THE RELATION OF MEDICINE 
TO INDUSTRY 
Proceedings of the 
Conference Board of Physicians in Industry 
.War 
Tenth Anniversary Meeting 
in New York City 
April 4, 1424 
Report Number 30 
National Industrial Conference Board 
247 Park Avenue 
New York City Copyright, 1924 
National Industrial Conference Board 
Published October, 1924 Foreword 
The long association of the Conference Board of Physicians 
in Industry with the National Industrial Conference Board as 
the latter's advisor on medical problems in industry renders of 
wider importance in our economic-industrial life and of general 
interest to industrialists and the public the papers and addresses 
presented by a group of eminent personalities in this field at the 
Tenth Anniversary meeting of the Conference Board of Phy- 
sicians in New York, April 4, 1924. The National Industrial 
Conference Board has here gathered together and published 
these papers in order to emphasize and give more enduring 
form to the notable record of the development of health service 
in industry which they constitute. 
III CONTENTS 
PAGE 
Introduction 1 
Afternoon Session 
Introductory Remarks 7 
Dr. Wm. H. Park: "The American Public Health Associa- 
tion and Industrial Medicine" 8 
Dr. Edward Livingston Hunt: "The American Medical 
Association and Industrial Medicine" 14 
Dr. L. A. Shoudy: "Function of the Physician in Industry". 16 
Mr. Samuel Gompers: "Employees' Interest in Industrial 
Medicine" 23 
Mr. C. R. Hook: "Employers' Cooperation in Medical 
Work" 26 
Dr. O. P. Geier: "Monopolistic State Insurance and In- 
dustry" 32 
Dr. Harlow Brooks: "Inspection in Physical Diagnosis". 36 
Evening Session 
Dr. R. C. Williams: "The United States Public Health 
Service and Industrial Medicine" 46 
Mr. M. W. Alexander: "The Conference Board of Physi- 
cians in Industry" 55 
Dr. J. J. Moorhead: "Traumatic Surgery-Its Develop- 
ment and Relation to Industry" 65 
Mr. Howell Cheney: "What Industry Requires of Medi- 
cal Supervision" 71 
Dr. W. Gilman Thompson: "Industrial Medicine and 
Medical Education" 80 
List of Officers and Members of The Conference Board of 
Physicians in Industry 89 
V The Relation of Medicine to Industry 
Proceedings of the Tenth Anniversary Meeting of 
the Conference Board of Physicians 
in Industry 
INTRODUCTION 
Organized effort to promote and protect the health of the 
working force is one of the features of modern industrial manage- 
ment that is receiving growing consideration. As its value is 
increasingly recognized such work tends to become more and 
more an integral part of the industrial system. While the medi- 
cal profession is being called upon perhaps more than ever before 
to contribute to the solution of health problems in industry, its 
members had to deal with the effect of industrial processes and 
materials upon the physical and mental well-being of workers 
long before the rise of the modern industrial system. 
References to the application of medical and hygienic knowl- 
edge to industrial occupations are found in the records of craft 
guilds which flourished during the Middle Ages. Among the 
functions which these guilds performed was that of rendering 
assistance to sick and poor members, and the records of these 
organizations contain many references to disease conditions 
brought on by the occupational activities of workers in handling 
mercury, lead and other metals. A more specific indication of 
the long history of these problems is furnished by the fact that 
as far back as 1700, there was published in Italy a book by Ber- 
nardino Ramazzini, entitled "The Diseases of Artificers and 
Tradesmen," in which the author described the symptomatology 
of diseases which are found today among workers in industries in 
which proper hygienic and safety precautions are not observed. 
The influence of occupation upon the health of workers is 
traceable through the history of such countries as England and 
Germany, where modern industrial processes saw their earliest 
development, and it is to these countries that we must look for 
much of the fundamental work that has been done in the study 
of this subject, and in the prevention as well as treatment of 
injury and disease arising out of occupation. The personnel of 
the departments of factory inspection of these two governments 
1 has long been recruited from the medical profession, and the re- 
ported observations and investigations of these medical inspec- 
tors are among the most valuable contributions to the literature 
of industrial medicine. 
In America the rise of the present industrial era has been more 
rapid and accompanied by greater changes in the relation of 
workers to their surroundings than in other industrial countries, 
with the result that medical work in industry has been given an 
impetus not yet attained elsewhere. The enactment of work- 
men's compensation laws in 1912 and subsequently, placed 
definitely on industry the cost of care and treatment as well as 
remuneration of those injured in their employment. The effect 
of this legislation was to bring physicians into industry in in- 
creasing numbers and to stimulate intensive study of the worker 
in relation to his work. 
The observations of physicians associated with this work soon 
showed that there exist in industry many problems which had 
not been encountered in their previous medical experience. 
Many of these problems were common to different types of 
industry and the need was felt for opportunities to discuss these 
matters of pressing interest and importance. Out of this recog- 
nition there developed in April, 1914, the Conference Board of 
Physicians in Industry, a voluntary association of medical prac- 
titioners who were devoting practically all their time to the care 
of workers in industry. The objects of the Conference as stated 
at that time were "for cooperative effort in introducing into in- 
dustrial establishments the most effective measures for the 
treatment of injuries or ailments of employees, for promoting 
sanitary conditions in workshops; and for prevention of indus- 
trial diseases." 
The Conference early addressed itself to the consideration of 
first-aid measures to be employed in industry, of the minimum 
equipment for first-aid kits, the equipment of dressing stations 
or plant dispensaries and similar matters. Physical examina- 
tion of workers and of applicants for employment was also 
among the questions discussed in the early days of the Confer- 
ence and has since been of continuing interest. Out of the ex- 
perience of the members of the Conference was developed a 
classification of the findings of physical examinations that has 
found widespread approval in whole or in part in the industrial 
medical field. Coincident with this work the Conference stand- 
2 ardized degrees of physical defect, which enabled workers in 
widely separated places and industries to be properly classified 
and assigned to their occupation. 
Constructive contributions were made to the solution of 
problems of administration of medical departments in industry. 
Owing to the importance of this work in the scheme of produc- 
tive efficiency, the Conference, after due deliberation, placed on 
record a resolution that the head of the medical department 
should be responsible to a high business executive, thus according 
to such departments recognition equal to that of other major 
departments of the organization. 
As the work of the physician in industry became more firmly 
established, the Conference recognized the need for a statement 
of his function and to this end the following definition was 
promulgated and adopted: 
"The physician in industry is one who applies the principles 
of modern medicine and surgery to the industrial worker, sick 
or well, supplementing the remedial agencies of medicine by 
the sound application of hygiene, sanitation and accident pre- 
vention; and who, in addition, has an adequate and coopera- 
tive appreciation of the social, economic and administrative 
problems and responsibilities of industry in its relation to 
society." 
As many of the requirements that make for successful medical 
work in industry are economic and administrative rather than 
professional, it was felt that the definition adopted should em- 
phasize both the medical attainments and the industrial require- 
ments of the physician engaged in this work in order to make 
his duties clear both to the medical profession and to industrial 
management. 
The Conference Board of Physicians in Industry also acts as 
advisor on medical problems in industry to the National Indus- 
trial Conference Board, and the knowledge gained by the one 
body is often of direct value to the other. As both boards are 
active in the industrial field, one studying economic problems, 
the other working in the field of health, their researches often 
supplement each other, thus making their studies of much 
greater value than if the work had been carried out by either 
body alone. 
In order to emphasize the progress that has been made in 
the industrial medical field during the past decade, the Con- 
ference Board of Physicians in Industry held its Tenth Anni- 
3 versary meeting in New York on April 4 and 5, 1924. This meet- 
ing was devoted to a consideration of the various phases of 
medical effort for the well-being of industrial employees. More 
than one hundred representatives of government, medical and 
public health associations, and employers and employees of 
many types of industries, discussed the place of industrial medi- 
cal work in the present social order. 
It is believed that these addresses form a distinct contribu- 
tion to the development of medical work in industry and that 
they mark a definite advancement in the evolution of the work 
of the physician as an integral and important part of well or- 
ganized and properly functioning industrial organizations. 
The program of discussion at this meeting was as follows: 
Friday, April 4, 1924 
Hotel Astor, New York 
1 p.m.-Luncheon. 
2 to 5 p.m.-Afternoon Session. 
Presiding, Dr. J. J. Moorhead, Chairman, Conference Board of 
Physicians in Industry. 
American Public Health Association and Industrial Medicine. 
Dr. W. H. Park, President, American Public Health Association, New 
York. 
American Medical Association and Industrial Medicine. 
Dr. Edward Livingston Hunt, Assistant Professor of Clinical Neu- 
rology, Columbia University, New York. 
Function of the Physician in Industry. 
Dr. L. A. Shoudy, Chief Surgeon, Bethlehem Steel Co., Bethlehem, Pa. 
Employees' Interest in Industrial Medicine. 
Mr. Samuel Gompers, President, American Federation of Labor, Wash- 
ington, D. C. 
Employers' Cooperation in Medical Work. 
Mr. C. R. Hook, Vice-President, American Rolling Mill Company > 
Middletown, Ohio. 
Monopolistic State Insurance and Industry. 
Dr. O. P. Geier, Manager, Employee's Service Department, Cincin- 
nati Milling Machine Co., Cincinnati, Ohio. 
Inspection in Physical Diagnosis. 
Dr. Harlow Brooks, Professor of Clinical Medicine, New York Uni- 
versity and Bellevue Hospital Medical College, New York. 
4 Friday, April 4, 1924 
Hotel Astor, New York 
7 p.m.-Dinner and Evening Session. 
Presiding, Dr. W. Irving Clark, Vice-Chairman, Conference Board 
of Physicians in Industry; Service Manager, Norton Co., Worcester, 
Mass. 
U. S. Public Health Service and Industrial Medicine. 
Dr. H. S. Cumming, Surgeon-General, U. S. Public Health Service, 
Washington, D. C. 
The Conference Board of Physicians in Industry. 
Mr. Magnus W. Alexander, Managing Director, National Industrial 
Conference Board, New York. 
Traumatic Surgery-Its Development and Relation to Industry. 
Dr. J. J. Moorhead, Professor of Surgery, New York Post Graduate 
Medical School and Hospital, New York. 
What Industry Requires of Medical Supervision. 
Mr. Howell Cheney, of Cheney Brothers, South Manchester, Connec- 
ticut. 
Industrial Medicine and Medical Education. 
Dr. W. Gilman Thompson, President, Reconstruction Hospital, New 
York. 
Saturday, April 5, 1924 
Clinics at the New York Post Graduate Medical School and 
Hospital, Second Avenue and 20th Street 
9-12 a.m.-Surgical-Prof. Moorhead, Prof. Buchanan. 
Amphitheatre, sixth floor. 
Operations 
(1) Bilateral Direct and Indirect Inguinal Hernia. 
(2) Direct Inguinal Hernia (Local Anesthesia). 
(3) Discussion-Anesthesia for Fractures, Dislocations and infec- 
tions-Prof. Buchanan 
Demo n strati ons 
(1) Knee Joint Calculi-Post-operative result. 
(2) Bilateral Kneejoint Calculi-Post-operative result. 
(3) Extensive Burns of Legs with Tetanus-end result. 
(4) Fractures of Tibia and Fibula-splintage-walking callipers. 
(5) Fracture of Neck of Femur-walking callipers. 
(6) Fracture of Clavicle-reduction and splintage. 
(7) Colles' Fracture-reduction and splintage. 
(8) Pott's Fracture-reduction and splintage. 
(9) Special Splints: 
(a) Thomas; for Leg and Thigh-Transport-Treatment. 
(b) Jones; for Arm and Forearm-Transport-Treatment. 
(c) Finger Splints-Adhesive-Thread Traction. 
(10) Massage Methods. 
(11) Case Recording Methods. 
(a) X-Ray film folders. 
(b) X-Ray silhouettes. 
(c) Calculating end results. 
5 12-1 p.m.-X-Ray Diagnosis-Prof. W. H. Meyer. 
X-Ray laboratory, basement. 
(1) Thoracic Lesions. 
(2) Bone Tumors and Diseases. 
(3) Fractures and Dislocations. 
(4) Foreign Bodies. 
1- p.m.-Luncheon-sixth floor. 
2- p.m.-Medical-Prof. Halsey. 
Amphitheatre "A," Main floor. 
Diagnostic Signs and Methods of Examination in Common Pul- 
monary and Cardiac Lesions. 
3- p.m.-Laboratory-Prof. MacNeal. 
Laboratory, sixth floor. 
(1) Laboratory Aids in Diagnosis. 
(2) Significance and Value of Certain Tests. 
4- p.m.-Clinical Demonstrations-Prof. Moorhead. 
Amphitheatre "C," Main floor. 
(1) Hand Injuries. 
(2) Back Injuries. 
In the following pages the addresses and papers presented at 
the meeting are given, with slight editorial revision. 
6 AFTERNOON SESSION 
Dr. J. J. Moorhead, Chairman, presiding 
Introductory Remarks 
Chairman Moorhead: We are met today to celebrate the 
tenth anniversary of the organization of the Conference Board 
of Physicians in Industry. Those of us who were present at the 
birth of this organization little realized that in the short space 
of ten years it would command the attention and presence of 
such a distinguished group as is assembled here today. 
I need not read to this audience the list of the members of 
this organization. It is quite a representative list, and, as the 
outgrowth of this original Conference Board, similar organiza- 
tions have been founded in other parts of the country, as you 
are well aware. 
The group of physicians representing this Conference Board 
minister to the needs of between four hundred thousand and 
five hundred thousand employees, so that you see they are a 
representative set of physicians. 
I am in receipt of a letter from the Managing Director of the 
National Industrial Conference Board which I should like to 
read. It says: 
"My Dear Dr. Moorhead: 
"It is with genuine pleasure and personal satisfaction that I 
convey to you and the Conference Board of Physicians in Indus- 
try, whose destinies you have been guiding, the best wishes 
of the National Industrial Conference Board on the occasion 
of the Tenth Birthday of your Board. 
"There are strong bonds that join your Board and ours in a 
common work in that both are striving to find the truth and, 
after careful analysis of the facts found, to express their 
meaning in the light of human experience and of the practical 
considerations of life. Your Board is appraising medical 
values; ours is appraising the more general economic values; 
but both are dedicating their efforts to the ultimate object of 
assisting the industrial development of our country and the 
welfare of those engaged in industry. 
"It was in recognition of the valuable service which your 
Board is rendering that the National Industrial Conference 
Board tendered, and your Board accepted, the invitation to 
act as the advisor to the National Industrial Conference Board 
on medical problems in industry. But more than that, we 
recognize very fully the valuable work which the members of 
7 your Board have accomplished for the industrial corporations 
of which they are the medical directors and which, in a 
broader way, they have contributed to that branch of medi- 
cine and surgery which is concerned with the application of 
medical science to the requirements of national production. 
"It is with sincere hope for the continued effective function- 
ing of your Board and with keen expectation of many more 
years of pleasant and fruitful cooperation between your Board 
and ours, that I send this message of congratulation and 
good will. 
Very sincerely yours, 
(Signed) M. W. Alexander, 
Managing Director." 
It is my pleasure this afternoon to introduce to you the various 
speakers who are to honor us with their presence and to en- 
lighten us with their contributions. The first on the list needs 
no introduction. He is a man of the highest type of civic virtue, 
a man of national and international reputation, a man than 
whom none other I think in this city has done more to contribute 
to child welfare and public welfare in general. I have the great- 
est pleasure in introducing to you Dr. W. H. Park of New York, 
President of the American Public Health Association, who will 
speak on the topic: "The American Public Health Association 
and Industrial Medicine." 
"The American Public Health Association and Industrial 
Medicine" 
by Dr. W. H. Park 
Dr. W. H. Park: First I want to express my appreciation 
of having been invited here to your anniversary meeting. I 
wish that the President of the American Public Health Associa- 
tion had a little broader knowledge of all these fields of public 
health than he has. He could then speak with more wisdom 
but not with more appreciation of what you are doing. 
I have several topics here that I thought might be along the 
line of what has been assigned to me, and the first is to just say 
a word about the changing types of disease. 
You go back only ten years, but I can go back thirty years in 
this work, and at that time the diseases of childhood, scarlet 
fever, diphtheria, and in infancy, diarrheas, were the major 
causes of death among children; typhus and typhoid fever and 
cholera, malaria and yellow fever were still dominant things. 
The public health work of that time was largely by public health 
officials trying to do away with these communicable diseases. 
8 Probably all of you realize that scarlet fever now causes only 
about one-thirtieth of the deaths among children that it did; 
that deaths from diphtheria are reduced to 9% of those of 
thirty years ago; typhoid is down the same amount; malaria is 
practically gone from our cities; cholera and typhus are curiosi- 
ties. 
With this gradual lessening of these diseases, came in the work 
of the lay organizations against tuberculosis, against cancer, 
against this and that type of disease which before had not been 
touched upon except in a very cursory way; and then still later 
we come into the work of such organizations as yours. The 
great industrial class began to see that it had a duty to perform, 
so took the advice of physicians and began to study what could 
be done to prevent disease and accidents. Then the life insur- 
ance companies entered the field and we all know how they are 
spreading their information throughout the land. So you see 
that we are changing our public health activities from the con- 
trol of the strictly communicable diseases, mostly of childhood 
and young adult life, to the consideration of the diseases of 
industry and civilization; we are widening and widening the 
circle of those who are interested in the combating of these ills. 
It might be worth while speaking of the cooperation of the 
industrial physician with those who have official relations to the 
Health Department or to the Department of Industry in the 
states. It happens that from the very beginning I have been 
interested in a little private and public health venture which 
might be of interest to speak about now. Twenty years ago, we 
started a little movement here for pure milk and certified milk. 
The certified milk is looked after by this private agency, through 
the Milk Commissioner of the County Medical Society, and in 
that respect is a private organization. On the other hand, the 
supervision of the milk supply must be a part of the public 
health duty, and so the certified milk is under the control of the 
Health Department. I have rather a mixed attitude in this. I 
have been looking after the running of the Milk Commission, 
and then, as Director of the Health Department Laboratories, 
I have been approving the work of the Milk Commission. 
During these years, we have had an inspector who has become 
very efficient in looking after the milk supply for the private 
Milk Commission, and we have had from the Health Depart- 
ment inspectors of various degrees of experience. Sometimes it 
9 is quite aggravating when the Health inspector suggests some 
very foolish changes or makes some foolish recommendations, 
and my personal inclination is to forget that I am in the Health 
Department and as a Medical Society man write back how 
ridiculous the suggestions are. Then I remember that this man 
is a new man just shifted into this work, and he has to learn, and 
so, with a little thought, we have worked along very comfortably 
these years, the private inspector and the public inspector. Each 
has learned from the other and have worked in cooperation to 
make the milk supply better. 
So it seems to me that the Health Department and the Labor 
Department have duties that they cannot turn over to the 
private physician, even though the private physician is far more 
experienced than the man representing the health or industry 
of the state. If you remember that they must have this jurisdic- 
tion and if you work with them, you will find that not only will 
they become more and more adapted and trained to this work 
which is specialized in your hands, but you will have their co- 
operation, and as a rule they will largely leave it to you to take 
care of these matters so long as you do it with interest and with 
knowledge. 
Now, I believe that this is one of the ways in which the Ameri- 
can Public Health Association can help you and it certainly is 
one of the ways in which you can help the association. If the 
members of this important association and if others whom they 
can influence in their companies become members of the Ameri- 
can Public Health Association, you will be comrades with the 
health inspectors, with the inspectors of industry, so that you 
are working together as members of one great organization. 
This will give a sympathetic relationship, which as a private and 
a public man might not exist between you and the public officer. 
So this is one of the ways in which this Public Health Association 
may be backed by your influence and your power, and you 
should join it, if you have not already done so, and come into 
sympathetic contact with the more generalized health officers. 
Some of you are the influential members of the Section on 
Industrial Hygiene of the Association, and you know that two 
years ago a number of those interested in the association had a 
reorganization, so that now we have fellows and members, and 
associate members. The idea was this-that there is no reason 
why this organization should not be the great public health or- 
10 ganization of the country so that all kinds of efforts for public 
health should be united in it. If that is to take place, there must 
be a trained and dignified group of members, and so it was 
arranged that there should be fellows, who will be those who 
have been trained in public health, who had shown by what they 
had done that they were worthy of such an association; and 
they will be the ones that will set the standards; they will be 
the ones that will have the power of making decisions. And 
then, that we might have a great body of those who are in- 
terested in public health, to give the backing to these trained 
men, we have the members. So, every one who is interested 
in public health, whether highly trained or simply interested 
and informed, can become either fellows or members, and make 
this a great power with the people and with the legislatures, so 
that proper public health measures can be put over. 
It just happens that in talking to Mr. Alexander he spoke of 
one of the reasons why he and others that started this organiza- 
tion, and I am rather glad that I come before he does, because 
he might say this and take away the little I have to say on it. 
That is the value of having a group of men studying these 
problems and making standards, standards for efficiency. 
