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AN INDUSTRIAL MEDICAL SERVICE.1
493
AN
INDUSTRIAL
MEDICAL
SERVICE.1
III.-THE MEANS OF PROMOTING THE SERVICE. OUR distinguished contemporary, the Tanzes, has recently ’done good service in pointing out,2 as we had already done, the development which is taking place in relation to indusWe have no doubt that employers are trial medicine. beginning to recognise the value of this new branch of preventive medicine ; nor have we any doubt that the workers will welcome the appearance of the factory medical officer. We also entirely agree with the Times as to the training and knowledge required by those who undertake the work ; but we feel some doubt as to the suggestions put forward that the General Medical Council should " found " a diploma in industrial medicine, and that the Royal Society of Medicine should forthwith form a section devoted to this subject. Industrial medicine must prove itself by deeds, and by showing employers of labour its economical value, and the workers its capacity for increasing efficiency and diminishing suffering. By such spade work only can foundations be laid. There is no royal road to construct a building by commencing with specious decorations.
Dr. Hastings (Toronto)’’ the employers of labour how the loss of 10 to 15 per cent. of efficiency in the employee could be saved, and they would be willing to put in good ventilation or any other desired improvement." Another American writer elsewhere 3 : " One of the greatest expenses in industry is the cost of labour turnover, and nearly 4500 new employees were examined to keep 3000 positions filled. In one department the work is of such a character that it costs$100 to teach a new employee to become efficient." Greenwood has shown4 that in this country labour turnover is much the same as in the States. We have about 8 millions employed in factories alone ; let us take the annual migration of workers at rather less than the probable cent. per cent., say at 6 millions ; and the cost of engagement and training at only 91 a head ; we arrive at an annual charge on industry due to the present-day trial and error method of engagement of 6 millioro pounds. Greenwood’s investigation further indicated that careful selection and supervision of workers can divide this turnover by three. Four millions so saved would far more than cover the total cost to industry of an adequate medical service ; and this matter of turnover is only one of many ways in which the service would benefit industry, and through it, as no other medical service can, the health of the community.
Avoidance
What is
_
of State Control. required to-day is to interest employers as the are doing. A letter appearing in our correspond-
What Need is therefor a State-recognised Diploma ? Americans On the side of curative medicine we do not find a diploma ence columns from the director of the Industrial Welfare for the ophthalmic surgeon, another for the gynaecologist, for Society suggests that a nucleus for this interest is already the rhinologist, the dermatologist, the bacteriologist, and the existent. A further need is to avoid functions, X ray operator. Nor in preventive medicine is a special diploma the result of State " recognition," stereotyping at too early a stage. demanded from the tuberculosis officer, the school medical From this industrial medicine is suffering to-day ; and one officer, or the officer of the maternity and child-welfare clinic. fence to be surmounted is the employer’s disgust with the The Diploma of Public Health as it exists to-day, though the work of the certifying factory surgeon who is called upon scope of its requirements might, as Sir G. Newman has by the State to undertake for 6d. work worth six pointed out, be advantageously widened, is a sufficient times that sum, and who, therefore, does badly what he of to all let means portal entry preventive medicine. By was not originally called into existence to perform. Once teaching authorities grant additional certificates to those birth certification was established the post of certifying who have benefited by special courses of instruction ; this has surgeon should have been abolished ; it has only lingered on long been the custom in curative medicine, and Manchester to the harm of medical progress. Let the State even at this has already acted in this way in relation to industrial hygiene. eleventh hour abolish the post, step aside, and allow the Let us follow this example and avoid multiplication of portals medical officer to evolve naturally, his appointment Let us strive to obtain for industrial medicine factory of entry. being made and his services remunerated according to the in and also in the the D.P.H. course earlier recognition laws of supply and demand. training of the medical student. The latter is a stronghold We note with satisfaction that the new of Health to attack, for the battlements are manned by the teaching shows no inclination to take a hand here. Ministry Those who direct consultants whose knowledge of general practice and of the the are clearly too wise and far-seeing. Knowledge life of the people is not conpicuous, while their acquaintance mustpolicy always precede progress, and industry will resent any with factory life and the occupations of their hospital medical service forced on it. But once employers know its patients is woefully deficient. How many ophthalmic value there will be no need for State action, unless it be to surgeons have been down a coal mine ? Yet they teach on assist. Such assistance was recognised during the war when miners’ nystagmus. How many dermatologists have been in the salary of a factory medical officer was allowed to be an engineering factory to justify their comments on lubricant ’, a working as charged expense when calculating excess dermatitis ? How many physicians have inspected the conNo more was needed or is needed to-day. profits duty. ditions under which lead-poisoning is contracted ? In fine, Industrial medicine is too vigorous a child to require the what example do these teachers give to students in investiswaddling clothes of a diploma or the supporting irons of at the the of the fountain head causation even gating State orders to enable it to grow to a sturdy manhood. obviously occupational diseases that come before them ? 3 Medical Inspection of Factory Employees, M. A. Austin, M.D., Joseph Bells are indeed scarce. The proceedings of sections of medical associations are Journal4 of Industrial Hygiene, June, 1919. Final Report, Health of Munition Workers Committee.] liable to become far too select and specialised to recommend without urgent need the multiplication of sections ; and PENSIONS AND ALLOWANCES FOR DISABLED MEN. industrial medicine to-day needs to excite interest, not to retire into seclusion. Further, anyone who has watched the -The revised scale of disablement pensions for the higher affecting soldiers and airmen comes into force as from proceedings of the Epidemiological and State Medicine ranks 3rd. It provides an increase of 17 per cent. to 19 per Sept. Section of the Royal Society of Medicine must have noted i, cent., varying with the rank, on the previous rate (including that ample opportunity has been given for the discussion of I bonus) for total disablement, in addition to allowances in industrial problems; among others, phthisis in industry ; respect of wife and children. Various alterations and adjustT.N.T. jaundice; industrial accidents have recently occupied ments have also been made for widows of men in all services. the section, but the attendance at the meetings has not been The new rates will continue for at least three years,and thereafter will be subject to readjustment according to the such as to justify a new section.
