Chapter XXII.

INDUSTRIAL HYGIENE.
(With the cooperation of Leonard Greenburg, W. E. C.
Allison E. Icaza and Helen B. Matthewman.)

This new viewpoint has to some extent been adopted in New Haven but, as we shall see, only to a limited extent as compared with its possibilities as recognized by progressive industries in other communities.

2. State Legislation and State Department Organization Relating to Industrial Hygiene. The basic influence in industrial hygiene in America has been the passage of Workmen's Compensation Acts, which made it obvious that a certain amount of attention devoted to safety and health was essential to sound business in order to escape heavy burden of insurance costs.

The Connecticut Compensation Law went into force January 1, 1914 and is on the whole an excellent piece of legislation. It covers a larger proportion of persons than do the laws of many states. Its financial provisions are reasonably liberal, including medical and surgical aid and hospital service and the system under which it is administered is flexible and efficient.

It is a source of satisfaction that Connecticut is one of the five states (the others being California, Massachusetts, North Dakota and Wisconsin) which includes a broad coverage of occupational injuries under its compensation law. In the past, indeed, the interpretation of this phase of the law has been unreasonably broad as regards contributory factors aggravating previously existing disease. The law was modified in this respect by the 1927 legislature, a step which was undoubtedly a sound one. In addition to compensation acts which provide direct but powerful stimulus to employers to prevent ventable accidents and diseases many states, such Neq York, Ohio and New Jersey, have effective direct legislative and administrative machinery for enforcing certain minimum essentials of health and safety in the factory.

In this respect Connectieut is less adequately equipped for service. Section 2345 of the Revised Laws of 1918 provides that "all factories and buildings where machinery is used shall be well lighted, ventilated and kept as clean the nature of the business will permit"; and that "the belting, shafting, gearing, machinery and drums, of all factories and buildings where machinery is used, when so placed as, in the opinion of the commissioner, to be dangerous to the persons employed therein while engaged in their ordinary duties, shall, as far as practicable, be securely guarded." Section 2350 provides that "every employer whose business requires the operation or use of any emery, tripoli, rouge, corundum, stone, carborundum, or other abrasive, polishing or buffing wheel, in the manufacture of articles of metal or iridium or whose business includes any process which generates an excessive amount of dust shall install and maintain in connection therewith devices as may be considered necessary by the commissioner and the State Department of Health to remove from the atmosphere any dust created by such process."

There is no legal provision whatever on industrial poisonings; and such general regulations as those in regard to light and ventilation and dust removal have little real force unless interpreted by experts. In states like New York and New Jersey there have been created special Industrial Commissions with power to formulate specific regulations carrying out the intent of such general laws; and furthermore the Labor Departments of these states have trained experts on their staffs to study the problem involved and make both the regulations and their enforcement scientific and reasonable. In Connecticut the legal control of factory sanitation is in general entrusted to the Factory Inspection Department (H. E. Mackenzie, Commissioner), with a staff of 16 inspectors. In the year 1925-1926 this force made 6012 inspections in factories, 3749 in mercantile establishments, 1660 mercantile elevator inspections and 673 bakeshop inspections and issued a total of 2029 orders. Of these orders, 547 dealt with mercantile elevators while other prominent types of orders concerned posting of labor notices, cleanliness of toilets, providing or replenishing emergency kits, cleaning and whitewashing bakeshops and the like. Machinery guarding, however, was the subject of 233 orders and ventilation and dust removal of 29. The Factory Inspection Department has no medical or sanitary or engineering experts on its staff and though its employees may be able to deal intelligently with the simple problems of machinery guarding they are quite incapable of providing against poison hazards or determining what constitutes " an excessive amount of dust" (which demands the use of analytical procedures) or of discovering whether a factory is, or is not "well lighted and ventilated."

Section 2416 of the Revised Laws requires physicians to report to the State Department of Health all cases of "poisoning from lead, phosphorus, arsenic, brass, wood alcohol or mercury or their compounds or from anthrax, or from compressed-air illness or any other disease, contracted as a result of the nature of the employment of such person." Prior to 1923, these reports were made to the Department of Factory Inspection and since the transfer to the Department of Health reporting has been somewhat improved. It is still, however, very incomplete. For the year 1925-26, the following reports were made under this provision.

REPORTS OF OCCUPATIONAL DISEASES,
JULY 1, 1925-July 1,1926.

