Document x1KXO1aM8VgkBv71gjKY7391Q

.'lili cr 1 tunin' .Xti/cty (. \jiiyr,jj ites toward an interior physician, less conrm-d mill the lack of qualifications. The .tent to liit'Ji l.nk ol qualifications in ne:I>.Umu.il tlt-ea-e work inav go is reflected tin- tart that reemtly a drily licensed .loan in the State of Michigan reported t. i tin.d |n;ri't;il-Ias a diagnosis of an CCUp.ition.il disca-c. While the tmw illnigiic's of a |ihjsiciau to eel't responsibility for |ialliolngiv states ilh whicli he is not com et'ant is Coui.nduhlc. lliere 'till remains a duty to di al Ilia patient into channels therein adeante --e<sicca may he procured of the chest of this workman may strongly suggest the possibility of silicosis, nowhere on the work record may it he shown that for a period of seven years at some much earlier tune this workman was employed a5 a labotci in a pottery^ in thi.' same connection it should he em phasized that one of the many handicaps to the plnsiciau in making an accurate ilia gnosis is to be found in the widespread practice of ho'pita!', of clinics, insurance records, etc , in merely naming the trade of a workman rather than describing his exait occupation. It is quite insufficient for med Industrial Terminology One of the mini annoy mi; handicap' :n Uilbllsliing the exact etiology Ot a pOS-iblc ccupntioiial disease resides in the uidviread practice of indu.-try in using code mhuK in the designation <>i its substance.'. ii inipnry. the patient may state to his iv sician that lus work eoti'ists of tilling mtaiiiers nith "li /2." lint, inquires the ny sician. "What is K-/2?" The patient ical purposes for a record merely to show, for example, that the patient was employed a an "automobile worker," 1'iuUr tie.' heading, there are perhaps not le>s than 2!)l) different and dissimilar lypes of em ployment leading to different exposures, .such for example as to silica in the foundry, cyanide in the heat treating room, chromium in the plating department, lead in body linisliing, and on and on. mtiuucs. H-r2 is a mixture of M-20 wuii Lack of Library Facilities 1 IP and I.-bz." Coni[detely the physician lelt m the dark, 1ml if the truth vveic am it it might be shown that this patient .1' engaged in the tilling of cans with a oaii'li tcutover, which consists of a mix.rc of wood alcohol, licn/nl and a -lu etic wax. With some temerity the statement is made that regardless ol many hunk publi cations in the held of industrial hygiene and occupational di'C.iscs, special maga zine', and articles appearing m ginci.il medical magazine publication., there is, at tins time, no condensed, informative raj- Such situations may Income, so cimiii'- lci ini on occupational di-ca'V' well suiu-d g that it may he almost impossible tor to the ui cds ot the family piaelitimiei. e physician to obtain proper information to work exposures. Medical, safety, soI service or insurance dcpaitmcnts ail iy have dmiciihy in obtaining full inniation as to actual chemicals and mix es of chemicals designated in production .atioiis only hy code numbers. It is of course impossible anil undesirable that any attempt should he made to reduce all of the lore of occupational diseases to some thin hook to which the practitioner may refer and with certainly obtain all tin guidance needed in the treatment anil man agement of occupational diseases. Granting The Absence of Records lie majority of industrial plants fail maintain siiiiiciiut medical and work >rds to serve flic physician properly in lection with occupational disease wuik l given instance tut afflicted workman give as his occupation some innocu- all this, there still is occasion to assert that a real need now exists for a book publica tion on occupational diseases designed for services to the neighborhood physician wlm in the aggicgate secs far more occupational disease cases than the small number ol specialists in this field. job ns "elevator operator." He may rc- Attitude Toward Industrial Medicine ilicr that the job before that was a* In times long ago, when mine workings, rude driver." There his memory may His work record may show no item transfer within the factory of his employment and no record of any pre. employments. Although tin- x-ray sawmill', ami railroad construction camp' were established in remote sections of the country, far removed from the usual sources ot medical services, it became necessary that the management bring into these iso lated work places a physician