INDUSTRIAL MEDICINE

also called Occupational Medicine, the branch of medicine concerned with the maintenance of health and the prevention and treatment of diseases and accidental injuries in working populations in the workplace. Historically, industrial medicine was limited to the treatment of injuries and diseases occurring to production workers while at work. Over the years this has changed, and everyone at a plant, factory, or office may now be eligible for medical services. College or school health programs might be considered as extensions of occupational medicine. Diseases directly related to occupations were recognized by early Egyptian and Roman physicians. Modern industrial medicine may be said to have started with Bernardino Ramazzini, an Italian physician of the 17th century, who strongly advised that the physician inquire into the occupations of his patient if he wished to learn about the causation of the patient's complaint. With the Industrial Revolution the number of persons exposed to potential hazards at work increased rapidly. Traumatic injuries became frequent, and diseases due to inhaled dusts and noxious gases and vapours were recognized, often by nonmedical persons. Initially, industrial medical programs were directed toward the treatment of injuries or diseases that resulted from or during work. It was soon apparent that prevention was more economical than treatment. Protective devices were developed and placed around moving parts of machinery. Control programs were developed by engineers to remove harmful dusts and vapours by proper ventilation of work areas or by substitution of less toxic materials. When the engineers could not control the environment the process was contained to prevent or at least minimize the exposure of workers. As a last resort protective devices such as masks and special clothing were worn by the workers. With the development of preventive controls the amount of industrial disease decreased. The development of new processes and new materials, however, produced new hazards at an ever-increasing rate, and constant vigilance was necessary. For example, the recognition that a pulmonary disease can result from exposure to beryllium demonstrated the need for a continued awareness of potentially toxic materials. It also demonstrated that a material once believed nontoxic may actually be toxic; this shift may be caused by a change in the physical or chemical characteristics of the material, an alteration in the method by which the material is used, a change in the amount of exposure of individuals to the material, and possible synergism with other materials. The concern with diseases due to occupation led to concern with the general health of the workers, not only because of an interest in their welfare but also because it was good business. A good industrial medical program improved labour-management relations and reduced absenteeism; labour turnover decreased and productivity increased. In many instances the savings produced by the reduction in premiums paid for workmen's compensation insurance paid for the occupational medical program. The types of programs varied greatly; some of the large industries had broad coverage, while small plants usually had no medical program. The comprehensive programs, in addition to providing treatment of diseases and injuries, might include pre-employment examinations and periodic examinations during employment. Throughout the world there is inadequate knowledge and reporting of industrial disease, and the data are suspect. Published figures for occupational illnesses, for instance, are smaller than for injuries because occurrence of job-related illness is less spectacular than, for example, an explosion of a mine causing a number of deaths. It may take a number of years of observation and research to discover that some particular dust, chemical, or type of physical energy is harmful. In addition, physicians may have difficulty in deciding that an illness is attributable to the job. Many industrial diseases mimic sickness from other causes, and little is known of the ill effects and signs of continued small exposures to toxic chemicals. Another difficulty arises from the fact that although job-related disease may be suspected, doctors often lack tests to identify such disease as specific. As a result, against every diagnosed case of occupational disease there may be many incipient or unrecognized cases from the same causes. Introduction of materials of unknown toxicity, as well as changes in industrial operations, may create unrecognized problems in preventing harmful effects until after workers have been affected.