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FILE NAME: Westinghouse (WH) DATE: 1942 Mar DOC#: WH108 DOCUMENT DESCRIPTION: Journal Article - Instruction in Industrial Medicine for Medical Students 19 thej have and tioni conn rially 3 the! con? encya c life ative ' diij indei fects* who leans! feels rable vn or ; and i that njoya ltting e will! iimer A 7 mas wort 'uina^ orthj i ver bee| weiQ ery plain! operlj s. Wj ;t COif 3es, d dur ccout ie sut icreas _ nic d(? lecaul and ad ing the jneficia ion at 1 exanij honesf ist hit ife and ily and and Ige thjj invite iisease yee, M :o takef hazal l is noj repot iuggeg Vol. 11, No. 3 INDUSTRIAL MEDICINE Page 115 References: 1. DONALD B. ARMSTRONG: "Periodic Health Examination--the Keystone of Preventive Medicine." New York State J. Med., 31 :10, 637, 1931. 2. U. S. Public Health Reports, 55: 34-1532, August 23, 1940. 3. IRVING ABELL: Proceedings of the Third Annual Congress on Industrial Health. J.A.M.A., 1941, p. 1. i, REGINALD FITZ: J.A.M.A., 112:1115 (March 25) 1939. 5. C. D. SELBY: Meeting Oakland County (Michigan) Medical So ciety, May 14, 1941. (i. D . A. MOORE: "The Employee." Industrial Health Conference, IntivM. Med., 9 :12, 599, December, 1940. 7. A. J. KAMMER: Some Practical Results of Physical Examina tions. Indust. Med., 10:232, June, 1941, Instruction in Industrial Medicine fit candidates be hired, and pre-placement examina tions were found to increase the safety of the worker, the safety of his fellow workers, and the efficiency of the plant. Following this trend, progressive companies organ ized classes in accident prevention, but even this in struction was seldom under the direct guidance of the physician. And now old and new manufacturing processes and materials are studied for possible health hazards as well as the hazards of environmental work ing conditions. All of this sounds intelligent, progressive and en couraging. However, the lack of interest with its accompanying effects can be well remembered. I for Medical Students At present the surgeon in industry is gradually T. Lyle Hazlett, M.D., giving place to the medical man as the idea of Professor of Industrial Hygiene, preventive medicine is supplanting the repair of the damage done. We have come to realize that laws are University of Pittsburgh not passed in anticipation of unfortunate occurrences, ' \ t h is age of tremendous achievement and general but are enacted only after a situation has become :advancement in all scientific fields, it is regrettable anti-social and has been' before the public eye long th,j the teaching of industrial medicine has fallen be enough to demand penalties for its continued existence. l l t h a t of the other branches of the art and science oi ling. Why is it that our best medical schools de vo> only four or five lecture hours to industrial medicii'o in a four-year course? Why does the worker so or;:! shun his company's medical department? Why do jo few graduates of medical schools choose industrku medicine as a career? It is easy to censure the companies for this laxity in placing industrial medicine in its rightful position. But we should ask ourselves honestly whether we as physicians must not share the blame. It will be ad mitted that a properly equipped industrial medical department with the necessary personnel is expensive to install and maintain, and it is hard to convince a company that this is a good investment when there is no concrete financial return in sight. Numerous com panies have spent money for preventive measures, but in some cases they have been forced into it by law after a noticeable morbidity in operations; and in others, the high compensation rates for industrial hazards have made changes compulsory. In the most successful in stances the improvements have been carried out through the company's faith in the physician, who has been able to demonstrate that such measures are not only right but will also prove to be an economy. This is not a criticism of the heads of industry, but rather an example of the lack of foresight character istic of all human nature; and the physician must share the responsibility for industrial medicine's pres ent role. The physician has been an integral part of every successful company for many years now, and it 18 up to him to make for his profession throughout in dustry in general a place similar to that which it holds in the world at large. | n tracing the history of the physician in industry we find a gradual evolution; but how slowly this prog ress has been made and how woefully it falls behind general medical progress. Originally the physician was called upon to take care only of the man who was in jured while at work. No questions were raised as to vdiether this worker was physically able to do his work. Later the doctor stayed on the company property dur ing the heavy shift and could be called for emergencies, tnen, with the specialization of modern industry, the Gaining of each worker became an investment of time flnd money. It became imperative, therefore, that only . f ' w n t e d at the Fifty-Second Annual Meeting of the Association of nerican Colleges, Richmond, Virginia, October 29, 1941. Has the medical man taken advantage of his new opportunity in the change which has taken place? Is it not the fault of the industrial physician that his place is not more important? Is it not we who are to be blamed for the minor place of industrial medicine in the school curriculum? Is it not our fault that the employee so often lacks confidence in his plant physi cian ? It is estimated that industry employs 42,000,000 workers in this country at present. This means that more than one-third of our total population is spending 24% of its productive life under the possible super vision and guidance of industrial physicians. The field is a tremendous one and its opportunities are con stantly enlarging. Why has a challenge of this sort been allowed to go so poorly answered ? Another challenge to the physician in industry is the responsibility being given to lay groups for the con servation of employee health and for employee safety. All important plants have such personnel, and the results of an energetic well-trained group of this type have been most beneficial to industry. However, is it not deplorable that successful companies with a low percentage of preventable accidents when asked, "What type of medical care is given the employees in your plant?" so often answer, "Our safety man takes care of that." No mention is made of the physician. The plant physician in many such companies is but a necessary evil, and essential only for caring for in juries occurring to employees on duty and for making routine pre-placement examinations. Is it not lack of proper respect for his job that has pushed many industrial physicians into this secondary place? May not this trend, if permitted to continue, push all into that position in the near future? Cer tainly it is not humbling our eminent position as pro fessional men to learn something of the type of hazard the workers must face. Is it not better that the physician investigate conditions himself and, with adequate engineering assistance, make