American Social Hygiene Association.

Journal of social hygiene (Volume 28) online

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However, since the place of employment of these persons is fre-
quently known, it was felt that the use of the services of the medical
or personnel departments of industrial concerns would be helpful, if
it could be obtained.

To develop this program, personal visits were made by a department
physician to factories in Detroit. The names of plants to be visited
were compiled as cases arose in which a conference seemed warranted.
It was considered preferable to see the full-time plant physician. If
a factory did not have a physician, the personnel manager or owner
of the plant was contacted. In cases where one physician took care
of several small plants, the physician rather than the personnel man
was contacted. The insurance or compensation physician was never

Each company official was approached with a frank discussion of the
problem. It was gratifying to learn of each one 's interest in the welfare
of the worker, since a request from the company official carries more
weight with the worker than a similar request from the Health Depart-
ment. Every official has been impressed favorably with the program,
and this cooperation has not only been offered, but has been proved by
their prompt and effective action. The development of this program has
proved to be of definite and important service, not only in locating
persons but also in the mutual educational value of this cooperative

Industrial plants, both large and small, have learned the policies
of the Social Hygiene Division, and the diversified services offered,



including all types of laboratory work for venereal disease and case
consultation. However, the problem is quite different in large and
small factories, primarily because in large factories hiring of
employees is governed by recommendations from the medical depart-
ment, while in smaller factories it depends to a large extent upon
the judgment of the personnel manager or the plant owner.

The large factories showed a considerable variation in their medi-
cal policies. All of them conducted pre-employment physical exam-
inations, but all did not take routine Kahn tests of employees, and
only a few had periodic reexaminations. The majority did not.
Some took routine Kahn tests in certain work departments and not
in others. A few large factories would not employ any person with
a positive blood test, disregarding the fact that his condition may not
be infectious and the fact that since periodic reexaminations are not
done, there may be infectious cases in the plant a week after a
negative employment examination.

In many cases there was a tendency on the part of the medical
officials to demand that the patient bring in a certificate of employ-
ability from the Social Hygiene Clinic, rather than from a private
physician. This practice was never encouraged by the clinic. Many
factories required a periodic statement from the physician of an
infected employee, certifying that he was under continuous treatment.

It is believed that the visits to the factories have helped to stand-
ardize the attitudes and occasionally even the policies of these fac-
tories. Medical policies are not easily changed in industrial plants,
since the medical men rarely have a free hand in deciding factory
policies. Although the plant physicians agree with the need for
periodic examinations and routine Kahn tests on all employees, they
cannot always promote these policies, partly because the additional
expense may not be sanctioned by the factory directors, and partly
because of the attitude of the labor unions who fear that this type
of medical activity provides an excuse for discharging union men
who are disliked by the company.

In the small factory without a regular plant physician, either a
private physician is hired for part-time work, or the insurance com-
pany physician is used. The lay officials have been eager to know
about syphilis and its relation to employability. Their knowledge of
the problem has been surprisingly accurate. During the past year,
two small plants with an average payroll of 30 paid for a complete
physical examination and Kahn test of their men. These small plants
are the most cooperative. Since they know all their employees per-
sonally, their actions are usually quick and effective.

This new understanding with the companies has resulted in sev-
eral changes in their policies. More men who are serologically positive
but non-infectious are being employed, provided they continue their
treatments. Statements from private physicians are being accepted
by more plants since the work of the Health Department with the
private physician was explained. The factories are placing more


emphasis on compelling delinquents to resume regular treatments.
Plants having their own laboratory facilities are willing to examine
their own employees when the latter are named as contacts to known
cases, and also are reporting their findings to the Social Hygiene
Clinic. Several factories not having their own laboratory facilities
are sending their men to the Social Hygiene Clinic for darkfield and
spinal fluid examinations.

At the present time, 51 different establishments employing about
450,000 persons are cooperating with the Health Department in this
program. Very few of these factories had previous knowledge of the
services offered by the Health Department.

This program has been a definite aid in locating delinquents and
contacts and has lightened the load of the Social Hygiene Clinic by
placing many delinquents under treatment with private physicians,
as well as the examination of contacts by plant physicians. In addi-
tion, definite emphasis has been given to the control of venereal
disease in Detroit industry.

The Department of Public Health of the state of Vermont has under-
taken a program for health education among the state's industrial workers
through the organization of Yours for Health committees in plants through-
out the state. Mr. John H. Slocum, Director of the fours for Health pro-
gram, writes:

"The program has two main objectives (1) to promote healthy work-
ing conditions in a plant through elimination of hazards and unhealthy
conditions, and (2) to improve workers' health in the plant and at home.