Bringing Conviction to the Employer. healthy line of advance is being followed
A more in the United States, as may be seen from our report of the American Medical Association held in June last. Stress was laid on the value of medical service to industry from examples of what has already been done. "Show," said 1 Previous articles appeared under this heading in THE LANCET of June 28th, The Need of an Industrial Medical Service, and July 5th, How to Start an Industrial Medical Service. 2 The Times Trade Supplement, August 23rd, 1919.
cost of living, but in any case they will not be lowered by than 20 per cent., or under the previous rates (including bonus). The Ministry of Labour and the Ministry of Pensions make the following announcement :1. War Pensions Committees are authorised, where recommended by
more
the medical referee, to continue to pay allowances to disabled men in training under the Ministry of Labour, over and above the training allowances which they are receiving from the Ministry of Labour for (a) " constant attendance"and (b) special diet. 2. The divisional directors of the Ministry of Labour are not responsible for the granting or payment of these allowances, which come under the heading of treatment, and any disabled men who desire their continuation or authorisation should apply to their War Pensions
Committees.
-
AN
INDUSTRIAL
MEDICAL
SERVICE.1
III.-THE MEANS OF PROMOTING THE SERVICE. OUR distinguished contemporary, the Tanzes, has recently ’done good service in pointing out,2 as we had already done, the development which is taking place in relation to indusWe have no doubt that employers are trial medicine. beginning to recognise the value of this new branch of preventive medicine ; nor have we any doubt that the workers will welcome the appearance of the factory medical officer. We also entirely agree with the Times as to the training and knowledge required by those who undertake the work ; but we feel some doubt as to the suggestions put forward that the General Medical Council should " found " a diploma in industrial medicine, and that the Royal Society of Medicine should forthwith form a section devoted to this subject. Industrial medicine must prove itself by deeds, and by showing employers of labour its economical value, and the workers its capacity for increasing efficiency and diminishing suffering. By such spade work only can foundations be laid. There is no royal road to construct a building by commencing with specious decorations.
Dr. Hastings (Toronto)’’ the employers of labour how the loss of 10 to 15 per cent. of efficiency in the employee could be saved, and they would be willing to put in good ventilation or any other desired improvement." Another American writer elsewhere 3 : " One of the greatest expenses in industry is the cost of labour turnover, and nearly 4500 new employees were examined to keep 3000 positions filled. In one department the work is of such a character that it costs$100 to teach a new employee to become efficient." Greenwood has shown4 that in this country labour turnover is much the same as in the States. We have about 8 millions employed in factories alone ; let us take the annual migration of workers at rather less than the probable cent. per cent., say at 6 millions ; and the cost of engagement and training at only 91 a head ; we arrive at an annual charge on industry due to the present-day trial and error method of engagement of 6 millioro pounds. Greenwood’s investigation further indicated that careful selection and supervision of workers can divide this turnover by three. Four millions so saved would far more than cover the total cost to industry of an adequate medical service ; and this matter of turnover is only one of many ways in which the service would benefit industry, and through it, as no other medical service can, the health of the community.
