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THE LANCET.LONDON: SATURDAY, JUNE 8, 1918.

Industrial Accidents.THE study of the occurrence and prevention of

industrial accidents should be looked upon as aform of preventive surgery, and preventive surgeryhas not been recognised as a branch of medicalscience: the medical profession has disregardedit, just as it disregarded preventive medicinebefore the days of SIMON. Probably most medicalmen consider the science of accident preventionto be summed up in danger notices in the

streets, in red lights on railways, in guardson dangerous machinery, and such-like devices,and that it ends there. Yet the recent inves-

tigation into industrial accidents carried out

by Dr. H. M. VERNON 1 shows how intricateare the influences determining accidents; andthat these influences call for careful study,not merely of the environment of the worker,but also of the condition of the worker inrelation to that environment. The environment-

including under that term such things as lighting,temperature, and ventilation-is as important as ishousing to general health; while alcohol consump-tion, fatigue, and psychical influences, since theseinfluences can here be more readily determined,present their importance even more clearly than inthe field of preventive medicine.Much in the past has been written on the occur-

rence of industrial accidents, but the data for investi-gation have been imperfect because they have onlyreferred to the occurrence of major accidents whichare at individual factories (fortunately) too few todraw valuable deductions from. But if the acci-dents from a number of factories are combined,while the conditions of each factory vary as

regards hours of work and of meal-times, processes,lighting, and all other circumstances, such a diver-sity of environment is presented as to baffle elucida-tion. Recently, however, a great development hastaken place, especially in engineering factories,owing to steps taken to improve the conditionof munition workers, which have included thetreatment and record of the occurrence of minor

injuries-a movement which has been expeditedby a Home Office Order calling for the provision infactories of first-aid facilities. Now, for the studyof the causation of accidents, minor injuries areas useful as major ones, and they are far morenumerous. Indeed, in practice each worker wouldappear on an average to receive first-aid treatmentthree or four times a year. Dr. VERNON has taken

advantage of the existence of such records and hassubmitted some 50,000 accidents occurring at onlythree factories to intensive inquiry; investigatingtheir hourly, daily, and monthly variations, allow-1 An Investigation of the Factors Concerned in the Causation of

Industrial Accidents. By H. M. Vernon, M.D. Health of MunitionWorkers’ Committee, Memo. No. 21 (Cd. 9046). Price 6d.

ing at the same time for rate of production, and thenumbers employed. No such investigation intoindustrial accidents has previously been made andthe publication reflects great credit on its author.The first point which is demonstrated is that theparamount influence affecting the occurrence of

accidents is rapidity of output; a simple andobvious fact which, curiously enough, had escapedthe attention of those who were busy claiming theincidence of accidents as the direct indication ofindustrial fatigue. Dr. VERNON shows that fatiguedoes affect accidents, but that it is only a subsidiaryinfluence, an influence often less important thansuch psychical influences as an excited mentalstate on. commencing work, or a calm mentalstate during the undisturbed hours of night work.The influence exerted by temperature, which Dr.VERNON detected by correlating the occurrence ofaccidents and thermograph readings, is a goodexample of the scientific character of his work, andof the way in which investigators of this interestingsubject must be prepared to make direct appeal toexperiment to obtain information. The conclusionthat accidents are fewest when the temperatureis between 65° and 69° F. is, perhaps, somewhatunexpected, as this range of temperature is notthat which is generally accepted to be an optimumtemperature for either work or the sickroom ; andinterest would attach to further investigation ofthis matter by correlating the occurrence of acci-dents with workshop ventilation as measured bythe Kata-thermometer.

Indeed, throughout all his work Dr. VERNON iscareful to point out that he is only commencinga study which calls for much further research indifferent directions. He has, however, broken newground; he has cleared away much useless impedi-menta ; he has shown how complicated is the

problem and demonstrated the necessity for furtherinquiry. Certain points are elucidated, and therestill remains the duty of making widely knownthese ascertained facts, that factory managers mayadopt practice in conformity with them. Any effortto describe in detail Dr. VERNON’S memorandumwould do less than justice to his work, for he hasgathered into it a wealth of detail and analyticaldiscussion which can only be appreciated by readingthe whole as set out by him. And we hope thatit will be closely read by all those interested inindustrial matters, and that the investigations nowstarted will be carried on. Otherwise industrialaccidents will, and must, continue to occur withtheir old familiar frequency.

The Vis Directrix of the HealthyBody.

IN a lecture delivered during his Americantour last year General T. H. J. C. GOODWIN paid atribute to the efficiency of general medical educa-tion and training in this country as evidenced bythe successful manner in which the youthfulmembers of the Army Medical Corps had, withoutspecial training, grappled with the complex

problems of army sanitation. He went on to urge

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the advisability of making public health work ’,and some instruction in military hygiene and sanitation a compulsory part of the curriculum ofevery medical student. The General Medical Councilis taking steps to put some such suggestion intopractice, and at its recent session instructed itsEducation Committee to report on the steps desir-able for promoting the teaching of preventivemedicine in the medical schools throughout thecountry. Dr. J. C. MOVAIL, who proposed themotion, desires for the general practitioner a largerinfluence in the prevention of disease. He is notconcerned so much with the establishment of new

teaching chairs as with a new orientation of out-look with regard to existing teaching. The wholeconduct of life from the point of view of

national efficiency must be the objective of a newsystem of medical education on preventive lines.Professor G. ELLIOT SMITH, who seconded the

