Assessing the health of the industrial worker.

In assessing the influence of an occupation on health, the main criterion must be disease, for it is measurable whereas " health " so far defies reliable measurement. The association between disease and occupation is easily observed when the clinical picture is clear as in lead poisoning or silicosis; but sometimes it is so obscure that it is only recognized by a man with a sharp and experienced mind. Sir Thomas Legge (1934), when told of two fatal cases of tetanus among Dundee jute workers, remembered that the Solomon Islanders poisoned their spears by dipping them into mud which was a culture of tetanus bacillus. It occurred to him that the alluvial soil of Bengal in which the jute was grown might be rich in the spores of tetanus bacilli which were then brought to Dundee on the jute fibres. His hypothesis was confirmed. The relatively simple association of cause and effect in much industrial disease and injury led inevitably to a narrow concept of industrial medicine. But today the industrial medical officer and research worker in addition to investigating ways of preventing clear-cut occupational hazards are expected to determine the extent to which many physical and psychological factors at work may be related to illness. Indeed every doctor in charge of patients is faced with this sort of question: Is the foreman's duodenal ulcer caused or aggravated by his work ? Has the dust from the metal grinder's work been the main cause of his chronic bronchitis ? Has stress played a part in the aetiology of the business executive's coronary heart disease ? These questions are extraordinarily difficult to answer. Yet, as doctors, we often accept too readily that work causes or aggravates disease and restrict our patients unnecessarily, often to their detriment (Melville Arnott, 1955). Doctors in hospital and in general practice have that most cherished responsibility of looking after individual patients. Those in industrial medicine have less responsibility for individuals but have opportunities, denied to their colleagues in hospital and general practice, to study the distribution of disease in groups of people. By using the methods of epidemiology and looking at groups of workers, it is possible to get information which, even if it does not answer all the questions about the occupational causes of disease, may at least show that work is not always harmful and guide doctors in their care of individual patients. In …