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and did not know your weakness or its drift, you would be apt to take a dusty job in a confined place. In such a case I would show you why you should seek for other work, preferably in the open air; and I would try to get you to build up your strength by exercise. If a casual examination indicated that your lungs were weak I would then examine them more extensively, for the grave tendency to pulmonary tuberculosis in such an instance must be checked, and this can sometimes be done most effectively by guiding the person into an open air job and by inducing his rigid observance of good habits in respect to his diet, exercise and rest. If tuberculosis had already taken hold, it would also be my duty to see that its contagion was minimized.
"The man with a weak heart or with shaky nerves is apt to become distracted if engaged on work that is full of quick surprises or excitement. The excitement itself saps his strength, interferes with his own safety and adds to the risk of hurting others; but there is much good and remunerative work that can be done by such a man. I would therefore try to steer him into a quiet occupation and would show him how to remedy his weakness or at least how to avoid getting worse. But you needn't worry about your chest or your heart or your lungs. They're all right."
In examining the abdomen, the physician looks particularly for indications of disease peculiar to that part of the body. He also searches with unusual care for evidence of hernia (rupture), a serious natural weakness common to persons in every walk of life. Yet thousands do not know that they are ruptured until it becomes painfully serious or unless a physician points it out. In one plant, seven out of every hundred persons were found to be slightly or seriously ruptured. A ruptured person mortgages his vitality and gambles with his very life when he lifts heavy loads or even coughs violently. "If you were ruptured, I would counsel you not to go to work without a truss, or until after a simple operation that would make you fit again. But it takes only a second to find that you are not ruptured."
Harry Maxwell was proud of his feet. He wore "number six shoes and hadn't a corn or a bunion." Imagine his amazement when the doctor told him that his feet were deformed, that his "arches had fallen" and that they were the chief cause of that tired run-down feeling that he had mentioned. "But," said the doctor, "that is easily fixed; if you will buy and wear suitable arch supporters, you will be surprised to find how much comfort and backbone they will put into you. Gradually they will force the arches into normal position. But if you don't get the right support for your feet, your feet will not be able to support you."
Harry had been with the doctor exactly nine minutes, but what a revelation about himself he had received! It was a big relief to know that he was as well fitted for work as he was. But he thought with a shudder of the suffering and misery he had blindly invited by neglecting to have a physician examine him before. He felt sure that he would get the job, but he made up his mind that whether he got it or not, he would attend to his feet and teeth. And he did. And Harry Maxwell was a much different chap after that.
In somewhat the same way as Harry Maxwell was examined by Doctor Burton, the doctor examines dozens of persons every week. He measures each physical element that might be
affected by the kind of work the person proposes to do, and he makes such other inspection as his judgment may dictate. The appearance of each person's skin, his mental and physical attitude, the condition of his spine and many other features which would indicate to a trained physician if anything is wrong, are carefully noted.
The working conditions common to some industries may require that the employees should be given a rigid examination, while in other industries a comparatively lax examination will answer all practical purposes. Those engaged in preparation of food stuffs, for instance, must be examined very often to insure cleanliness of their habits and person, and absolute freedom from communicable disease. The examination of those who work with oils or chemicals should be made with particular reference to their ability to withstand the effects of such materials upon their skin, eyes or lungs. Many persons work indoors under conditions that require special medical oversight, while those who work in the open air need much less attention. So that while the examination card referred to, records all commonly essential details, special conditions may call for a more elaborate or even for a more simple examination and record.
The record made by the physician becomes the basis, from the physical standpoint, for the judgment of the person who proposes to hire or who already employs the person examined; it also serves for comparison when the person is re-examined. But it should be clearly understood that it is not the physician's function to hire or reject applicants for employment; he merely determines the physical fitness of each for any branch of work. The employing department must assume full responsibility for hiring persons, else the physician's influence might be impaired and the hiring department's authority curtailed, to the dissatisfaction of both. No applicant for a job should be sent to the doctor for physical examination unless the employing department is satisfied to give him the job if he is found to be physically fit for it.
It is advisable to extend the practice of physical examination to all classes of employees. Any measure of economy in restricting its application is false economy. The more
valuable and intelligent the worker, the more loss to his employer his family and himself if he should impair his health and efficiency. The lower the grade of the worker, the more he needs the health supervision that physical examination affords. Perhaps the only exceptions that can be justified are those employees who are engaged for very short service.
It cannot be expected that an initial examination is a permanent protection; it is obvious that impairments to health may develop at any time afterward. All employees should therefore be re-examined from time to time, usually once every six months; more frequent attention should be given to those who work under conditions that might undermine health. For it is often found that where a hundred workmen are immune from the ill effects from certain acids, fumes, heat, cold, or dampness, some one of the hundred may have a peculiar susceptibility to skin irritation or other health injury when working under exactly the same conditions. It is often impossible to forecast such a tendency, and re-examinations should be frequent enough to determine this before any disease can become deep-rooted.
The frequent re-examination of employees, and the mere fact that the workers know that a physician is delegated to look after their health, leads them to consult him frequently about their ailments. This more or less continuous influence of the physician helps to decrease sickness of employees, builds up their health and energy and thus their efficiency and value. It is not advisable, however, that the examining physician treat employees except in
emergencies. Where conditions indicate that medical assistance is needed, he will urgently impress such need on the employee, will endeavor to induce him to secure adequate medical treatment, and will cordially co-operate as far as possible with the physician or specialist whom the employee may engage. On the other hand, the treatment of injuries incurred by employees in course of their employment is strictly the duty of the examining or works physician and should be rendered either by him or by trained nurses or laymen under his direction.
In order that the physician may intelligently direct prospective employees to tasks for which their physical condition fits them, he must become familiar with shop conditions. This better understanding of the requirements of industry enables him to co-operate with all concerned in promoting practical shop hygiene. He demonstrates his helpfulness by making the shop fit for the worker, as well as by making the worker fit for the shop.
There can be no question of the advisability of measuring a workman's physical fitness for his job, whether it is considered on the broad, humanitarian basis or from a selfish, cash-conserving standpoint. It adds to the worker's physical comfort, gives him better employment for longer periods, puts money into his pocket and improves conditions in his home and in the community. By paying attention to physical defects in timedefects that would be overlooked if such physical examination were not made-hundreds of employees have been re-fitted for work who would otherwise be jobless because partially incapacitated. Moreover, the health education imbibed by workers through their contact with the works physician extends also to the workman's family; the things that "Hubby" or "Daddy" does to protect his health are noted by his wife and children who, very naturally, are quick to follow his example. This influence accumulates more and more as it spreads from workman to workman, from family to family, and thus throughout the community.
To the employer the benefits are manifold. The greater prestige gained for his shop is worth considerable. The increased happiness and contentment of his employees bring real profits. Their more steady and efficient work adds to their productiveness and helps in the smooth running of the plant.