care.

Most of them involve much less participation by the employees than does the one described above. There are also plans for industrial medical service initiated and controlled entirely by the workers. The Joint Board of Sanitary Control, in New York City, furnishes perhaps the most prominent example. This is an organization managed and supported by workers in certain women's garment trades, and touching the lives of over 75,000 workers in more than 2,700 industrial establishments. Through its members the board supervises conditions of safety, sanitation, and general conditions relating to health in the clothing industries of New York, which are united under the Protocol of Peace. It seeks to enforce "standards not by police power or compulsion, but by education, co-operation, and educational persuasion." 1

In 1912 it established a clinic where any worker in the industry may be examined, and which supervises the sick benefits paid by the locals of the union. The unions also pay for sanatorium treatment for members suffering from tuberculosis, and provide nose, throat, eye and ear, and dental clinics. "The main significance of these clinics lies, of course, in the fact that they are conducted, financed, and managed by the workers themselves, for their own benefit." 1 As large numbers of the garment workers are Jews and Italians, either foreign born or the first generation here, it is evident that their organization is closely related to the problem of medical care for the immigrant. Only a minority of the members, however, appear to make regular use of their clinics.

1 Dr. George M. Price, Modern Medicine, May, 1919, p. 49. 2 Ibid., p. 50.

Another phase of industrial medicine with which the industrial physician should be familiar is to be found in New York City. This is the relationship established by the Department of Health between its Division of Industrial Hygiene and the labor unions in the city, and known as the Labor Sanitation Conference. It is an endeavor to associate labor unions and a city department in improving general health conditions in the factories of the city. Education, both of employees and employers, is a prominent part of the work. The police power of the city department is used when need arises, and the 75,000 members of the affiliated unions act as voluntary inspectors for the department. On one occasion the department conducted physical examinations on a voluntary basis for union members, who were largely foreign born.

To be successful, such plans require the voluntary co-operation of all workers concerned, and this involves an immense amount of educational work with the immigrants. Most of the foreign born are not so much interested in health as they are in personal illness. Sickness makes them think of the health they have had, but so long as they are well it is very difficult for them to appreciate the need of preventive work, and that is the ultimate interest of such organizations as these in New York City.

It should be apparent that plans for co-operative medical service by and for employees will not supersede the well-developed clinic in an industry. Many medical and sanitary problems are closely linked with the individual factory and can best be dealt with from

1 Dr. Louis I. Harris, Monthly Bulletin of the Department of Health of New York City, June, 1917.

the inside. The factory clinic should maintain supervision of the immigrant's health and the conditions under which he works. It should see directly or indirectly that medical care for himself and his family is available and within reach of his pocketbook. Whatever tends to keep workers well tends also to stabilize labor conditions. Good medical service to employees is also service to the employer.

EXTENSION OF SERVICE TO HOMES

A few industrial physicians have extended medical service beyond the plant itself to the homes of the employees. The value of such service to the immigrant and his family is great, especially if obstetrical care and medicines are included.

Not all physicians, however, agree to the advisability of doing this. It is contrary to the policies of such representative plants as the Norton Company in Worcester and the Goodrich Company in Akron, Ohio. Both these plants are located in cities large enough to provide other medical facilities, and their doctors feel that the industrial physician should not infringe on the practice of private doctors.

Endicott Johnson and Company, of Endicott, New York, hold the opposite point of view. They have three nurses for visiting the homes of their employees and another three for clinic activities. Obstetrical service, as well as eye, ear, nose, and throat work, are free to the families of employees. Their visiting nurses make both prenatal and postpartum calls.

Apparently a company's attitude on this question is determined to a large degree by the size of the

community in which it is located, and by the other medical resources which are available in the vicinity. The boundary line of responsibility is a delicate and changing one, and its decision for any industrial establishment requires careful analysis of environment.

In most places where the physicians employed by industries are the only ones available, it is of utmost importance to the immigrant employee that his family have access to the doctor's services. Moderate prices mean more prompt medical care, and this in turn means reduction in time lost through illness of the worker or his family.

Nursing aid extended to the homes has great value in any locality, particularly in relation to the immigrant. The visiting nurse is probably more welcome than any other person in the homes of the foreign born, because she comes on errands of mercy and helpfulness.

This is one reason why it is disastrous for an industry to use a nurse as a truant officer in following up absences among the immigrant workers. They soon feel that she to whom they have turned as a friend in time of illness has become a spy and intruder in their family life. The consequent resentment kills the nurse's opportunity to carry on educational work in connection with her friendly aid.

Hers is the chance to adjust food habits to the demands of American life; to teach American standards of hygiene and sanitation in both factory and home, and to spread knowledge as to the proper care of the children who are to be the workmen of to-morrow. Only by slowly winning the immigrant's confidence and trust can extension of medical service be made

of value to him and to the industry which employs him.

HOUSING

Some industries have extended their health work into the field of housing. The necessity for this, also, varies largely with the circumstances in which the industry finds itself. That the housing of his workers is important to the employer needs little proof. Evidence from England on this point is brought by Charles C. May in Modern Medicine: 1

Given two factories with identical conditions in all other respects, but one housing its workers well, the other permitting the old-style "settlement" to exist. . . it needs no argument to prove which of the two factories will have the greater charge for labor turnover.

TABLE XXXIII

COMPARISON OF THE WEIGHT AND HEIGHT OF CHILDREN OF DIFFERENT AGES, LIVING IN BOURNEVILLE AND BIRMINGHAM, ENGLAND

1 Charles C. May, "Better Housing," Modern Medicine, May, 1919, p. 70.