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Miss Annie W. Gill, Lady Superintendent of Nurses. ! 4. HIGHLANDS AND ISLANDS. Royal Infirmary. John Glaister, Esq., M.D..-Professor of Forensic Medicine and Her Grace the Duchess of Atholl, D.B.E., Member of the High- Public Health in the University of Glasgow. lands and Islands Medical Service Committee; President of the Professor Matthew Hay, M.D., Medical Officer of Health for the Perthshire Federation of District Nursing Associations. .City of Aberdeen. John Birnie, Esq., J.P., ex-Provost of Inverness; Chairman of John Rutherford Hill, Esq., Resident Secretary of the Pharma- Inverness Burgh Insurance and Local War Pensions Committees. ceutical Society in ; Secretary of the General Council of W’illiam Durran, Esq., J.P., ex-Provost of Thurso; Chairman of of and of Panel Chemists (Scotland). the Insurance Committee for the County’ Caithness the Sir Donald MacAlister, K.C.B., M.D., Principal of the University County Education Authority. of Glasgow ; President of the General Medical Council. Rev. Vt’m. Fotheringham, J.P., N-ice-Chairman of Zetland County John Yule Mackay, Esq., M.D., LL.D.. Principal of the University Insurance and Local War Pensions Committees; Late Vice- College, Dundee. Convener of the County and Chairman of the Mainland District Sir James Mackenzie, M.D., F.R.C.P., Clinical Institute, Committee. ° St. Andrews ; Consulting Physician to the Hospital. Lady Susan Gilmour, late Member of the Highlands and Islands Sir Robert William Philip, M.D., F.R.C.P., Professor of Tubercu- (Medical Service) Board. losis and Senior Lecturer on Clinical Medicine in the University of Miss Bella Jobson, Secretary of the Scottish Fish Workers’ Edinburgh ; President of the Royal College of Physicians, Edinburgh. Friendly Society. James Maxwell Ross, Esq., M.B., C.M., M.B.E., Medical Officer of Mrs. Helen Kerr, Member of the Royal Commission on Housing Health and Chief School Medical Officer for the County of Dumfries. (Scotland). Miss Laura Stewart-Sandeman. M.D., late Controller of Medical The Maclachlan of bIaclachlau, Convener of the County of Services to Queen Mary’s Army Auxiliary Corps, Overseas. Argyll. Sir Harold J. Stiles, K.B.E., Regius Professor of Clinical Surgery Miss Sybil M. Macphail, Honorary Secretary of the Ladies’ in the . Highland Association. F. Tocher, Esq., D.Sc., Public Analystforthe County of Aberdeen, Dr. A. C. Miller, J.P., Chairman of the Highlands and Islands &c. ; Honorary Secretary of the Association of Public Analysts of Subcommittee of the British Medical Association (Scottish Scotland. Committee). Norman Walker, Esq., M.D., General Medical Council. Wm. J. Munro, Esq., J.P., Clerk to Easter Ross District George Williamson, Esq., M.D., Chairman of Aberdeen Local Committee. Medical Committee. Dr. Donald Murray, M.P.. Late Medical Officer of Health for John A. Young, Esq., L.D.S., J.P., Vice-President of the Odonto- Lewis. Chirurgical Society of Scotland; Convener of the Public Health Dr. James B. Simpson, J.P., D.L., Vice-President of the Suther- Committee, Edinburgh Town Council. land Nursing Association and Secretary to the County Local Medical Committee. 2. NATIONAL HEALTH INSURANCE (Approved Societies’ Miss Margaret M. White, Superintendent of Queen Victoria’s Work). Jubilee Institute for Nurses (Scottish Branch). Thomas J. Addly, Esq., Secretary of the Scottish Professional Each Consultative Council will, in terms of the Order Assistants’ Society and of the St. Andrews and Edinburgh Diocesan in Council, its own chairman. Mr. A. Insurance Society; President of the Edinburgh, Leith, and District appoint George Friendly Societies’ Council. Birse, Scottish Board of Health, 125, George-street, Neil Beaton, Esq., National Amalgamated Union of Shop Assist- Edinburgh, will act as secretary to the Councils. ants, Warehousemen, and Clerks ; ex-President of the Scottish Trade Union Congress. Hugh Berrie. Esq., Secretary of the British Order of Ancient Free Gardeners. David Bertram, Esq., J.P., High Chief Ranger, Ancient Order of MEDICAL CARE IN INDUSTRY. Foresters’ Friendly Society. Miss May Dunbar, Secretary of the Scottish Women’s Friendly Society. THE appeal of modern preventive medicine, directed, James of the Miners’ Federation Gold. Esq., Secretary Scottish as it at the instead of confined as Friendly Society. is, individual, being John C. Hendry, Esq., J.P.. Secretary of the Brechin Mill and heretofore chiefly to the sanitary conditions of life, may Factory Operatives’ Union : President of the Scottish Textile be said to be concerned with three stages; (1) Obtain- Workers’ Federation. a of births and Thomas McMeekin, Esq., Glasgow District Secretary of the ing healthy population by supervision Independent Order of Rechabites; President of the Scottish infant life, what is known as maternal and infant Conference of Friendly and Approved Societies. welfare ; (2) supervising the growing child, carried out Miss Annie McRobbie, Secretary of the North of Scotland Women’s school medical and in Insurance Society. through service ; (3) maintaining W. S. Rimmer, Esq., J.P., Inspector (Glasgow District) Prudential health the adult worker. Assurance