recommenda tions to the employer than be told by the personnel or safety group to examine Mr. J ones for a disease after he has been exposed to its cause. I am not against these groups. I am all for them. They are essential to us. We need them and should cooperate and work with them. But I am not convinced that industrial physi cians should be in a subordinate position in matters affecting the health and safety of our industrial workers. Page 116 INDUSTRIAL MEDICINE March, 1942 As Most of our laws concerning employee health and struction in this field, the importance of the subject safety are the direct result of action by lay people, is lost. often by the worker, demanding explanation of haz 2. The lecture hours should include well-chosen ardous employment and the installation of safety topics in a general vein. The scope of industrial medi methods and equipment. The physician has merely cine, its history and importance should be presented. followed along and improved his technique when and Following this introduction, such broad groupings a s: where it was imperative. This situation is in part due (a ) Orientation and general considerations. to the great majority of men who, when attempting (b ) Placement of the worker from a physical stand to get started in practice, use the salary received for point. part time industrial work to pay the rent. They are (c) Routine role of the physician in the plant. not primarily interested in this field. They have had (d ) Hazardous occupations, preventive measures, no training in it, and as a consequence are not working and care of employees under these conditions. whole-heartedly. They are willing merely to follow (e) General health program for employees. instructions. It does not seem fair that industrial (f ) Research. . medicine should be handled in this manner. 3. Field trips should be made to a well-organized The 1939 report of the National Industrial Confer industrial medical department, with demonstration of ence Board covering medical and health programs of the above topics in action. 301 establishments showed that even in the large Such a program is entirely feasible if as little as plants with more than 5,000 workers, physicians were 20 hours were given in any one academic year, but employed part time more frequently than full time; preferably the senior year. The surface of the subject and that in plants with less than 500 employees, mem would have been only scratched; but a stimulus for bers of the medical profession were invariably main future study in graduate work would have been im tained on a part-time or call basis. Since more than planted in some; and the entire class would have been 60% of the wage earners in manufacturing establish afforded sufficient insight into the subject to respect ments are employed in plants of the latter category its importance. it is apparent that the responsibility for their medical I should like also to urge that much thought be service rests most heavily on the general practitioner given to providing adequate opportunity for graduate who devotes a portion of his time to industrial work. teaching in this special field of medicine comparable to the facilities and training offered in other special "VITHAT is to be done to rectify this condition? First, fields. > * * industrial medicine should be properly empha The faculty for both undergraduate and graduate ' sized, and the importance of its place in medicine and instruction may be very readily gathered in the ma industry clearly outlined. This can be accomplished jority of the communities in which medical schools only by providing sufficiently well-trained men in this are located. It has been the experience of most of us field. With the present interest evidenced by govern in the field of industrial medicine; that the time and ment, labor and industry in the conservation of man energy of self-trained industrial physicians is avail power no salesmanship would be necessary to place able for such teaching. Men for the chemical and such a group of understanding men. engineering phases are likewise readily available. This brings us to the second suggestion. Provide This presentation has been given as a challenge to : in the modern medical curriculum sufficient teaching you who carry the responsibility of medical education. ^ on industrial medicine to present its scope and its Let us be able to offer to industry physicians with future. This would allow the student to evaluate this sufficient knowledge so that they may assume their branch of medicine for a future field as he does in proper responsibility and status. When these trained $ choosing obstetrics, surgery, etc., for specialization. men are generally accepted as a necessary part ofjj Dr. S. Z. Levine, Professor of Pediatrics at Cornell, present-day industrial relations, their work will be in his opening remarks to the students this year bulwark against certain socialistic trends which are j said, "If the physician is to take the leadership in constantly appearing on the horizon. - the health program he must study not only the tech nique of healing but also such social factors as family income, housing, clothing, nutrition, education and Industrial Morale employment." Such preparation, he declared, is either lacking or wholly inadequate in present-day medical Lydia G. Giberson, M.D., education. Industrial Psychiatrist, The field of industrial medicine is too far-reaching Metropolitan Life Insurance Company, to be covered in undergraduate years, but certain New York hours should be given to prepare the student for a graduate course similar to the training demanded s A nation, we are preparing ourselves for a grave | today for a person admitted to the various specialty emergency. Such an effort to cope with modern armed conflict implies a dislocation of normal indus boards now in existence. Such courses would fit a physician to be called a specialist. If such a curriculum trial procedures, a confused, anxious period of waiting were adopted and companies could secure pre-trained while our industrial strength is being made effective, and that an immediate and unprecedented importance men, thoroughly acquainted with the problems to be met and handled, I feel sure they would properly will be attached to the morale of the ordinary indus remunerate them, and that they would be able to trial worker. Industrial populations have assumed a strategic im render value received. portance in current plans for total war. They are the , O uggestions for instruction in the undergraduate centers of strength and the first points of attack. Ways and means evolved in the extinction of a dozen ^ 1.curriIcnudluumstriwaol umldediniccionreposrhaotueldthebefoolflofewreindgtoideuansd:ercountries have been formulated into a polished tech graduates as a separate course. By merely referring nique of destruction aimed at industrial populations.' to disconnected bits of information in various courses Presented at the Fourth Session of the Industrial Hygiene Section# ;. throughout the four-year curriculum as sufficient in- Seventieth Annual Meeting, American Public Health Association, Fr*Vr day, October 17, 1941. a*