We all know that we say public health is purchasable. The 
question, is, though, practically, how much should we spend to 
purchase it. There are so many ways to spend money that we 
cannot afford to buy too expensively. 
Now, if the members of this association, joining with those 
who are outside this membership but in this same line of work, 
cooperate together and carefully study and make standards, it 
helps you, it helps the association if you are members of it, and 
if it is a large association covering all your efforts, these stand- 
ards made by you and adopted by the association may then 
become practically the health law of the land. 
So it seems to me that one of the ways in which the association 
can be helpful to you and you can be helpful to the association, 
is that you shall carefully decide on the various measures that 
will conduce to the well-being and to the effective work of those 
who are under your jurisdiction; and if at the same time you are 
active fellows and members, and the corporations are associate 
members, they give the backing of their enormous influence to 
the association, and you are go-betweens between the health 
officers and the workers and your corporations. 
11 I was just thinking, for instance, of the question of child labor. 
Not only is there the question of age but the question of examin- 
ation. Should children be admitted to certain industries simply 
on their age, or should they be admitted on their age and on 
examination for their physical development ? You all know 
that some children at a certain age are more able to stand the 
strain than others. 
Things of this kind I simply suggest because you know a 
thousand times as much as I do on such topics, but they show 
how an association working together with these experts in differ- 
ent lines can make rules that will govern and influence legislation 
and the people. 
There is just one other point that I want to bring up-that in 
making these standards, the most careful thought is necessary. 
One of my hobbies is control, control of everything that we do. 
Just recently we have been making two studies on pneumonia 
that bring out the point. One is the question whether pneu- 
monia vaccine would really be of value in preventing pneumonia. 
We took a large institution in which it was understood there 
was a great deal of sickness from pneumonia and many deaths. 
When we came to study the institution, we found that most of 
the deaths were really not from pneumonia but they were simply 
terminal bronchial pneumonias in the last days of life, and when 
those were stricken out, the deaths and the cases were really 
comparatively few. 
Then we began by giving half of the inmates vaccine and half 
no vaccine, and we watched that for four years. During the 
first year, those that were vaccinated had very much the best 
record. We could have stopped there, but the next year there 
was no difference, and the next year those that were not vac- 
cinated had a little less pneumonia, and last year those that 
were vaccinated had a little less pneumonia. 
I still believe that vaccine to prevent local pneumonia has 
some value, but the value is too slight, the immunity is too short 
in duration, to make it a public health measure. 
Just along the same line, it was thought a year ago by one of 
our skillful experimentalists, that anti-pneumonia serum could 
be given subcutaneously with beneficial results and without fear 
of serious consequences. That was done after a year of quiet 
work. This past year, we have tested that out in the hospitals 
of New York and Boston, Cincinnati and Chicago, and the 
12 results have been that, given under the skin, it has no effect 
whatever. It shows how we can't jump at conclusions if we 
are to make standards that will be valuable and that will con- 
tinue to be warranted by later work. 
I just want to speak of one other control incident to show that 
we must look sometimes deeper than it would seem at first to be 
necessary. This happened at the beginning of my work, and it 
has had a very good effect on my subsequent efforts. 
The very first year that diphtheria antitoxin became available, 
a large firm, through its chemist, suggested that they had a 
peculiar substance derived from the white blood cells that was a 
general antitoxin, that would do as much good for diphtheria 
as for scarlet fever and other things. They asked me if I would 
test it out. 
I said I was so sure it would fail that I hated to do it. They 
assured me that it would be a success. I said, "If you will give 
one hundred dollars for experimental work if you fail, I will 
gladly do the test." They agreed to that. 
Some guinea-pigs were assembled, and we gave all the guinea- 
pigs the diphtheria bacillus and the chemist gave his pigs his 
protective substance and I gave my pigs antitoxin. Then we 
had the controls. His pigs lived and my pigs lived and the 
controls died. 
Should we jump to the conclusion that the impossible had 
happened, or should we go a little further ? I said, "We will re- 
peat the experiment, if you don't mind." This time I used one 
other control, the human control, and I kept him out of the 
animal house after he had injected his substance, and then his 
pigs died, the antitoxin pigs lived and the control pigs died. 
He undoubtedly had sneaked into the laboratory after we had 
gone and given his pigs also some antitoxin. At least the firm 
paid the one hundred dollars to experimental work, so I think 
they acknowledged that he had done it. This incident shows 
that in our control we must be most careful that we really are 
controlling the work. 
I will close by saying that I hope you all believe that we 
should try to join in the Public Health Association all these 
various specialized efforts for the prevention of sickness and 
disease and the promotion of physical efficiency; if we do that 
and if we all work together, we will give a momentum to this 
work which individually we cannot do. 
13 Chairman Moorhead: The next topic on the program is 
entitled "The American Medical Association and Industrial 
Medicine," and I am very glad to be able to introduce this 
speaker because he has gone up and down our state and is known 
nationally also, not only as a very good speaker but as a very 
efficient propagandist for his topic, and, incidentally, a very good 
clinician. I have great pleasure in introducing Dr. Edward 
Livingston Hunt, Assistant Professor of Clinical Neurology at 
Columbia University. 
"The American Medical Association and Industrial Medicine" 
by Dr. Edward Livingston Hunt 
Dr. E. L. Hunt: It is a great pleasure for me to be here today 
and, as the representative of the American Medical Association 
and the Medical Society of the State of New York, to greet you 
at this Tenth Anniversary meeting. 
You who have devoted your lives to industrial medicine should 
be proud of your specialty. In ten years, it has made tre- 
mendous strides. It began as a minor specialty and now it has 
taken its place as one of the leading branches of the medical 
profession. It was inevitable that such results should accrue, 
both because there was a place for such a specialty and because 
you, the workers in industrial medicine, have advanced in a 
broad and just way. 
The employee has a right to be taken care of by the employer 
within certain restrictions. By this I mean that any ills or com- 
plications which may result from his work should be taken care 
of as far as possible and remedied by the employer. 
This one point I wish especially to emphasize today: the 
company, however, must not make the mistake of carrying it 
too far. It will only injure itself and fail to accomplish its pur- 
pose if it undertakes to look after the employee physically for 
an indefinite period of time. 
Too often an effort has been made on the part of the company 
to carry the medical care and protection of the employee into 
the home. This has always proven a mistake. It arouses the 
suspicions of the employee, it savors of paternalism and in- 
variably ends disastrously. 
The relationship between the medical man of industry and the 
general practitioner is one which should give no uneasiness nor 
be the cause of any difficulties. There should be no antagonism 
14 existing between the two, but, on the contrary, there should be a 
spirit of cooperation. The physician in industrial medicine has 
a definite function. It is to examine the applicant, to point out 
to him where he needs medical advice, and to see that he is re- 
ferred to a reputable man. The general practitioner should 
regard the specialist in industrial medicine not only as his 
friend but as his benefactor. It should be from the physician 
in industrial medicine that the general practitioner should draw 
some of his practice. The man who practices in industrial 
medicine can never starve the general practitioner; rather must 
he feed him. 
I think you all realize the pertinence of this point, because in 
the last few years the change in this respect has been marked. 
When industrial medicine began, the tendency was to follow 
the patient into his home and to continue to take care of him 
there. Not only was this unfair to the practitioner, but also to 
the patient. It resulted in the latter's questioning the motives 
of the management. He began to wonder whether or not he 
was sick, what the management was saying, and just what was 
his position. It was too much of a step towards state medicine, 
a procedure which in the end must spell disaster for industrial 
medicine, for patient and for general practitioner. 
I am glad to see that this tendency has long since disappeared, 
and that now both the captains of industry and the physicians 
of industry regard the employees' ills from a wholly different 
and from a much more rational point of view. Today, the ten- 
dency is that anything for which the industry is responsible, 
it should aid and remedy, but that the moment the physical ills 
of the patient are outside of the industry, that moment they 
belong to someone else. 
Another duty which you practitioners of industrial medicine 
have is the choice of the medical man to whom you should refer 
the patient when such reference is needed. In referring patients, 
it is your duty to give the names of reputable and not question- 
able men, and may I add that it is best always to give the patient 
the opportunity to select from two or more names. In this way 
you will avoid the charge of favoritism, as this is not a time for 
friendship. 
If you will bear in mind these two points which I have tried 
to bring out today, I think you will agree with me that you will 
15 then place industrial medicine in a position of its own which will 
be secure and free from criticism or attack. 
Chairman Moorhead: We will next have the opportunity 
of hearing one of our own members, one of the men who is most 
active at our meetings, most prompt in his attendance, and while 
he has not the record of our chiefest attendant, still his record is 
sufficiently good to give me a very great deal of pleasure in in- 
troducing him to you. I may say that our organization has had 
in all, during these years that we have been in existence, forty- 
one meetings, and one of our members has never missed a 
meeting. I take great pleasure in calling attention to the fact 
that Dr. Woodman has been with us at every meeting that 
we have had. 
Our next subject is "The Function of the Physician in In- 
dustry," by Dr. L. A. Shoudy, the Chief Surgeon of the Bethle- 
hem Steel Co., of Bethlehem, Pa. 
"The Function of the Physician in Industry" 
by Dr. L. A. Shoudy 
Dr. L. A. Shoudy: The industrial physicians and surgeons 
of this country form a great service organization whose chief 
function is to serve the workers in industry and serve them well. 
In serving the workers, we serve the industry. I want to tell 
you, we are useful, helpful and necessary to the well-being of 
industry. That is what we think of ourselves. 
You all know the origin of the company doctor, the old type of 
the mine doctor, employed because "we must have a doctor at 
the camp." But with the advancement of industry has come 
the advancement of the worker. 
Working conditions have changed in many respects in the 
past eight or ten years, and the wise producer has seen that the 
care for his men pays in proportion to the extent of that care. 
The better understanding of labor and capital has led to many 
changes to the advantage of both. We can all look back and 
see the evolution of the so-called safety engineer, the production 
man, the efficiency expert, and so forth, and we can all see how 
these branches must need one thing which they did not possess 
to make their point, and the one thing needed was the industrial 
doctor. 
From thence we came, born of necessity; at first tolerated be- 
16 cause they needed somebody to tie up injured fingers; then used 
to solve small health problems, but now acknowledged a distinct 
part of any great industry. 
Just as you have used the various departments for results, so 
your physician and your medical department give results as 
used. Compensation laws were enacted, and manufacturers 
learned that the well regulated medical and surgical department 
helped to keep down the compensation cost. 
We worked along for a while, and then some of us were bold 
enough to suggest here and there certain things which we 
thought might help, and we worked ourselves into a job before 
we knew it. 
I am sure that many of us did not see this work as it now is. 
The men, the workers and the employers, saw in our workshops, 
our dispensaries and plant hospitals, a new point of contact, and 
from this point we are developing. 
Now that industry has the physician, what will you do with 
him ? You men who have followed this work, call it what you 
please, industrial relations, service, safety, welfare or what not, 
you know the success of the work is largely due to personnel, 
and I want to drive home to you that a doctor without the touch 
of human kindness is not the man for industry. The success of 
your medical department will depend to a large degree upon the 
personality and sympathy of the man at the head. 
The great war which has just closed has taught us many 
things, and has proven to the world what some of us were bold 
enough to try to prove before, that it is possible to reclaim and 
remake the human machine just as you reclaim iron from the 
scrap heap and put it out into a new service. In days gone past, 
the greatest of all machines, the human body, has been but little 
repaired compared to what you and I will see. The scrap heap 
of industry will be no more, because from our fast gaining knowl- 
edge and ability men will be remade and returned just as old 
iron and scrap are used today. 
Now that you have the industrial physician and surgeon, 
how are you going to use him to get the fullest service and the 
best results ? In other words, what can the industrial surgeon 
or the physician do to hold his job ? It is hard to outline the 
work because of the various kinds and sizes of the industries. 
The first necessity of any plant is men, human machines. Hear 
then a word about choosing machines of this sort. In building, 
17 you choose your architect and make plans, go into every detail, 
but what of the men to man the plant and its machinery ? 
Here comes the job, the entering wedge for the physician- 
physical examination. 
How shall this be done ? It is to be emphasized that this 
should be done not with a view of rejecting men, but to fitting 
them to their jobs and placing them in their proper work. It 
will pay to develop physical examination to the fullest extent. 
It should not be superficial, but should be thorough and of 
course directed to the purpose of each industry. Every plant 
and every doctor will work out his own system. For example, 
you will not look for the same thing in a man in the steel mill 
as in the cotton or silk factory worker. 
You should keep records; forms should be worked out. Get a 
system. In attempting, as a result of physical examination, to 
fit the man to the job, you may have a hard time telling the 
foreman that he should have a certain man for a certain place, 
but you can do it. The foreman does not like to have the hiring 
and firing taken out of his hands, but he can eventually be made 
to understand the importance of properly placing men. I 
firmly believe that all foremen are good at heart; they only need 
a heart stimulant now and then. 
Next, you will have to consider hours. We should study each 
industry carefully to determine the proper number of working 
hours and the most advantageous periods of rest. The British 
investigations of the war industries showed interesting results 
and proved that it is impossible to lay down any fixed rule to 
apply to all industries. 
Next, look over your plant. The physician must be familiar 
with his plant, especially in such respects as sanitary provisions, 
ventilation, water supply, eating places, their equipment and 
cleanliness. The rest rooms should be made attractive and the 
physician should see that they are kept in proper condition. 
The doctor must know and recommend to his people where to 
buy the best of equipment and the best for cleansing. 
Go the limit in knowing your plant, because medical super- 
vision is necessary over the whole plant. Don't become dis- 
couraged because of course the whole thing cannot be done in 
one day or one night. Your dispensaries and plant hospitals 
must be established throughout the plant. The matter of style 
and location, the personnel of your force and equipment have 
18 to be considered, and the physician is the man who should 
recommend. Make them accessible, make them usable to the 
man of the plant. Don't put in a plant a dispensary or hospital 
that the men cannot use. Don't make it so fine they will be 
afraid to come in. Make it a place where there is welcome on 
the mat and welcome over the door and welcome when you greet 
the man. In planning your hospital or dispensary, use your 
knowledge in location. The company will expect you to know 
more about that than they do. You should know where you 
want your different rooms like your operating room and your 
X-ray room and your other departments. Put it on paper. 
Place it before them. They will talk it over with you. That is 
one of the functions of the physician in industry. You are the 
authority in this department and you should act accordingly. 
In selecting your personnel, including your nurses, your re- 
cording clerks, and so forth, kindness and sympathy should be 
the first consideration. Sympathy is one of the first things that 
should be given to an injured man. Here, as nowhere else in 
industry, you must know how to handle men, and so must your 
assistants. Make your relations with the men such that you 
know the men as men, and they know you as one of the workers 
with them. I would rather have the men in the plant, when I 
go through, smile and say, "Hy, doc ! " than to receive the 
friendly but more dignified "Good morning, doctor," from the 
heads of the departments. 
I believe that one of the biggest things for the industrial man 
who is on the job, where the men come in with injuries or to talk 
to you about their troubles, is to have rooms where you can talk 
to them and meet them. I believe that the best thing for the 
physician to have and to give is service. 
Personally, I do not believe in having large waiting rooms. 
If the industrial physician gives the service he should, there is 
no need for keeping fifty or sixty men waiting, wasting their own 
and the company's time. They can and should be kept coming 
and going. Loss of time means loss of money in industry and 
long waits for injured men or men under treatment are wholly 
undesirable. Make your waiting room small and make your 
work go good and fast. Do not permit it to become crowded 
with waiting men. Working men do not care to lose time. 
First-aid work differs in large and small plants. It will be 
your function to direct where first-aid is needed. The amount of 
19 first-aid work will depend upon whether there is accessible a 
completely equipped hospital. In the big plant, the first-aid 
dressing station should be used to a minimum, strictly confining 
its treatments to those given for the first time. I do not believe 
that any plant physician should try to train first-aid men so that 
they want to take his place. 
As to the hospital itself, here again the possible equipment 
differs. It will depend upon the nature and the kind of industry 
that you are supervising. It may pay to tie up with a local 
hospital or it may pay to turn over the men to the local hospital 
entirely-a question and a problem which will be put up to you 
as the industrial surgeon. 
Just how far you want to go in the care of your men, or how 
far your home care should extend, including the work of the 
visiting nurse, is a problem that will be put up to you. The 
working man likes you to come so far, but does not like to feel 
that he is depending on the company for everything. 
If you get a visiting nurse, get one with a breadth of vision. 
An elderly woman is perhaps best because she can pick up little 
things in the house and give advice that will help the people out. 
And here again, choose as your visiting nurse one who keeps her 
nose in your own business and does not get into the man's 
personal affairs. 
Home care is an important factor in getting the injured man 
back on the job in the best possible condition and in the shortest 
possible time. Care for him to the limit in order to accomplish 
this and never mind the cost. It will pay in the end. 
Be quick to recognize the cooperation that is possible with 
the family physician when a sick man is referred for treatment, 
and his treatment followed up in a tactful manner. Such co- 
operation brings the worker back to his job with the least loss 
of time. 
Education, however, is the biggest thing of all. The place in 
which to teach preventive medicine is in the school. If you 
could get your schools, instead of devoting all their time to some 
of the things which they do, to give the same time to preventive 
medicine and safety education, in twenty years, the industrial 
physician-well, would we have a job ? You would build a new 
race. In this educational work, do not emphasize your com- 
pany. Get behind the community organizations and back of 
your Red Cross and your Y. M. C. A., Boy Scouts, Camp Fire 
20 Girls, and local medical societies. Get the wives of your work- 
ing men interested in the plan that you are trying to put over in 
educating the children in health matters. 
Where the industry employs girls and women, there is fre- 
quently more work for the physician than for the surgeon. 
This work means new activities for the physician. 
Through the school education in health work, we can provide 
stronger and healthier workers, and I believe that the industrial 
physician should interest himself in the local conditions in which 
the families live. Don't attempt to go too far. As I told you 
before, the worker does not want to feel that he is dependent. 
You may lead to socialized medicine, and do you want it ? 
The human body is a machine, a splendid machine. Like 
any other machine, it has a large factor of safety. It is by no 
means fool-proof. Like other machines, it requires a certain 
amount of care. As a matter of fact, it is often shamefully 
neglected. Many a man who would not drive a flivver for a 
block on a flat tire will go himself in a worse condition. He 
wouldn't run with a dry radiator or one cylinder, but he tries 
to get along on only six or seven hours' sleep, with only one 
kidney functioning properly. He wouldn't put sand in the 
bearings of a lathe, yet he breathes foul air and retains waste 
material in his bowels for days which should be freely eliminated. 
He works hard and is contemptuous of physical conservation 
as something unmanly. He gives the best that he has and all 
that he has for the pride of giving and the love of giving, and at 
forty-five, down he goes, sick of some disease that he had no 
business to acquire before sixty. 
The facts are fairly well known as to what should be done. 
Organize your plant and go as far as the needs of the workers 
require. We, as industrial physicians and surgeons, should 
first provide stronger and healthier workers by attention to 
child hygiene, health education in the public schools and other 
available means. Second, study the industry carefully, re- 
membering that the human body has its proper speed for 
maximum and safe production. Know your plant. Meet with 
your foremen and talk these things over. Make physical ex- 
aminations of all employees not for the purpose of throwing 
them out but for the purpose of placing them and keeping them 
on the right kind of work. 
You have the duty of getting the sick men and the injured men 
21 well and back to work. You must provide adequate and regular 
medical supervision. Be patient. Be constructive. It takes 
time for the adjustment of industry to the new ideas of medical 
and industrial service. In short, we medical men in industry 
must teach men how to live as well as how to make a living. 
Chairman Moorhead: At this point, we will depart from 
our regular program. We will skip two numbers and come 
down to the topic, "Employees' Interest in Industrial Medi- 
cine." It gives me very great pleasure indeed to introduce to 
you Mr. Samuel Gompers, the President of the American 
Federation of Labor. 
Owing to a recent illness Mr. Gompers' address was read by his 
secretary after he had spoken briefly as follows: 
I must crave your indulgence in that a very dear friend of 
mine of the medical profession has enjoined me from public 
speaking. I have prepared a brief paper which I am going to 
ask, with your permission, my secretary to read for you. 
Before asking him to read the paper, I can't help the risk of 
bringing myself even within contempt of my physician when I 
make an observation of the very great gratification which every 
intelligent labor man of our country and in our movement has 
felt and expressed for the declaration made by the Congress of 
Physicians and Surgeons held in the United States a year or 
two ago in allocating the main causes for disease and illness of 
all kinds to a few major reasons. One of them was overwork 
or the poison of fatigue, another the unsanitary conditions of 
homes and workshops, another malnutrition and lack of nu- 
trition. I should like also to call attention to the fact that, with 
all the altruistic and philanthropic movements to bring about 
changes in the conditions of life and work among the great 
masses of the working people of America, there is but one move- 
ment which is aggressively concerned or concerns itself with the 
bringing about of the changes which you allocate as the causes 
for the diseases and early deaths. 
I feel that, after all, having violated my friend and physician's 
injunction, I have violated it sufficiently to submit to your 
tender care the thoughts that I have expressed and will express 
through my secretary. 