who might carry owt all manner of medical services. These phy'iiinn' set the broken arm. of injured ihuri-.; delivered the babies os the miner'' wilts; treated the miners' children for iiica-lis and mump* and Olheiwi-c at tempted to meet the medical needs ol these detached cnnumimtics. Gsiially the com panies conli ihiited to the income ot these physicians ami ever) family and cicry 'High- man wa- taxid a Mijmkitcd stun each month m -order to cover the physician's -alary. Thus aro-c the term ''Contract 1 *51y sician." This perhaps did not always rcpic-cui the hot of medicine and not in all iii'lamcs were tlic-e contract pfiy-iciiuis of the highest type. I.ater sunn of these communities became larger towns, or cities, and other physi cians sought to gam a livelihood, only to find that the contract physician was in the -addle. This gave rise to complaint and out of this "Pandora's box" have come in numerable evils that even to this day at tend the highest type of industrial medical supervision under the most ethical ami commendable circumstances. It has be come a tradition on the part of many of the medical proies-iyii to blame almost any in.inner of their iviAiomii' dlVieulties upon indii-tiial J.liy-ieiaiis. So real is this ili-atuetion that some organized medical groups have sought to legislate against al most any iorm ot industrial medical prac tice ami in -nine instances to deny meinlier-liip in medical societies to industrial phisicatis. As a result, industrial physi cians in some respects have been branded with a scarlet letter. This queer situation, strange to say, may serve as a handicap in the diagnosis of occupational diseases, since some of the best physicians, and particularly the mure timid ones, fear lest they may become be smirched hy cooperating in this type of medical endeavor and to some extent slum any elo-e alliliation that might lead to lilted eyebrows by tlmsf regarded as the leaders of the profession. Now that .the American Medical Asso ciation is somewhat alert to this situation and has organized a Council on Industrial Health, including some members with in dustrial medical experience, it is to be hoped that at ter all the industrial physi cian may he- 'mie respectable. New Chemicals A further deterrent to accurate (bag nosis uf occupational diseases is linked -u with an almost endless Mow of new chcm ivals into iudusliy's proics-c?. bear Iv year, a far greater number of new chcm ieals are introduced than the number o investigations referable to their toxicity It is often true that nouheie in the cutin till r.ilurc concerned with indu-uial to\ irnlogy may any word he found aiding tl.-< phy sician in determining ii a given ckiuuc.d might he responsible for a series of objec tive and subjective symptoms in any patient One of the most desirable changes needed in connection with worker health protec tion is the mini lenient that no new sub stance be introduced into imhistiy on a production basis until it shall have been established to the extent possible, through animal experimentation, that such a sub stance is without dangerous potentialities. Significance of Handicaps in Diagnosis A recital of the type just presented might be continued almost indcnuitely, but perhaps without profit. The entire situa tion may he summarized by stating that whereas occupational dlsca-cs tlu-m-iins are probably as diagnos.iblu a- any naur diliicult flit's of diseases, just about eveiy stumbling block tlr.il may he produced is laid at the door of the physician sincerely sciking to acquire sidiicient evidence upon winch to make exact diagnostic dcci-ii.n The greater number of these -tumbling blocks represent no willful desire to hamper the physician, but instead arise irom the results of peculiar circumstances that in some measure separate industrial di.-cascs front the general rim of afflictions. As a consequence, large numbers of un warranted diagnoses of occupational dis eases have been made and are being made Scores of suits have been instituted and some have bent won hy claimants whose claims possess no whit of merit, chiefly be cause well meaning physician* unhappily implanted the seed of possibility that Indisease might have been cau-ed by work and that the responsibility might he laid at the door of the employer. While the re sults may have appeared to woik an in justice and monetary loss upon the em ployer, in the long run the interests ol the worker, himself are not served by tbi-e