"Under the first point, we try by actively enlisting the workers in the
Yours for Health plan to make them feel a sense of responsibility in
helping to maintain general good housekeeping in the plant. We also
make it understood that workers may make suggestions to the management
pertaining to health conditions. The management is encouraged to call
upon our doctor, engineer and nurse for any service they can render. In
some plants we have formed workers' committees which serve to represent
employee opinion and which interest other men in the plant in the program.

"Under the second point, we send health educational material to the
homes of the workers, feeling that more attention will be paid to literature
sent through the mail."

An application form is signed by each worker who wishes to participate
in the program and he receives a membership letter and a button. ... Of
Vermont's 360,000 population, ordinarily about 50,000 are industrial
workers. That number is now increased by some 10,000 additional war
workers in various defense industries.



Industrial Assistant

Preparatory to expanding its educational program for industrial
workers in 1941, the American Social Hygiene Association made a
questionnaire * study of what industry was actually doing about
venereal disease control. This was completed with excellent results
from a statistical point of view and with extremely optimistic findings
from the venereal disease control angle.

More than two hundred plants scattered through 43 states answered
the questionnaire. These plants represent every type of industry
and altogether employ one million men. The form query was sent
to "big industry"; that is, factories for the most part with at least
one thousand employees, since the size of the plant is one of the two
most important factors controlling industry's interest in health and
medical care ; the other being the nature of the work required. These
two factors are necessarily of major importance, influencing as they
must the cost and practicability, and the incidence and severity of
employee injury and illness. Plants operating machines and processes
which are distinct health and accident hazards or which require the
employees to work under conditions tending to promote sickness
stimulate management's interest in ways and means to counteract
these harmful effects.

Selection of companies for questioning was also determined by
location and type of industry so as to insure varied representation.
Names were drawn from The American College of Surgeons list *
of companies with approved medical services, and from those com-
panies producing a major share of munitions, tanks and planes for
the government. Big companies were selected not only because they
have the facilities to answer such queries, but because venereal
disease control has not yet reached below the level of the largest plants
to any great extent. The findings are, therefore, confined to a

* See copyright page for questionnaire.

i American College of Surgeons List of approved industrial medical depart-
ments totaled approximately one thousand in 1940. There were only about 1000
plants in the country employing more than a thousand workers in 1940 according
to census figures. (Over 60 per cent of the country's workers are in plants
employing less than five hundred.)



study of what large industrial plants are doing to control venereal

Reasons for Study of Syphilis Control Work in Industry

During the last five years industry has begun to think of venereal
disease when examining its employees. 2 This interest has been accel-
erating at a marked rate, with more plants including tests for syphilis
in their routine physical examinations this year than ever before.
While twenty-nine per cent of the plants now giving serological tests
stated on their questionnaire returns that they began giving them
between 1926 and 1936, seventy-one per cent began including such
tests in the five year period, 1937-1941. Seven other plants replied
that they intend to include "tests" for syphilis in the near future,
and are preparing their facilities now. This increased attention is
due in part to the war effort, which makes workers' health even more
essential, and which has also led to great plants springing up over
night with full-fledged medical departments putting the latest provi-
sions into practice. Examples of this situation are the ordnance
plants, erected in a few months, but nearly all providing excellent
medical care including examinations for syphilis and requiring treat-
ment when infections are found.

"Does Your Company Seek to Discover Syphilis f"

The plants selected were asked an "attitude" question. "Does
your company seek to discover all cases of syphilis among its
employees, and does it require that they be treated as a condition of
continued employment? To this 151 replied "yes" and 57 "no".

To get a picture of the general provisions for medical care in the
plant we then asked, "Do you require a general physical examina-
tion of:

a. All new applicants for employment ? 195 yes 8 no. 3

b. Employees after absence? 160 yes 35 no.

c. All employees annually or otherwise periodically ? 93 yes
100 no.

From these answers it appears that this group of companies is
following rigid plans for checking on the health of its employees. The
relatively low count for "c" is partly due to the fact that the answers
to this question were very rigidly interpreted, and while a company
might give periodical examinations to several groups of its workers,
unless it gave them to all, it was counted as a "no" answer.