A most important step was taken by the 1927 Legislature in authorizing the State Department of Health to investigate and make recommendations for the control of occupational diseases, for which purpose the sum of $17,500 was appropriated for the biennium, 1927-29. In accordance with this law Dr. A. S. Gray was appointed Director of a new Division of Oceupational Diseases in the State Department of Health, beginning service January 1. This is a sound and progressive step which should be fraught with far-reaching benefits to the health and the economic efficiency of the state.

All employers coming under the Compensation Act must of course provide medical and surgical care for injuries or diseases directly resulting from conditions of employment. What we are here interested in, is the extent to which employers have gone further and have made constructive provisions for medical and nursing service and safety organization as a preventive of disease and injury and for the positive promotion of efficiency.

The State Factory Inspection Department Report for 1926 lists 545 manufacturing establishments within the limits of the city of New Haven, of which 10 had over 500 employees, 37 between 100 and 500 employees and 41, between 50 and 100 employees, the remaining 457 being smaller. To find out what the larger employers were doing for the health of their operatives we sent out a questionnaire to all firms having 50 or more employees and followed up the replies of those who reported the employment of physicians or nurses by personal inspections. The general results of this study are presented in the two tables below.

INDUSTRIAL ORGANIZATIONS REGULARLY EMPLOYING
PHYSICIANS AND NURSES FOR HEALTH PROMOTION
AMONG THEIR EMPLOYEES.

INDUSTRIAL ORGANIZATIONS EMPLOYING NURSES ONLY
FOR HEALTH PROMOTION AMONG THEIR EMPLOYEES

Thus it appears that, of 11 firms employing over 500 operatives, all provide some sort of nursing service but only 7 have regular medical service. Of approximately 50 factories and stores with 100 or more employees there are, however, only 10 which employ physicians (except after a compensable accident has occurred) only 10 which employ graduate nurses and only 14 which employ nursing attendants of a lower grade. It is generally recognized bp industrial hygienists that regular medical service should be provided for every plant employing 500 persons and that a plant employing 2,000 needs a full time medical director. It is therefore obvious that the service provided in New I Haven is in few instances adequate for the best results.

"Plant hospitals", so-called, really rooms for medical examination and treatment, are found in most of the plants but they vary widely in equipment and suitability. In one plant the only provision for the nurse (there is no physician) is "a corner of the general superintendent's office and one half of his desk." The New York, New Haven and Hartford Railroad, the Winchester Repeating Arms Company and the American Steel and Wire Company on the I other hand have admirably equipped hospitals. The Railroad has a physician's private office, a nurses' office, a treatment room with good equipment, an examination room with eye chair, operating table, treatment chair, fluoroscope and laboratory equipment, a physiotherapy department with ultra-violet and infra red lights and diathermy apparatus, a ward with 2 beds, bath, shower and toilet and storage and locker rooms. The Steel and Wire Company has an admirable equipment for a smaller plant, the entire first floor of a small building being set aside for this purpose, with an office, examining room, toilets and club room. There is an H-H inhalator, an electric baking apparatus, a couch, an autoclave and a good stock of drugs and supplies. First-aid kits and stretcher are provided in every department throughout the factory. The Malley Company has a particularly good lay-out for a department store service, with a small dispensary, a waiting room, a rest room, provided with 2 beds and an examining and consulting room. The firm supports a room at St. Raphael's Hospital and practically all employees can arrange for free hospital care.

The type of work performed varies as widely as the equipment provided. In one plant it appeared that the entire provision made for the health of the operatives consisted in the employment of a nursing attendant with no training whatever who "dressed in a black jersey and dirty apron" and whose duty "in the main seemed to be to give the girls a hot water bottle and let them lie down. " At the other extreme, stands-the Railroad Company with a physician on duty for five hours a day, two trained female nurses, one trained male nurse and one male hospital assistant. Four thousand cases have been handled by this department during 1927 with over 25,000 treatments. Berger Brothers have a specially admirable program for a plant of only 300 employees. The Superintendent says,

"Daily a physician visits the Plant, generally between eleven and twelve o'clock. He will see the persons whose names have been listed for interview, treatment or advice. He will treat or prescribe for minor ills and advise employee to see personal physician in more serious cases. He will average about half an hour per day at the Plant.
"The Plant nurse is a full time worker who cares for the general health and welfare of employees. She administers simple remedies and treatments from a well equipped dispensary. Of course such services are not charged to employees.
"The nurse will arrange for dental or eye examinations. If work is recommended, the Company will guarantee all charges and deduct a small amount each week at the employee's convenience. Many times the nurse arranges for hospital care and operations.
"We have been very fortunate in having a mature woman of high character, forceful and yet kindly enough to act as nurse, counselor and friend to the varied assortment of people found in an industry employing many girls and women in office and factory."