Company, Limited. This country is probably abreast, if not ahead, of - W. M. Shaw, Esq., Manager of the Scottish Legal Health Assurance other civilised countries with to the first two Approved Society. regard Miss Eleanor Stewart, Workers’ Union. stages. but we are behind America with regard to the William Thomson, Esq., Secretary of the Scottish Coöperative last. Something we are doing through the activities Friendly Society. known as "industrial welfare," ivhich received, Peter Webster, Esq., Secretary of the Scottish Horse and Motor- through men’s Association. the influence of the Ministry of Munitions, a great William Wood, Esq.. Secretary of the Scottish Rural Workers’ impetus during the war in the engineering trades ; and Friendly Society. we have to-day a powerful Welfare Supervisors’ Associa- 3. LOCAL HEALTH ADMINISTRATION AND GENERAL tion over 1000 strong, an Industrial Welfare Society HEALTH QUESTIONS. (representative of an important group of employers), The Most Honourable the Marchioness of Aberdeen and Temair. the powers of the Home Office in relation to welfare President of the International Council of Women, accommodation, and the work carried on by the Robert Allan, Esq., Secretary of the Scottish Trade Union training section of the Ministry of Labour. But the Congress. , Sir Henry Ballantyne, D.L., Chairman of the Royal Commission work, as readers of semi-popular journals and the daily on Housing (Scotland). press can testify, is steadily drifting into lay hands ; the Joseph F. Duncan, Esq., Secretary of the Scottish Farm Servants’ medical profession is only called in here and there to Union. of this J. 13. Fergusson, Esq., Ayr County Council. help ; it is not as it ought to be the fons et origo Andrew Grierson, Esq., Town Clerk of Edinburgh. important branch of preventive medicine. Presently - Joseph Johnstone, Esq., M.P., Renfrew County Council; President the profession will discover that vested interests have of the Scottish Association of Insurance Committees. in of its true William Jones, Esq., Clerk to Glasgow Insurance Committee. been created which stand the way H. S. Keith, Esq., ex-Provost of Hamilton. recognition and influence. W-. W. Kelson, Esq., Chief Sanitary Inspector, Paisley. Mrs. Mary Burns Laird, Scottish Labour Housing Association. Industrial Medicine in the United States. Lady Leslie Mackenzie, Vice-Chairman of Edinburgh Insurance Advance in the United States is proceeding on Committee; President of the Scottish National Association of the Health Visitors and W’omeu Sanitary Inspectors. different lines, and these are clearly indicated by W. M. Marshall, Esq., Clerk to Lanarkshire Insurance Committee ; Public Health Bulletin. written by C. D. Selby, on Secretary of the Scottish Association of Insurance Committees. the Medical and Care of Industrial W orkers.1 Sir Thomas Munro, E.B.E., County Clerk of Lanarkshire. Surgical Thomas G. Nasmyth, Esq.. M.D., D.Sc., ex-President of the Industrial medicine is therein recognised as a new and Scottish Society of Medical Officers of Health; formerly Medical interesting science, a branch of the science of industrial Superintendent of Perth Infirmary. on the one hand, as it is of Malcolm WT. Scott, Secretary of the Society of Inspectors of Poor management preventive and Poor Law Officers of Scotland. medicine on the other a compromise between the James Stewart, Esq., Glasgow Town Council (Convener of Health ideals of medicine and the necessities of business." Mr. Committee). I defines industrial medicine as "the and Joseph Sullivan, Esq., M.B.E., Lanark County Council ; Secretary I Selby theory of the Scottish Labour Housing Association. practice of medicine applied to the purpose of preventing James Thomson. Esq., City Engineer, Dundee ; Vice-President of the Institute of Municipal and County Engineers. 1 Studies of the Medical and Surgical Care of Industrial Workers. W. E. Whyte. Esq.. O.B.E.. District Clerk. Middle 11-ard of By C. D. Selby. Public Health Bulletin, No. 99. 1919. United Lanarkshire. States Public Health Service, Washington. 342 and alleviating sickness and injury among industrial The need in larger establishments is, of course, still workers in order that they may enjoy the benefits ofgreater ; and where from 500 to 1000 persons are continuous productive employment and he points outemployed the part-time services of a dentist for prophy- its value both to employers and to workers. lactic service is considered warranted. The personnel Adoption of work on the lines of this definition gives and organisation of medical departments in establish- to industrial medicine a clear line of action and a duty ments employing different numbers of employees is to fulfil, so that workers shall no longer feel themselves usefully discussed and set out. But attention is drawn slaves, to the need for physicians trained in industrial Hardened to hope, insensible to fear, medicine: those who drift into the work tend to drift Scarce of a dead living pulleys machine, with and those who act as for Mere wheels of work and articles of it; "finger wrappers" trade, the it them are a to the science. That grace the proud and noisy pomp of wealth ! money gives reproach What is wanted is men " giving their brains and hearts The report is based upon information obtained from to industry, striving at all times to better conditions 155 industrial establishments as to the medical activities among the working people, and to benefit industry carried on. These establishments employed 20 con- itself.’’ The advice given to the industrial doctor sulting physicians, 68 whole-time physicians, 50 part- for arranging his work is, " organise, deputise, and time, and 37 on call-i.e.. 175 physicians in all-and in supervise " ; and training and aptitude are required for addition 13 dentists. while there were dispensaries at 137. its adoption. The place of the dispensary attendant These figures show how this new science in the States and factory nurse is set forth clearly, and the need is under the direction of the medical profession. The for adequate clerical staff. factory doctor can make his value felt in every stage of Good plans and illustrations of dispensaries and industrial life :- medical quarters are given in the report, which is worth (i.) At industrial birth—in selecting workers suited consulting on this account alone ; and attention is also to their work. The effect produced can only be appre- directed to equipment, furniture, and fixtures. The ciated by contrasting it with the present way of engaging practical information given in these portions of the workers by the method of trial and error with its report will be of the greatest use to those called upon to attendant financial waste and instability for labour; advise manufacturers wishful to embark upon this under this method it is usual to-day to engage annually remunerative branch of industrial management. 1000 new workers to maintain a of 1000, and personnel Industrial Medical Activities. Mr. Selby quotes one company in which the labour turnover for the year 1917 was somewhat over 400 per The following summary is worth quoting verbatim to cent. Every engagement represents a cost of about £1. indicate the wide field of work which comes within the Careful selection lessens the turnover by not less than boundaries of industrial medicine :- two-thirds; and the money saved is sufficient of itself 1. Treatment of injuries in dispensary, home, or hospital, to carry the cost of industrial medical service. by physician, attendant, or consultant, including orthopedic (ii.) Throughout industrial life-in supervising the and reconstructive surgery when necessary. health of the workers and the hygiene of workplaces. 2. Opinions as to disabilities from injury and recommenda- Medical attention to personal ailments, small at their tions as to compensation awards. lessens lost time and 3. Rehabilitation of impaired workers. start, promotes working efficiency; 4. Consultation and for the this is at the ambulance room or service, including dental, given dispensary. alleviation of ailments that become evident during hours Tours of inspection are required to ensure adequate of employment. sewage and waste disposal, washing and toilet facilities, 5. Assistance in obtaining skilled medical, dental, and ventilation, illumination, heating or cooling apparatus, nursing attentions when employees themselves are unable blowers, exhaust draughts. floor and window cleaning, to procure them. and pure drinking water. Machinery, tools, and methods 6. Visits on sick absentees to assist in treatments, to render social or to instruct. of work call for medical attention to reduce to a aid, 7. to uncover minimum hazards to health Health instruc- Regular factory inspection designed condi- and body. tions that are inimical to health, and written recommenda- tion and dental are essential of the prophylaxis parts tions to proper officials for their correction. work. Supervision of the provision, during attendance 8. Studies of the effects of methods, processes, and at the factory, of food suitable in quantity and quality machinery operations upon health and body functions, to the work is a physiological question. Hours of labour relating to posture, eyestrain, monotomy, speed, poisons, in relation to fatigue. with facilities for rest and recu- &c. Written recommendations to proper officials when: effects are found to be and advice to can be a medical harmful, employees peration, only scientifically arranged by which will enable them to minimise the harmful results in industrial Accident expert hygiene. prevention, of processes from which hazards cannot wholly be removed. effected by the safety-lirst movement, is essentially 9. Physical examinations of applicants for employment, psychological in aspect. These are some of the medical and written recommendations to employing officers relative aspects of industrial life. to applicants’ fitness for work. (iii.) At threatened industrial demise-in restoring 10. Examinations of applicants for re-employment when to productive activity those who have temporarily the periods of absence warrant them. 11. of when their broken down or sustained some Examinations employees shop efficiency incapacitating injury. falls unless the reasons are not of nrst-aid treatment and ambulance off, evidently physical; Organisation