Now the main question appears, for what we want to know is:
whether plants with well-thought-out health and medical programs
are including syphilis in their list of diseases to be controlled. " Is a

2 In 1936 a study by the American College of Surgeons of absenteeism caused
by illness and injury showed that the days lost per employee per year were
8.85 from non-industrial injury and illness, 1.59 from industrial injury and
.01 from occupational disease.

a Many questionnaires neglected to answer some of the questions. These
"no answers" account for the discrepancy between the total affirmative and
negative answers and the total number of firms returning the form.


blood test for syphilis regularly included in any or all of the examina-
tions?" To this, 115 replied "yes", and 90 "no". In other words,
of those companies giving physical examinations to new employees,
fifty-seven per cent decided to make examinations for syphilis. A high
percentage, when we remember how recently syphilis has been widely
recognized as a public health question by the civilian population. 4

Procedure When Syphilis Is Found

The findings reveal that few companies (eleven per cent), provide
treatment themselves, the majority sending infected workers to their
family doctors or to clinics. In cases where the company found it
advisable to care for its own workers, nearly half do so at no expense
to the employee; the rest charging from the cost of the drug up to
$1.00 a treatment.

Two questions were devoted to ascertaining what disposition was
made of applicants or those already employed who were found to be
syphilitic. This procedure, so important to the public as well as to
labor organizations, was described in a way which demonstrated how
far industry has gone in adopting a public health and practical point

of view.


While not all plants answering the questionnaire actually looked
for syphilis, nearly all had decided on a policy concerning infected
workers. Such cases were brought to the management's attention
through compensation adjustments, open lesions, accidents and so
forth. Twenty-six per cent of the companies would reject infected
applicants for employment, but sixty-one per cent would accept them.
Many plants qualified the conditions under which infected applicants
would be hired ; thirty-seven per cent accepting if the worker agreed
to take treatment, forty-five per cent if he were non-infectious.

With regard to those already employed, discovered infection meant
their dismissal in only three per cent of the plants replying. Nine
per cent had no established policy, but eighty-eight per cent retained
all such workers. Again the company qualified the terms under
which it would retain them. Sixty-seven per cent required those it
retained to take adequate treatment, fourteen per cent retained their
workers only if they were non-infectious.

A separate study of plants actually giving routine Wassermanns
as part of their regular physical examinations reveals an even higher
percentage maintaining a liberal attitude toward the infected worker.
Seventy-two per cent of these plants, evidently considering a syphilitic
worker under treatment no greater compensation risk than his unin-
fected fellow, accept for employment positive reactors to the serolog-
ical test. Two-thirds of these plants retaining workers insist on

4 In 1933 the American Social Hygiene Association sent the same venereal
disease control questionnaire to eighty-five plants with highly developed medical
departments. Only six replied that they were including routine tests for syphilis
in any of their employee physical examinations. Comparing this fact with the
high figures for the 1941 returns we get an indication as to the rate at which
interest in syphilis as an industrial problem is growing.


treatment. A number take into consideration whether the pros-
pective employee is infectious or not, some factories requiring him
to begin treatment before he starts the job so the chemical quaran-
tine will be set up. Twenty-seven per cent reject infected applicants.

Of plants actually testing for syphilis, an even larger number,
ninety-six per cent, retain workers already on the job if it is dis-
covered that they have contracted syphilis. Again approximately
two-thirds of the companies examining for syphilis insist that the
infected employees take treatment. Only two per cent of these com-
panies discharge their workers for syphilis.

Various methods are used to make sure that workers continue
treatment for the necessary period. Some companies require a
statement from the attending doctor every so often, others have the
nurse check up. In some cases the employee is required to sign a
statement that he will follow his physician's directions. The purpose
of these measures in large part is to see that the worker understands
that job-holding is contingent on taking adequate treatment.

A surprisingly small number of companies stated that care for
syphilis was included in the medical benefits of their health insurance
plan. Over half replied in the negative. Two have coverage for
syphilis, but restricted to hospital care. Twenty-six per cent replied
in the affirmative, and a large number of the companies did not
answer; presumably either because they had no health insurance
whatsoever, or the question had never come to a decision.

Instruction Concerning Syphilis

Since the American Social Hygiene Association considers accurate
public information one of the most important weapons in the fight
against syphilis, a question was included to discover what educational
work was being done on venereal disease by industry, "Do you seek
to instruct your employees about syphilis as a health and social
menace? If so, how is this accomplished?" Nearly half, forty-seven
per cent, replied in the affirmative. When explaining how this edu-
cational work was done, half of these plants specified distribution of
literature and posters, nearly a fourth stated that they were accus-
tomed to discussing syphilis either in groups or personal talks, a few
showed moving pictures, an equal number brought up the question
in first aid classes, and one plant offered free Wassermann tests as an
educational measure. Unfortunately, thirteen per cent of those carry-
ing out an educational program did so only for the benefit of workers
already infected. This procedure, of course, neglects to protect the
healthy worker and advise him to seek treatment at once if he should
contract an infection.

