Document rmwp3vjB36O1eBrow72RkyYG

2v T. Lyle Hazlett: His Role in Industrial Medicine, 1920-50 O. |ohn Latter, MD. Kather than discoursing on Bernardo Ramazzini in this Ramazzini Lecture, I wish to talk about Dr. T. Lyle Hazlett. one of the true pioneers of occupational medicine in the United States, and his contributions to the field during the years of 1920 and 1950. Among his con temporaries were others whose careers demonstrate equally well the trends in occupational medicine and hygiene during this period. I refer to such eminent men as Sawyer of Rochester, Lanza and Greenberg of New York, Selby and McCord of Detroit, Geier and Kehoe of Cincin nati, Legge of California, Lynch of Boston. Gehrman of Wilmington. Cummings of Denver, and Sayers of Washington, each of whom deserves to be chronicled as a .pioneer.' I have chosen Dr. Hazlett because of his in fluence upon my early career, and upon the careers of others. The following quotation is the opening sentence of an article announcing a fellowship in Industrial Medicine which appeared in the August 1944, issue of a journal known as Industrial Medicine: 'The development of in dustrial medicine in recent years has changed an illdefined field of medical practice into one requiring a definite body of knowledge and of functional skills." Dr. Hazlett its author, was then Professor of Industrial Hygiene at the Medical School of the University of Pitts burgh and Medical Director of Westinghouse Electric and Manufacturing Company. In announcing this graduate course in Industrial Medicine, probably the first full-time organized study series, the foundation for a dynamic and far-reaching medical specialty for the future was laid. kariy YUn Or. Hazlett was bom April 19,1885 in Butler County in western Pennsylvania, the son of an immigrant Presbyterian minister. His mother, Margaret Ann Lyle, died shortly after his birth, and until his father remarried oine years later, he was reared by a niece of the Reverend Hazlett. Little is known of his youth beyond the fact that oe aspired to become an engineer and pursued a course > civil engineering at Grove City College and at West * taftenutowl Telephone & Tetet'ftph Corportton. 110 Peri Aw . New **.NY10Q22 . * ^kwneU tfv Kmxiiih Secety Onion. Hoi Spoil. Vi. October 10. kW|. -'Journal ol Occupational Medicine/Vol. 21. No. 6/June 1979 Virginia Wesleyan College. After completing his studies, he took a job as assistant engineer on a railroad construc tion project in West Virginia, whereji_tunnel he helped build is still in use. ' Late in 1904 he moved to Pittsburgh to become a salesman for the wholesale hardware business owned by his mother's family. Between sales trips through Ohio, Pennsylvania, and West Virginia he formed a close association with the family physician, accompanying him on house calls in a horse and buggy. The medical profes sion appealed to him so much that in 1908 he dropped his job as salesman and entered medical school at (he University of Pittsburgh. Following his graduation in 1912, Dr. Hazlett interned \ for one year and spent a second year as resident staff \ physician at Pittsburgh's South Side Hospital. He had . been in private general practice only a few months when World War I broke upon Europe in August 1914. Imbued with a spirit of adventure, he joined the American Red Cross and was enroute to Russia by late autumn. He spent 1915 at a military hospital in Kiev. In 1916 he was detailed to head a hospital for Russian troops in northern Persia. His diary reveals that the work was tedious and the glamour, minimal. The hospitals were primitive; the staff and equipment, inadequate. The case load of wounded soldiers was heavy and there were frequent outbreaks of typhus. In April 1916 Dr. Hazlett suffered an acute attack of typhus. Late in that year he returned to the United States by way of Siberia. China, and Japan. There is a romantic touch to Dr. Hazlett's Russian ex periences. Sometime during 1915, a small group of American Red Cross nurses reported for duty at the Kiev Hospital. Although he allowed in his diary that none were very good looking, one of these young ladies caught his fancy. She helped nurse him through his typhus illness and one may conjecture that he followed her around the world, for she. traveling with the nurses, returned home eastward through Siberia. China and Japan three months before he did. They were subsequently married. When the United States declared war on Germany in April 1917, Dr. Hazlett as a member of the Pennsylvania National Guard, organized a field medical unit which was sent to Camp Hancock. Georgia, for training. The division embarked for England in May of 1918 and for the bat- 403 tlefields of France in June. Dr. Hazlett served as com manding officer of Field Hospital 112. the first American hospital to serve at Chateau Thierry, until the division returned home in June 1919 and he was mustered out of the Army as a Lieutenant Colonel. Medical Corps. In the same month he accepted an appointment as Medical Director of the Pennsylvania State Sanitorium for Tuberculosis at Ml Alto. He soon became aware that a large number of patients came to the hospital from in dustry. an observation that set into motion his overriding determination to contribute to the control of this disease 'which had been a scourge for centuries. During the year and a