is an interstate one, the United States Public Health Service, or some other Federal agency, may properly intervene to prevent unsanitary camp conditions.

THE PIONEER MINING COMMUNITY

As in the floating labor camps, conditions in isolated mining communities require the employers to carry health work beyond the confines of the industry itself. This is exemplified in the Mesabi and Vermilion iron ranges of Minnesota and the copper range of northern Michigan. Seven mining towns in these two ranges were visited in the course of this study and many interviews were held with persons engaged in and affected by health work-doctors, nurses, employees, and superintendents.

When this region was first opened, housing, water supply, sewage, garbage, and ash removal, maintenance of streets, all were provided by the companies. In the iron ranges where open-pit mining obtains, permanent dwellings are impracticable. Little shacks, uninviting, unhealthful, and desolate, are erected at the edge of the pits. The company is unwilling to spend money on buildings in a locality which in a brief interval will be evacuated for another site, and the workers cannot afford to. Under such conditions less headway has been made in the solution of medical and sanitary problems than in the copper ranges.

The mines' mouths in the copper ranges are fixed for years, and here the companies provide better houses and more adequate sanitation. Overcrowding is evident, however, and public-health problems are still far from being solved.

The reason for this can perhaps be found in the so

called contract system of industrial medicine, used widely on all these ranges. This is said to have been imported with the Cornishmen in the early days of copper mining in Michigan, when it was claimed that only assured incomes would keep doctors in the newly opened mining regions. According to the present system an amount ranging from 75 cents to $1.50 per month, deducted from each employee's wages, guarantees the doctor an annual income in return for caring for all the medical work of the community. Given a doctor of vision and energy, the system affords possibilities for broad development of constructive health work. But too often it lends itself to exploitation from both sides; the workers make excessive demands

for free medicine and medical service, and the doctor is often lax and careless.

The workers have no choice in the deduction from their wages for medical work. They have no control over the system, no voice in the administration of the funds or the choice of the doctor. Few of the contract doctors regard themselves as employees of the workers. They are engaged and discharged by the company, though paid for by the workers. Representatives of the mining companies generally seem to regard the system as "welfare work." This is also the point of view of most of the "contract surgeons." Many of the miners are indifferent to the question. Others see in it a just cause of discontent and criticism. There is evidence that the essential justice and efficiency of the system is being questioned. Everywhere symptoms of unrest are showing themselves, and the value of the system is being challenged on all sides.

In contrast to the system in these mining districts is that prevailing in Ohio and Illinois. Here, according to the Insurance Commissions of these two states, the contract system is found much less frequently, and although the general community health work is of lower grade, a serious source of unrest among the workers is absent.

In a Pennsylvania town in the Monongahela Valley, a plan has been worked out whereby industrial and community medical service is provided and administered jointly by the miners through their unions, and the company. Here membership in the health program was voluntary and responsibility and control were shared by all concerned. Surely this partnership contains the germs of a system that will work for

better health, as well as better feeling and understanding between the industry and its workers.

A joint plan for health which has had more extensive application is that of the Colorado Fuel and Iron Company of Pueblo. The workers as well as the management are represented on committees on safety and accidents, and on sanitation, health, and housing.1 Jurisdiction over all matters of health and sanitation is in the hands of these committees, and these problems have been dealt with entirely by this form of organization.

The testimony of persons immediately concerned points to the success of the plan. Interest is stimulated on the part of the workers, and opportunities for self-expression and responsibility are developed. Considering the large numbers of foreign born engaged in the mining industry, the importance to health work of a plan which engages their co-operation and interest cannot be overestimated. In this way, as in no other so successfully, can American health methods and standards be adapted to the varying demands made upon them.

SUMMARY

Industrial medicine is not only a matter of health technique; it is an industrial issue. In the economic difficulties that grew up in Colorado in 1913 and 1914 medical service was distinctly an issue. To-day, in many factories and mines, an ill-understood and unexplained system of medical examination or medical care is a factor in industrial unrest.

1 Industrial Representation Plan, Colorado Fuel and Iron Company.

The foreign born constitute a large proportion of the employees in many industries; in fact, they form a majority of the entire population in many industrial communities, both large and small. Yet correspondence and conference with industrial physicians, employment managers, and others make it clear that relatively little attention has been given to the special medical and health problems presented by this important labor element.

The value of medical service to industry in securing the maximum efficiency of labor is too well established to need discussion here. In the many communities where an industry is the only large and effective force, its responsibility in this respect looms large. Moreover, the industry has a much greater hold on its employees than the visiting nurse or dispensary social worker can usually acquire, and a consequently greater opportunity to get results in curative and preventive medicine. Whatever the industry's responsibilities and opportunities in regard to labor in general, these are intensified in the case of the immigrant by his comparative ignorance and helplessness in his new environment.

Some of the major questions with which industrial physicians and nurses are dealing, are: the prevention of accidents; the prevention and, where necessary, the treatment of occupational and other diseases; the maintenance and promotion of sanitation within the plant; and of personal hygiene among the workers.

Industrial medicine must justify itself on a business basis, and to achieve profitable results it must fulfill certain requirements. It must specialize in human as well as in medical relations. Knowledge and consid