The following paper was then read by Mr. Gompers' secretary: 
22 "Employees' Interest in Industrial Medicine" 
by Samuel Gompers 
Organized labor was a pioneer in the field of industrial hygiene. 
In the many years in which I have been associated with in- 
dustry, I have observed the development of industrial hygiene 
from its very beginnings. In the 60's when I began working in 
the cigar factories of New York, industrial hygiene was un- 
known. Factories were physically unattractive places with no 
conveniences for the employees-oil lamps, stoves, crude light- 
ing, primitive toilet facilities, no towels, no systems of ventila- 
tion. The beginnings of industrial hygiene were the personal 
standards of cleanliness and comfort of the workmen. The first 
steps in the development of sanitary standards were labor pro- 
tests against revolting and harmful conditions. Through our 
union we made demands for changes. I remember a strike 
caused by unbearably offensive toilets. It was the union that 
first compelled attention to unsanitary factory practices. At 
another time by threatening to quit work, we prevented the 
foreman from changing a fellow-worker from a seat by the 
window to a dark corner in order to make a place for one of his 
friends. We could not always present scientific justification for 
our complaints, but based our demand upon humanitarian 
reasons and we compelled the attention of humanitarians and 
those who had technical information. 
A further illustration of the pioneer work of unions was our 
ten-year fight to abolish the practice of tenement manufacture 
of cigars. That fight of the Cigar Makers' Union brought our 
industry back into factories, focused attention upon the rela- 
tionship between industrial sanitation and public health and 
was a factor in the enactment of a tenement code establishing 
minimum standards for tenement construction. 
The next important health measure our union established was 
the eight-hour day. As our union had established a number of 
union benefits, we kept comprehensive statistics. The eight- 
hour day was established in our industry in 1886. Years after- 
ward we found that the average life of our membership had been 
increased fifteen years. 
The illustrations taken from the experiences of my own union 
could be duplicated by similar happenings in practically every 
union. Like all pioneer undertakings, methods and agencies 
were frequently determined by necessity. The scientific 
23 method could follow only the study of the pioneer experiences. 
With the development of public health agencies and pre- 
ventive medicine came understanding of the health aspects of 
industrial practices and conditions. To the scientists studying 
this field, the human beings employed in industries were more or 
less distinguishable from the microbes and other laboratory 
phenomena. Again it was necessary for the workers to demon- 
strate clearly and forcefully that they were humans and that 
any other treatment of them was unscientific, and that unscien- 
tific use of combustibles, such as constitute human nature, may 
lead to dangerous explosions. Here we have a fundamental in 
planning to include industrial hygiene as an integral part of 
industrial organization. There can be no question but that in- 
dustrial hygiene is essential both for the welfare of the workers 
and for the best interests of the industry, but if the basis of 
administration does not conform to principles of sound industrial 
relations it will result in conditions neither beneficent nor 
profitable. 
Every industrial establishment represents associated effort. 
Unless management provides plans for proper coordination 
under which all elements that contribute to production "mesh 
in" in a way that allows free play for all, trouble men will be 
working overtime. The efficiency of management depends upon 
the extent and degree to which all management policies are 
motivated by sound industrial relations. 
The first step in production is organization of all factors in 
production. This law of organization applies to humans just 
as much as to materials. Organization must follow natural 
lines if it is to help in assimilating group experience and thus 
lead to formulation of group opinion and action. 
To those of you responsible for administration of practical 
industrial medicine, it is not necessary to emphasize the value 
of this sort of organized agency for cooperation in the promotion 
of hygienic practices. Science and skill are handicapped with- 
out the full cooperation of those to be benefited. Workmen 
want to avoid disease and accident but they want most of all 
to avoid loss of self-esteem and independence. 
Though responsibility for industrial hygiene rests primarily 
upon industry, workers are not helpless if industry fails to act. 
For example, the International Ladies Garment Workers' 
Union maintains a health bureau and provides medical, dental 
24 and other health services to its membership at nominal costs. 
Fees for medical services constitute one of the chief barriers to 
health among the poor, for after all, industrial hygiene is almost 
inseparable from public health. The consequences of home 
conditions accompany the workman to the shop and when he 
returns at the end of the day's work he cannot leave behind 
germs and physical ills that have accumulated in his body during 
the day. 
The sweatshop is not yet a thing of the past and is a menace 
both to those within such industries as well as to the users of 
their products. Then there are the dusty trades with their 
insidious menace to the respiratory organs; those attended by 
poison hazards, as painting, explosives, infected materials, such 
as hides, etc. There is hardly an occupation without its health 
hazard - preventable or reducible in practically all cases. 
The continued development of industrial medicine until pre- 
vention shall approach its maximum is of tremendous impor- 
tance to us as a nation as well as to the individuals concerned. 
It is of vital importance to industry because of the value of 
continuity of service from workers trained in the methods of the 
establishment and of the greater productive capacity of healthy 
workers. One of the most effective general health measures 
would be the development of clinics where professional service 
could be had for charges that would not debar the poor. 
Such clinics might be under joint auspices of the industry, 
organizations of the workers and the U. S. Public Health 
Service or State Board of Health. Where industries are small, 
allied industries could inaugurate cooperative plans. 
I urge finally that industrial medicine avoid the errors of pater- 
nalism and that it be truly scientific not only as to the content of 
its own professional field but as to the performance of its practi- 
cal service as an agent of management. The world pays tribute 
to the great ideal of the medical profession-service in the pro- 
motion of human welfare-and we are doubly anxious that in the 
development of new aspects of the profession that ideal shall be 
more sharply defined and given wider scope for benefaction. 
Chairman Moorhead: We will next have the opportunity 
of hearing from Mr. C. R. Hook, vice-president of the American 
Rolling Mill Co., of Middletown, Ohio, on the topic, "Employ- 
ers' Cooperation in Medical Work." 
25 "Employers' Cooperation in Medical Work" 
by C. R. Hook 
Mr. C. R. Hook: An Irishman went into an employment 
office in Detroit the other day and walked up to the interviewer 
and said he wanted a job. 
The interviewer said, "What can you do ?" 
"Oh," he said, "Sure I can do anything." 
"Oh, you can," he said, "Are you a carpenter ?" 
"Sure I'm a carpenter." 
"Well, what can you make ?" 
"Oh, I can make anything." 
"Well, can you make a Venetian blind ?" 
"Sure I can." 
"How would you do it ?" 
"I would stick me finger in his eye, sir." 
I don't pretend to know all about, or, for that matter, very 
little about industrial medicine, but even so, if you were to put 
me on the stand and begin asking me questions, no doubt I 
would make replies that would make you think of Pat. So, 
with your permission, I am going to confine my remarks to our 
conclusions as a result of our own experiences in our own plants. 
I don't know anything about any other business but the steel 
business, and probably I know darned little about that, but as 
a workman and as a foreman and as a superintendent and as a 
manager, I have had some experiences that I believe would 
warrant me in expressing an opinion on the subject which has 
been given to me today. 
Eddie Guest said that the United States is the most costly 
place in the world to live, but it is worth the price. If you have 
a money income, you have to pay a money income tax, and if 
you want an income of happiness, you have to pay an income 
tax of personal interest and you have to pay it in advance. You 
can't have a healthy, safe plant unless you spend both money 
and personal effort to get it. 
To get desired results, it is our opinion, from our own experi- 
ence, that management has got to spend both money and per- 
sonal effort. Generally speaking, I think management does not 
realize how much more profitable their medical department can 
operate if they, the management, are more outspoken and more 
definite in their statements with reference to their belief in their 
26 medical department when conferring with managers, superin- 
tendents and others. 
Management can greatly assist and make more effective the 
medical work by assisting the industrial physician in pointing 
out to the foreman what a well group means to the efficiency 
of the foreman's job. 
It would be foolish for me to take time to discuss the respon- 
sibility of the employer to cooperate with the industrial physi- 
cian and surgeon with respect to all those things which concern 
the proper and efficient handling of the injured. That is self- 
evident. What I would like to talk to you about a little bit is 
with respect to sickness and accident prevention, for here is 
where management needs more light. 
You must remember that we are laymen and due allowance 
must be made when we fail to appreciate and understand those 
things which are as simple and as clear as spring water to you 
men. We need a lot of light and explanation, and much lack of 
cooperation on the part of management has been due to the 
lack of patience and lack of persistence on the part of our medi- 
cal advisors. By making notes and preparing a number of illus- 
trations for the benefit of the general manager, you can very 
materially assist him in evaluating the medical department and 
furnish him with ammunition which he can use when addressing 
department managers, superintendents, foremen and workmen. 
It is a simple but true statement that a well organization is 
more efficient, but what management needs from you is specific 
cases which will help them more clearly to visualize that truth 
to themselves and to the organization. 
May I just recount a few personal experiences in order that I 
may present to you the kinds of things that I think you ought 
to persistently and continuously present to your management 
in order that they can better understand the value of your work 
and more efficiently cooperate with you ? 
I have in mind at this moment the case of a blacksmith, at 
one time a very loyal and efficient worker. One day the fore- 
man noticed him take a revolver out of his pocket and put it in 
his cupboard. Fearing that something was wrong and waiting 
for the opportune moment, he went up and talked to him. 
During the talk, the foreman found that this man had a hal- 
lucination that his wife was unfaithful, and that his own son 
was guilty. He had placed the revolver in his pocket, had come 
27 out to work, put it in his cupboard until it was time for him to 
go home, and had the intention of doing a violent act. How 
the medical department got into this you can find out from 
Dr. Murat at your leisure. I will not take the time. However, 
suffice it to say that our medical department did get hold of the 
fellow; it did develop that he had very high blood pressure. 
You know what effect that might have on him-I don't-but 
that was one of the things they found. 
In the last analysis, that man was saved unto himself and for 
his family. He was persuaded to take medical treatment, and 
today he is a well man and he is an efficient workman. That 
home has been saved. 
Now, I want to ask you whether it paid to have a medical 
department to whom the foreman could appeal for help ? I 
don't know whether that particular instance saved industry 
dollars or not, but I do know that the morale of not only that 
department but other departments was helped. I do know that 
a family was saved, and I say that is worth while. That is a 
specific case. 
More than seven years ago, we inaugurated complete physical 
examination before accepting men for employment, not with the 
idea of eliminating men from the plant but with the idea of 
selecting them for the particular job that they were best fitted 
to do. Of course, that did not carry with it the obligation on 
the part of those who were already in the plant to take complete 
physical examination. Some months after that was inaugurated, 
Dr. Murat began an intensive campaign to find out how fit cer- 
tain operators were that were performing specific jobs where it 
required good eyesight and a level head. He started on the 
cranes in our plant, and he rode those cranes himself. He didn't 
take anybody's word for it; he got up in the cab and rode, and 
he saw what the ladle crane man had to do when he handled 
125 tons of molten metal, and he found out whether or not de- 
fective vision would endanger the lives of not only the men below 
but those above, and as a result of that survey, many of those 
men were transferred from those cranes to other jobs which they 
could perform safely, and the number of accidents due not to 
carelessness but to the fact that the man was not in physical 
shape to perform his job properly, the number of accidents due 
to improper handling of cranes, was very greatly reduced. 
I don't need to tell you men that it is a dangerous thing to 
28 put a man in the cab of an engine who is color-blind. Yet don't 
you know that the executive today in very large establishments 
has so many things to do and so many varied things to look after, 
that unless you bring these simple truths to him, he doesn't 
know them. You have got to help the executive understand, and 
then once it has been brought to his understanding, his respon- 
sibility is very definite. 
Let me tell you a rather amusing case that would appeal to 
you. Our regular staff is a chief surgeon with two assistants. 
Dr. Murat's second assistant resigned, and we had to get another 
man. A fellow applied who looked pretty good, and they 
started to interview him. After getting all the facts with respect 
to his history and professional ability, etc., he was informed 
that of course he would have to take a physical examination 
just like everybody else. He said, "Do you mean to tell me 
that I have got to take a physical examination ?" 
"Why, sure you do." 
"Well," he said, "I guess you don't want me." 
"Why ?" 
"Well," he said, "I am hard of hearing. I am no good with 
a stethoscope." 
Now, I want to know whether physical examination paid in 
this particular case. You know better than I do. 
I wish I had time to outline to you gentlemen the things that 
you could do to awaken in the entire organization a conscious- 
ness of the great value of preventive medicine. You would be 
surprised at the enthusiasm you could engender for your work 
if you fellows would just loosen up and forget your professional 
austerity and get down to earth with a lot of these fine fellows 
in rough clothes. 
Last month, we carried on a safety campaign over at our 
Zanesville works where we have 992 men on the payroll on the 
average. The Safety Committee of the workmen proposed 
that we start a safety campaign for no accidents in March. 
The average in that plant for a year had been twelve, that is, 
lost time accidents. They started out, and every night at eight 
o'clock, when there had been no accidents, they fired off a great 
big skyrocket. By the end of the second week, practically every 
home in Zanesville was looking for that skyrocket to find out 
whether Armco's safety record was still intact, and pretty soon 
the town got so worked up over it that the mayor declared 
29 Safety Week the last week in March. I wish I had time to tell 
you of some of the placards that were painted by the fellows in the 
mill. I wish I had time to show you some of the cartoons of our 
embryo cartoonists. I am going to read you one telegram that 
will appeal to you. We got through, by the way, without an 
accident, not a lost time accident in that plant. 
Managers and superintendents and foremen couldn't do it. 
The fellows had to do it themselves. Somebody had to sell 
them, and they had to be sold on the value of safety to them, 
and it had to mean something real to them. They made a real 
game out of it, and they came out on top, and while we were 
having our big rally and safety dinner, some two hundred and 
fifty fellows, and I was up at the head of the table, I received 
this telegram-this is from Group Five over at Middletown. 
We have four thousand men in the Middletown plants, and they 
are having a No Accident Campaign for April. They are all 
right so far, and I think they will come through. They divided 
the plant into groups, and each group has a novel way of pre- 
senting its ideas with respect to this safety proposition, and 
they are allowed to use their own judgment as to how to create 
enthusiasm. One group, that is Group Five, includes the trans- 
portation department and labor department and some other 
departments, and this is what Group Five said in their telegram: 
Charles R. Hook, 
Gold Hall, 
Zanesville, Ohio. 
"You may fire Doc Murat and Ray Adair when ready. 
Bet you five we do it."-Group Five, Middletown. 
I referred the telegram to Dr. Murat and Mr. Adair, who is 
our Safety Engineer, and this is what Adair says: "Mr. Hook, 
have already asked the employment department for a new job." 
And Dr. Murat says: "Doing my best to help them do it." 
Here is a little card that came to my desk. One of these comes 
everyday. Group Five is sending them out. This says: "Safety 
Slim says, better late to work than early to heaven. Drive 
slow ! " 
Now, gentlemen, we can determine results that we are getting 
in accident prevention because we have very complete records 
of all accidents. It is more difficult to determine your accom- 
plishment in poor health prevention, but I am positive that we 
can get just as much enthusiasm from the fellows in the ranks 
30 in connection with a health campaign as we can in connection 
with a safety campaign. 
No doubt you fellows have met superintendents and foremen 
just as I have, fellows who say to you, "Well, I have been in the 
mill for twenty or twenty-five years, and I have been making 
steel, and I have been making lots of it, and I have been making 
good steel, and, by gum, I am sound as a dollar today. I didn't 
have to have any doctor help me run my department." 
When you run across a fellow like that, you just read this 
little poem. I have done it a couple of times, and it is quite 
effective: 
An old man traveling a lone highway 
Came in the evening, cold and gray 
To a chasm vast and deep and wide. 
The old man crossed in the twilight dim, 
For the sullen stream had no fears for him. 
But he paused when safe on the other side 
And builded a bridge to span the tide. 
"Old man," said a fellow traveler near, 
"You're wasting your time a-building here. 
Your journey will end with the closing day. 
You never again will pass this way. 
You've crossed this chasm deep and wide. 
Why build you this bridge in the eventide ?" 
The builder lifted his old, gray head. 
"Good friend, in the way I have come," he said 
"There followed after me today 
A youth whose feet must pass this way. 
This stream which has been as naught to me 
To that fair youth might a pitfall be. 
He, too, must cross in the twilight dim. 
Good friend, I am building this bridge for him!" 
Increases and decreases in output and the money value 
thereof can be easily shown. You can weigh coal and you can 
measure lumber, but the most difficult thing that I know of in 
industry today is to evaluate the services of the medical depart- 
ment. We are confident that it pays both in money and in 
happiness. Your principal compensation comes from the satis- 
faction derived from the knowledge of a job well done. 
It seems to me Eddie Guest had you in mind when he wrote 
this little poem: 
31 I'd rather write in friendly ink 
Than in the lasting stone of fame. 
I'd rather for a little time 
Inscribe on human hearts my name 
And pass as one who'd smoothed the way 
For others and had tried to live 
Not solely for what he could get, 
But sometimes for what he could give. 
I'd rather fill with little deeds 
The hours and days and weeks and years 
Than say, in one great shining task 
The record of my life appears. 
I'd rather own the poor man's smile 
Of gratitude, than to possess 
A place of honor with the great 
And all the glory of success. 
He who forgets his own desires 
And lets his chance for glory go 
That he may serve some humbler need 
Of which the world may never know, 
Is greater than the man of fame 
And braver than some hero bold, 
For day by day and year by year 
His splendid sacrifice is told. 
Chairman Moorhead: We will next have the pleasure of 
listening to a man who scarcely needs any introduction to this 
audience. He is going to talk to us on the subject of "Mono- 
polistic State Insurance and Industry." I refer to Dr. Otto P. 
Geier, Manager of the Employees' Service Department, of the 
Cincinnati Milling Machine Co., of Cincinnati, Ohio. 
"Monopolistic State Insurance and Industry" 
by Dr. Otto P. Geier 
Dr. Otto P. Geier: I think it is a step in progress when 
this conference group has at its board Mr. Gompers represen ting 
the Federation of Labor, which as an organization has not been 
altogether too favorable to the program of physical examination, 
medical inspection and medical supervision, and so on, in in- 
dustry. But I believe the work of this conference group has 
had much to do with changing that opinion in organized labor 
and showing that there are some virtues in the work of the 
industrial physician, that some contribution has been made to 
the welfare of society through no organization so much as 
through organized industrial medicine. 
We cannot hope to wait now for that time when the organized 
employers and organized labor together erect clinics, public 
32 clinics, to which the employee may be directed. Organized 
labor, I believe, must accept that which is here today, the medi- 
cal department, as a part of organized industry. Surely it can- 
not stand in the way of progress and wave aside the good that 
may come from medicine as it is found in industry today. The 
development in time may reach out to that point where the two 
organized groups may develop this work together. 
The subject that has been assigned me today is one that is 
perhaps a little beyond my depth and more within the purview 
of Mr. Hook who has just spoken to you so splendidly. 
I had certain facts committed to paper when I came into 
New York this morning, but somehow the atmosphere of New 
York made a change in my plans for this afternoon, so I sat 
down in my room and wrote down these observations as a very 
brief introduction-in fact it is practically all that I propose to 
say in reference to the monopolistic system of insurance as 
carried on in Ohio. 
I wonder whether we hadn't best consider for a few minutes 
the broad aspects of a compensation law rather than that of the 
Ohio law versus the casualty insurance carriers in the East. I 
asked myself these questions: Industrial insurance, is it not a 
social and economic necessity ? Should it be compulsory ? In 
Ohio it is compulsory on every employer of three or more work- 
ers. Should it not give the maximum protection at the minimum 
cost ? Should it not include prevention of accidents and occu- 
pational diseases, and in doing that, should it not educate both 
the employer and employee ? Should it not include coverage for 
strictly defined occupational diseases ? Should its operation 
not make for industrial peace ? Should it not improve the rela- 
tions between these two groups ? Should it not reduce to a 
minimum the friction between the individual employer and his 
employee over compensation settlements and thus prove another 
factor in better relations ? Should it not look towards the 
abolition of litigation over compensation matters ? Should it 
not adequately compensate the injured so as to preserve his in- 
dependence from charity ? Should its operation not prove a 
constant reminder of the common interests of management and 
men ? Should it not provide the very best surgical and medical 
service obtainable, thus reducing the cost of accidents and ill 
health ? Should the physician not be allowed to preserve the 
best traditional relations between himself and the patients ? 
33 Should his treatment not be actuated solely by interest in the 
employee so that he may best advance the knowledge of scien- 
tific medicine and surgery ? Finally, isn't the true test of any 
mechanism, private, semi-private or public, that of whether it 
serves all of the people ? 
Now, answering some of these questions in reference to the 
law, we in Ohio have accepted the principle that compensation 
is an economic and social necessity, that it must be compulsory; 
and, as I have said a moment ago, it now includes every employer 
with at least three employees. We believe, and this may be 
debatable, that we do give adequate care and maximum protec- 
tion at the minimum cost. 
Ohio does not permit the private carrier to insure the employer 
or his risk, and in doing that, we believe we have eliminated an 
unnecessary cost of that competition which exists in other 
places. There are men here who can give you far better than I 
the dollars and cents figures of the comparison between cost of 
insurance in Ohio and in other states. The administrative costs 
are less than 4%. No one makes any profit. 