half he served at Ml Alto he introduced the use of cottages for the care and isolation of patients, stimulated the interest of several of the larger industrial concerns of western Pennsylvania in supporting cottages for their own afflicted employees, and raised the morale of both staff and patients. He also attracted the attention of Westinghouse Electric Company officials, who invited him to direct the company's medical activities. His appointment as Medical Director of Westinghouse on December 1,1920, marked the beginning of his direct involvement in the health of the worker and in industrial medicine. For the next 30 years his dedication, his imag ination, his organizational abilities, and his persuasiveness were devoted to improving the health environment of the worker. During that period Westinghouse grew from 36,000 employees to 106,000 and its medical department expanded from a handful of physicians and nurses to 12 full-time physicians, 22 part-time physicians. 91 registered nurses, three industrial hygiene engineers, two chemists, three technicians and a corps of clerks and stenographers. Contribution to the Treatment of Tuberculosis Treatment of tuberculosis brought Dr. Hazlett into in dustrial medicine and continued to engage his energies. He wrote frequently on the subject. "Tuberculosis Preven tion Work in a Large Plant" published in the loumal of Outdoor Life in 1925,' seems to have been the first of many articles published in both lay and medical journals.*4* In essence, he recommended early detec tion, prompt diagnosis through chest x-ray and laboratory tests, and treatment in' a sanitorium or at home. Rehabilitation included a return to selected work and systematic follow-up examinations. Today all of these measures would seem only simple and logical, but in the 1920's and 1930's the stigma of the disease severely beclouded simple logic. Dr. Hazlett regarded education as an important conv portent of tuberculosis control. In presenting his philosphy and program for the control of the disease to the New York Tuberculosis Association in 1944, he wrote. "No plan for tuberculosis control is complete unless education on the subject is continuous and has been made a large part of the program."* He was responsible in 1943 for the publication of a series of eight leaflets on the following topics:7 1. What Is Tuberculosis? 2. War and Tuberculosis 3. Do I Have Tuberculosis? -4. How the Doctor Diagnoses Tuberculosis 5. Infected Sputum Spreads Tuberculosis 6. Hygienic Living Protects from Tuberculosis 7. Good Nutrition Helps Prevent Tuberculosis 6. The Modem Treatment of Tuberculosis * Dr. Hazlett's concern for tuberculosis prevention led to broader concepts of preventive medicine.* He advocated a careful medical examination, including chest x-ray for every employee at the time of employmenL Although the main purpose of the examination was to detect h4r culosis. it provided an opportunity to inventory (hr employee's total health. Dr. Hazlett recognized that the information could be used not only as an aid to proper job placement, but also to prevent or correct other ill nesses and disabilities and to educate the worker about health. Contribution to the Field of Industrial Hygiene As early as 1925 Dr. Hazlett saw the need for an engineer associated with the medical department. Ban ning in 1926 he annually submitted a budget request for an engineer, citing the need to make the total environ ment of the worker a prime factor in health conservation, the need to measure the environment in order to deter mine the magnitude of health hazards, and the need to recommend measures to control such hazards. Each year this budget request was disallowed until, in 1933, a spate of compensation claims for silicosis burst upon all of in dustry, including Westinghouse, and his request for an engineer was honored hastily. Thus began one of f**t* earliest programs of industrial hygiene equipped with\_ laboratory in U.S. industry. It was a fruitful collaboration of physician and engineer in what Dr. Hazlett termed. "medicalengineering to protect the health of worker."* Edgar Barnes was the engineer and his first tasfcir was to make dust studies in the company foundries. By 1938 the demand for hygiene services was such that, another engineer was authorized; by 1941 still further ex pansion of professional personnel and laboratory space and equipment were necessary. From the beginning. Mr. William Yant industrial hygiene and research engineer at the Bureau of Mines and later at the Mine Safety Appliance Company, was Dr. Hazlett's consultant on matters pertaining to programs, personnel and training in the fields of hygiene and safety. When Dr. Hazlett was given direct responsibility for the company safety program in 1937, in characteristic fashion he sought an energetic professional engineer to head this section and gave him full support as he modernized the company's safety activities. Throughout his career in industry. Dr. Hazlett main tained that there was a connection between health and accident prevention and that the physician, before he could determine a person's fitness for a job. needed to be familiar with the work environment and the physical and mental demands of that job. He recognized that he need ed to collaborate with the safety engineer and the hygienist when and where such personnel existed. These matters $eem self-evident today. Sometime during the early 1930'$. the company's Relief and Benefits Association was transferred to the medical department. Administering the "Relief," as it was called, gave Dr. Hazlett new perspectives on the worker's needs in sickness and health and an opportunity to research the magnitude of illness on the economic and social life of the worker and on the industry. In a paper published in 404 T. Lyle Hazlett: His Role in Industrial Medicine/Lauer he reported that "a review of 400 cases on a disabili ty roll showed 105% of cases were tuberculosis. These represent an accumulation over a 10-year period in a plant with an average population of 15.000 workers."