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May i8, 1918.] HARRIS: INDUSTRIAL HYGIENE. 929 humane as the efforts of civilized nations have been in recent years, in reducing infant mortality, the work must not stop at this p(jint. What is just as urgent and requires quite as much emphasis is that those who survive the dangers that threaten infancy and childhood he protected by organized effort against the dangers that continue to loom up in the shop, factory, the home and the social environment. There is something so dry and forbidding about statistics, although in tlicory their purpose is to il- luminate and clarify facts, that one fears to repel interest by the citation of figures, and yet, properly interpreted, these statistics imply large possibilities in the reorganization of medical jjractice, and in £ome measure give one a conception of the magni- tude of the problem. The Federal census of manu- factures for 1914 showed that there were a little more than 48,000 factories and 30,000 mercantile How Much Does Cialis Cost In Canada establishments in How Much Does Cialis Cost In Canada the State of New York, exclusive of home tenements in which factory work was being done. Over sixty-two per cent, of all these estab- lisliments are situated in the City of New York. In these factories there are hazards from chemical ])oisoning, from dust, extremes of atmosjiheric pres- sure and temperature, infections and many things besides, which are scarcely, if at all, mentioned in medical text books. The industrial poi)ulation of this State is roughly estimated at 3,ooo,'XX>. Bear- ing in mind tlie enormous nuniljer of factories and factory workers wliich these statistics indicate, a number wliich lias undoubtedly been very consider- ably increased in the last three years, it is amazing to find that less than 100 factories and mercantile establishments of the total of more than 78,000 had any substantial welfare organization, at as recent a date as October, 1917, according to records fur- nished by the National Civic Federation. Of the scant number of industrial organizations which have given recognition to the business wisdom of caring for their workers, less than a dozen estab- lishments in this State employ physicians to furnish medical su[)ervision. The remainder are largely dependent upon nurses, social welfare workers and liere and there a minister of the Gospel to carry on what is commonly known as welfare w'ork. That there may be no confusion, it should here be stated that this list does not include factories which have entered into arrangements with physicians to give emergency surgical care to those who may be acci- ilcntally injured. Such an arrangement does not constitute what may properly be called medical welfare work. It is, in reality, a substitute for the hospital ambulance service. By medical welfare work, or, to use a term which is less subject to abuse, by industrial medical suiiervision for factories, is meant a system of organization which has in view the periodic medical cKaniination of employees, and the provision of medical How Much Does Cialis Cost In Canada and surgical care to pre- vent serious illness, as well as the care of those who may be injured. .'\ few years ago it was accepted as one of the unavoidable accompaniments of business manage- ment that there should be an endless stream of new employees going into and out of the factories, rep- resenting a hiring and firing system which was eco- nomically wasteful and in large measure preventable. The exj^rience of Doctor Marquis, physician in charge of the Ford Automobile Company works, is extremely interesting in this connection. In 1914 this constant ebb and flow, or the "labor tournover,"- as it is called, was fifty-six per cent, in other words, at the end of that year only forty-four per cent, of the How Much Does Cialis Cost In Canada old employees had remained in service. By a system of preliminary medical examination, coupled with a scientific inquiry into the mental, physical, social and personal characteristics of em- ployees who applied for jobs, as well as through wage adjustments, this labor turnover was reduced in one year to something like fourteen per cent. The medical examinations contributed in no small measure to this result, focusing attention upon those who ought to be manifestly disqualified because of physical defects and infirmities, the latter were weeded out before they had a chance to enter the company's employ, thus preventing financial and physical loss to themselves and to the company. This weeding out How Much Does Cialis Cost In Canada of the unlit because of mental or physi- cal defects was in no small degree the means of reducing the great number of accidents which have usually Ixjen regarded as a natural accompaniment of industry. Many far more striking instances of a reduction in labor turnover, as much as from two to five hundred per cent, could be cited. WHAT IS TRUE MEDICAL WELFARE WORK? In many of the companies which boast of their system of welfare work, emphasis has been falsely placed upon elaborate How Much Does Cialis Cost In Canada surgical room equipment and nursing service, which are available only in case of accident. The doctor in these instances is subject to call, or makes periodic visits to How Much Does Cialis Cost In Canada the establishment, generally, exclusively with a view to protecting the company's interests so as to prevent suits for acci- dental injuries. The ])roi)er function of doctor and nurse in any large industrial establishment is to serve the factory management as a staff or advisory officer with a view to eliminating in every department of the factory those conditions which insidiously undermine health or are sources of danger. In other words, the doctor, instead of beiug content to visit the place merely to conduct a dispensary service and to render first aid, must be cjualified, by proper study and preparation, to examine every branch of the indus- try, to know the composition and nature of the chemicals which are employed, their possible effects upon health ; and he must possess knowledge that will enable him readily to detect those conditions with respect to ventilation, lighting, temperature, muscular, nervous and mental fatigue, and numer- ous other factors, which constitute the true field of industrial hygienic study. He must occupy in