The next question that I had: Does it include the coverage 
for occupational diseases ? For the last two years the Ohio law 
has done so, but it is too early to say what that cost is going to 
add to compensation, because, as we must recognize, even the 
profession knows too little about occupational diseases, and it is 
going to take some time for the public at large and the workman 
and the employer to report occupational diseases properly and 
promptly. 
The next question that I raised was the gap between labor 
and capital. We believe in Ohio, and I think I represent the 
opinion of the physicians and the employers at large, that we 
hold a rather enviable position in the matter, that friction be- 
tween employers and the unions and the individual laborers is 
practically eliminated; at least that which comes as the result 
of the discussion of compensation awards. 
In the recent amendment to the constitution, we had the very 
unusual situation where labor and capital were united on the 
matter of increasing the benefits 25%, which raised the weekly 
benefits from $15 to $18.75, which raised the death benefits 
from $5,000 to $6,500, and which added a penalty of from 1% 
to 50% in those cases where industry could be shown to be 
grossly negligent of safeguarding the worker, so that in addition 
34 to the $6,500, the employer can be penalized up to 50% of that 
award in addition; and likewise in the matter of weekly com- 
pensation. 
Should adequate compensation be awarded ? I believe that 
the weekly benefits and the extent to which they are allowed, 
the time at which they begin the award for permanent injuries, 
are today in Ohio as great, if not greater, than those allowed 
anywhere else, and at a cost no greater than in any other state. 
Just this last observation, and then I have finished, because 
I believe you have had a pretty heavy program today. The 
test of any mechanism, such as a workman's compensation act, 
is the degree to which it benefits all of the people of the state. 
After all, the criticism that is offered against the Ohio law, that 
it injects politics into business, is answerable. May I say that 
I believe that politics is, after all, the business of all of the people, 
and we are finally measured in our general welfare by the way 
we manage our public business, and it would be better business 
for all business if they injected a little more politics into their 
business, and, inversely, injected a little more business into 
politics. I don't think you can separate the two very well. 
In a democracy, the majority rules. Under a compensation 
law such as there is in Ohio, when it is everybody's business to 
see that the act is as efficient as possible, we believe we are forc- 
ing the employer to take a mass viewpoint of public questions. 
We are forcing him to sit down with organized labor and the 
politician, to go to the legislature, and to show leadership if he 
has that within him. After all, I believe we are forcing our big 
men in industry to recognize what contribution or what respon- 
sibility they have to state matters. 
The purpose of production, the whole scheme of production, 
if it is sound on its basic social and economic sides, must be to 
afford the average man the maximum comforts, conveniences 
and happiness that can be secured from that scheme of produc- 
tion. If, through the organization of a compensation act, we 
by any means or methods draw the attention of our industrial- 
ists to the tremendous responsibility that they as individuals 
and collectively, as the employer's association, have, towards 
the welfare of our country at large; if we can make them think 
in terms of the average man; if, through the closer knowledge 
that must come through the consideration of these public ques- 
tions, they begin to have a point of view and closer knowl- 
35 edge of the working man's point of view; if through their asso- 
ciations meeting with organized labor they are forced to work 
out the welfare of the average man-then I believe we are taking 
a step towards making our state a more efficient state, serving 
its highest social purposes. 
Chairman Moorhead: The next topic on the program is 
"Inspection in Physical Diagnosis," and it gives me very real 
pleasure to introduce my friend, Dr. Harlow Brooks, Professor 
of Clinical Medicine, New York University and Bellevue Hos- 
pital Medical College, New York. 
"Inspection in Physical Diagnosis" 
by Dr. Harlow Brooks 
Dr. Harlow Brooks: The easiest, most simple and natural, 
most valuable and most neglected method of physical examina- 
tion is inspection. In a great many conditions absolute diagnosis 
may be made by inspection alone, as in smallpox, in certain 
phases of syphilis, in many bone and joint diseases and the like. 
In a great many instances other methods of diagnosis or physical 
examination are dependent on an inspection' to which such 
other methods are merely subsidiary. This is largely true, for 
example, of percussion. The veterinarian and pediatrician in 
very large part base their diagnosis almost completely on 
inspection. 
It is probably the easiest method of diagnosis and physical 
examination; it is certainly the quickest and most time-saving. 
Doubtless more can be determined from inspection in a given 
length of time than from any other method. It is, further, a 
method of examination which permits of less fraud and decep- 
tion than any of the other methods of examination which we 
utilize. 
Nonetheless, inspection is probably the most neglected of 
all the arts of diagnosis. As compared to instrumentation in 
general, to examinations of the urine or blood, to bacteriology, 
to the use of the stethoscope or of the electro-cardiograph, it is 
definitely superior in practically all ways, yet I find that the 
average recent graduate and the usual hospital interne are far 
better prepared in all these laboratory methods than in the 
simple and ancient art of inspection. There are only a few 
teachers of physical diagnosis who are as skilled in inspection 
36 as the average horseman, stockman, or veterinarian. It is in- 
deed rare to find a student or recent graduate who is able to 
make a proper inspection, or who can, after having watched a 
patient for a given time turn about and give an account of what 
he has seen in him, what abnormalities or peculiarities, what 
evidences of specific disease processes, of infirmities or of his 
possibilities in any direction. Yet the average experienced 
practitioner is able to determine much, very much and some- 
times too much, from a mere glance at his patient, even though 
he be not disrobed. How frequently we find in the dispensary 
a very successful man who spends almost no time on his patients 
or with their detailed examination, and yet who succeeds mar- 
velously in practice, who successfully prescribes for and cures 
his patients, who pleases them and develops oftentimes an almost 
supernatural ability in snap diagnosis, to the great humiliation 
and scandal of his more scientific and painstaking colleague. 
This is due to a highly trained ability in judgment founded on 
inspection. 
There are a few among you who are prepared to dispute these 
statements with me, and yet how much training did any of you 
receive in your course in physical diagnosis in inspection ? How 
much time do you give to it, for example, as compared to 
auscultation in your average examination ? Which do you get 
most out of in valuable data, your laboratory examinations, or 
your study of the patient ? Which takes the most time ? I 
have seen the great clinician Naunyn spend his entire lecture 
hour with the inspection of but a single patient and with not one 
moment wasted or trivially spent. 
Inspection is particularly valuable to you gentlemen engaged 
in industrial medicine and surgery. It forms the chief, or per- 
haps I had better say it should form the chief basis of selection 
of workmen. To a very considerable degree when properly con- 
ducted it can determine the character of labor for which a man 
may be fitted or for which he may fit himself. It is the chief 
basis of the exclusion of men suffering from contagious diseases 
which may develop a serious epidemic in your factory or camp. 
It will tell you with no mean degree of accuracy those men who 
are most likely to suffer accidents, or who through their care- 
lessness and indifference or because of some other disability may 
endanger the safety of others. 
Another great advantage of inspection in the examination of 
37 men in industrial life is the ease with which this method may be 
amplified by palpation, another method of tremendous value 
and, like the first, one which requires but very little time, and 
yet which gives data of the most absolute and valuable character 
in medical and surgical conditions. 
Why, then, is it that so little attention is paid to the develop- 
ment of this essential art of diagnosis in our colleges and hospi- 
tals ? I believe that the chief reason is because it implies, 
or should imply, that patients should be examined nude. In 
this country we have a curious and foolish aversion to the proper 
stripping of a patient. 
Those of you who served in the army or on the draft examina- 
tion boards need no arguments to persuade you of this necessity 
and yet a very satisfactory examination can be made by ex- 
posure of parts of the body piece by piece, but in the examination 
of men there is no possible adequate reason why they should 
not be stripped absolutely. It saves you an immense amount 
of time, adds much to the adequacy of the examination and in- 
sures, as nothing else can, that all essential features in every 
case shall be noted. 
In so far as sex delicacy is concerned there is no reason why the 
same thoroughness should not be enforced with women if a 
woman physician does the examinations. 
Instead of attempting today to take up the consideration of 
the general subject of inspection as it should be practiced by the 
physician and surgeon, I shall attempt to particularly present 
those phases of the art which should be of particular value to the 
employer of labor, and to the physician concerned in this new 
specialty of industrial medicine and surgery. 
In these days when most states require a certain degree of 
responsibility on the part of the erfiployer for the health of his 
workmen and women, and in which the employer is to a very 
considerable degree financially responsible, even when injuries 
and accidents occur through the fault or contributory neglect of 
the workmen, it is of primary importance that those persons 
selected for your positions should be, first, in relatively good 
physical state. Secondly, they should be of sound mind; thirdly, 
they should be of such a type that the training of them, a rather 
expensive process in many instances, is worth while; fourthly, 
that they are not suffering from any disease likely to be con- 
tributed to their fellows, with a resulting great loss in material 
38 and in time to the employer, to say nothing of the human life 
and suffering involved. In a considerable number of instances, 
as here in New York, the employer is held responsible to a greater 
or lesser degree for many disease conditions contracted in this 
way. 
The first safeguard which the employer has in this problem 
is the careful selection of his employees; second is the care and 
protection of them, and third is the early recognition of disease 
and disqualifying defects. To a very considerable extent it 
must be apparent that these are largely medical functions and 
most large employers now fully recognize this fact and employ 
competent physicians for these examinations and judgments. 
There is still another large field of usefulness in which the 
physician, if properly trained and keenly alive to the possibilities 
of his position, may contribute very valuable assistance to you, 
and that is in the selection of employees. This is particularly 
valuable in those occupations which imply a certain degree of 
hazard, as in those in which the carelessness of a workman may 
imperil the well-being of his colleagues. A few simple tests as 
to agility, as to adaptability and as to ability to learn in a physi- 
cal way, will quickly select or reject those men whose activities 
are safe and sane, or those who would endanger others engaged 
in work with them. Such a system has been in vogue in a large 
steel industry with which I am acquainted, and as a result the 
number of accidents, resulting in maiming, loss of life and loss 
of time, personnel and material has been greatly reduced. The 
early detection of nervous or mental disease in workmen charged 
with great vital or financial responsibility is of tremendous im- 
portance, and proper adjustment will result in a great saving in 
every respect. 
In too frequent instances you are satisfied for a physical ex- 
amination that the heart be examined, and the urine be tested 
for albumen and sugar. For your purposes an inspection of the 
patient or candidate is of infinitely greater importance and value. 
Many data easily determined in the course of a physical examin- 
ation would be desirable to retain on a blank which would be 
of much importance in many legal procedures. Most of this 
clerical work can be done by comparatively low salaried order- 
lies or nurses, such as may be obtained from discharged men 
from the Medical Department of the Army. Weight, height, 
chest and abdomen circumference, vital capacity and the no- 
39 tation of any glaring physical defect can be quickly made and 
adequately recorded if you employ such blanks, for example, as 
are used in the Army. 
After this a careful inspection of the candidate for employment 
can be conducted very quickly, efficiently and cheaply if proper 
facilities and training for inspection are available. The candi- 
date must be stripped. The room for examination must be 
adequately warmed; it must be properly provided with light, 
preferably with daylight, for many of the skin rashes, such as 
appear in syphilis, in scarlet fever, typhus fever and the like 
are difficult to identify under the usual artificial lighting. 
Great economy of time and effort without consequent in- 
accuracy is furnished when groups of candidates are examined 
together rather than singly. The essential data of weight, 
height, color of hair, eyes and identifying deformities or marks 
having been taken by nurse or orderly, the men are ranged in 
single file and the inspecting physician accompanied by his clerk 
or orderly passes down the line, first in front and then in the 
back, noting any defect apparent at the time. Hernia and 
varicocele may be tested for as he passes down the front of the 
line, hemorrhoids and fistula, if their existence be of importance, 
as the rear is inspected. Aside from inspection of these details 
the examiner should run his eyes from head to foot, particularly 
noting the condition of the scalp and the presence of scars or 
rashes on the skin. 
Men found on this first inspection disqualified for the work 
in question should be promptly eliminated in order that no un- 
necessary time may be wasted. As each candidate is inspected, 
positive findings of any importance in the labor concerned should 
be noted; negative findings may be noted by the clerk, then or 
later on if this be desired. 
The hands and feet, if of importance in the work, may then 
be especially inspected in much the same manner. The next 
important step in the examination should consist in making the 
men to run, standing in place and urging that the knees be 
brought high up on the pelvis as the men so exercise. The ap- 
pearance of undue dyspnoea, of cyanosis, or early exhaustion 
will be indicative of disqualifying heart, lung or liver disease. 
If any defect of the joints of the leg, pelvis, or thigh exist they 
will then become apparent, and men may be rejected as dis- 
covered. The men are then asked to bend forward with the arms 
40 outstretched, thumbs locked above the head trying to touch the 
floor of the examining room. Disqualifying obesity, disease of 
the shoulder, joints and arms will become apparent and further 
elimination may take place. The flexibility of other articula- 
tions may then be tested out as indicated. 
As a part of inspection, breathing exercises may be introduced. 
In nearly all instances these exercises, together with the general 
attitude of the candidate, the shape of his chest and his respira- 
tory movements will, for example, definitely identify nearly all 
instances of tuberculosis. 
The running exercise will promptly indicate also many forms 
of lung disease and early exhaustibility, a most important indi- 
cation of anaemias, of cancer, of kidney disease and of many 
other similar conditions. 
The same exercises will show, in the early appearance of 
dyspnoea, pulmonary, liver or kidney disease or disturbances 
of the heart which would be commonly indicated also by cyano- 
sis, by unusual throbbing of the vessels of the neck or by dis- 
placed and unnatural pulsations in the region of the heart apex. 
Even diseases of the heart may be often more satisfactorily 
determined by inspection than by any other single method of 
examination, and in certain frequent types of heart disease a 
very accurate diagnosis may be possible from mere inspection 
alone. This is true, for example, in most cases of aortic disease 
when the Corrigan pulse can be usually definitely discovered by 
inspection. 
As it happens, however, in relation to cardiac disease the em- 
ployer is commonly more interested in the man's ability to do 
the required work in question rather than in an accurate scien- 
tific diagnosis, and there is nothing which so definitely establishes 
the presence or absence of complete compensation of the heart 
like inspection. 
Tumors, adenopathies, disabling deformities, old fractures 
and dislocations are all usually evident on mere inspection. 
Then there are many distinct disease conditions, such as Base- 
dow's disease, Addison's disease, leprosy, rheumatism and 
instances even more widespread over the entire field of medicine 
which are quickly recognized by inspection. Among these is the 
usual active instance of the venereal diseases. 
The nose, throat, and tongue should then be inspected, be- 
cause of the great frequency with which contagious diseases 
41 such as syphilis, diphtheria, tonsilitis and the like may be mani- 
fest in these areas. If necessary the teeth may be inspected at 
the same time. 
When detailed data are not required, this examination may 
entirely suffice, but of course men may be examined in as much 
detail as desired. Such an inspection as I have described will 
eliminate quickly and with the minimum loss of time nearly all 
the contagious diseases, those suffering from any sort of disease 
which disqualifies for ordinary labor and of course those unduly 
emaciated, as from tuberculosis or cancer, or those obese to a 
disqualifying degree. Experience has shown that such an ex- 
amination may be conducted and recorded by the physician at 
a cost of about five minutes per man, provided that proper 
clerical or orderly help is available. 
Such an inspection will suffice to exclude most serious organic 
disease, but of course more detailed examination must be made 
if it is desired to accurately define and classify these. Probably 
the most important of these further examinations is that of the 
heart, next of the urine, both of which demand such special 
technique as is well known to every physician. Next in im- 
portance is examination of the lungs, though inspection is prac- 
tically certain to have indicated probable pulmonary disease if 
present in an advanced degree. The absolute exclusion of early 
pulmonary tuberculosis will require a detailed physical examina- 
tion preferably augmented by fluroscope or x-ray study. This 
will require in definitely positive cases perhaps only a few 
moments but as much as fifteen minutes may be necessary in 
questionable cases. 
If adequate room, light and clerical force exists, groups of 
about twenty-five men are the limit for a proper inspection ex- 
amination. Where enough examiners are available it has been 
found that ten trained examiners can examine completely, in- 
cluding eyes, ears, cardiac, pulmonary and urine, about three 
thousand men in a day of eight hours. The inspection examina- 
tion, with sufficient orderly, nurse or clerical assistance can be 
made in a satisfactory way at the rate of about five hundred 
men per day, depending chiefly on the amount of recorded data 
required. One trained physician can inspect for gross physical 
defect or for contagious disease fully one thousand men per day, 
provided always that proper facilities are afforded. 
It must be then apparent to you that the cost of such examin- 
42 ations is not prohibitive where mere physical disqualification 
and contagious disease is in question. When mental defects or 
nervous diseases are in question, very much more time is neces- 
sary, for this entails talking to the men, drawing them out, judg- 
ing as to their reactions mentally, morally and so on. 
Much more time and an even higher grade of trained physi- 
cian is needed where tests are to be made as to nerve reactions, 
as to adaptability, intelligence and accuracy, or where the pos- 
sibility of acquiring accuracy must be ascertained. It may be 
necessary to install instruments or machines of the type to be 
operated, on which candidates may be tested out. When it is 
important for the saving of material, life or maiming, it is 
probably cheaper to test these men out experimentally as it were, 
rather than to risk serious waste of time in attempting to train 
them to some delicate procedure which fundamental tests 
should quickly demonstrate they could never successfully 
undertake. 
By and large, however, it is quite possible to exclude most 
serious disease conditions, the chief contagious and incidentally 
many nervous and mental disorders by the mere examination 
by inspection, the cheapest in time of any of the methods of 
examination, but at the same time demanding on the part of the 
examiner a training and an understanding of medical mechanics 
of the highest degree possible. Such work cannot be expected 
of a recent graduate or of a man of ordinary medical equipment, 
for training of the eyes to see and interpret can be only attained 
by skill, effort, experience and most of all, by an interest and 
desire to accomplish and learn. 
To those of you who have served in the Army it is apparent 
that most of what I have said has conformed more or less to the 
method employed in the army in the selection of soldiers. In- 
deed I confess that this experience has prompted this paper, and 
I wish to recommend to you employers further that if you are 
finding it necessary, as constantly increasing legislation seems to 
indicate will soon be universally the case, to record more or less 
detailed data of the physical status of your men, you can employ 
no more suitable blanks for filing these examinations than those 
furnished by the Army. 
Further I wish to say that of all those who have taught me 
as to these methods, my most valued teacher was an old Army 
sergeant back in 1898, who first taught me to look at a man as a 
43 horse jockey looks at a horse. Three years intimate experience 
with this past master of physical examination demonstrated to 
me that a properly conducted inspection will detect disease with 
a very high degree of accuracy. More detailed examinations are 
of course required in many instances for the proper classification 
of disease, but if it is merely desired to exclude those incompe- 
tent, or contagiously ill, inspection is the thing, and in most 
cases it is all that is necessary. 
In the selection of employees, I imagine the employer is not 
so much interested in the detailed scientific disease conditions 
which his prospective workmen may or may not have. His first 
consideration is, "Can he do the work required ?" Inspection 
answers this more certainly than all the other methods of 
physical examination put together. Next, I imagine he will ask, 
"Is this man the subject of any contagious disease which will 
endanger the health of the other workmen ?" This, also, in- 
spection usually answers better than any other three methods 
of examination combined. Is he likely to be frequently sick, is 
he inherently crippled or incapacitated in any essential way ? 
Inspection will answer this in most cases immediately. 
There is one great drawback to inspection. It requires a man 
highly skilled in its practice, a man with keen, analytic and 
appraising judgment, founded on a wide experience not only 
in disease and in medicine but also a familiarity to a considerable 
degree with the character of work in the industry concerned. 
He must be a broad man in many ways. He must be quick, 
decisive and waste no time or effort, or the good purposes of the 
method are defeated to large extent. Such men are not common 
nor are they cheap. They may be trained from the young and 
experienced interne. Such a man must necessarily be an expen- 
sive luxury; if he is not, then he is probably inefficient and there- 
fore ultimately expensive, for I think that most employers of 
men will grant that a poor workman is the most expensive one 
of all. 
Chairman Moorhead: Before we have the recess preliminary 
to the dinner tonight at seven o'clock, I would like to mention 
formally by name some of our guests: Dr. Germund Wirgin, 
Professor of Hygiene, University of Upsala, Upsala, Sweden; 
Miss Eleanor L. Hinder, of Sydney, Australia; Dr. Brackett, of 
Boston; Dr. Coley, of the New York Central R. R.; Dr. John 
44 Walker, of the Pennsylvania R. R.; Dr. Guthrie, of Lehigh 
Valley R. R.; Dr. Wade Wright, of the Department of Industrial 
Hygiene of Harvard; Dr. Mary Crawford, of the Federal Re- 
serve Bank; Dr. H. G. Murray, of the New England Conference 
of Industrial Physicians; Dr. Sayres, Chief Surgeon of the Bu- 
reau of Mines, U. S. Public Health Service; Dr. Ernst, of the 
Federal Employees' Compensation Bureau at Washington; and 
some of our laymen: Mr. W. H. Nichols, of the General Chemi- 
cal Company; Mr. Howell Cheney of the Cheney Silk Co.; 
Colonel E. Z. Steever, of the General Electric Co.; and Mr. 
