The industrial physicians were asked to mention the outstanding problems in connection with their work with immigrants. The answers are indicated below: TABLE XXXII OUTSTANDING PROBLEMS OF THE FOREIGN BORN IN INDUSTRY MENTIONED BY SEVENTY INDUSTRIAL PHYSICIANS PROBLEMS Housing conditions.... Kinds and preparation of food. Personal hygiene.. Tuberculosis.. Alcohol.... Occupational diseases (chiefly lead poisoning).. Teaching English language. Trachoma... Bad teeth.. Extension of medical service to homes. Hernia.. TIMES MENTIONED 22 12 10 7 6 6 4 3 3 2 2 It is evident that many of the "problems" mentioned in the questionnaires are common to all employees of industry, native and foreign born. But as we have seen, the immigrants' problem is complicated by unfamiliarity with language and American conditions, and by habits of life derived from an entirely different environment. The problems listed above group themselves roughly into two classes, those that can be taken care of within the factory walls, and those that extend industrial medical work into the homes of the employees and the community. The former includes medical examination, emergency work, care of occupational as well as general diseases, personal hygiene as well as plant sanitation. The broader problems of housing, family care, and public-health work in the community fall in the second group and represent an extension of industrial health work already undertaken in many places. MEDICAL SERVICE IN INDUSTRIAL ESTABLISHMENTS Most industrial clinics originated as a result of accident compensation laws. In the first stage of development a first-aid kit was kept in the building and doctors were engaged to answer emergency calls. The next step was the installation of first-aid stations within the plant itself, with a nurse employed full time; a surgeon was still on call for serious accidents. Selby, in his study of 181 plants with clinics,1 found that 14 per cent had what he called "detached emergency service"-that is, doctors were summoned only in case of accident. Then began the physical examination of applicants for work, and the periodic reexamination of those exposed to industrial health hazards. From this it was not a far step to the fulltime employment of physicians as well as nurses. Selby found that 65 per cent of the 362 doctors in the plants he visited were full-time men. Following this, the scope of the work has broadened. Medical staffs have been enlarged to include oculists and dentists. Special medical equipment is often provided. Service is extended to the homes. Educational literature and health talks are part of the activities of a few departments. Everywhere there is evidence of the emphasis put on preventive medicine. This expansion of industrial medical work is ably 1 C. D. Selby, Studies of the Medical and Surgical Care of Industrial Workers, United States Department of Labor, 1918. brought out by Dr. Harry E. Mock, in the Journal of Industrial Hygiene for May, 1919. In this field, what recognition has there been of the special problems of the immigrant employee, and what has been done to meet them? The best way to discover this is to follow an individual immigrant through a typical industrial clinic. His first point of contact is the man at the desk in the employment office. If our applicant understands any English he will get by there somehow. If not, some friend or neighbor may help out, or he will have to talk as best he can by signs. In one particular factory, which we are taking as our example, he is then sent to the clinic for physical examination before being placed at a job. Here his troubles increase. He is stripped, without knowing why in many cases, because he can't understand what is being said. Then the doctor makes his examination. How can an English-speaking physician hope to get a personal history from an immigrant who understands at best only a little English, and speaks imperfectly? How can the doctor explain to such a man the necessity of remedying his physical defects so that he may become a more efficient workman for the company which is going to employ him? If the employee knows a little English he may catch the words "operation,” "cut," or "hospital," and at once terror may fill his soul. The new employee's job may expose him to the hazards of industrial disease. Poisons, protection from which requires careful personal habits and cleanliness, are a greater hazard to such a workman than to the native born. The situation must be carefully explained. Here again the barrier of language is a handicap. To make clear the danger of something the workman cannot see, such as wood-alcohol vapors, is difficult if he cannot understand the language of the instructor. An interpreter who is familiar with medical and social work, and who also understands the racial heritage of the man concerned, is needed. To work through a third person is clumsy at best; but it is infinitely better to use a trained interpreter than any untrained person who happens along. It is not unlikely that the man we have been following through a clinic is very dirty. The doctor's first and peremptory orders are to take a bath-not once, but frequently. Then he cannot understand why his orders are not carried out. The suggestion of frequent bathing is not such a great shock to a native American. He at least knows our bathing customs and is familiar with city water supplies and bathtubs. But to the newly arrived immigrant such a suggestion may indicate lunacy or evil intent. Roberts1 has cited some vivid examples, of which the following is one, of the attitude some immigrants have toward frequent bathing: A young Pole was induced to go into the swimming pool in a Young Men's Christian Association; after that he kept away from the building, and the secretary went to find out why he stayed away. The mother of the lad met him, gave him a piece of her mind, that he dared make her boy take a bath in winter time. "Did you want to kill him?” Thousands of immigrants from southeastern Europe do not appreciate the value of personal cleanliness. One important way in which the industrial physician can aid his employer to reduce disease and accident, is 1 Peter Roberts, The New Immigration, 1914, p. 134. to enter the mother tongue and nationality of every man examined on his medical records, and then analyze statistics by race. The making of the original entry may be the duty of the employment department, but the medical department should know and utilize the facts. So few industrial clinics do this that the point cannot be too strongly stressed. Our investigation revealed that many nurses had no knowledge of the races in their plant, the number of employees of each, nor of diseases or accidents by races. They did not even know that there was a place on their medical record for a nationality entry. A few doctors have carried out this idea with great advantage, not only to the company employing them, but to others having to meet the same problems. One of these men found by analyzing his records that hernia occurred more commonly among the southeastern European employees, Italians in particular, than among other races doing the same kind of work. His next step in regard to this observation will probably be a study of food habits among the Italian employees. This same doctor has noted more pernicious anæmia among Swedes than among the southern European races. So he will go on analyzing the data secured day by day in the routine work of the clinic, and applying the knowledge gained to the practical demands of his industry. There is a great need for more extended study of this kind to provide a sound statistical basis for work with foreign-born employees. ACCIDENT PREVENTION Education of employees to prevent accidents and industrial diseases has received a great deal of attention |