* Itole in Industrial Medical Education Or. Hazlett devoted much of his energy to the promo tion of education. He served on several hospital staffs. "As early as 1922," He wrote, "the dean of Pittsburgh Medical School supported the need to emphasize the role of industrial medical problems in our medical school because of our highly industrialized community."* From that time until 1936, industrial medical problems were the subject of lectures given by the Department of Preventive Medicine. In 1936 a Department of Industrial Hygiene was established and Dr. Hazlett was appointed Professor of Industrial Hygiene and Head of the Department The objective of the department was "to provide undergraduate and graduate instruction in industrial medical problems, and to establish facilities for research on specific industrial problems as they pertain to the health and well-being of workers."'* Initially, undergraduate instruction consisted of an eleven-hour course of lectures in the senior year. Dr. Hazlett wrote that these lectures attempted to correlate the work of students in chemistry, physiology, toxicology, and preven tive medicine with application in industry. An analytical laboratory was established, and hospital facilities were available for the investigation of occupational disease." |>.ln 1944, Dr. Hazlett edited Introduction to Industrial jpfed/c/ne, a compilation of the lectures given to the _ medical students by himself and ten other persons. He |ontributed background material and lectures on dust, eases, and silicosis. ` *lt b interesting to note that Dr. Hazlett convinced the si county medical society to establish a Committee of "Industrial Hygiene. In 1938 this committee and his departftabit at the medical school co-sponsored an intensive ^One-week course in industrial medicine for practicing physicians of industry. Thirty-eight men registered and at tended. In a report to the AMA Conference on Medical Educa tion in 1939. Dr Hazlett outlined the following duties and responsibilities of the physician in industry:* 1. Safeguarding the health of industrial workers in their working environment. Included are attention to air hygiene, lighting, noise, fatigue syndrome, and sanitation; Appropriate placement of workers from both a mental end a physical standpoint periodic examination, especial ly of workers exposed to known health hazards; and recommendations for the elimination of any unhealthful practices. 2. Medical care of occupational injuries and diseases. And emergency medical care of on-the-job illnesses. 3. Clinical research. The constant development of new processes, materials, and combinations and the effect of Jhese on the human body present the graduate in ^redicine his greatest opportunity in the study of occupa tional environment careful clinical observations can pro vide knowledge of the effects of a constant daily dosage ,jf A known material over a period of years. Vf-Health education. No groupis more easily accessible 4" more desirous of knowing health facts than those employed by industry. ' During World War II Dr. Hazlett was able to fulfill a major ambition, the provision of more health information in his company. He appointed a physician to monitor the nutrition program in the factories and to disseminate in formation by lectures, demonstrations and pamphlets. A -continuing flow of materials on a wide range of healthrelated subjects emanated from the medical department. Contribution to Professional Organizations Dr. Hazlett first became active in organized industrial medical work with a committee appointment in 1926. Many subsequent appointments followed. He worked with colleagues from all parts of the country in the American Association of Industrial Physicians and Sur geons (AAIPS1 the forerunner of our present American Occupational Medical Association (AOMA1 and was par ticularly active on its education committee. He seemed to reach the peak of his career when, at its annual con vention held in 1941 in Pittsburgh, the AAIPS named him its president." During World War II he represented the association on a liaison committee with_the USPHS and other organizations. He participated vigorously in efforts to achieve recognition of industrial medicine as a special ty. Other organizations among the many in which Dr. Hazlett was active are the National Safety Council, the American College of Physicians, the American Public Health Association, medical societies, and the Pittsburgh Medical Directors Club, which he organized in 1943. In 1948 the AAIPS presented him with the Knudsen Award, and, in 1958. he collaborated with William Hummel on a history of industrial medicine in western Pennsylvania, 1850-1950.'