Darling also of the General Electric Co. We also have Dr. 
S. P. Mengel, of the Lehigh & Wilkes-Barre Coal Co.; Dr. T. M. 
Baird, of the U. S. Veterans' Bureau, of Newark; Dr. A. J. 
Lanza, Director of the National Health Council; Dr. J. G. 
Cunningham, Director of the Department oflndustrial Hygiene, 
Ontario Department of Health, Toronto; Dr. L. A. Ensminger, 
Chief Surgeon of the Big Four Railroad, of Indianapolis, 
Indiana. 
We are very glad indeed to have you gentlemen with us. 
That completes our program for this afternoon. 
45 EVENING SESSION 
Dr. W. Irving Clark, Vice-Chairman, Conference Board of 
Physicians in Industry, presiding. 
Chairman Clark: This is a very delightful occasion for me 
because it is the first time I ever presided, so far as I can re- 
member, at any meeting of such size as this. 
There is one thing that you will all welcome that I shall tell 
you now and I expect to stick to it. I shall have very little to 
say. I am going to leave that to the very competent speakers 
that we have on the program. 
The first speaker on our program this evening is Dr. Ralph C. 
Williams of the Department of Industrial Hygiene of the Bureau 
of Public Health in Washington. Unfortunately, Dr. Cumming 
is unable to be here, and Dr. Williams has very kindly con- 
sented to come and talk in his place. I don't know what Dr. 
Williams is going to talk about, and so I am going to give you 
his subject as "The United States Public Health Service and 
Industrial Medicine," imagining that he will probably talk 
along those lines as his specialty is industrial hygiene. I know 
we will all be very much interested to hear just exactly what 
the Public Health Service is now doing in industrial hygiene. 
"The United States Public Health Service and Industrial 
Medicine" 
by Dr. Ralph C. Williams 
Dr. Ralph C. Williams: Because of certain important mat- 
ters pending in Congress, Surgeon-General Cumming is unable 
to be here tonight, and he has asked me to express his extreme 
regret at not being able to be present, and to say that he hopes 
to have an opportunity to address this Board at some future 
date. 
As you all realize, there are, broadly speaking, three general 
divisions of Industrial Medicine: Industrial Medical Work, 
Law Enforcement, and Scientific Research. You gentlemen of 
the Board are largely concerned with industrial medical work. 
The various state governments are concerned with the legal en- 
forcement of the standards relating to industrial hygiene. The 
fact has long been recognized that research work is a legitimate 
46 function of the Federal Government; and for that reason the 
Public Health Service feels that its largest field in connection 
with industrial hygiene is that of research work-investigation 
of the various problems that confront industrial physicians and 
industries at large. With these facts in mind, I shall undertake 
briefly to explain to you the nature of the research work which 
we are undertaking and the results which we hope to accomplish. 
Law enforcement, which has to do with the regulations of 
sanitation and hygiene of industrial workers, is, or should be, 
the practical application of the information obtained in the 
fields of industrial medical work and scientific research. That 
they may be just to the industries and to industrial employees, 
such laws must have basic scientific foundation. Unnecessarily 
rigid and arbitrary industrial laws not only interfere with indus- 
trial life, but fail to furnish protection to the worker. Those 
laws which are based on the results of scientific investigations 
evince an intelligent understanding of the end result to be ac- 
complished. The research worker in industrial hygiene under- 
takes the investigation of industrial hazards in occupational 
diseases, the relations between the former and the latter, and 
methods of correcting or combating the hazards so that all 
workers may have equal life expectancy. 
A review of the literature relating to industrial hygiene makes 
it quite clear that there is a correlation between industrial laws 
and the progress of industrial hygiene, and that the development 
of the latter has, with certain exceptions, been due to the estab- 
lishment and enforcement of these laws. In every country that 
shows industrial development, industrial laws have antedated 
industrial medicine, except in such industries as have advanced 
on their own initiative. Industrial legislation has, however, 
come about by piecemeal. The formulation of industrial laws 
is not a simple problem. Fortunately, the fundamental object 
of industrial laws is the protection of the worker, and that fact 
must be constantly borne in mind. But in formulating these 
laws, unnecessary expenditures should not be required, and pro- 
duction should not be seriously hindered; and careful considera- 
tion should be given to the effect of the laws on industry and 
the cost of production. The worker must be protected against 
the health hazards of his work process; but regulatory methods 
and measures must be based on the results of scientific investiga- 
tions, so that, while the main requirement of protection is satis- 
47 fled, useless and unnecessary regulations will not be increased. 
The most important advances that have been made in indus- 
trial hygiene within the past few years are results of researches 
in regard to pathological changes which occur in the body from 
exposure to various industrial hazards. Three avenues have 
generally been used for approaching and analyzing this subject: 
analysis of death records, physical examinations, and the study 
of sickness records. 
In a general way, the comparative hazard of the various trades 
is well known. In countries where death records have been 
kept it has not been difficult to sort out the records of the various 
occupational groups and thus to study the diseases which are 
most prevalent. Physical examinations are of double impor- 
tance-that is, they are of value to both the employee and the 
industry in which he is engaged. A knowledge of his own 
physical defects is of inestimable value to the employee. The 
great number of minor correctible defects that exist among 
workers and pass unnoticed by them is certainly surprising. 
How much better health might be enjoyed and what increased 
efficiency might be attained by the individual worker if his 
minor physical defects were known to him and to his physician, 
is at the present time purely a matter of conjecture. But the 
subject is of major importance not only to the employee but to 
industry. There can be no doubt of the possibility that the 
employee might add years to his life expectancy by acquiring a 
frank understanding of his own physical defects, his physician 
having at the same time an intelligent understanding of the 
hygienic measures which should be followed to keep him in good 
health. 
In studying the various problems of public health and indus- 
trial hygiene, we have been so absorbed in analyzing mortality 
records and the causes of death that we have almost allowed the 
importance of sickness records to become obscured, and perhaps 
have failed to place the proper emphasis upon this, which should 
by no means be overlooked. If individual plants adopt their 
own systems of keeping sickness records, these records, though 
very valuable for comparing lost time in the various departments 
of these particular plants by which they are kept, miss their 
greatest value; for in many instances such records cannot be 
satisfactorily compared with those of other plants. Plants 
keeping such records may have a clear understanding of their 
48 own status in regard to sickness, but no definite idea of how they 
compare with other plants of similar trades. This point has 
impressed us so strongly that the Public Health Service has 
developed, in cooperation with several large industrial plants, a 
tentative standard method and form to be used in reporting 
sickness. Any industrial plant or any industrial physician in- 
terested in such work may, upon application, receive a copy of 
this form, to be looked over and studied. 
It is hardly reasonable to expect each industry and each plant 
to work out individual methods of prevention of its various 
health hazards, nor each state to study and care independently 
for its own individual health problems, for many of the same 
problems are presented in practically every state in which in- 
dustry is carried on, and the same hazards exist in many differ- 
ent branches of industry. It therefore seems that it is the 
function of the Federal Government to make investigations and 
to carry on researches leading toward the prevention of the 
graver health hazards. These hazards are very numerous, and 
the scope of the service work in this connection is limited only 
by the number of officers available for this work and by the 
amount of funds available as appropriated by Congress for its 
prosecution. 
Scientific investigations into these various problems that now 
lie before us constitute, therefore, the most important work of 
the Public Health Service in the field of industrial hygiene. 
The general policy of the Public Health Service in the conduct of 
this work is to take up first the broad problems that affect large 
numbers of workers; and so we are endeavoring at the present 
time to solve those problems that affect great groups and not a 
single industry only, but a number of industries. 
I will give you a brief summary of what we are trying to do: 
We are studying the effect of dust upon the health of the indus- 
trial worker; the chronic effect of carbon monoxide; posture; 
fatigue; industrial ventilation; questions of consultation service; 
statistical analysis of the data that we collect; illumination 
studies; and studies of temperature and humidity, in cooperation 
with the Bureau of Mines; and we are compiling an industrial 
sanitation code. These are the projects which we now have 
under way and are carrying forward. It is our plan, our hope, 
if we can find a man who is available to head the work, to make 
within a short time a more or less general survey of the indus- 
49 tries; in this connection one or two men will go about and talk 
with the various industrial physicians and plant physicians, to 
find out their various problems and to ascertain whether any 
new health hazards or industrial and occupational hazards are 
developing. Dr. Thompson, who is actually in charge of the 
Office of Industrial Hygiene, is at the present time in England, 
where he is engaged in observing and studying the industrial 
hygiene work being done there. He has seen Collis and Green- 
wood and the various leaders of work in industrial hygiene in 
England, and he has gathered some very excellent ideas. One 
of these ideas that has impressed him most is the plan of sending 
a man around to make a general survey, to find out just what 
particular problems are engaging the attention of the various 
industrial physicians. 
Although a great amount of research work has already been 
done on dust and its effect upon workers, there still remain 
numerous problems to be solved in regard to this question. 
With this fact in mind, we have undertaken a thorough and com- 
prehensive study of dust, which will probably require several 
years for completion. We have only begun this study-it has 
been going on now about six months-and we have three units 
at work. We hope to have later about six. In the course of this 
study of dust we plan to ascertain the best method for collecting 
dust of the various classes; to determine, from post-mortem 
examinations, the nature of the various particles in the different 
classes or kinds of dust; to attempt the determination of specific 
standards and distinctions for the different classes of dust; and 
last, to determine from morbidity and mortality records, the 
relative harmfulness of different classes of dust. In these in- 
vestigations we plan to cover all the various classes of dust 
which, roughly given, are mineral dust, as quartz dust in the 
metal mines; metallic dust, as dust from silver polishing; vege- 
table dust, as dust in cotton mills and flour mills; animal dust, 
as dust in felt hat manufacturing; organic dust, as coal dust; 
and municipal dust, as the dust from city streets. 
We plan to make a thorough study of each one of these classes 
of dust. In connection with this work, branch studies have al- 
ready been inaugurated at Wilkes-Barre, Pa., at Meriden, Conn., 
and at Barre, Vt.; and as I have said already, we hope later to 
begin elsewhere three other branch studies on the three other 
50 classes of dust. We have not yet decided on the locations for 
these additional branches. 
We are also making researches among the cement workers at 
Hagerstown, Md. This work was begun primarily as a study 
of morbidity and sickness records, but was later developed into 
a study of the effect of working in cement upon the employees 
in the cement plant. 
A great deal of research has been carried on in regard to carbon 
monoxide. The Bureau of Mines has done some very excellent 
work on the question, under the direction of Dr. Sayers, but 
there are still numerous problems in regard to carbon monoxide 
-especially its chronic effect-that have not been thoroughly 
worked out. Touching these problems, we are just beginning 
some investigations, which will extend over a considerable 
period of time, to determine the chronic effects or chronic results, 
of exposure to carbon monoxide over a long period. This work 
will include physical examinations of men employed in the 
various industries in which they are exposed to carbon monoxide; 
chemical examinations of the atmosphere, or air, to which these 
men are exposed; blood studies, and lastly, laboratory studies of 
animals exposed to known quantities of carbon monoxide over 
given periods of time. We are just at present studying men who 
are engaged in the automobile industry-that is, who work in 
repair shops and garages. We have now a group of about eighty 
men upon whom we are making physical examinations and from 
whom we are taking blood for examination, and we expect to 
enlarge the group considerably very soon. 
The importance of correct bodily posture in its relation to 
health has long been known, but there is quite a variety of 
opinions as to what constitutes correct posture. It is the general 
opinion that there is a time in the life of every normal individual 
when he habitually assumes a correct bodily posture; perhaps 
this may be at some time during his childhood, and as he grows, 
various factors contribute to change his good posture to an in- 
correct or poor one. With this idea in mind, together with the 
conviction that a good many trade processes are conducive to 
harmful posture, we are undertaking a study to determine what 
posture is correct, and later on we will develop this study into a 
study of the harmful postures observed among employees in 
industries. At present, we are making observations among 
children, in the hope of arriving at a definite idea of correct 
51 posture. We expect during the coming year to launch out into 
the larger study of posture in the various industries. 
The influence of fatigue in industry is almost inestimable. 
If we knew the nature of the changes in the human body that 
cause fatigue, we might test this or that individual and regulate 
his work in order that too great a strain should not be put upon 
him. We do know that sudden physical changes take place in 
connection with fatigue-that the stored-up fuel of the body, 
glycogen, is used up; that certain products, called fatigue bodies, 
such as lactic acid, are generated; and that urine examinations 
indicate that certain kinds of work are more arduous than others. 
But as to measurement of the amount of fatigue or of the effect 
of atmospheric conditions, such as humidity and high and low 
temperatures, we are only beginning to open the doors of this 
branch of physiological research, and have not yet achieved 
anything that is very definite or very satisfactory in regard to its 
questions. 
At the present time we are making some studies with sodium 
di-hydrogen phosphate. You are perhaps familiar with the 
literature on this substance. Some investigators, Germans, I 
believe, claim a good deal for it in the way of preventing fatigue. 
It seems that this salt was used during the world war, being 
given, in small doses, to some of the German shock troops; and 
it was maintained that the shock troops that were given the 
salt came out of battle much better than those to whom it was 
not given. 
We have under observation just now a group of about 125 
people in the Post Office Department who do card perforating- 
designating certain data upon certain cards, by means of per- 
forations. Records have been kept of some of the people in this 
group for as long as ten years back. From these records we 
know just what has been the average production of each of these 
individuals. We are now giving them small doses of sodium 
di-hydrogen phosphate to see whether or not it has any effect 
upon their productive power and upon the amount of fatigue 
which they experience from production. We are, of course, going 
to run blanks on some of the workers, letting them think they 
are taking the dose, sometimes when they are not, in order to 
see whether there is a psychic influence also at work. The study 
will extend over a considerable period of time. 
In a volunteer group composed of about twenty-five or thirty 
52 laboratory workers in the Hygienic Laboratory in Washington, 
who have volunteered to use the salt, we have found that there 
is a decided mental factor present. If the workers think they 
are getting the salt, they do not become nearly so tired as when 
they know they are not getting it. 
As you know, in certain doses this salt has a mild cathartic 
effect, and we aim to give a dose that is just a little less than 
a cathartic dose, so as not to produce catharsis. 
The Office of Industrial Hygiene has undertaken, at the re- 
quest of the American Engineering Standards Committee, the 
formulation of an industrial sanitation code. We have got 
together a tentative draft of the first outline of this code and 
have submitted it to various industrial concerns and to the 
Sectional Committee that has been formed for the consideration 
of a code. Comments on the outline have been received from 
some of the industrial concerns and have been tabulated; but 
the tabulations have not yet been written up and sent out to the 
members of the committee. We expect, however, to send them 
out very shortly. It is our hope to prepare an industrial sanita- 
tion code that will be of service to the various industrial plants 
and to the various legislative bodies of the states in their con- 
sideration of the matter of standards for various industries. 
The code that we propose to formulate will be in no way 
obligatory, as you know, because the Federal Government has 
no right to enforce the use of such a code. To do so is purely a 
state police power. We simply prepare the code with the idea 
that it may furnish suggestions to legislative bodies of states or 
cities or may be used by the plants themselves as a standard 
source of reference. 
There is another branch of our work which may appear in- 
significant to those on the outside, but it really demands a large 
share of our time-the consultation service, or the work of re- 
plying to inquiries from those who are seeking help or informa- 
tion in regard to health questions. 
You would be surprised at the number and the variety of in- 
quiries which we receive. A man in Mexico wants to know 
about the hazards of a cotton mill, or a lawyer in St. Louis wants 
to know the effect of arc welding on the eyes, and so on, and so 
on. We have sometimes from three to five such inquiries a day, 
and it often requires the time of one man for three or four days 
to assemble the data necessary for adequate replies. Certainly, 
53 if a man writes and asks such information from us, it is our duty 
to try to tell him all we know, and to assemble all the informa- 
tion from the literature that we can find on the subject con- 
cerned, putting it in compact form, so as to give the inquirer our 
own opinion and the opinions of the various authorities on each 
particular subject. This work consumes quite a good deal of 
time; but we are very glad to render the service, and we answer 
the questions very carefully and as quickly as we can. 
We are also making investigations to ascertain the effect of 
various degrees of illumination upon the eyes of workers. We 
have made an exhaustive study with reference to the standards 
of illumination in the two main post offices here in New York; 
the report of the study is now in the printing office, and we hope 
to have it out in a month or two. 
The field of research in connection with industrial hygiene is 
so broad and varied that the Public Health Service cannot cover 
it all, and the door is open for the various industries themselves 
and for the universities and other private research organizations 
to take up such problems as they may see fit to study. 
The great aim of industrial hygiene is not only to reduce the 
hazards of disease and the dangers connected with some of the 
most objectionable work processes, but to raise the standard of 
health of the ordinary worker at the ordinary job; yet in the 
case of specific industrial diseases, half the battle we have had 
to wage has been to get the ordinary, everyday rules of health 
observed. 
I have given you briefly an idea of what we are attempting 
to do. We feel that our especial and particular work is to make 
investigations of the various problems that confront industrial 
physicians and industrial plants. 
Chairman Clark: I am always interested to hear from head- 
quarters how things should be done. I am always very glad to 
hear from any one from the Public Health Service because I 
am continually being asked questions about these health people. 
The last question was the day before I left, when our plant en- 
gineer said to me, "For God's sake, what are we going to do 
with those coffee warmers that they made us put in ?" I am 
sure I don't know why they were put in; but it was a sanitation 
law of Massachusetts that there should be coffee warmers, in 
spite of the fact that we serve hot coffee from five different 
points in the factory every day. 
54 The next speaker on our program is Mr. Magnus W. Alex- 
ander, Managing Director of the National Industrial Conference 
Board of New York. That is all that it is necessary to say, 
gentlemen. Mr. Alexander. 
"The Conference Board of Physicians in Industry" 
by Magnus W. Alexander 
Mr. Magnus W. Alexander: As civilization developed and 
customs changed, there arose new relationships between persons 
in their basic human activities. Early in the industrial life of 
the world, all production was carried on by hand labor, and 
later by simple machine processes, at first by individuals and 
then in small organizations. The home was the usual work 
place, and the members of the family constituted the majority 
of the workers. The master workman, who was the employer, 
the owner and the salesman, lived and labored next to his work- 
men, with whom he maintained a natural and intimate relation- 
ship. Their joys and sorrows, their health and ills, were his 
concern, as they had equally an interest in their master's life 
and labor, and the master and man problem was simple in char- 
acter and solution. The master was the teacher and the friend 
of his few working men, and especially of his apprentices whom 
he tried to introduce into the arts and mysteries of the trade. 
That time has passed forever. With the invention and the 
use of power machinery and the discovery and application of 
new and improved processes of production, industry gradually 
moved out of the home into special places and localities devoted 
primarily to productive purposes. The intimate small family 
of a few workers in the home or in the workroom expanded into 
the personally more unrelated aggregation of larger numbers of 
men and women, brought together in larger buildings and often 
under different roofs, yet still under single employer leadership, 
but with naturally less personal acquaintance and less personal 
interest between the employer and his workers. 
As machine production and specialization of manufactures 
grew still further and finally developed into the heretofore un- 
dreamed of volume of production and massing of workers that 
the last few decades have seen, new and vastly different social 
and economic relationships between employers and employees 
arose. Thousands and tens of thousands of men and women 
were brought together into common work, under either indi- 
55 vidual or corporate management, and the relationship between 
employer and employee in large scale production has now be- 
come a direct work relationship rather than a personal one. 
The household economy was replaced by the factory economy 
with its intenser pace and requirements, but also with less stimu- 
lating and more monotonous tendencies. 
To illustrate this intensity of production-in the United States 
in 1850, there were about one hundred thousand manufacturing 
establishments in which nearly one million workers produced 
salable goods at a value of five and one-third billions of dollars. 
Only seventy years later, by 1920, three hundred thousand 
manufacturing establishments were the beehives for over ten 
million workers whose production in that year sold for about 
sixty-two billions of dollars. And the end of this tremendous 
growth is not yet in sight. What an enormous change ! And 
what enormous social and economic consequences have grown 
out of it. 
As already indicated, many individual employers or those 
directly representing corporate ownership and control, ob- 
viously cannot now know all their employees and take the same 
personal interest in them that they had formerly taken, nor can 
they expect in turn the same personal interest on the part of the 
workers in their employers. The joys and sorrows, the health 
and ills of each employee in the larger employments can no 
longer receive the personal attention of the employer except 
through his managerial assistants and foremen. 
But this disturbed balance between the employer's expecta- 
tions of performance from his workers and his personal interest 
in them began to right itself when far-sighted industrial man- 
agers realized the growing importance of restoring in some 
manner and measure the formerly intimate and natural relation- 
ship with their employees, and so there developed new efforts 
in the course of industrial operation that concerned themselves 
with the individual worker no less than with his work and en- 
deavored to make the work life of the employee more pleasant 
and contented and his attitude toward his manager and em- 
ployer more like that of bygone days. 