squads advice and treatment, or aid in obtaining treatment, to such are called for here. medical and Out-patient work, as need it; and written recommendations to foremen when surgical, at the ambulance station makes a constant deemed wise. demand for service. Visitation of sick or injured 12. Examinations of employees returning to work after workers in their homes is often needed. After-care and sickness or injury and written recommendations to employ- training of those in any way maimed can, in medical ing officers and foremen if employees are not fully restored. hands, often restore to usefulness those who must other- 13. Examinations of employees who do not feel well or do not well to their foremen or advice to wise drift the a which appear fellows; among unemployable ; discovery when it is indicated ; and written recommenda- the Pensions in this is now demon- employees Ministry country tions to foremen if altered working conditions are essential. strating for the enlightenment of industry. Mr. Selby 14. Examinations of workmen ceasing employment after tells of two blind men found in the plant of a large having been exposed to special health hazards and explicit electric motor company, and of 51 crippled employees records of their conditions. at the factory of an Ohio shoe company ! 15. Frequent examinations to follow up previous nndinga. 16. examinations of all workers, those Where and How Medical Service should Start. Monthly process who may be engaged in any work that may in any way have The report considers that: "An establishment employ- ill effects, and of food handlers. ing anywhere from 200 to 500 people is warranted in 17. Epidemiological service including intimate co6peration with health authorities. having a dispensary; that such an establishment is municipal 18. Health instruction by talks in the homes or justified in having either a whole-time or part-time personal if factory, by lectures, posters, or pamphlets. physician ; and that he be on a part-time basis his 19. Records of data that will assist in the prevention of services may advantageously be augmented by a accidents and sickness. trained female nurse or a person who has been taught 20. Records of facts that will enable employers and to handle the routine work under his direction." employees to obtain equitable compensation adjustments. 343

21. Records of information that will show the scope and when it was recommended by a known research worker. value of all medical activities. In 1915, a of two gallons of the 22. Studies of facts and data with the view to September, purchase developing solution was made from the at a cost of scientific and usefulness. respondents knowledge a of the solution 23. Contributions to scientific and trade publications. 17s. 6d. a gallon. Last September gallon 24. Attendance at meetings of scientific societies. was ordered, and when the invoice arrived the Com- 25. Constant efforts to merit and retain the confidence mittee. was intensely surprised to find that a charge of the employees and the approbation of tne employers. was made of £14 10s. 7d. It refused to accept the 26. Frequent conferences with those in authority. solution, which was returned to the company, who sent 27. Cooperation with other establishments and local, them a credit note for the amount The Com- and National Health authorities. charged. State, mittee extracted a small of the solution from the 28. And the admonition to portion finally, organise, deputise, which it no was and supervise, remembering always that anything which bulk, offered to pay for, but charge is important enough to do is sufficiently important to be ever made for it. The witness gave it as his opinion done well. that there was no reasonable explanation for a rise in Records and Reports. price of over 1500 per cent. The Committee brought the as it had in the first instance recommended Work of the kind here indicated* cannot be done complaint the solution and it also felt that it should without and is not publicly, organisation, organisation possible take to excessive made for without records and Mr. has taken strong exception charges reports. Selby materials which were used in research work. much trouble in setting out and discussing the value of In answer to the Chairman of the tribunal the records found in use, and the way in which they (Sir Herbert it was stated Dr. should be employed to ensure efficiency and rapid work. Neild, K.C., M.P.) by Dudley The diversity of forms adopted makes him appeal for that the Committee was now purchasing a solution elsewhere which answered its at a of some standardisation: and we cordially agree that much purpose price about 28s. a would accrue therefrom. In this we gallon. advantage country to Mr. A. who understand that an effort in this direction is to be Replying Brammall, solicitor, appeared likely for the the witness that the of made; and that a set of forms recommended for use company, agreed price the used in the such as may soon be placed before manufacturers by a Govern- ingredients solution, ether, ment methylated spirit, and nitro-cellulose, had considerably department. , No useful would be served the advanced in price