motion, further emphasised the necessity for

bringing the teaching of physiology into moreintimate relation with the practice of medicine.In this connexion we should like to commend for

careful study the thoughtful address given byDr. J. S. HALDANE before the Edinburgh Patho-logical Club. Dr. HALDANE drew therein a strikingpicture of the vis medicatrix of the sick body andthe vis directrix of the healthy body which corre-sponds to it. As the former restores both structureand function in the sick, so the latter regulatesat every moment the activity of the healthy.The two forces are indeed different aspects of oneand the same thing, and the organic regulation ofboth structure and activity is constantly neededto aid and supplement the practice of medicine andsurgery. Disease is the breakdown of regulationat one point or another, and practical medicineis simply the assistance rendered to nature in

restoring and maintaining effective organic regula-tion. This is, we take it, the kind of application ofphysiology to the practical medical needs of every-day life desired alike by the Director-General and theGeneral Medical Council. Dr. HALDANE’S damagingassertion that a

"

capable doctor has to neglect to alarge extent the physiology he has been taughtand has to make for himself a new and often verycrude physiology " must not rule in the recon-

structed medicine of the future.po-

THE NATIONAL MEDICAL UNION.-The annualgeneral meeting ef the National Medical Union, presidedover by Professor William Russell, President of the RoyalCollege of Physicians, Edinburgh, was held on June lst at346, Strand, London. The meeting was well attended, andthe following resolutions were unanimously agreed to :-

1. " That this annual meeting of the National Medical Union advisesits members not to sign any application for exemption under theSecond Military Service Act, as, to do so. may render them liable to betransferred to other localities for civilian practice or to be compelled toundertake panel practice in their own localities."

2. "That the National Medical Union re-states its contention that theestablishment of a Ministry of Health ought to be postponed until afterthe war and protests against a propaganda directed towards the pre-paration of an atmosphere in the public mind favourable to an estab-lishment of general State Medical Service, such a general Srate MedicalService being, in the opinion of the Union, an unwarrantable interfer-ence on the part of the Government with the relation which existsbetween the public and members of the medical profession."The meeting also unanimously confirmed and adopted theresolution of its Council approving of the principle of com-pulsory medical service of purely military nature, butstrongly condemning any attempt to extend compulsion inrespect of civilian practice.

Annotations."Ne quid nimis."

CAMP INFECTIONS.

ONE of the serious problems which sanitaryauthorities the world over now have to face is theprevention of infection among the population ofmilitary camps. Living, as the men do, in a hygienicmilieu vastly better than the average of civil life,the problem might have been supposed easy ofsolution. How far that is from being the case theexperience in regard to cerebro-spinal fever andmeasles in camp life gives eloquent testimony;and if such unproved and vague suppositions werenot opposed to the right medical spirit, we mightshare the view that there is a something in thenature of camp life which tends toward the

grouping of unusual infections or unusual formsof common infections. Taking cerebro-spinal feveras it occurred, for instance, in the New Zealandcamps during the year 1916, the Director-Generalof Medical Services then found no evidence thatthe infection originated in the civil districts.The crowding together of men of like age anddisposition had been followed by, even if it had notdetermined, the outbreak. Another striking illustra.tion is afforded by an account of the outbreak ofpneumonia in an unusual form during the lastquarter of 1917 at the camp Zachary Taylor inLouisville, Ky., and reported in the Journal of theAmerican Medical Association for March 30th byDr. W. W. Hamburger and Dr. L. H. Mayers, of theMedical Reserve Corps, U.S. Army:-The base hospital was opened in September, and in this

and the following month 30 cases were admitted with theusual picture of lobar pneumonia, only one death occurringfrom pneumococcic meningitis. October ushered in an

epidemic of measles followed by broncho-pneumoniaof a fulminating character, leading rapidly to dyspnoeaand cyanosis. Of 102 cases of this type many (theauthors omit to state how many) died. The majorityof cases developed while the men were Rtill warded formeasles as close sequelæ to the primary disease, only afew after returning to duty. Post mortem multiple peri-bronchial abscesses were found. At the beginning ofDecember a very fatal form of lobar pneumonia took itsplace, this proving due to a brand of hasmolytic strepto-coccus. Some cases started insidiously with sore-throat orcough, others abruptly with extreme prostration and evencollapse, death occurring in three or four days with asuggestion of general sepsis. In both groups empyemawas of frequent occurrence, amounting to nearly one-third,and during a particular four-week period almost to one-halfof the total 274 cases. Chests full of pus were found givinga history of less than 24 hours’ duration, and the develop-ment of complete empyema within this period was demon-strated repeatedly on the X ray screen. Purulent pericarditiswas an occasional accompaniment. Rib resection proved adisastrous method of treatment, no single patient survivingit. Continuous intercostal drainage by water-pump suctiongave much better results, especially after experience hadled to regarding every patient complaining of tightness inthe chest as a potential empyema. Collapse occasionally’following mere puncture was attributed to the withdrawalof too large a quantity of fluid at one time, or to thereleasing into the circulation of toxic substances, nofurther accident occurring after the use of per cent.cocaine to anaesehetise the needle-track right down to thepleura and the removal of only a small quantity of pus atthe first sitting.

It may be noted that the outbreak at ZacharyTaylor has had its parallel in camps on this side."An epidemic of measles followed by broncho.pneumonia of a fulminating character leadingrapidly to dyspnoea and cyanosis" has its exact

counterpart in the " purulent bronchitis " describedin two instructive articles which we publishedlast year : the one by Hammond, Rolland, and