But these efforts also focused in making management con- 
tribute its proper share and personal attitude and performance 
toward the workers, and thus tend to give to the soulless, or 
alleged soulless, corporation a new and recognizable soul. 
56 In order to accomplish this purpose, the architect was called 
in and asked to provide more adequate light and cheerfulness 
in the construction of workshops. The engineer was directed to 
so protect machinery and work places that personal injuries to 
employees would be eliminated, and the superintendent and 
foremen were enjoined to recognize the human equation in 
the work relationship and to inject all rightful human con- 
sideration into their daily contact with the workers. 
Finally, men and women especially trained and qualified for 
the task were added to the supervisory staff of corporations and 
entrusted with the improvement of work conditions, prompt 
attention to alleged grievances of the workers, adequate redress 
of grievances found to be justified, and encouragement of the 
workers and their proper advancement. Call it welfare work, 
call it industrial betterment work, or call it downright humane, 
intelligent management; it is now generally conceded that such 
effort, by whatever name, but along effective lines, is a necessary 
part of a well functioning industrial organization. 
Modern industry could develop on its material side into 
present day tremendous mass production and effectively sus- 
tain such mass production by a large number of workers only 
because that development was paralleled by these efforts on 
the human side of industry. This development was further 
aided because employers more fully realized that they as citizens 
in responsible positions of leadership had social obligations to 
their employees and the community in which they labored and 
lived, no less than economic obligations to those whose money 
was placed in their trust; and to society which gave to them the 
opportunity for productive enterprises and protected them in 
their rightful acts by the law of the land and the agencies of the 
government. 
Once this new conception had developed, there was added in 
recent years to the architect, the engineer, the superintendent, 
the foreman and the personnel manager, all of whom had been 
called into service in order that industry might not neglect its 
human duties while it was working out its material destiny, the 
physician as one especially qualified by training and experience 
to understand human nature and to promote the health and 
welfare of the workers. 
Let it be said right at the outset that the physician in industry 
has amply justified the trust and responsibility placed in him 
57 and has proved himself a necessary, integral part of an industrial 
organization employing considerable numbers of men and 
women. 
It was during the period from 1908 to 1910, in the midst of an 
active life as an engineer and manufacturer, and in response to 
an appointment from the Governor of Massachusetts, that I 
was privileged to assist in framing the workmen's compensation 
law for that state, one of the early laws of that nature enacted 
and put into operation in the United States. In consequence of 
this experience, I became thoroughly impressed with the neces- 
sity for adequate attention to the health and well-being of in- 
dustrial employees by medically trained men and women, and 
with the desirability of thus meeting the new and potentially 
expensive obligations arising out of workmen's compensation 
laws. The introduction of the physician into the management 
personnel in industry seemed to be the right step. 
Persuading first the large corporation with which I was then 
actively connected to establish medical service in its plant with 
a qualified physician in charge, I became and have ever since 
been a strong and devout advocate of the value and necessity of 
such extension of industrial activity on its human side. Out of 
this conviction and out of this new experience with the physician 
in industry developed the thought that this new effort for con- 
sideration of human life and limb, for the cure of diseased minds, 
real or potential, and for the growth of a healthy mental attitude 
on the part of the workers, might be led into channels beneficial 
alike to employers and employees by cooperative deliberation 
and action of physicians in industry. 
It was in response to my request to fifteen industrial corpora- 
tions that I met in this city on the fourth of April ten years ago 
the medical directors of as many industrial enterprises. Most of 
these physicians were then unacquainted with each other and 
most of them felt that they were more or less pioneering in a 
new field of endeavor which, however, fortunately had already 
had its first cultivation by one whom I delight to call the father 
of medicine in industry, Dr. W. Irving Clark, of Worcester, 
Mass. 
Refusing to be overawed into silence as the only layman in 
such a group of austere men of medical science, I submitted this 
plain proposition to the conference, and it seems to me as if I 
had said it only yesterday: "You physicians in industry are 
58 devoting yourselves to the healing of the wounds of the body 
and the fancied or real ills of the minds of industrial employees. 
You are endeavoring to bring the incapacitated as speedily as 
can be back to productive usefulness and wage-earning power. 
You are concerned in the placing of employees in only such 
positions of work and environment as can adequately be met by 
the physical abilities of the workers. As an injured limb or an 
overwrought mind is treated, or an unconscious worker is resusci- 
tated, there must be one best way of doing this, considering all 
the circumstances surrounding each case. By pooling your 
knowledge and experience, you surely can find and agree upon 
these best ways, and industrial management is keenly desirous 
that there be found a reply both out of humane consideration 
for the employee and as a satisfaction and economy to the em- 
ployer. If my premises are right, should you not associate 
yourselves in a simple, practical and effective manner for this 
task ?" 
I remember as I went to the meeting and was talking to a man 
about the purposes of the gathering, he said to me, "You can 
never get two doctors to agree." I assented by saying that I 
should not endeavor to make two doctors agree, but I hoped to 
make fifteen doctors agree-and they did. 
The response to the suggestion made to that group of doctors 
was the organization of the Conference Board of Physicians in 
Industry just ten years ago, and its effective functioning since 
under the able and stimulating leadership of that respected 
surgeon, medical advisor and man, my good friend, Dr. John J. 
Moorhead, of New York City. 
With a limited membership of thirty earnest, able and splen- 
didly cooperating medical directors in industry, this Board has 
met in whole-day sessions about every second month and has to 
date held forty-one conferences. It is an honorable record of 
achievement upon which this Board can look, and it was all 
accomplished in a quiet way without self-seeking and without 
clamor for public notoriety. 
Privileged as the only layman to sit regularly in these meet- 
ings, I could clearly sense the value of the work done and even 
understand many of the discussions because they were carried 
on neither with the mysteriously wise looks nor in the obscure 
jargon of a dead language so often encountered by laymen when 
they are professionally dealing with some physicians. 
59 Time will not permit me to discuss in full the splendid con- 
ference work of this group of physicians and the practical value 
to industry and society that has come from it. I can speak now 
only of the more fundamental problems which these physicians 
have considered and the procedures which have been standard- 
ized by reason of their deliberations. 
The first subject under consideration concerned itself with 
first-aid by laymen to injured and sick persons and with the best 
methods of training selected men in factories and offices in this 
work. The Board accordingly devoted considerable time to the 
formulation of simple but effective first-aid instructions and 
gave special attention to effective means of resuscitation of 
persons who had become unconscious because of electric shock, 
suffocation or drowning. The rules adopted distinguish them- 
selves for their brevity and clearness as well as their effectiveness 
and the elimination of technical terms usually unfamiliar to the 
layman. 
Naturally, the kind and contents of first-aid outfits became a 
part of this discussion and led the Board to standardize a set of 
medicines and medicaments adequate for emergency treatment 
and fairly safe in the hands of untrained men. These first-aid 
paraphernalia met the requirements for general industrial work 
as well as those of states and municipalities that have legislated 
on this subject. 
The extent to which the Board has succeeded in both these 
matters is evidenced by the wide use now made in and out of 
industry of these first-aid instructions and provisions. By their 
effective organization and training, first-aid men were found in 
many industrial establishments to be of valuable assistance to 
the supervising physician in case of need, and the active regular 
staff of the physician could therefore be held within smaller 
numbers. Effective organization, however, requires that these 
first-aid men record fully each first-aid treatment given by them 
and that they promptly report to the physician in charge in order 
that he may have an opportunity of checking up each case and 
guard against harmful consequences. 
The Board then turned to the problem of determining the 
physical fitness of applicants for work. After much study and 
discussion of this important subject, standardized methods of 
making and recording physical examinations were promulgated 
and adopted. It was determined that applicants for employment 
60 who had otherwise been found acceptable to the employment 
officer should there and then be examined for physical defects 
and should not be allowed to work except with the approval of 
the examining physician. The latter must, however, at all 
times, endeavor to impress upon these applicants that the 
physical examination is made primarily for the purpose of 
assisting them in finding work suitable to their physical condi- 
tion and not to prevent them from finding work. 
The ultimate object of physical examination of the worker is 
to place him where he can work to the best advantage and where 
he would be neither a danger to himself nor his fellow-workmen 
nor to property. When this is once made clear to employees in 
industry, the first natural opposition to compulsory physical 
examination as a condition of employment soon gives way to 
satisfaction for being helped and benefited. The tact and skill 
of the examining physician usually determine the attitude 
of the worker in respect to this matter, and it is to the credit of 
these physicians that opposition to physical examination in 
industry has practically disappeared. 
To do this work well, the physician in industry must make him- 
self fully familiar with the nature of each job in the plant under 
his medical care in order to determine the specific character of 
physical examination and re-examination that will best, but 
also in the simplest manner, meet the requirements of the plant 
for man-power. Many times in the course of their study of labor 
processes, these physicians have been able to help the superin- 
tendent in removing inherent risk to workers by changing or 
simplifying the work or guarding more fully the machinery. 
In fact, the physician in industry is in part also a safety engineer, 
but his value in this respect extends beyond the mere safeguard- 
ing of machinery, fixtures and processes, to the establishment 
and maintainenance of sanitary work conditions and adequate 
lighting and ventilation. In all these matters, the Conference 
Board of Physicians in Industry has rendered valuable service 
to industry and those engaged therein. 
One of the most important activities of the Board is the full 
and frank exchange of experience and opinions by the members 
at Board meetings, thus making the aggregate knowledge avail- 
able to each. These intimate discussions have led to agreements 
in respect to efficient methods of procedure and technique of 
treatment of injuries and sickness, the uniform classification of 
61 physical findings, and to minimum standards of medical work 
in industry, below which no industrial organization can afford 
to go without ultimate loss to the efficiency and efficacy of its 
medical service. 
In the administration of workmen's compensation laws, the 
physician in industry has a peculiar and important interest. 
First and last, in my judgment, the attending physician, or, in 
case of dispute, the state's impartial physician, will determine 
how far and how long compensation benefits are to accrue to 
an injured worker. By his judgment and the quality of his 
treatment of injured persons, the physician, after all, determines 
when a worker is incapacitated fully or partially for work, and 
when he will again be physically fit to undertake his regular 
work. In other words, it is the physician who practically settles 
what expenses the employer must shoulder when one of his em- 
ployees suffers injury arising out of and in the course of his em- 
ployment, and often he influences to a large degree the final 
determination as to whether a claim for compensation benefits 
under the law is justified. Not only knowledge and skill and 
good judgment but also a keen sense of justice must therefore 
be the attributes of a physician in industry in order that he may 
serve well and faithfully the employees as well as the employer. 
Again, the Conference Board of Physicians in Industry can 
point with great satisfaction to the personnel of its membership 
whose frequent discussion of workmen's compensation cases are 
actuated by a keen sense of justice and equity. Much time and 
thought has been devoted by the Board to the problems arising 
out of workmen's compensation laws, and the Board has been 
of great assistance to the National Industrial Conference Board 
in its comprehensive study of the medical phases of workmen's 
compensation laws embodied in the Conference Board's recent 
Research Report No. 61. 
The Secretary of the Conference Board of Physicians in In- 
dustry, Dr. F. L. Rector, who is also a member of the research 
staff of the National Industrial Conference Board, has, in this 
dual capacity, been guiding this investigation and much credit 
for it belongs to him; as much credit also is due him for his very 
efficient service to both organizations. 
From the study of the medical phases of workmen's compensa- 
tion laws, certain discrepancies and unsatisfactory practices have 
been gathered. The Conference Board of Physicians in In- 
62 dustry is now studying these results in an attempt to formulate 
provisions applicable to all compensation laws, which if enacted 
would tend to greater uniformity in these laws and greater justice 
as between employers and their injured or incapacitated em- 
ployees. 
At first, there developed, no doubt, a feeling among these 
physicians in industry, and repeatedly expressed opinions in 
Board meetings indicate this, that in time their work should 
be recognized as a special branch of medical practice. In the 
more recent meetings of the Board, however, I have gathered 
the impression that these physicians are now realizing that the 
difference between their work and that of the general medical 
practitioner does not lie in the medical and surgical work per- 
formed by them nor in their diagnostic activities, but essentially 
in the administrative character of their work. I take it that the 
principles of treatment of disease and injury are the same 
whether applied to workers in industrial establishments or to 
persons in the general population. The relationship of the phy- 
sician in industry to the injured or incapacitated employee, on 
the other hand, is quite different from that of the medical prac- 
titioner to his personal client. The duties and work of the former 
require a knowledge of the laws of social and industrial eco- 
nomics and of administrative problems in the conduct of pro- 
ductive enterprises that are not required of the general prac- 
titioner. 
In order to identify clearly and concisely the physician who 
engages exclusively in medical practice within industry, the 
Board adopted the following definition: 
The physician in industry is one who applies the principles of 
modern medicine and surgery to the industrial worker, sick or 
well, supplementing the remedial agencies of medicine by the 
sound application of hygiene, sanitation and accident pre- 
vention, and who in addition has an adequate and cooperative 
appreciation of the social, economic and administrative prob- 
lems and responsibilities of industry in its relation to society. 
It is evident to me, and I think it is evident to all of you who 
are coming in contact with these problems, that the physician 
has found a permanent place in the industrial system. Whether 
he serves solely a corporation or extends his efforts and work 
over a number of smaller units of employment does not mate- 
rially alter his functions. In either case, he must eventually 
take an active part in the health problem as it affects the com- 
63 munity in which the productive processes are carried on. The 
health conscience of the country is being aroused as never before 
to the present inadequacies of public health administration, and 
this is not said in any derogatory spirit or criticism of that health 
service. Communities are more and more comingto realize the 
value of improved sanitary standards and health conditions and 
are spending increasing amounts for their achievement. The 
physician in industry can carry these ideas into the minds of 
the workers who themselves form a large part of the community 
population, so that these workers will assist in the maintenance 
of sanitary homes, streets and public places, and in the proper 
safeguarding against necessary hazards in private and public. 
Medical work in industry has demonstrated its economic 
value, the full extent of which cannot be measured merely by 
the usual standards of measurement. Medical work in industry 
is rendering an essential service in helping to build up a strong 
and virile man power in industry which is both an industrial 
and a community asset. I am looking forward to the time when 
the physician in industry will become a most valuable assistant 
and associate of the industrial manager whose attention and 
efforts will have to concern themselves more and more with the 
human equation in the productive processes of industry as in- 
dustry grows more complex and more intense. 
I look upon the Conference Board of Physicians in Industry 
as an organization best fitted to elevate the status and influence 
of its members and their associates outside the membership, 
and even more important, I look to that Board for the rendering, 
through its members, of that personal industrial and community 
service to which I have referred. 
Chairman Clark: It is very splendid to hear such a wonder- 
ful exposition of the work which this Board of ours has been 
doing in the past ten years, and I think that we all realize that 
the basis of it is the enthusiasm and the interest which Mr. 
Alexander has given us in this work and the splendid assistance 
which he has given us in every possible way. 
The next speaker on our program is Dr. John J. Moorhead, 
Professor of Surgery at the New York Post Graduate Medical 
School and Hospital, New York; also the Chairman of the Con- 
ference Board of Physicians in Industry, and, I might add, a 
good surgeon, a good soldier, and a very charming gentleman. 
64 "Traumatic Surgery: Its Development and Relation to 
Industry" 
by Dr. John J. Moorhead 
Dr. John J. Moorhead: I feel somewhat embarrassed in 
occupying this position on the program, because you will notice 
that I am sandwiched in between two laymen. One of them has 
already spoken to you very directly and very positively, as he 
only can, and I am quite sure that Mr. Cheney will do likewise. 
My embarrassment is not any lessened because on my right 
is my former professor, and inasmuch as I have always sought 
to be very well prepared when I recited anything in his hearing, 
I will undertake to provide myself now with a very accurate 
"crib." 
The topic that has been assigned to me for this evening is 
rather wide, and if I touch upon it in rather a sketchy manner, 
please blame the clock rather than my desire to encompass the 
entire topic, "Traumatic Surgery: Its Development and Re- 
lation to Industry." 
The development of any art or science primarily is the out- 
growth of necessity, the following out of an economic law that 
supply must equal demand. Stated in another way, we can say 
that progress in every human or mechanical endeavor is based 
on the stern law of necessity. 
If thus we are to postulate the development of traumatic 
surgery, we begin by stating that from prehistoric times the 
members of the human race have been subject to accidents and 
injuries, and among all races, civilized and uncivilized, were 
those by natural aptitude or experience who were set apart to 
bind up the wound, to replace the broken bone, to trephine the 
skull, to allay the fever of poison, to overcome the effects of 
attack by beasts of the forest, or to care for those injured in 
battle. Human aid for the injured was antecedent to human 
aid for the sick, and in the early days as now, was predicated 
upon knowledge and aptitude less mystical, less empirical, less 
fantastical than that devoted to the care and treatment of the 
sick. Hemorrhage from a severed vessel due to a crushing in- 
jury to be life saving demanded just as active positive treatment 
in the stone age as it does now. No priestly incantations, no 
ghostly dance, no exhortation of the devils, no beating on tom 
toms could or can heal a broken limb or replace a dislocated 
joint. Hence an outstanding feature of traumatic surgery from 
65 earliest times to the present has been the application of the 
mechanics of surgery, the external aids necessary to wound 
healing, to bone setting, to joint reduction. 
In prehistoric days the badly wounded, the potentially crip- 
pled, were put to death by methods then known to be the most 
merciful. Later, those doomed to lasting disability were as- 
signed special tasks of a non-laborious type, and in some in- 
stances were developed by their own experiences into craftsmen 
skilled in caring for those subsequently injured. Thus was initi- 
ated among all races a group specially selected to care for the 
injuries of their fellows, and their chief need was in time of 
tribal warfare. 
Hence, war surgeons were the group who made the earliest 
contributions to the knowledge of traumatic surgery, for war- 
fare has always provided the mass of men needed to supply the 
mass of material. It is a safe assertion that in any war there 
will occur injuries of a type seen in any community, however 
complex or specialized the industry of that community may be. 
Following this era of knowledge gained in war on land and 
sea, came the era of knowledge gained in such peace time pur- 
suits as shipping, tilling the soil, leveling the forest. Later still 
came the era of transportation, of mining, of machinery, and 
thereupon traumatic surgery entered upon that phase of develop- 
ment which attracted to it, of necessity, attention from surgeons 
the world over. 
Half a century ago surgery in general consisted very largely 
in the treatment of injuries, mainly wounds, fractures and dis- 
locations. Hernia operations were also performed; stone in the 
bladder was removed; superficial tumors were excised; the abdo- 
men and chest were tapped; varicocele and aneurisms were 
ligated. But aside from these, the surgeons of our civil war 
period were all of them engaged mainly in the care and treatment 
of the injured. The era of anesthesia and antiseptics broadened 
the surgical field and soon the era of abdominal exploration 
appeared, and soon a group of surgeons arose who invaded all 
the closed cavities hitherto regarded as inaccessible. 
Then began that era of surgical development started by the 
mechanical skill and diagnostic acumen of the surgeon, ably 
aided by the assistance of the pathologist, the bacteriologist, 
the radiologist, and later the biological chemist and then the 
radium expert. The anatomist was one of the foundation stones 
66 of this structure, the pathologist another, but soon the biopsy 
came to be regarded as the best teacher of all until a mass of 
collected information demonstrated that certain cases regarded 
as strictly surgical were in reality non-surgical and were better 
cared for by non-surgical means. That is the era in which we 
are now living, and general surgery has not invaded any new 
field since the close of the Great War, and indeed has receded 
from some fields hitherto regarded as suitable only for surgical 
harvesting. 
Up to the time of our Civil War (1860), traumatic surgery, 
as already stated, very largely engaged the attention of all our 
surgeons. Numerous devices for the management of fractures 
and dislocations were in use, setons for infected wounds were in 
vogue, amputations were more skillfully and far more speedily 
performed than they are today. The post Civil War period 
gave a great impetus to traumatic surgery, and this lasted until 
about 1880, when abdominal surgeons began to attack the ap- 
pendix with a vigor only exceeded later by the nose and throat 
surgeons in attacking tonsils and adenoids. 
When the general surgeon entered this newer field, traumatic 
surgery was promptly relegated to a group of younger and less 
experienced surgeons and abjectly fell into a decline. About 
this time the railroad era in our country began a noteworthy 
expansion and out of stern necessity was created that group 
known as railroad surgeons, who at first were selected for their 
geographical relationship more than for their surgical knowledge. 
Later, mining and engineering enterprises were staffed with 
surgeons for similar reasons and in many cases the medical men 
thus selected were derelicts or failures in other locations. Here 
again necessity made it requisite to fill the demand, and trau- 
matic surgery was not enhanced by appointees of this class. 
Later still, a manufacturing era, an industrial era, arose in which 
large groups of men were working in certain communities and 
the hazards of their employment made it necessary to provide 
prompt medical aid to care for the injured. Hence appeared the 
plant surgeon to rank with the railway surgeon, the mine sur- 
geon, the ship surgeon, all of them in reality war surgeons, 
because engaged in the relief of those injuries incidental to 
industrial strife as compared with military strife. 