during the last few years, while purpose by discussing labour had forms in the at we need also gone up considerably. reproduced report length ; only Dr. further stated that the formula for the point out that while summary reports are needed by Dudley solution was to the manufacturers the industrial officials, which should be as simple and supplied by Medical Research Committee. He was not aware that concise as possible, they must be based on detailed before the war the solution could be obtained from records which incidentally are invaluable for the only of scientific industrial Germany, and pointed out that there was nothing very pursuit knowledge. Every difficult about the of the stuff. He did not know physician should be a research worker in this new field, making that in 1915 the was and make full use of the experiments continually, even respondent company specially though unintentionally, being carried out in the estab- asked to make the solution as it could not be obtained lishment he is attached to. The need for knowledge in elsewhere. industrial medicine is to-day great and pressing when Mr. Brammall said that the charge of £14 was a the whole world is calling for production, production, mistake and was never intended. If, when the Com- and again production; it is required to enable the mittee complained, it had mentioned that it had industrial worker to multiply his output without detri- been charged £14 the whole matter would have been ment to his health and contentment-that detriment rectified at once, and a full explanation given. The which is the foundation of industrial unrest and strikes, correct charge was 37s. 6d. The solution was sold as a solid or in form. As a solid the was 37s. 6d. with their inevitable drag on the wheels of social liquid price while the same amount was for a progress. per pound, charged The was that when a of the Industrial medicine can here play an important part, gallon. explanation gallon solution was there remained 1 lb. of solid because, as Mr. Selby justly writes, it "is not only evaporated matter which were called " the humane but essential to production. It is beneficial to chips." When employee Iof the to whom the order was handed saw workers and profitable to employers. It offers splendid company a was ordered he that a of advantages to physicians for the development of careers gallon thought gallon Ithatthe solid substance was He estimated a in a field of rapidly growing importance, vital with required. opportunities for service to humanity." gallon as being equal to 3 kilos or 7 lb. 12 oz., and the charge of £14 odd was made out in that way. His I clients were specially requested to make the solution in 1915 when the supplies from Germany were ALLEGATIONS OF PROFITEERING: exhausted. The company did not want to make it, A COMPLAINT FROM THE MEDICAL and they only consented from patriotic motives, as they RESEARCH COMMITTEE. were told that medical people required it for the relief of suffering manhood. Literally and truly they only commenced the manufacture from philanthropic and the turnover AT a meeting of the Complaints Tribunal of the patriotic motives. Between 1916 and 1919 Central Committee, held on Jan. 30th at the Hotel of the company was four millions sterling, while in the Windsor, Victoria-street, S.W., a complaint was investi- four years the sales of the solution only amounted to gated which had been lodged by the Medical Research £80. From a business point of view the company ought Committee, of 15, Buckingham-street, Strand, W.C., never to have touched it, and would rather not have regarding the price of a gallon of collodion solution had the business. The company had a very high which was supplied to them by the British Zylonite Co., reputation in the country. He also pointed out that Ltd. of Hale End, London, E. The complainants alleged between 1915 and 191R no orders for the solution were that they were charged £14 10s. 7d. for a gallon of the received, and only " chips " were sold by the company. solution which they had previously purchased from the Mr. T. R. Brooke, the commercial manager of the respondent company at a cost of 17s. 6d. company, said that in 1915 he was told by the Medical Dr. H. W. Dudley, who appeared in support of the Research Committee that Schering’s collodion was no complaint, mentioned that the Medical Research Com- longer procurable, and, as it was required, they under- mittee conducted general medical research for the took to produce collodion, being told how it was purpose of combating disease. He recalled the fact produced. The price had increased from 17s. 6d. a that in 1915 a paper was written in which the author pound or gallon to 37s. 6d. mentioned that the British Xylonite Co. were willing The Chairman: That increase would not be com- to supply the solution, which was essential for some plained about. research work. That was not a customary step to take I Mr. Brooke further stated that when the complaints when research work was published, and the result were received there was nothing in the letters to show would be that other people would apply for the solution I that i;14 had been charged. It was not until they