctocn eases; hcnoglobin detemination in forty-nine; white blood count in twenty and in no ease was there a recording of examination of a stained blood filn. Results of serologic tests for syphilis were given in only 264 eases or less than one third of the total. Of these, two gavo positivo reactions, Chost x-rays wore recorded in only thirty-six eases. Cardiac --nl'.rgor.ont was described in two and abnormality of the aorta in cno. Medical Histories In general the his crical part of the records was unproductive. Little infennticn was given about previous illnesses cxcopt for accounts of surgical procedures. Fmily histories were nen-oxistent. Data on driving accidonts were nissing in nnny eases when the records were first received but -It was possiblo to securo this information on 671 drivers. In slightly ncrc than half, records indicated, one cr core accidents on the job significant enough to be recorded. The preportien with an accident history increased slightly with ago which is to be expected sinco acci dents accumulate with duration of driving experience which in turn is greater in the older age groups. Deficiencies in the Rocords It is apparent free this study that inp-rtant items :.f 449387 infornation arc lacking in our health records. Thoso include, the historical data already mentioned, and itous concerning physical oxania- atiens and laboratory tests. In order to make our records noro nonrly conplcto and of greater value, certain rcconncndations for your consideration appoar to be in erdor. Medical histories should includo details about tho past hoalth, emotional reactions and essential itons in tho fnnily history. Moro conploto acci dent data should be ontcred in nodical records, Crnccrning tho physical examinations, it is rcconmcndod that nega tive as woll as positive findings bo recorded and that sono additional observations arc made. In the oxanination of eyes, the results of tests for visual acuity for both distant and close vision should bo given as woll as results of color vision tcst3. The condition of tho lids should be noted as well as tho ocular ccvcncnts. Examination of tho fundi is a also rccomucndod. Examination of the cars should includo results of tests for auditory acuity and an ctoscopic examination. Cardiovascular System Blood pressure neasurenents should be repeated on more than ono occasion. The condition of peripheral vessels should be recorded. Electrocardiograms should be nado on all truck drivers over forty years of ago at intervals to be decidod. Chest x-rays should be a routino part of the pre-placement examination and should bo repeated at suitable intervals. Tho Skeletal System: Special attention should bo paid to the spine in relation to nobility, pain on notion, tenderness on percussion and any evidence if abnormality should bo noted. Nouramuscular system Records should bo nado of observation of doep reflexes. - 34 - '->7515 449388 Laboratory Procedures: Urinalyses should bo conplcto and should include an examination of sediment. Hemoglobin determinations and exam ination of stained blood films are desirable. Serologic tosts for syphilis should bo routine procedure on all pre-placement examinations and should be repeated at suitablo intervals thereafter, particularly in the younger men. Other laboratory tosts should bo done as indicated. SU?t\RY AND CONCLUSIONS 1. Radical reports on a sample of 850 truck drivers have been studiod. 2. .'.bout one-half of them are more than forty-five and nearly one- third are more than fifty years old. 3. California drivers arc generally younger than those from Hew England. 4. As a group, the drivers appear to bo aging. 5. Structually thoy arc large men both in height ?nd weight and nearly twenty percent were classed as overweight. 6. Hypertension is a relatively common finding and this diagnosis was made in nearly five percent of those loss than fifty years old and in more than eight percent of the older group. 7. Evidence of cardiac abnormality or arteriosclerosis was noted in about four percent. The frequency of these conditions is ton times greater in those over fifty years old than in the younger group. 3. Varicose veins and hemorrhoids arc not uncommon. 9. Visual acuity was found to be diminished in a fairly largo - 35 - 449389 proportion of non, corrected by lenses in cost instances and apparent ly about one-fourth of the drivers wear glasses. 10. Albuninuria was recorded in 2.5 percent and glycosuria in nearly two percent of those tested. THE INCIDENCE OF PEPTIC ULCER Dt THE PETROLEUM INDUSTRY by: Max N. Howard, M. D. It appears to be axionatic that the nunber of words written, and spoken, on any given subject is in inverse proportion to the ancunt of factual informtion known about that subject. Thus the nodical lit erature contains rcocs of articles on the subject of causation of peptdc ulcer. With the etiology of gastric and duodenal ulcers still to be established, it is only natural that the discussion of tho various fact ors supposedly related to their dcvclopnent should be narked by contro versy. Eustercan and others, in duscussing the origin of peptic ulcers list the following theories: 1. The Vascular Theory of Virchow and Hausen 2. The Chenical or Corrosive Theory of Chrcnhoin 3. The Gastritis Theory of Konjetzny 4. The Infectious Theory of Billings and Roscnow 5. The Traurcatic Theory 6. The Mechanical Theory of .'schoff 7. The Endocrine Theory - 36 - 449390