As a final request, the company was asked to state whether it
regarded any of the suggested steps as not feasible. Eighty-four
per cent did not answer. Of those that did reply, nearly half said
they lacked the necessary facilities, approximately a third felt syphilis
was a community rather than an industrial problem, with a number
of these objecting to the blood test as regimentation. Four companies


had met opposition from organized labor, and four found venereal
disease control unnecessary in their plant.

Summary and Conclusions

Analysis of the replies reveals well over half of this representative
groups of large plants including tests for syphilis in employee physical
examinations. That industry finds this policy worthwhile is evidenced
by the accelerating rate at which more companies each year are
employing this test to protect both employer and employee.

Two-thirds of those including serologic tests maintain the realistic
policy of accepting infected applicants for employment if they are
not infectious and will take treatment. This policy with its important
implications for morale is even more liberally interpreted for workers
already on the job. Three-fourths of the plants retain these employees,
with the usual provision that they cannot work while infectious and
must take adequate treatment. Since the first few treatments render
a man non-infectious, and safe for ordinary contacts as long as he
follows his physician's orders, these lay-offs work little hardship.

Such provisions for the disposition of infected workers are impor-
tant not only to maintain employee confidence, but from a public
health point of view represent a real contribution. For, instead of
driving cases under cover or creating an army of unemployed syphili-
tics, such measures aid case-holding by assuring that employees will
not be discriminated against as long as they take adequate treatment.

With approximately half the plants which replied to the question-
naire carrying on some form of educational work about syphilis, we
can reach the very hopeful conclusion that, according to this sampling
survey, the majority of large plants now engaged on defense produc-
tion are including in their medical program provisions for finding
syphilis and informing their workers about its danger, treatment
and cure.

We can also feel optimistic when we continually find new plants
improving their medical care to include serological tests, and to
accept, retain, and require treatment for infected workers. With
industry playing its part, we can feel that syphilis control for that
large and important sector of the population, the workers, is well
under way.

Questionnaire On Syphilis Control

1. Does your company seek to discover all cases of syphilis among
its employees, and does it require that they be treated as a condition
of continued employment?

2. Do you require a general physical examination of:

(a) All new applicants for employment?

(b) Employees after absence?

(c) All employees annually or otherwise periodically?


3. Is a blood test for syphilis regularly included in any or all
of these ?

4. If treatment is required of all employees who are infected, does
the company provide treatment or are patients referred to other
sources for medical care?

5. If the company provides treatment, on what cost basis is it given ?

6. Are applicants who are found to be infected with syphilis
rejected, or accepted when not infectious and able to do adequate

7. Are employees who are found to be syphilitic discharged or
retained ?

8. Is medical care for syphilis included in the medical benefits of
the health insurance plan in use?

9. Do you seek to instruct your employees about syphilis as a
health and social menace? If so, how is this accomplished?

10. In case you regard any of the suggested steps as not feasible
in your service, please state why.

11. If you now give serological tests for syphilis what year did
you begin doing so?

12. How many workers does your plant employ?

"The Division of Industrial Hygiene has shown that 1,400,000 of the
Nation's 50,000,000 gainful workers lose time each year through tem-
porary disabilities of nonoccupational origin, the average industrial
worker losing 10 days annually. Nonoccupational causes of disease and
injury are responsible for ten times as great a loss in time as the occupa-
tional causes. The cost of nonoceupational sickness in industry has been
estimated by other investigators as ten billion dollars a year. Due to the
strictly personal nature of the venereal diseases, it has not been possible
to determine the time and money lost in industry because of syphilis
and gonorrhea.

We have an indication, however, of the effect of syphilis upon a man's
ability to work. In 1934 a resurvey was made of 1,300 of the plantation
laborers who had received treatment for syphilis during the 1930-1932
Bosenwald demonstration control program in six Southern States. It was
found that those in poor health had dropped from 39 per cent before the
demonstration to 4 per cent two years afterwards. Moreover, 40 per cent
had been unable to do a full day's work before, whereas, only 7 per cent
indicated their inability to do so after the demonstration. It was most
striking that this gain in working ability occurred despite the failure of
most of these individuals to receive adequate treatment by present-day


Assistant Surgeon General, United
States Public Health Service



Assistant to Rosenberg Lecturer, University of California

In a graduate seminar conducted by Professor C.-E. A.
Winslow, University of California Eosenberg Lecturer in
the Public Social Services for the Fall Session of 1941, the
annual rate for syphilis and gonorrhea by states, July 1, 1939-

Online LibraryAmerican Social Hygiene AssociationJournal of social hygiene (Volume 28) → online text (page 14 of 71)