Coincident with this industrial development as manifested 
by railroading, mining and manufacturing, there appeared a 
67 new accident hazard affecting not only employees in an industrial 
community, but the entire population even in rural districts, 
and this great factor was and is the automobile. With the 
advent of this new trauma-producing agency, necessity again 
made demands and general surgeons now were once again in- 
teresting themselves in the outcome of injury because many of 
these automobile injuries produced major effects requiring 
expert care and attention. 
A further stimulus to traumatic surgery was the enactment 
of compensation laws which required a checking up of proce- 
dures, a tabulation of end results, a quasi-judicial form of ex- 
amination by more or less well-informed medical civil service 
appointees. Suits for malpractice, especially in fracture cases, 
also were becoming more numerous so that many general prac- 
titioners feared to undertake the care and treatment of a certain 
group of injuries lest even their best intentioned efforts might 
become an object of scrutiny by a hostily disposed jury. 
Then seven years ago this week our country entered the Great 
War and virtually our whole profession the world over became 
for a time traumatic surgeons. Nothing of this sort had ever 
occurred before nor probably ever will occur again, and from 
it an immense experience has been gained which clarified and 
standardized procedures hitherto none too well understood or 
applied. 
Nothing revolutionary in traumatic surgery developed out of 
this vast experience with the war injured; no specific for wound 
treatment has appeared; no sovereign remedy for infection has 
been compounded; no certain method has been devised for the 
cure of broken bones, and osteomyelitis and the streptococcus are 
almost as unconquered as ever. There is no Surgical League of 
Nations open to membership that can have for a slogan Univer- 
sal Freedom from Infection; but there have been innumerable 
gains, and to me the chiefest of them all is that the knowledge 
of the care of the injured has been shown to be possessed by 
relatively few of our profession otherwise well equipped medi- 
cally and surgically. Second, is the recognition that the care of 
the injured requires a follow up and a follow through beyond 
that required for any other class of patient. Third, is the recog- 
nition that traumatic surgery is special surgery requiring a 
background of general surgical experience just as extensive and 
just as profound as that required by the highest demands of 
68 general surgery. And fourth, is the conviction that the segre- 
gation in hospitals of traumatic cases and the teaching of this 
subject should be delegated to groups of surgeons who are vir- 
tually specialists in this branch of general surgery. 
We are now in the post-war period with ample opportunity 
to use the surgical fruits of victory in the care of those injured 
in civil life. Physicians who are caring for special groups in 
industry are doing a pioneer work in demonstrating that in- 
tensive medical and surgical care can accomplish much in 
promoting that grade of health and well-being that is synony- 
mous with functional activity. 
Men of this class are virtually human engineers who appraise 
the human machine before it is installed. They are inspectors 
who examine the human machine to measure its efficiency. 
They are repaiimen to restore it after physical breakdown. 
This combination of appraisal, inspection and repair summates 
the ultimate aim of medicine the world over, for it comprises the 
acme of professional endeavor, namely, prophylaxis and cure. 
Groups of this kind mould the community physically to a high 
health standard in that by example they carry the gospel of 
health far outside the limits of their respective industries. The 
development of traumatic surgery has been aided very largely 
by this sort of industrial surgery, for the intensive work of the 
plant surgeon has demonstrated that the maximum of initial 
care and attention means the minimum of disability. In war, 
the aim is to bring the injured back to the firing line promptly 
and with effectivity restored; the same precept guides the sur- 
geon in industrial warfare. 
The statistical information made possible by the work of 
industrial surgeons has an important value in determining the 
efficacy of certain types of treatment and nowhere is there better 
opportunity for follow-up or follow through of cases. Industry 
thus has demonstrated the need for zealous care of the injured 
to the end that man power be conserved and the community 
preserved. The human conservation efforts of industrial sur- 
geons are an example for other surgeons, and indeed the high 
standards established by progressive industry for the care of its 
injured should be the standard aimed at by all surgeons. 
We are entering upon an era of rapid development in trau- 
matic surgery, of advance in the care of such common injuries 
as wounds, burns, sprains, synovitis, dislocations, fractures. 
69 The surgery incident to the knee joint is literally opening up 
since our attack on that joint is no longer interdicted by fear 
of infection. Our disability period in synovitis and allied in- 
juries is halved by immediate aspiration and immediate mobil- 
ization. Our fractures of the femur are now up and about at 
a period when hitherto they were still abed in plaster casings. 
Our joint fractures are functioning at a period when hitherto 
they were as yet immobilized. The injection of own blood or 
own blood-serum is on the way to curing some infections even 
if they cannot be cured by intravenous medication of antiseptic 
dyes or foreign proteins. Our deformities are yielding to cleverly 
devised and skillfully executed plastics. Our amputation and 
crippled cases are being fitted to new jobs with no lessening of 
earning power. Our hand infections are more boldly attacked 
and hence are more effectively treated. These things are the 
outgrowth of centralized intensive care that mean much to the 
injured and mean much to those who would share in the ad- 
vances made possible through concentrated experience. 
Progress is noteworthy also in the final steps toward full func- 
tional recovery in that physiotherapy has become a recognized 
aid. It should not however become an end form of treatment, 
but on the contrary, a coincident form of treatment, thus seeking 
to prevent rather than cure the joint stiffness, the atrophy, the 
deformity so prone to occur even after a most carefully planned 
and skillfully performed operation or initial treatment. The 
final step is the induction of the crippled into new fields of em- 
ployment in their own industry, and this can be accomplished 
to a surprising extent by taking advantage of the numerous 
appliances now at our disposal. The aim of traumatic surgery 
is first safety, and second conservation-and indeed that is the 
aim of all surgery and all medicine. 
You men with direct contact and direct early care of the in- 
jured have a unique opportunity to demonstrate the efficacy of 
immediate maximum treatment in its relation to a minimum 
of disability. You have the opportunity of demonstrating the 
efficacy of treatment during the period of enforced disability. 
Finally, you have the opportunity of demonstrating the end re- 
sults of treatment by the observation of your patients after 
their return to employment. I know of no surgical opportunities 
greater than these in the field of traumatic surgery and you have 
it in your power to render great aid not only to your industry 
70 and its community but also to your fellow practitioners who may 
profit from an experience so segregated, so easily recorded, so 
faultlessly subject to checking up. 
Traumatic surgery is to become the surgery of this era, in my 
opinion, so destined because so little standardized, so little 
really understood. So destined also because of stern necessity, 
for in no other branch of surgery is lasting disability so readily 
imposed by improper primary or secondary treatment. Rail- 
roading, mining and industry formerly provided the majority 
of injuries, but now all three combined do not equal those in- 
jured by automobile accidents. The age of aviation is soon to 
appear, so the prospects for taumatic surgery are far in excess of 
our knowledge and far beyond our present ability to cope with. 
Thus if industry is bound up with traumatic surgery, so you 
as surgeons in industry are bound up with the development of 
that branch of surgery which of necessity is engaging the atten- 
tion of general surgeons to an extent not hitherto deemed 
possible. 
Chairman Clark: We have now heard from the Public 
Health Service, we have heard from industry as a whole repre- 
sented by Mr. Alexander, we have heard from the surgeon, and 
now we are going to hear from industry from the point of view 
of an industrial manager. It gives me great pleasure to intro- 
duce Mr. Howell Cheney, of Cheney Brothers, South Man- 
chester, Conn., who will speak on "What Industry Requires of 
Medical Supervision." 
"What Industry Requires of Medical Supervision" 
by Mr. Howell Cheney 
Mr. Howell Cheney: I am afraid you have had a pretty 
good dose of talking today, even for physicians who are taking 
your own medicine, and now for a layman to attempt to pre- 
scribe is perhaps superfluous. Besides, Mr. Alexander has just 
read a paper containing everything I would have liked to have 
said, so that I am afraid there is nothing I can add to the elabora- 
tion and the illumination, and the scholarly detail that he put 
into its authorship. 
We are here to celebrate a great achievement. You are here 
as fathers-I am not sure but Dr. Clark is a grandfather of the 
idea on which this organization was planted. You have win- 
71 tered and summered with your managers. They have shared 
perhaps in your glories, if not in some of your defeats, and it 
may not be unnatural to think that you can come to them and 
ask them, man to man, what they think of us ? Have we 
done our job well or ill ? Is the future ahead of us clear, or is 
the way in darkness ? 
Doesn't that in itself indicate a healthy attitude towards this 
problem ? Doesn't it denote an open mind that perhaps is the 
best lever to get us out of a rut ? Doesn't it suggest a con- 
sciousness and a groping that, great as our achievements have 
been in the past (and I for one believe they have been unexpect- 
edly great), that the path ahead of us opens broader visions 
and greater fields of accomplishment than we have had any 
idea of in the past. 
At the commencement of our undertaking, many of us ap- 
proached it with the thought of creating a position of medical 
and surgical engineer to industry, the functions of which were 
looked upon as broadly as the title indicates. We conceived of 
it vaguely as a function of this department and this individual 
to treat the human problem from its physical standpoint, if not 
from the same angle, with the same obiective as we approached 
the maintenance of the physical equipment of the plant. 
We had an attitude-at least if I remember some of those 
earlier arguments, and I have heard the idea today still faintly 
re-echoed-that the physician in industry was the medical en- 
gineer; that it was his job to employ the best possible raw 
material, to get the highest possible degree of production out of 
it, and then to salvage, if he could, the wrecks of the industrial 
system. 
No, we none of us believe that today. We don't think of our- 
selves, and we don't think of these organizations as medical 
engineers. We have come back to the older and the homelier 
phrase of the "Physician to Industry," and we have come to 
look at him as a very human sort of fellow, and we have come 
to expect of him very much what you and I expect of our per- 
sonal physician. In industry, as in the life at large, we expect 
him to safeguard our living conditions. We expect him, in no 
indefinite terms, to maintain our joy and pleasure in life. We 
expect him to hold out a longer prospect of life and of working 
effectiveness by the enforcement of simple and plain rules of 
health, and not only to restore us to health when ill. In all of 
72 these matters, industry looks to you industrial physicians as 
personal advisors, as personal consultants. It looks to you as 
liberators, if you will, of the minds of the great community of 
industrial workers from the physical and mental fears which 
afflict us, as well as to free us from the disabilities and ills and 
pains which have so beset our progress for many a generation. 
By quitting the field of the medical engineer and by returning 
to the simpler field of the physician to industry, we have recre- 
ated and intensified the personal relation, the personal mission, 
the habit of an individual point of contact, without which a 
real physician must die. 
In its larger sense, how is this related to that magnificent 
story of industrial progress that Mr. Alexander laid before you ? 
What general relationship has it in the aim that we are trying 
to recreate in industry ? There is a wide term-"Industrial 
Democracy"-coming into general use. It is an inchoate term. 
We none of us know exactly what forms industrial democ- 
racy will take. But we think we are coming pretty clearly to 
know that the forms of a social and a political democracy are 
not the answer in their entirety to the problems of an industrial 
democracy. We know, without dispute, that an industrial 
democracy inheres in the central idea of every democracy; in an 
equality of opportunity; in the clearness of the path of promo- 
tion; in individuality and in the ability to impress upon our 
products and upon our surroundings our own creative energies, 
our own personalities. The industrial physician takes his place 
in that broad vision of an industrial democracy as the insurer 
and protector of the field of opportunity; the one who sets us 
free to pursue to that standard of physical effectiveness that, 
whether it be low or high in the individual, belongs to him and 
may not be taken from him by the quack or the charlatan or 
the bluff or the fake, or even entirely by his own ignorance. 
Perhaps in the privacy of this room we may confess to our 
personal knowledge that there is no class of our citizens that have 
been more exploited as to their bodies and their minds by the 
fake physician and the charlatan, than has the industrial worker. 
If the industrial physician can enter that field, he is a liberator 
in more senses than one. He is a beacon light in the insurance 
of an essential step to promotion, the first basis for any real 
industrial democracy. 
We have strayed a little from the path I endeavored to lay 
73 out in stating what industry demanded of you. Let us come 
back to the statement that industry first demands that you be 
individuals and that you treat us as individuals. But in asking 
you to cherish your individuality in your professional work, 
there is no reason why you should not approach your other 
scientific tasks in industry from the same point of view, and with 
the same scientific method that any impersonal problem is ap- 
proached. The first of these is in safeguarding the sanitary 
conditions which surround our shops. Here we approach your 
duty as an engineer and as a sanitarian. I say it perhaps with- 
out fear of being contradicted-we have talked about this field 
a great deal more than we have had solid accomplishments to 
our credit. 
The usual physician is impatient with the work of a sanitarian 
and of a public health officer. His task, his accumulating daily 
task, of studying disabilities and ills, so pursues him, that he 
doesn't find the time to center upon those researches and those 
investigations, upon which any sound basis of sanitation and 
public health must be built. We have speculated about indus- 
trial hygiene and sanitation. We have gone off on tangents, 
have investigated the microbes on shafts and the qualities of the 
dust created by the processes, but in actual progress our attain- 
ments to date are not very great, and here I hold industrial 
management equally responsible with the physicians. It has 
been all too slow in giving the physician opportunities to develop 
this science. 
I was, therefore, glad to hear from Washington tonight that 
they were starting to occupy this field, that they were doing a 
work which it was impossible for us to do. Only, if you will 
permit a digression, I wish that there might have been added to 
those seven dusts which were under investigation, the dust of 
ideas that has hung about this subject of industrial hygiene and 
occupational disease all too long. 
I had also a feeling of satisfaction, a feeling of sympathy, 
when I learned that you in Washington were actually applying 
to the post office employees some injections of an invigorating 
fluid. 
No, gentlemen, the most effective researches are not remote, 
they are immediate. We have got to make good first on those 
which are right under our noses. You have got to tackle our 
own personal problems and solve them. You are perfectly right 
74 in leaving to the public health officials at Washington the sub- 
ject of these broader investigations, but if you knew your shops 
as you ought to know them, and as we believe industry has a 
right to expect that you should know them, you have imme- 
diate, definite and vital problems before you that demand your 
personal attention. We want you to go to them, we want to 
point, before another decade, to more specific measures of ac- 
complishment in them. 
There is another field that perhaps is not so definitely com- 
prised within that term of research as it is within the statistical 
mastery of the details of your business. Until we come to have 
standards of measurement, a comparative yardstick of the 
effect of various occupational ills, the term of occupational 
disease will be just as hazy, just as shadowy, just as subject to 
abuse by every charlatan and by every enemy of our industrial 
organization as it is today. You can't today even classify the 
disabilities to which industrial workers are subject. You don't 
know their sources. You can name a very few positive industrial 
poisons, but when you get beyond that field, you are in the field 
of that range of dusty ideas that we don't yet see the way out of. 
Industry looks to the physician to establish standards of dis- 
ability, to develop a method and a means of conducting a re- 
search into the causes and quantities of physical disability, which 
is accurate and exact. No standards of progress are really at- 
tainable until measures have been erected. Nobody knows 
today what are attainable standards of continued working effi- 
ciency, though we may have glimmerings of standards of dis- 
ability. As to the matter, there is no accepted agreement as to 
the classification of diseases, much less as to their causes. Here 
again is a field for the expert scientist, if not for the engineer. 
Here is a field for creative research, if only it can hold itself 
down to definitely enough conceived aims to carry a conviction 
to industry and the public of the reality of the service you are 
endeavoring to offer. Certainly, if we are to reduce disability, 
we must know what are reasonable standards of disability. 
If we are to get at causes of disability, our classifications of dis- 
ability must correspond somewhat tangibly and definitely with 
these causes. 
Now, gentlemen, when as industrialists we leave the field, so- 
called, of research and of statistics and executive work, or when 
we as laymen venture into the expert field of the physician, I am 
75 painfully in the position of so many of your speakers today, who 
confessed that .they didn't know what they were talking about. 
So I hesitate about laying before you any further requirements 
of industry. But in a broad way, the problem is a direct and 
simple one if we keep before us its personal and individual 
character. 
I would say that, in its major part, industry looks to you first 
to prevent, and next to diagnose disease. It looks to you to sur- 
round us with every safety condition which will prevent the 
spread of disease. Then it looks to you to diagnose disease in 
its earlier stages, and, in order to make this service effective, it 
gives you the opportunity of treating an enormous number of 
comparatively unimportant and minor afflictions. 
I am sorry to take issue, in part, with the gentleman who 
stated today that the industrial physician had no business to 
deal with those disabilities which did not more or less directly 
arise out of industry and for which industry was not responsible. 
Unless you make it your daily endeavor to look after those 
minor and ambulatory disabilities which drift into your office, 
you will never have the opportunity in this world or in the next 
to diagnose the major disabilities. Unless you spray their 
throats and take care of their ears and blow their noses; unless 
you cut their corns, puncture their boils and clean their teeth 
and do the thousands of little, trivial things that bring them to 
the doctor's office, you are never going to get that personal 
contact; you are never going to get the opportunity to make a 
major diagnosis. Diagnosis is the real field, the real job, the 
real mission that industry is putting up to you. And surely I 
would say to you that industry expects, and has a right to expect, 
that in allaying those little, trivial ills that so affect the imme- 
diate working capacity of our employees, you are going to find 
the direct, the effective, the perfectly straightforward and 
legitimate path towards catching in advance those deteriora- 
tions of health, and the breaking down of the physical organiza- 
tion, which it is your major duty, the thing above all other 
things that you are there to perform for us. 
It is an old story-I imagine in these ten years it has been 
repeated to you in fifty-seven different varieties of ways-that 
as sanitarians, as statisticians, as those who treat the little, 
trivial, petty ills that come before you, you are endeavoring in 
every point of contact to lay the foundation for a clearer, a more 
76 definite basis for education and understanding as to what sup- 
ports this physical organism, how it must be treated, how it 
must be kept as an effective working machine. It isn't because 
the story is old that we haven't always kept it before us. It is 
because the day's duties have so crowded upon us that we are 
not able to get a shot at the vision in the large, we are not able to 
see the bigness of the educational work that is before us. 
There has been a confusion in the minds of some that the 
demands of industry conflict with this intimate and personal 
service, upon which alone your success will be predicated. I 
cannot so see it. Industry asks of you, it is true, to perform 
certain impersonal services, like sanitation and research. It 
has thrown upon you perhaps too much of executive work and 
clerical routine which are foreign to your spirit and abilities. 
But industry ought never to ask you to violate the confidence 
which exists between yourself and your patient, and if it does 
so, it does so at the peril of its own interest and its own major 
objective in its employees as individuals, and its own determina- 
tion to establish individual points of contact with them. There 
is here no conflict, if the matter is rightly understood, between 
the employer and the industrial physician. 
An increasing amount of executive work industry looks to 
you to perform. Your research can only be nourished and sup- 
ported by it. The visible accomplishments of your task can 
only be proved and given confidence through it. That physician 
who carefully plans and thoroughly executes the details of his 
work can be a true individualist. He must have a corps of able 
assistants, and he must have them ably organized and trained 
to their tasks. He must be an executive in the higher sense of 
the word. 
Industry thinks that it has a right to ask certain things of 
you. I don't think we have recognized quite clearly enough 
that you have the right or the necessity, if you will, of demanding 
certain things of industry. We are putting up to you an execu- 
tive's job, surrounded by executive details, related to the execu- 
tive management of the company, reaching out more or less 
intimately into all of its highways and byways of industrial 
activity, and you have not only the right to ask but to expect 
that you shall be treated as an inherent part of that executive 
organization. 
No industrial medical department that is considered as subject 
77 to an employment manager or a personnel director, that does 
not come directly in contact with the executive officers, has a 
chance to effectively get its ideas over or to do its work with the 
least amount of friction and the most direct points of contact. 
No industrial physician can do his job in its entirety unless 
he is free from some of the clerical details, some of the routine 
accounting, some of the work which a skilled girl, at eighteen to 
twenty-four dollars a week, can do, and do a great deal better 
than he can. It is a useless waste to pin a man down, who has 
devoted ten to twelve years to his professional training, to keep- 
ing accounts, which he does very imperfectly and very in- 
accurately. 
As an intimate part of the executive organization, with the 
proper tools to do your work with, you should welcome an exact 
budgeting of your expenses. You should be responsible for its 
intiation, and it is up to you to say, "I need such funds for such 
purposes, and here, per contra, is an exact accounting of their 
expenditure." You need to be held to a more exact budgeting 
system, to a more exact accounting of what you have accom- 
plished and by so doing you will relate yourself much more 
effectively to the executive organization. 
In all of these ways, the executive manager, I believe, has 
been short-sighted. I believe he has conceived in too narrow a 
purpose of the field that is before him. 
Gentlemen, we have been talking about details. All of you, 
through your years of service in industry, have been building up 
a vision which you have been expressing in various ways today. 