Routine physical examinations of new employees are made by the American Steel and Wire Company, L. Candee and Company, the Edward Malley Company, the Safety Car Heating and Lighting Company, and the Southern New England Telephone Company.

Particularly well organized programs for industrial safety, including the display of National Safety Council posters, safety talks and organization of shop safety committees, were noted at the Acme Wire Company, the American Steel and Wire Company, Berger Brothers, L. Candee and Company, the National Folding Box Company, the New York, New Haven and Hartford Railroad Company, Peek Brothers, the Seamless Rubber Company, the Southern New England Telephone Company, the Whitney Blake C'ompany and the Winchester Repeating Arms Company. The Kolynos Company, among the smaller firms, is notable for a good safety and health program, directed by its bacteriologist, with the result that the number of accidents requiring medical attention has decreased from 23 in 1920-21 to 8 in 1925-26, the average number of days lost per accident from 6 to 2 and the number of accidents upon which compensation was paid from 6 to 0.

The safety movement has been markedly stimulated by the work of the Safety Council of the Chamber of Commerce under Mr. Marshman who arranges for the distribution of posters and the holding of meetings and conferences. The strong Foreman's Club is a powerful force in the same direction. Approximately a year ago, under the able direction of Mr. E. R. DeJon of the Southern New England Telephone Company, and with the aid of the American Red Cross, the Safety Council instituted a course in first aid instruction. Nearly forty certificates were issued to industrial workers who took the required number of study hours and passed the written examination, - most of them representing small plants with no medical or nursing service. Some twenty workers are taking a similar course at the present time.

Locally, it is evident that some of the larger plants and department stores are beginning to provide real health service for their employees. In most instances, however, the provision made is still somewhat embryonic. When seven plants, employing over 1,000 persons each and having between them 24,000 employees, provide an aggregate total of 11 hours a day of regular medical service it is evident that the possibilities of industrial medicine have not been realized. Furthermore it will be noted that there are apparentIy but 31 nurses and nursing attendants in all the factories and stores of New Haven and, of these 31, only 13 are trained nurses.

It has been amply proved that industrial medical and nursing service is a paying investment. By industrial medical service, however, is meant not merely the practice of minor surgery for an hour a day within the walls of a plant but the service of a physician of industrial experience who studies the workers and their tasks and applies all the resources of medical and sanitary science to the promotion of health and efficiency under the conditions of a particular industry. Except in the Railroad there is not a single industrial physician of this type in New Haven. By industrial nursing is meant, not the presence of an untrained attendant but of a graduate nurse who has similarly specialized in the field of industry. The care of minor injuries is only the first step in industrial hygiene. It should be supplemented by treatment of minor illnesses, by routine medical examinations, by health education and by the continuing study of hazardous processes and the application of means for rendering them safe. Such a service as this pays for itself tenfold, not only in diminished compensation cost, but in decreased overturn and in increased efficiency and contentment.

Even among the larger firms it seems evident that some definite leadership is necessary in order to promote a wider appreciation of the values of industrial hygiene. The smaller firms cannot possibly secure service of the right sort without assistance, since the only way in which industrial medicine ean be brought to the small plant is through cooperation. The Safety Council of the Chamber of Commerce seems the logical body to lead in this field, since the National Safety Council which it represents was organized to promote health as well as safety in the narrower sense. It could perform an extraordinarily useful service by working out programs of cooperative industrial medicine suitable to both the large and the small industries of New Haven and by bringing to the attention of the industries the possibilities of such service.

Finally, in every great industrial center like New Haven there should be a well-equipped central Industrial Clinic with a staff, able not only to diagnose industrial diseases such as industrial poisoning and industrial silicosis, but to work out practical methods for their control. Such a clinic would also be in position to offer the expert guidance needed in the development of sound programs for industrial health services within the walls of the individual factories. It could be developed with special facility in connection with the Yale Medical School, whose Department of Public Health has for years been active in this field and which enjoys the advantage of the presence on its staff of Dr. Leonard Greenburg of the U. S. Public Health Service, one of the leading experts on industrial dust and poison hazards in the United States.

We would urge as

Recommendation 86. That the Chamber of Commerce appoint a special committee on Industrial Hygiene to investigate the possibility of local developments in this field with a view to (a) the organization as a branch of its Safety Council work of a systematic program for the promotion of health services in the factories and stores of New Haven and (b) the establishment in cooperation with the Yale Medical School of a central industrial hygiene clinic for the study and control of industrial hazards and the promotion of industrial health and efflciency.

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