Avoidance
What is
_
of State Control. required to-day is to interest employers as the are doing. A letter appearing in our correspond-
What Need is therefor a State-recognised Diploma ? Americans On the side of curative medicine we do not find a diploma ence columns from the director of the Industrial Welfare for the ophthalmic surgeon, another for the gynaecologist, for Society suggests that a nucleus for this interest is already the rhinologist, the dermatologist, the bacteriologist, and the existent. A further need is to avoid functions, X ray operator. Nor in preventive medicine is a special diploma the result of State " recognition," stereotyping at too early a stage. demanded from the tuberculosis officer, the school medical From this industrial medicine is suffering to-day ; and one officer, or the officer of the maternity and child-welfare clinic. fence to be surmounted is the employer’s disgust with the The Diploma of Public Health as it exists to-day, though the work of the certifying factory surgeon who is called upon scope of its requirements might, as Sir G. Newman has by the State to undertake for 6d. work worth six pointed out, be advantageously widened, is a sufficient times that sum, and who, therefore, does badly what he of to all let means portal entry preventive medicine. By was not originally called into existence to perform. Once teaching authorities grant additional certificates to those birth certification was established the post of certifying who have benefited by special courses of instruction ; this has surgeon should have been abolished ; it has only lingered on long been the custom in curative medicine, and Manchester to the harm of medical progress. Let the State even at this has already acted in this way in relation to industrial hygiene. eleventh hour abolish the post, step aside, and allow the Let us follow this example and avoid multiplication of portals medical officer to evolve naturally, his appointment Let us strive to obtain for industrial medicine factory of entry. being made and his services remunerated according to the in and also in the the D.P.H. course earlier recognition laws of supply and demand. training of the medical student. The latter is a stronghold We note with satisfaction that the new of Health to attack, for the battlements are manned by the teaching shows no inclination to take a hand here. Ministry Those who direct consultants whose knowledge of general practice and of the the are clearly too wise and far-seeing. Knowledge life of the people is not conpicuous, while their acquaintance mustpolicy always precede progress, and industry will resent any with factory life and the occupations of their hospital medical service forced on it. But once employers know its patients is woefully deficient. How many ophthalmic value there will be no need for State action, unless it be to surgeons have been down a coal mine ? Yet they teach on assist. Such assistance was recognised during the war when miners’ nystagmus. How many dermatologists have been in the salary of a factory medical officer was allowed to be an engineering factory to justify their comments on lubricant ’, a working as charged expense when calculating excess dermatitis ? How many physicians have inspected the conNo more was needed or is needed to-day. profits duty. ditions under which lead-poisoning is contracted ? In fine, Industrial medicine is too vigorous a child to require the what example do these teachers give to students in investiswaddling clothes of a diploma or the supporting irons of at the the of the fountain head causation even gating State orders to enable it to grow to a sturdy manhood. obviously occupational diseases that come before them ? 3 Medical Inspection of Factory Employees, M. A. Austin, M.D., Joseph Bells are indeed scarce. The proceedings of sections of medical associations are Journal4 of Industrial Hygiene, June, 1919. Final Report, Health of Munition Workers Committee.] liable to become far too select and specialised to recommend without urgent need the multiplication of sections ; and PENSIONS AND ALLOWANCES FOR DISABLED MEN. industrial medicine to-day needs to excite interest, not to retire into seclusion. Further, anyone who has watched the -The revised scale of disablement pensions for the higher affecting soldiers and airmen comes into force as from proceedings of the Epidemiological and State Medicine ranks 3rd. It provides an increase of 17 per cent. to 19 per Sept. Section of the Royal Society of Medicine must have noted i, cent., varying with the rank, on the previous rate (including that ample opportunity has been given for the discussion of I bonus) for total disablement, in addition to allowances in industrial problems; among others, phthisis in industry ; respect of wife and children. Various alterations and adjustT.N.T. jaundice; industrial accidents have recently occupied ments have also been made for widows of men in all services. the section, but the attendance at the meetings has not been The new rates will continue for at least three years,and thereafter will be subject to readjustment according to the such as to justify a new section.
Bringing Conviction to the Employer. healthy line of advance is being followed
A more in the United States, as may be seen from our report of the American Medical Association held in June last. Stress was laid on the value of medical service to industry from examples of what has already been done. "Show," said 1 Previous articles appeared under this heading in THE LANCET of June 28th, The Need of an Industrial Medical Service, and July 5th, How to Start an Industrial Medical Service. 2 The Times Trade Supplement, August 23rd, 1919.
cost of living, but in any case they will not be lowered by than 20 per cent., or under the previous rates (including bonus). The Ministry of Labour and the Ministry of Pensions make the following announcement :1. War Pensions Committees are authorised, where recommended by
more
the medical referee, to continue to pay allowances to disabled men in training under the Ministry of Labour, over and above the training allowances which they are receiving from the Ministry of Labour for (a) " constant attendance"and (b) special diet. 2. The divisional directors of the Ministry of Labour are not responsible for the granting or payment of these allowances, which come under the heading of treatment, and any disabled men who desire their continuation or authorisation should apply to their War Pensions
Committees.
-