It is a vision which you alone, who are set free from the necessity 
for an individual charge for every treatment, may get in its clear- 
ness. It is a vision which Dr. Moorhead expressed with startling 
clearness when he showed what had been accomplished or what 
may be accomplished in the field of traumatic surgery. It is a 
vision that appeals to the highest standards of medical ethics; 
not medical ethics conceived in any legalistic or selfish spirit, 
but to medical ethics that set the highest standards of pro- 
fessional accomplishment to you as individuals, to the promotion 
of your science, and to the real protection of your fellow-prac- 
titioners. It lays before you a field of education that never 
can be open to the private practitioner in its fullness. It gives 
you the access to and the supervision of your patients, as Dr. 
Moorhead has pointed out, for a continuous period of time. 
78 You can keep them continuously under observation. You have, 
therefore, that most powerful agent at your command-a 
constant contact with their physical if not with their mental 
organizations. You never have to think of the integrity of 
your own practice, insofar as it is measured by a charge per 
patient. Having established a diagnosis, you can direct a man 
to the best private consultant or the best private specialist in the 
particular disability, with never a fear that it is belittling your 
practice or belittling the community's estimate of your 
abilities. 
I would be recreant to my faith in the possibilities of your 
vocation, if I hadn't attempted to sketch even so very imper- 
fectly the vision of the ideal. After all, we as industrial leaders 
will continue to be short-sighted. Physicians will continue to be 
misled, and the selfishness of all human endeavors will throw 
obstacles in the path of progress. It is only in proportion as we 
are able to set up an idealized vision, that out of this vision will 
come progress and assured development. 
To you it will be given in a peculiar sense to free men in large 
communities and in common undertakings from the supersti- 
tions and disabilities which so beset their bodies and minds as 
to physical ills. To you it is given in a continuing and peculiarly 
intimate way to lay before them the reasonable laws of health, 
and the reasonable compliance with God's purposes for man, so 
that they may escape the abuse of their physical bodies by either 
a pitiful subjection to fear or by actually overburdening their 
strength. 
To you who have the possibility of continuously keeping men 
under observation is given the opportunity more patiently and 
thoroughly to develop the science of your vocation, and to 
avoid the hasty experiments and the half-tried expedients that 
even the most conscientious of private physicians are driven 
back upon. The quiet patience of a continued effort, the in- 
spired purpose of a teacher, cannot but bring satisfactions and 
results that will far outweigh in the long run the more brilliant 
achievements of the pure individualist, of the specialist. 
Absolute integrity of effort, the quiet and diligent patience of 
a strong faith, the field of the teacher and liberator from cant, 
and the satisfaction of an unselfish and single-minded service- 
these are yours. Their compensations are intangible. Their 
results far outweigh any possible vision we have of them today. 
79 Chairman Clark: The last speaker on our program tonight is 
Dr. W. Gilman Thompson, President of the Reconstruction 
Hospital of New York. Dr. Thompson always has been most 
interested in industrial medicine from every point of view, and 
I am sure he will finish our evening with a most interesting 
paper. 
"Industrial Medicine and Medical Education" 
by Dr. W. Gilman Thompson 
Dr. W. Gilman Thompson: I am quite sure that my good 
friend, Dr. Moorhead, when he was a medical student, never 
felt the need of using a "crib," and if he chooses to call that most 
interesting synospis which he gave us this evening a "crib," 
I can only say that I would like to have a full examination paper 
from him at any time. 
Mr. Chairman, I have been very greatly impressed as I sat 
here this evening at the growth of this organization, at its size 
and the importance which it has achieved. It was my privilege 
to attend one of the earlier conferences shortly after the or- 
ganization was formed, and I recall that we all sat together at a 
table which was not longer than that here upon the dais-and 
look at this assembly here tonight ! The importance of medicine 
in industry is fully equal to that of the study and practice of 
epidemiology in its great economic value for the country. I 
fancy that the next time we gather here, it will have to be in 
that larger ballroom upstairs. 
I was invited by your secretary to speak upon "The Influence 
of Industry upon Medical Education," but as one cannot obtain 
a medical education without incessant industry, perhaps more 
than in any other profession today, I ask leave to change the 
title of my address to "Industrial Medicine and Medical Educa- 
tion," for that is a topic which may well merit discussion. 
I found some years ago in my hospital service that a knowledge 
of the details of a patient's occupation often was the means of 
clearing up promptly an otherwise obscure diagnosis. I further 
acquired the habit, whenever traveling, of going over industrial 
plants with a view of learning at first hand something of the 
disease hazards which obtain in many industries. Moreover, 
as a teacher I endeavored to impress upon my students the 
value of this point of view, in so far as a crowded curriculum 
permitted. 
80 I believe there can be no question in the mind of this audience 
that industrial medicine (meaning the practice of medicine as 
applied in industry) has grown, of recent years, into a very 
definite and most important specialty, and yet one constantly is 
surprised at the scant recognition which it thus far has received 
at the hands of medical faculties. Were a group of oculists or 
dermatologists, for example, to have their subjects completely 
ignored in the college curriculum, it would be strange indeed, 
yet the physician in industry still has to enter upon a broad field 
and train himself in many things which his alma mater has 
absolutely ignored. 
In discussing this matter with my colleagues, I usually am 
reminded that the undergraduate curriculum in the average 
medical college as at present conducted, comprises only about 
one thousand hours a year or four thousand hours in all, in 
which to cover the basic facts of medical science. One cannot 
crowd more than a certain amount of information into the cells 
of the gray matter in that time, just as one cannot put more 
than a given number of beans into a pint pot or they will spill 
over and be lost. 
Nevertheless, if his instructors were more interested and bet- 
ter informed themselves regarding the origin and behavior of 
industrial diseases, they might still find time to point out to the 
student much of value regarding them, and give him a broader 
background and perspective which would always be of use to 
him whether he became a physician or surgeon in industry or not. 
When we turn to graduate instruction, however, the matter is 
quite different and the lack of intensive courses in industrial 
medicine is both extraordinary and deplorable. Harvard is 
making an excellent beginning in this direction, and so are some 
of the western colleges, but, in so far as I am aware, no medical 
college in this state, which comprises so many and varied indus- 
tries, has hitherto put into practice any definite plan for meeting 
the need of the hour. 
Now just what is this need ? Industrial corporations which a 
few years ago provided only the most meager of first-aid stations 
for their employees, in charge, part of the time at least, of only 
an orderly or nurse, are now installing quite elaborate medical 
and surgical units with full-time, well organized staffs and com- 
plete equipment with such diagnostic aids as X-ray apparatus 
and clinical laboratories, dental clinics and sometimes physio- 
81 therapy appliances. They are looking for trained directors of 
such service with numerous assistants and nurses trained in 
industrial work. The medical staff also is expected to care for 
the general hygiene of the plant and offer constructive sugges- 
tions for betterment. Where the corporation is a large one, 
with branches in different parts of the country, or in foreign 
countries, the medical director is expected to supervise, control 
and coordinate the medical service in these remote plants. 
He may be required to organize a field hospital in a distant 
state, to ship vaccines and medical supplies to aid in suppressing 
epidemics in Mexico or Colombia, to furnish field emergency 
kits for use in Peru, to provide and supervise medical service 
for ships of transport, and issue circulars or booklets of first-aid 
instructions. At home he must be proficient in physical ex- 
aminations for admission, disability benefits, and old age retire- 
ment from service. And, what often is as difficult as it is im- 
portant, he must learn to be expert in estimating degrees of 
permanent disability through accident or disease, acting both 
with fairness to his company and the employee. Finally, he 
may have to familiarize himself with the intricacies of the com- 
pensation laws, varying as they do in different states. If the 
company is engaged in shipping imports or exports, he will be up 
against the Admiralty laws also. 
Is the employees' pain in the back a result of some remote 
focal infection, is it a lumbago, is it result of trauma, or is the 
man merely malingering ? Is his lame knee a simple arthritis 
which trauma has localized and intensified, or is it a commencing 
Charcot joint with a four plus Wassermann ? Did the employee 
get past his admission examination with a latent tuberculous 
lesion, or was it acquired in the plant ? It is such etiological 
factors which require very special emphasis in the work of the 
physician in industry. 
Those of our professional colleagues who sometimes are prone 
to look down upon the "company doctor" as an inferior being, 
a sort of mongrel, only show their complete ignorance of the 
constantly widening field of industrial medicine, a field which is 
often as broad as the company doctor chooses to make it. Not 
even in the Army or Navy medical services is its scope more 
wide, more varied, or more interesting. 
When will our medical colleges awaken to this appreciation 
and offer graduate intensive courses where those desiring to 
82 equip themselves thoroughly for industrial service can find what 
they most need and short-circuit many things which today they 
only can learn through long and laborious self-instruction ? 
The country practitioner, for example, who feels that many 
of his genito-urinary cases are beyond him, can go for a few 
weeks to a graduate school and acquire the training and infor- 
mation which he lacks, without the tedious and hazardous proc- 
ess of self instruction through experimentation. But the phy- 
sician in industry finds no welcoming hand among many of the 
colleges. 
There should be two types of courses of instruction in indus- 
trial medicine and surgery organized to meet the manifold prob- 
lems to which I have referred. The first type should be offered 
to those about to enter the field of medicine in industry without 
as yet having any particular plant in view but who might greatly 
widen their opportunities of selection through better preliminary 
training. Such a course should be diverse but comprehensive 
and comprise, perhaps, a year or more of instruction, with a 
special certificate or diploma granted upon completion of their 
work. 
The second type should be adapted to those physicians al- 
ready employed in particular plants who might, in periods of a 
few weeks-even from three to six-of intensive work, obtain 
much valuable information bearing upon their individual prob- 
lems. 
In plants of moderate size it may prove of enormous advan- 
tage to obtain, here and there, a man who is trained in com- 
binations of work not usually associated together. For example, 
I know of an excellent company dentist who is an expert in 
taking radiograms, and a company radiologist who is also an 
expert in clinical laboratory work, making all the blood, sputum 
and urine tests as well as taking very satisfactory radiograms. 
It often happens that, as the service grows, it is desirable to add 
some new phase of diagnostic work without burdening the com- 
pany payroll with another medical employee. With properly 
organized graduate college courses it should be easy to grant 
leave of absence for a few weeks to one of the company staff to 
take the appropriate intensive instruction to fit him for such 
special work. 
All that has been said thus far of the shortcomings of many of 
the colleges in not realizing their opportunities applies to the 
83 training schools for nurses which, almost without exception, 
ignore the field of industrial nursing. You must either teach the 
nurses yourself or steal them from some other plant where they 
may have had some experience. 
I have long had the dream of seeing established somewhere in 
this country, what I may term an "Institute of Industrial Hy- 
giene, Medicine, and Surgery," that is, an institution conducted 
upon both a theoretical and practical basis where the entire 
field might be covered, comprising undergraduate and graduate 
instruction of both industrial physicians and nurses, research in 
the industrial diseases, with field service, including advice to 
corporations as to the hygiene of their plants and adequate 
medical equipment. This dream is, I believe, slowly developing 
into reality. 
During the World War I was enabled, in 1918, through a 
benefactor, to organize and establish a hospital for the returning 
disabled service men, designed to shorten their periods of dis- 
ability through all the means which had proved so extraordi- 
narily successful in France, mainly by comprehensive physio- 
therapy, and this work is being continued for those disabled in 
industry through either accident or disease. After various 
stages of development and expansion, this institution is now 
known as The Reconstruction Hospital, at 100th Street and 
Central Park West, New York. 
In 1919 I went to the trustees of Columbia University and 
offered them this organized industrial hospital unit as the 
clinical part of an industrial hygiene school or institute. They 
accepted the plan which I had worked out in detail, and offered 
me a site upon the University grounds provided I could raise 
funds for a building and adequate endowment. This, however, 
proved easier said than done. The plan was to have three 
divisions, first the laboratory work and lectures, to be supplied 
through existing University facilities; second, the reconstruction 
hospital for practical demonstrations in the operative treatment 
and after care of industrial accidents and research in industrial 
diseases; and third, a field service. Both physicians and nurses 
were to be instructed, researches were to be published and em- 
ployers were to be aided by hygienic inspections made through 
the field service. 
This plan has, however, again been taken up, and the new 
Columbia medical center where the Presbyterian Hospital and 
84 College of Physicians and Surgeons are to be combined, has 
offered land to The Reconstruction Hospital if it can furnish a 
new building and endowment. Furthermore, I lately have or- 
ganized an industrial hygiene clinic for the treatment of the 
compensable industrial disease cases coming under the New 
York State Law. This clinic is to be opened on May first, 1924, 
at The Reconstruction Hospital and conducted under the com- 
bined auspices of the hospital, the College of Physicians and 
Surgeons, and the New York State Industrial Hygiene Bureau. 
The Bureau will seek out the industrial disease cases and refer 
them to the Industrial Hygiene Clinic of the Reconstruction 
Hospital where treatment and routine diagnosis will be fur- 
nished. Any more elaborate diagnosis and research in bio- 
chemistry, in physiology, etc., may be conducted in the labora- 
tories of the College of Physicians and Surgeons. It is to be 
hoped that with the cooperation of the physicians of the State, 
cases of industrial poisoning may more frequently be early 
recognized and referred to this clinic for study and research. 
It is my belief that your own organization which is growing 
so rapidly in influence might accomplish much through memo- 
rializing the medical colleges, urging them to give heed to the 
importance of establishing courses in industrial medicine and 
surgery. 
Along such lines as I have suggested I hope we soon may see 
the solution, in some degree at least, of the problem of medical 
education in relation to medicine in industry. 
In conclusion, I have here a diagram illustrative of the plan 
which I have in mind for an Institute of Industrial Medicine 
and Surgery. It would have three essential subdivisions; first, 
laboratories for diagnosis and research together with provision 
for certain lecture courses; secondly, the hospital and clinic for 
the reception and treatment of industrial diseases and accidents; 
third, a field service for the inspection of the hygienic conditions 
in industrial plants, and aid in the education of both employees 
and employers in the modes of preventing industrial diseases 
and accidents, and in plant hygiene in general. The institution 
should furnish instruction not alone to pupils, but to the general 
public through lectures and publications and intensive research 
to be conducted in the effects of the many new poisons which 
85 now constantly are entering into manufacture, for I am con- 
vinced that in controlling the effects of these poisons far more 
is to be achieved through education than compulsory legislation. 
The idea is that the institution will be divided into three 
parts. There will be a governing board and director and as- 
sistant, and under them the three divisions would be the univer- 
sity school, the hospital and the field service. 
The university is already equipped with many departments 
which, by a little coordination and cooperation, could make use 
of existing facilities to give a few short, intensive courses to those 
wishing to take special work in particular fields in which they 
feel the need of additional instruction. There will be short lec- 
tures on the different types of occupational diseases, what to 
look out for in surgical emergencies, etc., and laboratory work. 
The professor of architecture of the university might very well 
have a brief course on the architecture, the structure of ideal 
medical buildings. The company physician nowadays is very 
often asked by a plant which is appreciating the value of medical 
service more and more, to lay out a plan for the type of office 
that he would like to have and the facilities of work that would 
interest him; to be able to find in a short time what is being done 
in other lines and in other places would be helpful. In that 
course could be collected the data concerning equipment and 
organization of medical units in the various industrial plants. 
The professor of law in the university could give a few lec- 
tures in an intensive course on the whole relation of industrial 
medicine and surgery to accident compensation and point out 
the progress of the different state laws and their differences and 
their application to the individual case. 
The matter of statistics should also be checked up. In the 
university laboratories, the more elaborate biochemical examina- 
tions could be made. What do we know about the condition 
of the blood in benzol poisoning ? There are a good many cases 
of benzol poisoning occurring. This new lead preparation that 
they are using to prevent knocking in automobiles has caused 
several deaths already in its manufacture, and it is a very im- 
portant matter and almost nothing is known about that. We 
ought to have a center somewhere where cases of that type could 
be investigated and a thorough biochemical study made of any 
86 conditions found. These laboratories, therefore, would call 
upon certain assigned workers in the university laboratories of 
organic chemistry and physics to study problems of ventilation, 
gas analysis, clinical pathology, etc. 
Then, there would be the hospital group which we have al- 
ready worked out at the Reconstruction Hospital, designed 
particularly for the after-care of accident cases and the restora- 
tion of the injured employee to his work as soon as may be; 
shortening his period of disability in other words. That includes 
quite a large staff and a number of specialists. 
Of course, there is the dental department, and we hope to 
have specialists in nervous diseases; an eye specialist; good 
X-ray work of the highest type. And then occupational therapy, 
which is an exceedingly important aid in shortening the period 
of disability in many patients, with the psychic value that it 
has as well as the actual training they get in the restoration of 
lost functions in different members. 
There would be a department of field service where both 
nurses and physicians could be instructed through visits to 
various plants in the neighborhood. They could be shown good 
and poor plant conditions from the hygienic point of view and 
also the different disease hazards and how to discover them. 
This department would include, perhaps, courses of lectures 
not only for doctors and nurses but the employees, where that is 
permissible, in regard to the prevention of disease as well as 
accident hazard. 
There would be a special department of research, a library 
and a department for publication and a museum in which graphic 
representations could be made of a number of different things, 
accident prevention as well as disease prevention. 
That, briefly, is my conception of what I should very much 
like to see developed somewhere in this country. I hope very 
much that we can bring it about in New York. This is an enor- 
mous industrial center. If you take the zone from Trenton to 
Bridgeport, you have practically every kind of industrial disease 
hazard except those occurring in the productive industries like 
mining. There is an enormous amount of material to draw 
upon, and if we only had somewhere a medical center where all 
of this work could be focused and centralized, I think we should 
make real progress, and industrial physicians could there avail 
themselves of intensive courses in any way they like. 
87 I have been greatly gratified, Mr. Chairman, at the privilege 
of coming here tonight. I am a good deal in the position of the 
old negro mammy who went to a Baptist revival. She was 
asked about it afterwards, and she wasn't quite sure whether 
she had got religion, but she was a well wisher. I am not a 
physician in industry, but I am most distinctly a well wisher. 
Adjournment 
88 CONFERENCE BOARD OF PHYSICIANS IN INDUSTRY 
247 Park Avenue, New York 
Advisor on Medical Problems in Industry to 
The National Industrial Conference Board 
Organized in April, 1914, for Co-operative Effort in Introducing into 
Industrial Establishments the Most Effective Measures for 
the Treatment of Injuries or Ailments of Employees; for 
Promoting Sanitary Conditions in Workshops; and 
for Prevention of Industrial Diseases 
Dr. John J. Moorhead, Chairman. 
Dr. W. Irving Clark, Vice-Chairman. 
Magnus W. Alexander, Treasurer. 
Dr. F. L. Rector, Secretary, 247 Park Avenue, New York. 
MEMBERS 
Dr. A. V. Allen, Commonwealth Edison Co., Chicago, Ill. 
Dr. T. John Bowes, Philadelphia Electric Co., Philadelphia, Pa. 
Dr. H. E. Bricker, Philadelphia Rapid Transit Co., Philadelphia, Pa. 
Dr. W. Irving Clark, Norton Company, Worcester, Mass. 
Dr. A. Vernon Clarke, Consolidated Gas Company, New York. 
Dr. R. P. Cummins, The Midvale Co., Philadelphia, Pa. 
Dr. W. B. Fisk, International Harvester Co., Chicago, Ill. 
Dr. Otto P. Geier, Cincinnati Milling Machine Co., Cincinnati, Ohio. 
Dr. J. W. Harvey, Tidewater Oil Co., Bayonne, N. J. 
Dr. T. L. Hazlett, Westinghouse Electric & Mfg. Co., East Pitts- 
burgh, Pa. 
Dr. E. H. Ingram, Wm. Cramp & Sons Co., Philadelphia, Pa. 
Dr. J. A. Jackson, New York Edison Co., New York. 
Dr. R. P. Knapp, Cheney Bros., South Manchester, Conn. 
Dr. A. C. Marshall. Powers-Weightman-Rosengarten Co., Phila- 
delphia, Pa. 
Dr. S. M. McCurdy, Youngstown Sheet and Tube Co., Youngstown, 
Ohio. 
Dr. John J. Moorhead, Professor of Surgery, Post Graduate Med. 
School and Hospital, New York. 
Dr. H. S. Murat, American Rolling Mill Co., Middletown, Ohio. 
Dr. Voyle A. Paul, The Yale & Towne Mfg. Co., Stamford, Conn. 
Dr. R. S. Quinby, Hood Rubber Co., Watertown, Mass. 
Dr. W. E. Ramsay, Raritan Copper Works, Perth Amboy, N. J. 
Dr. Wm. Alfred Sawyer, Eastman Kodak Co., Rochester, N. Y. 
Dr. F. E. Schubmehl, General Electric Co., West Lynn, Mass. 
Dr. Loyal A. Shoudy, Bethlehem Steel Corp., Bethlehem, Pa. 
Dr. A. K. Smith, E. I. duPont de Nemours & Co., Wilmington, Del. 
Dr. C. H. Watson, Amer. Telephone & Telegraph Co., New York. 
Dr. John Woodman, United Elec. Light and Power Co., New York. 
Dr. C. C. Burlingame, 17 East 42d St., New York. 
Dr. C. A. Lauffer, 521 Franklin Ave., Wilkinsburg, Pa. PUBLICATIONS 
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