* Stand on Social Issues As one would expect of a man from his background. Dr. Hazlett spoke out on social issues in his lectures and papers. For example, in 1930 he stated: "Industry should be charged with proper living wage, proper working hours, and proper work surroundings, and also with taking an interest in all community health problems."4 In a paper presented before the Southern Medical Society in 1940, he spoke of the problem of fatigue and its relation to accident prevention. He suggested that the time had come to initiate rest periods during the work shift and that the physician in industry could contribute to the full value of such rest intervals by making observa tions and studies.14 Conclusions The temptation is great to compare the industrial health issues of the period 1920-50 with those which con front us today. Direct comparisons would not be valid. We can. however, look at the earlier period for guidance. Tuberculosis and dust diseases, especially silicosis, ex ploded into public concerns much like the environmental cancer issues of today. Tuberculosis has been conquered but silica problems are still with us. I expect some of the same anxieties beclouded the dis cussions then as now. One wonders if the same acrimoniousness prevailed. I expect it did. although at a level several magnitudes less, because a much smaller Journal of Occupational Medicine/Vol. 21. No. 6/June 1979 405 segment of society was involved than is participating to-. ' day in our national concern with the diseases of cancer. It is noteworthy that in our medical schools today the interest in occupational medicine as an organized curric ulum is not much greater than it was in the 1930's, on the part of either students or faculty at the undergraduate level. Yet the growing importance of the field is recog nized by organized labor, by government and in creasingly by management The opportunities for careers in occupational medicine, hygiene, and toxicology are infinitely more dbundant now. In the earlier period they were limited to a few jobs in industry, a few in universities, and a few in state and national government health and labor depart ments. There were none in labor organizations. The ever-increasing interest of the public in the envi ronment especially as it affects health in the workplace, brings with it opportunities for vivid news stories, for newspaper and television interviews, and for appearances before congressional committees and executive agencies holding public hearings. Such appearances can be heady experiences for the occupational physician and hygienist, among others, and showmanship, grantsmanship, and the like may supersede more traditional talents. Inaccuracies, superficialities and challenges to one another's integrity in the absence of data can easily follow. We seem to be badgered into advocacy rather than measured discussion. Emotions flare, attitudes harden and positions become fixed. Maybe here we might turn to our predecessors. I ex pea that in such situations Dr. Hazlett would have quot ed Holy Writ "And why beholdest thou the mote that is in thy brother's eye. but considerest not the beam that is ~ in thine own eye?" Dr. Hazlett's words seem as true today as when he wrote them in 1944: "The development of industrial *_ medicine in recent years has changed an ill-defined fields of medical praaice into one requiring a definite body of;- knowledge and of functional skills"" - I wsh 10 acknowledge die Mp and encouragement I receded Iron Or Hazletts ton and namesake. Theodore l Hazlettrlr Without h help. that of many when, a would have been too ddficutt to put tha pwee together Let me name a lew with mv gratitude tdgar Barnes. Wilbur Speiker. Daniel Brown, frank Cano. Mary O'Rourke. W Leigh Cook. Campbell Mores References 1. Setlecfc H and Whittaker AH: Occupational Health m America. Detroit Wayne University Press. 1962 2. Hazlett TL: Tuberculosis prevention wort in a large plant / Out door Life. 192S. 3. Hazlett TL: Placement of the worter. Ind Med 10.535-536,1941. 4. Hazlett TL: Value of good physical and mental health m industry ft Health *12-16.1930 5. Hazlett TL: Introduction to Industrial Medicine. Pittsburgh: University of Pittsburgh Press. 1944. ' 6. Hazlett TL: Tuberculosis in industry. Ind Med 13.239-241,1944. 7. Hazlett TL: Industrial medical problems in war production. Arm Intern Med 20:371-37S. 1944. S. Hazlett TL: The value of industrial hygiene. Am / Public Health 37:421-425.1947 a 9. Hazlett TL: Fundamentals of industrial hygiene. Proceedings ti the AMA Annual Congress of Medical Education and Licensurg* Chicago. Feb 13 & 14.1939. 10. Hazlett TL: Industrial health in relation to undergraduate and. ';., graduate medical education, ft Med I April 1941. . ' Perception of Stress People who suffer from stress have a subjective impression that their lives are con trolled by outside forces and they can't do anything about them. People who thrive on stress have the opposite, objective feeling that "I can manage; I can even manipulate; I can determine my own destiny. I am not dependent on outside control or outside deci sions." . -- Or. Peter Brother. Menmnger foundation. Topeka, as Quoted m -Stress May mm be Hazardous so Your Health" by Berme Ward, m Sky. Delta Airlmet. March 1979 406 T. Lyle Hazlett: His Role in Industrial Medicine/Lauer